GP told me to stop wasting his time - AIBU?

[TimeWastingTeresa]

I had my third trip to my GP today in 3 months.

I feel like absolute rubbish constantly - tired all the time , achy , generally run down .

My hair is awful - dry as a bone and gets greasy at the roots within hours of a wash.

My skin is so dry it flakes . My legs look like a reptiles !

My periods are much heavier than usual - I need to change a super plus tampon after 3 hours . I used to wear regular for the whole duration.

I have gained over a stone in weight in less than a year and I just can't shift it .

My GP ran bloods around a month ago and all vitamin levels were fine.

My thyroid came back as TSH 4.5.

He told me everything was normal and to go back in 6 months .

I went back a month later as I just don't feel well at all.

He ran bloods again and again my TSH came back as normal (4.5).

He told me I'm fine and I'll feel better if I exercise and lose weight .

I can not go on like this so I went back today and he told me that I just need to lose some weight . He told me not to come back before 6 months is up as there's nothing wrong with me .

I left in tears .
I feel so down . I'm so so tired I can't cope with much at all.

I look and feel disgusting . My hair is dull and lifeless and my scalp is so dry .

I don't know what to do

My mum says I should go private but if my TSH comes back as 4.5 again , my GP will still refuse to treat it !

Help please !

8misskitty8 I know the NHS can prescribe T3 in some cases, but GPs are not supposed to, only Endocrinologists although now even they are being told to stop as it's on the DropList. I did take the T3 my GP gave me from her cabinet, it wasn't for me. It saved me from myxedemic coma for sure but it definitely wasn't the best drug for me. Having had graves disease in the past, my body seems very sensitive to certain medications and chemicals.healthunlocked.com/thyroiduk/posts/133405715/liothyronine-under-threat

StressedAndConfusedArgh you deliberately take my comment out of context. I was trying to make the point that erroneously being treated for depression when there are physical organic causes is madness. Not that all depression should be untreated.

perfumedlife - I never claimed that the thyroid gland produces solely T4, merely that this is the majority (80%) of what it produces.

Conversion of T4 to T3 happens mainly as needed in peripheral tissues, not in the thyroid gland itself, therefore thryoidectomy should not prevent this. I would be very interested if you could provide links suggesting otherwise.

There may be separate conditions where patients have trouble converting T4 to T3 and thus require exogenous T3, but such patients are in the minority.

T3 is not routinely prescribed due to its short half life making dosing difficult and levels unpredictable, which can be dangerous for patients.

I'm on thyroxine and have been for the last 6 months - my GP has just upped it to 75mg - and me last level was 2.5 - he was going to leave me on 50 and I asked for more as I still feel tired all the time, not just sleepy tired a real bone dead tired.

What's these other tests ?

perfumedlife - here is a study of T4 therapy in patients who have undergone a total/partial thyroidectomy. It concludes that T3 therapy is unnecessary as there is adequate conversion of T4 to T3 peripherally (with the added advantage of it being preferentially converted in tissues where it is most needed).

And for I don't take a "proper" iron tablet everyday (anemia) strength I go anaemic really quickly

Neefs I paid £700 to get tested by Genova, and even though it picked up campylobacter my GP refused to accept the results because 'They're not FDA approved'.

I had these issues which seemed to be triggered after using an IPL hair removal machine, have you used one at all?
This is what I love about MN, you find out things like this.

Gentle walking when I first start to do exercise the first week is always the hardest and most tiring I cant do no more than 10 minutes. A gentle walk is not very challenging. Swimming would do you a world of good your not pounding the streets and you could lose weight.

I don't know if you are on the pill but it can help with your periods they won't be so heavy. They could be non-existent.

My DDs TSH came back a little high, it turned out to be a B12 deficiency. Your other symptoms could fit that too. How is your potassium? Low potassium can cause the skin trouble etc

perfumedlife were in the U.K. are you ? I'm in Scotland and liothyronine (T3) is not bring withdrawn from prescribing. Originally my endocrinologist prescribed it and now my gp does. Its on repeat prescription. Boots the chemist keep it in stock as do other pharmacists. I've never had a problem getting the prescription filled it doesn't have to be specially ordered or anything.
I'm sorry you've been told that you can't have it, when was this ? But if you want it then try gp again.

I'm scanning posts at the minute as I'm working .

Really helpful advice here .
I'll reply to the PM soon too

Someone mentioned acid reflux - I get this quite often - really painful to the point my mouth fills with warm water - is this a symptom of lowered metabolism ?

I'm not on hormonal contraception and I'm unable to take it for various reasons .

My libido is non existent anyway

I don't feel depressed at all . I get on with things I want to do and I don't feel sad all the time .

I'm teary anyway as my period is due .

I'd love to see your evidence for those patients in the minority StressedAndConfusedArgh becauase when I ask for references to this statement, and I do, often, all that's proferred is it's a consensus statement.

sourceforge.net/p/spina/news/2015/04/large-study-unveils-existence-of-a-tsh-t3-shunt-in-vivo/

No increased risk of fractures or atrial fibrillation in patients taking liothyronine compared to L-thyroxine was demonstrated.
www.endocrine-abstracts.org/ea/0038/ea0038OC5.6.htm

We could exchange links all day but it's clear you are buying wholesale the lie that thyroid disease is all sewn up and research is robust. Consider this though. Guidelines for the use of Thyroid Function Tests are based on generally poor quality evidence from the now defunct American Association of Clinical Biochemists 2006. Bad tools mean bad workmanship. I by no means think GPs are to blame, have said this before. I believe they're taught dangerously unvalidated pseudo science and are stuck in this situation. I would never advise an undiagnosed hypothyroid patient to buy medicines onine. Infact I would never advise anyone to do so. I take that risk myself because I have no choice, others ought to explore all avenues with their GP and of course not remain blinkered to a hope that hypothyroidism in the diagnosis if it plainly isn't. But with a TSH of 4.5 and the op's symptoms, I'd bet my house it is hypothyroidism.

Must get on.

Do you drink alcohol or eat spicy food. Acid reflux that is coming from your stomach have you ever taken acid tablets.

No alcohol at all and I don't like spicy food .

Thanks 8misskitty8 I am in Scotland too and my practice has been issued an instruction by the health board not to prescribe it. Many friends locally have been taken off it and some have seen Endocrinologists and been put back on it, others not so lucky. Like I said though, it didn't suit me at all. I'm very healthy on my natural thyroid so don't fancy rocking the boat.

Someone mention t4/T3 conversion upthread. Most of the conversion takes place Outwith the thyroid, t4 converts to T3 which then binds with your blood cells and gets taken via the blood to your organs etc. To run your body. You can take loads of T4 but if your body doesn't covert it to T3 then you will still feel like hell. If you take too much T4 it can damage your heart.
That's why checking T4 alone in someone who is still showing symptoms isn't enough.

My endocrinologist is fantastic. Professor strachan, royal infirmary of Edinburgh so NHS.
Don't know if he takes private patients ?

I don't feel any anger to GPs but sadness that British people think they receive basic health care. I had better in Bangladesh. People think they're lucky but they aren't because don't bloody get treated for anything.

perfumedlife Here are current NICE guidelines on thyroid replacement therapy explained:

"Do not prescribe combination therapy (LT4 and LT3) in primary care

The recommendation that combination therapy should not be prescribed in primary care is based on the clinical guideline The use of L-T4 + L-T3 in the treatment of hypothyroidism [Wiersinga et al, 2012] and statements from the Royal College of Physicians The diagnosis and management of primary hypothyroidism [Royal College of Physicians, 2011] and the British Thyroid Association Management of primary hypothyroidism [Okosieme, 2015].

‘The Royal College of Physicians do not recommended prescription of additional tri-iodothyronine (T3) in any available formulation. This includes Armour thyroid (T4 and T3 extracted from the thyroid gland of pigs) as it is inconsistent with normal physiology, has not been unequivocally proven to be of any benefit to patients and may be harmful’ [Royal College of Physicians, 2011].

Potential adverse effects from treatment with T3, using current preparations, include osteoporosis and arrhythmias [RCP 2011].

‘Long-term safety data and availability of liothyronine (LT3) preparations that mirror natural physiology are lacking’ [Okosieme, 2015].

A systematic review of clinical guidelines on LT4 therapy alone versus combination therapy (a total of 13 guidelines, 12 of which were published after 2010) found that clinical practice guidelines worldwide do not recommend or support the routine use of combination (LT4 and LT3) therapy to treat hypothyroidism [Kraut, 2015].

Combination therapy with LT4 and LT3 may be considered by endocrinology specialists as an experimental approach in people who have persistent symptoms despite compliance with LT4 treatment and a TSH value in the normal range [Wiersinga et al, 2012]."

The evidence has clearly been thoroughly evaluated by many highly trained professionals. Forgive me if I trust their judgement over yours.

At a similar age to you, I started to feel incredibly tired and put on loads of weight. My thyroid was tested a couple of times and I was told it was normal. Eventually my results got worse, and I was prescribed thyroxine. It made such a difference to my energy, although it was a struggle to lose the weight. Many years later I'm on 125mcg and I find that the closer my results are to the bottom of the reference range (ie almost too far the other way) , the better I feel. The consultant I saw said some people need to be right at the bottom. The year or so when I was having synonyms but not diagnosed was just miserable.

perfumedlife that's just rediculous. T4 does nothing for me. Without a thyroid and poor conversion I was like the walking dead. Put on 2 stone following thyroidectomy which was over 20% of the weight I was before as well. If I sat down during the day I would fall into a deep sleep. Was awful.
Professor Strachan put me on the T3 which has been amazing.
I have had issue with the gp surgery though, not from getting T3 suprisingly but about levothyroxine (T4) as they keep trying to lower it because In their opinion I take too much. I take 100mgs if that so not really that much. I told them to speak to professor Strachan, they backed down after hearing his name as he is the top endocrinologist !

It is miserable .

I just want to feel better .

My period has just started (sorry TMI but there's no light build up anymore - it's like a heavy day 3 immediately )

I'm going to look a bit unhinged if I demand a thyroid screen and it all comes back "normal" again .

my mom is on Levothyroxine and recently was diagnosed with acid reflux, she's having to take omeprazole 4 times a ay to suppress it.

Could it be her thyroid issue causing it?

stressed being in a combined treatment has worked for me. Without the T3 I would be seriously ill or worse. So it has been proven to be of significant benefit to me.

Your body needs T3 hormone to function and run your organs. Without T3 your body cannot survive.

I'm going to look a bit unhinged if I demand a thyroid screen and it all comes back "normal" again
Personally I don't think that there is much point in having the same test again as it will [probably only tell you the same thing but as PP have mentioned you need to have a full battery of tests to find out exactly where the problem lies.