To not follow GPs advice?

[Rainbowhairdontcare]

I'm 9 weeks pp, and currently breastfeeding. I'm on levothyroxine for being hypothyroid. This was discovered by my usual endocrinologist in the US, and he has overseen my treatment and my GP surgery here has always been happy to oblige. A couple of weeks ago I had my test results and the GP said to lower my dose. I sent the results to my endocrinologist who said I shouldn't as I'm still breastfeeding and it's best to keep them that way. I'm on two kinds about it because usually I come back with my own set of bloods done and the endocrinologists advice but this time they've both seen the same results and it would be the opinion of one against the other. I feel like my endocrinologist knows my clinical history better and he's always been better at planning for the future. AIBU of following his advice rather than the GPs?

If you are not going to follow the GP's advice, I trust you will not waste their time by seeing them again. Someone else may be glad to have that appointment.

I actually didn't have an appointment to discuss the results, just a phone call from the receptionist

Normally I would say yabu but your specialist has contradicted your gps advice, in such cases I always say follow the experts advice and not the gp so yanbu

I would chat with your GP about the endocrinologists contrary advice

As someone who has breastfed on levothyroxine, I would follow the advice of your endocrinologist. Being hypothyroid can contribute to low milk supply, and as I understand it, pregnant/breastfeeding women should have levels on the lower side of normal. And at the end of the day, the endocrinologist is the expert on the subject. It might be worth you knowing what the signs of being over-treated are though , so you can watch out for them. For me, they are pretty obvious, and actually I did end up slightly over-treated post partem and had to lower my dose.

The only potential sign of overtreatment is insomnia but I've always been an insomniac, the only fee weeks I've slept more than my share were right after giving birth. And a couple of headaches but that was a few weeks ago. I'd say I'm feeling normal, so wouldn't think I needed to adjust my dose.

I'm actually border-line over treated at the moment, apparently, and after my last set of bloods, my GP asked me to make an appointment to discuss the results. I didn't want to waste an appointment on just being told the results of my blood test, so had a phone appointment with the duty GP, who advised me to stick with my current dose, and just have repeat bloods sooner than the usual annual check up, and watch out for signs of being over treated. She recognised that the results were borderline, that I'd been lower in the past, and that I felt well, so she didn't see the need to change anything. I guess my point is that even two GP's didn't agree in that case, it's not that there is a black and white 'perfect score'. If you're worried about it, maybe chat to your GP about it and you might find that they agree when they hear what the endocrinologist said, anyway.

I'm also hypothyroid and in my experience GPs really don't know much about it. I'd go with your specialist.

Definitely go with specialist advice rather than GP - except, do you rely on your GP to prescribe? in which case you need to talk to him, on phone possibly and discuss with him what the specialist has said.

I take the same medication, and overmedicate as I feel better and the blood tests still come back normal. The problem is that, apart from the fluctuation in pp TSH and T4, there are national differences in what is deemed 'normal' for thyroid function. Also, a GP will test TSH and T4 typically, whereas an endocrine specialist may also look at T3 and other blood parameters. They may also look at clinical symptoms such as fatigue, hair loss, weight, cold sensation etc since the blood tests do not give a complete picture of disease. In the USA, the cut off point for treatment is different to the UK guidelines so more patients will receive tablets for hypothyroidism under that health care system. Therefore, I would go with your US expert, and ask him to write a note for your NHS GP so that he can justify prescribing outside current guidelines.

The NHS is very conservative with doses of Thyroxine.
I would definitely say to follow your endocrinologist.

I had years of battle here with dosage even though it is a condition my whole family have and I had al the symptoms.
The NHS use very low "normal guidelines and also Thyroxine varies with Brand I have discovered I need less with one brand than another.

Regardless of any nationalities I would always say follow specialist over GP.

Specialist is more of an expert in your condition, so I would say to follow their advice, however, they should be writing to your GP with that same advice so that your GP can acknowledge it- as they will be the ones writing the prescription.
You might find your GP is unwilling/unable to change the dose based on the advice of a doctor in another country where the guidelines etc are different, though.

YANBU to go with the specialist's advice.

However, I would say that the differences in treatment advice could be down to a) the GP knowing less about this topic than the specialist, GPs are not specialists of course but b) it could also be down to differing medical consensus / approach in the two countries. It could go either way as to which medical establishment has the better approach on any given issue. (I'm not hypothyroid myself and not a doctor so not knowledgeable about this particular issue.)

Personally, over the years I have grown to have a lot of respect for the guidance and general approach in the UK to medicine (and dentistry believe it or not). I feel now that when I was growing up and living in the US, they erred on the side of over-treating, or unnecessary interventions where the risks outweighed the benefits. Just something to watch out for, especially if you are starting to feel over-treated.

Yes that's correct Scooby he usually checks 6 markers and has commented that diagnosing hypothyroidism with just TSH and T4 gives a very incomplete picture of what's really going on.

Khione that's part of the problem

Always go with an endocrinologist when it comes to thyroid advice; I have Hashimotos and it took years to even convince my GP to test my thyroid, it was always "it's just a virus, it's just a virus". Turns out it was most definitely not a virus.

Specialist over gp

Specialist over GP.

Why do you see a GP at all about your thyroid - is it so you don’t need to pay for your prescription? In your place I would just make private appointments with a specialist and swallow the private charge for prescription if it keeps you healthy. My GP / Obstatrician messed up my dosages while I was pregnant (I have hypothyroid and produce antibodies) and now I need to wait and see if my baby’s thyroid has been harmed as a result.

US citizen here, living in the UK though for many years. Doctors in the US have a reputation for over medicating. I would personally be more inclined to take the advice of the UK based GP and not want to risk overmedication when bfing.

But if the choice was UK specialist vs UK GP, I'd take the UK specialist.

I would go with the expert tbh

oh just seen the specialist is in US.
Please have a chat with the GP,

The medication might not be entirely the same, the guidelines may not be the same.
can you get a UK specialist?