Advice following GP visit please

[TheMudRunner]

Hi,

I posted a few days ago asking for advice after having had results back from blood tests and struggling to see my GP.

Well, I finally saw her today. She was sympathetic, and has referred my results to an endocrinologist for guidance. I wanted to get some thoughts on something she did say, bearing in mind I have high TPO Abs and out of range Vit D (low B12, and my thyroid hormones are near the ends of range for the most part so technically subclinical but symptomatic).

She was concerned to treat me symptomatically, even for 3-6 months, on the basis that levothyroxine can cause bone brittleness if taken unnecessarily. Is this correct? Is the risk of this over that period of time higher than the risk of failure to absorb calcium due to out of range Vitamin D? She also didn’t want to retest me for a year for my TPO or hormone levels which seemed a long wait…

I am now taking vitamin D, B12 and B complex supplements (which she didn’t seem to feel I needed).

Thoughts? Advice on next steps, other than waiting to see what the endocrinologist says, of course.

Thanks again 😀

[greygoose]

She was concerned to treat me symptomatically, even for 3-6 months, on the basis that levothyroxine can cause bone brittleness if taken unnecessarily. Is this correct?

Well, it depends on your definition of 'necessary'. It is 'necessary' to have good levels of thyroid hormone for good health - whether that hormone comes from your thyroid or a pill is irrelevant. You don't have good levels. Your FT4 is only 16% through the range and, as I explain in your previous post, that is too low, it should be around 50%.

healthunlocked.com/thyroidu...

So, it seems to me - and I'm sure to many others - that taking levo is necessary for you.

But it's not just the fact of taking it that will cause brittle bones (more likely to get that if you take calcium supplements), it's taking too much of it. And no-one is suggesting you do that! After all, levo is just the thyroid hormone, T4, which healthy thyroids make naturally every day. Doesn't mean everyone has brittle bones. So either she has seriously misunderstood her endocrinology classes, or she is just making excuses not to treat you.

Or else, she's under the misapprehension that taking levo 'tops up' the hormone that your thyroid is making. A lot of doctors think that. But it doesn't, it stops the thyroid making hormone, by lowering the TSH, and replaces it. That's why it's called 'thyroid hormone replacement', not 'thyroid hormone top-up'. So, on the right dose - which is different for everyone - you will get the right level of FT4/3 for you. Perhaps she doesn't understand that.

I am now taking vitamin D, B12 and B complex supplements (which she didn’t seem to feel I needed).

Rule n°1: never, ever take nutritional advice from a doctor. They know nothing about it. As long as the result is in-range, even scraping along the bottom, they are of the opinion that it must be alright, because they don't understand ranges, or interpreting blood test results, either! So, ignore her and take your supplement.

so technically subclinical but symptomatic).

No, technically you are hypo. 'Subclinical' means without symptoms. You have symptoms so it cannot be 'subclinical'. This is just another medical get-out-of-jail-free card, an excuse not to treat. Because believe me, the very last thing any doctor wants to do is diagnose and treat hypothyroidism. And they will use just about any excuse not to. Don't be fooled by the jargon!

[TheMudRunner in reply to greygoose]

Thanks you greygoose . She has referred on to an endocrinologist which is some to info at this point, but it’s all a bit bleak, mainly because I don’t feel I know enough yet to really advocate for myself. It seems to be a lottery of finding a knowledgeable enough and sympathetic enough GP (if anyone knows one around the Derby area, please shout up..!).

I’ll do another round of private blood tests at 3 months, and see if anything has improved on the vitamin level front and if there are changes to the thyroid functional hormone levels (noting to stop taking B7 a week beforehand).

Thank you again for your support. It’s more of a minefield than I’d ever imagined!

[greygoose in reply to TheMudRunner]

Oh it is indeed a mine-field!

It seems to be a lottery of finding a knowledgeable enough and sympathetic enough GP (if anyone knows one around the Derby area, please shout up..!).

If I were you, I'd write another post asking just that so that if anyone does, they can pm you. We're not allowed to talk about specific doctors on the forum.

[SlowDragon Administrator]

osteoporosis linked to high or LOW Ft3

Your previous post shows Ft3 on low side

Free T3 (fT3) 4.3 pmol/L (3.1 - 6.8) 32.4%

….so getting started on levothyroxine and getting increases in dose of Levo over coming months likely to improve your Ft3

Standard STARTER Dose is 50mcg …..so you may initially feel worse on only 25mcg …..persist and get dose increase after next test in 2 months

Avoid starting on Teva, unless you know you are lactose intolerant

Teva brand upsets many people

Wockhardt or Mercury Pharma make 25mcg

Osteoporosis

thyroidpatients.ca/2018/07/...

Osteoporosis and iron deficiency

healthunlocked.com/thyroidu...

[TheMudRunner in reply to SlowDragon]

Thanks SlowDragon . All noted, I just need to get through to my / a GP to get started on medication. I’m contemplating going private, but thinking I’ll wait for the GP to come back with information from the endocrinologist as that may resolve things through the normal route. Downside is it’s a 3-4 week wait (worst case I’m led to believe). The saga continues for now…

[healthyLife78]

Well, you most certainly should consider a stop on the vitamin B12 because B-Complex has a very high amount of B12 and its not wise to overdo it.

[FallingInReverse in reply to healthyLife78]

healthyLife78 Curious why you say this, I think Mudrunner has low active b12, and Bs are water soluble anyway.

[healthyLife78 in reply to FallingInReverse]

Maybe, I just know that it's not good to be both over and under vitamin levels. I know that b-homplex has a very high b12 dose, I'm just not sure that it's wise to combine it with another high dose of B12. I could be wrong though

[FallingInReverse in reply to healthyLife78]

Not all b complexes have the same combination of Bs, so one can be chosen for the right balance of 12 and the others. And for us hypos, optimal B12 is essential - hence the recommendation to take a couple weeks with a B12 to specifically boost B12 if needed, and then shortly after add a B complex because ultimately all Bs need to work together. Also, Bs are water soluble which mitigates potential overages.

[TheMudRunner in reply to FallingInReverse]

Hi both. I have very low B12 at present. My intention is to try and boost this (& my horribly low vitamin D levels) over the next 2-3 months and then get my blood tests re-done to assess if it has helped with both my vitamin levels and any of my thyroid related levels. I figure more information is best at this stage as my GP is reluctant to start me on levothyroxine currently.

My vitamin B complex has 900ug per tablet and the vitamin B12 tablets have 1000ug for info 🙂

[greygoose in reply to healthyLife78]

It's not good to have high B12 if you're not taking supplements. It's an entirely different thing to have high B12 because you're taking supplements. It's not the B12 itself that is 'not good', it's the reason for it being high.