Thyroid issues and GPs

[jarofpickles]

I'm a GP and having read a lot of threads on here I just wanted to make a couple of comments regarding thyroid issues. There seems to be a reasonable amount of mistrust of GPs/GP bashing/misinformation.

1. I do loads and loads of thyroid function tests and I treat loads and loads of people for under and over active thyroids. I see a lot of people with the kind of non-specific symptoms I read on here and send bloods for tests (tfts as well as the other usual suspects vit b12/vit d/ferritin etc etc). I would say the vast majority of people I find to have biochemically under active thyroids are incidental findings, I.e. they are asymptomatic, and conversely those who I suspect/the pt suspects they are generally come back normal. Recently I treated someone with a TSH of several hundred and a free T4 of around 1 who had no symptoms. My point being yes there are lots of symptoms people can get with hypothyroidism, but there is very poor clinical correlation.

1. I would love to see the evidence for this "TSH should be less than 2" thing that is often said on here. Even TSH which is slightly high (subclinical hypothyroidism) often resolves. It goes up and down a lot, again, most of the time it is an incidental finding.

1. Having thyroxine when you don't need it is dangerous.

1. As a GP, I am not in control of blood tests that are done by the lab when I request TFTs. The biochemists are. I will however ring the consultant biochemist if pts are very concerned and beg them to do things like free T3s, probably because pts have been on sites like this and told they desperately need them doing. They have always been normal when I have done this. Similarly, if I sent a referral to a consultant endocrinologist about someone with a normal TSH, my referral would likely be rejected.

So in summary, I am sympathetic to your symptoms... I will investigate them... It is not necessarily in my power to do everything you are told on here to do. A lot of people have thyroid-y symptoms with a normal thyroid, I think we need to be thinking what else could be going on, rather than making new rules with regard to the biochemistry.

i'm glad you feel better now vit d and ferritin are higher. its usually the case that you will be low in both those plus also perhaps b12 when hypo. sadly gps dont seem to know this. luckily the thyroid websites do. i asked for mine to be tested within weeks of diagnosis because of advice from thyroid uk

its really gps who are obsessed with tsh i usually get private tests done to check t4 and t3.

I don't actually know buttercups! At the moment I can only go by how I'm feeling and I'm feeling really well, but I do want to have proper testing. I was on 100mcg thyroxine before and was so exhausted that I could only stand at the sink washing up for about a minute before I had to go and lie down. That probably sounds like an exaggeration but it's true. The first thing I had to do after getting up in the morning and walking downstairs was lie down on the sofa to recover! Now I'm on T3 I can function like a normal human being. My hypo symptoms aren't completely gone, but I'm much better. I would like to increase my dosage but hopefully I can get some tests done first.