Doctors can no longer order further tests if tsh is within range lab will only do this if endo requests, has anybody else found this.

[tactano50]

Doctors can no longer order futher tests if tsh is witin the range as lab will only accept from endo .has anybody else found this.

[RoloHibbs]

Yes, that was my experience last week. I was told that TSH and FT4 were in range and no further action to be taken and no increase in Levo allowed. (FreeT4 - 22 (11-25).

Serum TSH - 0.27 (0.270-4.200).). I explained to GP that I still felt unwell with many symptoms. I explained about Dr Toft and showed him the relevant pages of the BMA/Toft booklet where he says that some people only feel well if at higher range of FT4 or possibly above; and TSH <1 or even suppressed. He said "Dr who?" (I kid you not!). I suggested he tested T3 to find out what was happening there and he agreed to the blood test, referencing Dr Toft in the reason why T3 test was required. I called on Friday to get my results to be told that the lab refused to do the T3 test as TSH was in range. GP says I should discuss with Endo at next appointment in 3 weeks' time. So the labs, not the GPs are in charge.

[NaamiSue]

Yes I had the same thing last week and am T3 only, the labs said that FT3 is meaningless when on T3 only......so why have they done the test for the last 3 + years????? Me thinks this all about budget squeezes!

Yes the labs are in charge of blood tests..... GP's incentive is keeping within their medication budget....what a crazy, crazy world we are living in!

[Jackie]

Hi Tha is terrible, A few years ago TSH, T4 and Free T3 were done as a routine both to diagnose thyroid disease and treat it. When I was first diagnosed,long ago,only my F T 3 was "out" so if it was now, I would not have been diagnosed, yet so bad, autoimmune with many complications.Now,at least, it is possible to pay for blood tests on line,,although it should not be necessary! Then, there was no way they could be had years ago except through a doctor. In fact, i always pay for mine now as here, NHS Labs are never allowed to do Free T3, whatever the reason. It is all cost!

Jackie

[nobodysdriving]

I know this happens in many places, however where I am almost anyone can order fT4/fT3/antibodies, what I mean by that is that nurses/midwives can so if they can probably GPs can also I'd imagine LOL

[rookery]

I guess it depends on region. In SouthWest, GPs can request the full range, but labs will test for TSH and if it is in range will not test for the rest. The endo can order and receive the results of all tests regardless of the TSH value. Labs apply the policies.

[Hidden]

Pretty much regional, but it is down to the labs discretion what they test. FT3 isn't available here at all only the less useful TT3 and that is only at labs discretion although will be tested so long as it is indicated that a patient is taking T3 meds. It wasn't tested at all in GGHB (glasgow) whether requested or not, although I think Endo's have more choice over tests available than GP's

By the "labs discretion" I would pretty much guess their discretion is also budget controlled!

[helvella Administrator]

Not in any way saying this is right. But we do need to consider the flip-side.

Quite a number of people have had a TSH test requested - but then got FT4 and even FT3 as well - because the lab has interpreted the request in the light of the TSH result and performed additional tests.

And, another recent example, at least one lab is doing the active B12 test regardless that the doctor requested an "ordinary" B12 test. A sensible re-interpretation.

My gripe is mostly that the labs do not appear to have a 100% duty to inform the requester what has happened (e.g. test not done because <reason>). So the non-performance gets missed and ignored. Even in situations as above, the lab should inform the requester "Other tests done because elevated TSH identified." or "Active B12 test now replaces standard B12 test." And that should be mandatory.

And that doctors have allowed this situation to build-up over many years.

Had these not occurred, doctors might have been in a better position to argue that they should still be able to get their requested tests performed.

[SamGozo]

The last time I my thyroid blood levels were checked in September, my GP requested Free T3 and Free T4 because I was taking Armour Thyroid and I got them back, no problem. It'll be interesting to see what happens next time!

SamGozo

[skyfall]

Try living in North Yorkshire. My GP won't test T3 up here at all and is adamant that we only need to look at T4.

Just FYI tactano50 - are you sure you don't have too much T4 washing around. My results are T4 = 19 BUT the test range = 11-22. My TSH = 0.26 range 0.24-4.0. I've just been told to cut my dose and that my conversion T4 to T3 looks like it's not working (possible adrenal stress). I've been feeling wretched but apparently too much T4 and not enough T3 has same effect as not enough T4. OBVIOUSLY they need to do a complete set of tests. I've now ordered my own because I'm fed up of feeling rubbish!

[Hidden]

Yes, that happened to me and the doc refused to test T3. He told me I was fine because the previous test had come in within the reference range. If your doctor doesn't know how to read these tests anyway, then there isn't much point having them done. In fact, it can have a negative effect. A doc will try to cut own on your dose of thyroid hormone even if you are feeling well on it if the beloved test says your TSH is being suppressed. The way they diagnose and treat hypothyroidism is pathetically inadequate as is their knowledge.

[Pink_Bear]

This has been the case in my area for at least the last 12 months. My GP asks for TSH, FT3 and FT4 but only TSH comes back, with a message from the Lab saying TSH is in range, no further tests necessary. My GP doesn't seem inclined to challenge this behavior. I contacted the Patient Advice and Liaison Service at the local Clinical Commissioning Group and they professed great surprise and dismay that a Lab could overturn a GP's request and suggested I discuss further with my GP how to ensure we get the test results he orders. I haven't felt up to doing this yet - I think my GP is a waste of space, so I'm thinking of changing GP before my next blood tests are due and trying again.

[Hidden]

It's been like this where I am in Coventry for some years... and with a TSH upper range up to 5.0 it's even more of a miracle to get T3 or T4 levels at all!

[appy45]

Yes, I asked why test only showed TSH, and was told that if TSH in guidelines, they don't test T3 & T4.I don't know how long this has been going on for ,as don't usually ask for a print out. Only did so as feeling rough lately, and hoped for some explanation.