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.

Hi lorraine

It was 5.52 previously with Ft4 of 12.3. This time its 3.81 but no FT4 run. I appreciate 5.52 is not off the chart mad btw, its just that it comes out on the report with the word HIGH next to it! There is almost a year between these tests.

I feel cold to the core (though to confuse matters I occasionally superheat, but only when I can get some heat into my feet and hands, and this is causing night sweating - I can recreate these events perfectly in the day though with the aid of some sort of blanket/duvet/other heat source and stop them instantly by letting my extremities touch something cold for a minute). My kids and hubby can run around in our house in flimsy pjs whilst I'm in thermals, 2 pairs of socks, t shirt, thick jumper, scarf, hand warmers and a nightgown and am still complaining of the cold.

I'm fuzzy headed, can't concentrate, can't get enough sleep despite having a lot of it (this is slightly different feeling to a B12 low feeling, and I'm only a few weeks into a new jab so I'm sure its not that - not anaemia either for a change too). I'm achy and my nails are softer than a very soft thing even with nail varnish on. I also from time to time get a swelling in the thyroid region, although I was assured today that it wasn't my thyroid that's swollen (that is completely possible, I'm no anatomy expert!). I get moments of high stress that resounds in my chest. I was, around the time of the first test, getting exceptionally heavy periods too but I have since been implanted and until recently hadn't gotten any, plus the ones I have had are a marvellous improvement.

I also have patchy eyebrows, I can't actually remember the last time I did anything to tame them. However as some sort of hairy monobrowed beast normally, this is one symptom I want to keep!

Of course I realise that those symptoms aren't solely thyroid related. And I get some of them cross over with menopausal symptoms. Its just that when these symptoms were new I did have an over range TSH level which they decided to ignore. Also my FSH and other hormones are apparently just fine.

Do you know what the ranges are for TSH and fT4?

TSH 0.35-5.5
FT4 I don't but I believe I was told 10 was bottom of the range.

I'm aware the first result would have been an indicator of subclinical hypothyroidism. I'm also aware that the diagnosis should have been made if the result was similar/worse 3-6m later, as well as having antibodies tested for. Sadly I know this now. Over a year later. Though its taken a year to find out I had indicators of subclinical hypothyroidism, my surgery having denied it until recently. [bitter]

My TSH has gone up from nothing to 7 in the last 2 months. I've had a baby and now I've no idea what's happening! I'm hypothyroid.

That range is inaccurate. It was recently announced that levels of more than 2.2 on repeated blood testing should be treated. I'm on my phone, will try to link later.

I'd be very happy to see that inanimate. The NICE guidelines have a different range 0.4-4.5, plus also a note that subclinical patients with TSH between 4.5-10 may have symptoms compatible with hypothyroid and the option of a trial of treatment should be considered. Not that I was after medication tbh, but being taken seriously would be nice. I suppose its all a little moot now I've had my latest reading of 3.81, but i'm even more bitter as my GPs are more than happy to trot the NICE guidelines out when they can't do something yet decide they're "nonsense" when it means they may have to do something.

Oh god, you see this is how fricking fuzzy headed I am.

In my list of symptoms I haven't added that I'm often constipated and have a small weight gain (this only started as the symptoms ramped up again and isn't mammoth, just exceptionally irritating given I work hard on maintaining my weight) that I can't completely shift. I've been stressed out as hell over this, and normally that would prompt a massive ahem clearout, but at the moment it just means I go normally...

I'd also be interested to see that link inanimate
had test in Dec
t4 8.6 (9.0-24), tsh 4.91 (0.2-4.5). then repeat test Jan
t4 9.5 (9.0-24.0)
tsh 8.46 (0.2 -4.5)
I'm seeing my go on weds to check my thyroid as a module has appeared. over the phone he was very dismissive of my symptoms (fatigue, aching joints, slow bowl, low libido blah blah blah).

ITrulyMoustache are you on b12 jabs because you have been diagnosed with Pernicious Anemia? If so, well done! That's another disease doctors seem to find hard to diagnose. I can't see if you have tested positive for antibodies but there is a strong link between b12 def and hypothyroidism.

www.ncbi.nlm.nih.gov/pubmed/18655403

With a TSH of 3 I was literally on my knees, sleeping 20hours a day, bald, obese, tachycardic and ready to give up. I've been hyper, prior to thyroid coming out and only an imbecile would choose to take thyroid hormones if they didn't need them. We don't know what your 'good' and normal TSH levels are. For all doctors know, you feel best with TSH at 0.01 and T4/T3 right at the top.

if you get a copy of the 'understanding your thyroid' book, it might be helpful in persuading the gp to trial levo, although a low dose of say 25 might be worse than waiting til your thyroid completely packs in and you get a proper dose depends on how you feel your gp will manage it.
ask for vit d, ferritin n.b12 tests as well as at least one will also be low i imagine
celiacs test might be useful too ?

Thyroid UK keep a list updated of doctors/Endos that patients have found helpful. Worth asking to see. Also they have a good database of companies who do private tests. If I had these symptoms and a TSH over 3, I'd be testing my Free T3 and seeking a decent doctor.

The whole thing is a shambles.

lorraine sadly not, I'm on B12 jabs because my levels dropped low despite normal higher level supplementation. At that time I was so naive that I never realised that the cause needed to be discovered before treatment so I'm technically on it for poor diet (Oh GP, I can't tell you how much I did not appreciate that when we had a conversation where we'd detailed how good my diet was for B12) and undefined poor absorption issues. Current GP tested me for antibodies but said he did not expect to find them as I'd been under active treatment for some time, result came back negative. Pernicious Anaemia is in my family, as is thyroid issues, as is vitamin D deficiencies, etc.etc. This is sort of why I'm attempting to be dogged over this, I even explained that to the Dr today.

san B12 will be high because I've just had a jab, ferritin was decently normal for the first time in my life without being on active iron treatment. it D denied today despite family history. My GP really doesn't really want to deal with anything.

The thing is that I'm rarely angsty against my GPs, and in the few circumstances I have been I've not yet been wrong. Everything in me is telling me there is something askew.

I'm looking for the article. I'm trying to remember where I read it.

Your T4 is low and your TSH is high. Over 2 and you start to get problems. My doctor (when I finally got one to listen to me) told me he didn't know how I was still standing with a TSH of 7. I'm on 100mcg of levo a day.

The good news is that there are loads of functional physicians out there that are finally changing their approach to medicine. In university they are taught to treat the illnesses and the symptoms not the root cause. I work with a functional physician and he's fantastic. My first appointment with him went on for two hours and it was just questions. He was so thorough. It was the best doctor's appointment I've ever had. He did a ton of tests (I'm still doing them because some require certain cycle days) and after all the dietary change I feel a million times better. He said that if he could get everyone in the world off gluten he would.

If you can't get to talk to a functional physician there are plenty of online resources:

drhyman.com/blog/2010/05/31/how-your-thyroid-can-make-you-sick-tired-fat-2/

hypothyroidmom.com/

When you read all these posts, you can see why so many of us turn to online support groups for information and help. We shouldn't have to fight to regain our health, but we do.

For anyone wanting advice a good forum is health unlocked thyroid - helped me out when doctors would not.

Itruly maybe worth investigating celiacs?

san I was tested years ago for that, came back clear. I did have an IBS diagnosis. IBS completely cleared up when I started minimising my lactose consumption though. Again, another treat from my family. And when I say my family I am always talking about my maternal side. The paternal side just gave me asthma . I am contemplating going gluten free though to see if that helps.

Maybe the op will come back in her GP capacity and suggest? ITruly is clearly suffering from classic hypothyroid symptoms including low body temperature and missing eyebrows. www.molbiolcell.org/content/early/2015/02/02/mbc.E14-07-1251.full.pdf

I had no problem getting a hypo diagnosis as my thyroid was removed but I had dreadful trouble with not converting levothyroxine and was just dismissed as anxious and sent for CBT! Even with labs that proved I wasn't converting, Endo could not have cared less. My GP was lovely, said she wasn't allowed to say what she really thought but gave me some T3 and referred me to the late Dr Skinner. I feel heart sorry for patients who haven't got the options I had. But, even with my private health insurance and access to tests, I now have to go it alone and order my hormones on line. Disgraceful.

Oh yes lorraine, I remember the CBT and antidepressants for my chronic anxiety attacks. Of course it's psychological not physiological. Silly me.

Terrible isn't it InanimateCorbonRod ? Even my therapist said she could see I wasn't anxious by physically ill and desperate for someone to listen.

I often wonder if the Endocrine disrupting contraceptive is linked to the frequency of women suffering with thyroid trouble, that and the obvious flux our hormones go through with periods, childbirth and menopause.

Exposure Issues
Most potential EDCs enter the human body via ingestion as
components of pharmaceutical products such as contraceptive
pills and estrogen replacement therapy and through
food. A minor proportion comes from drinking water. It is
informative to examine the relative potencies of potentially
ingested compounds, including hormonal pharmaceuticals
and plant and fungal estrogens (Table 4). A 1998 estimate
of the comparative intake of estrogens and their biological
equivalents indicated that oral contraceptives would be the
main source of exposure to estrogen equivalents in women
using these pharmaceuticals (Table 5).

Endocrine-Disrupting Compounds: A Review of
Their Challenge to Sustainable and Safe Water
Supply and Water Reuse
Ian R. Falconer,1,2* Heather F. Chapman,3 Michael R. Moore,4 Geetha Ranmuthugala5

Serious question - how do you filter out information online? With the greatest of respect, while some of you are obviously very informed about thyroid issues, how do you filter the woo from the wacky? That's what makes me nervous about seeking advice online.

It's easy to criticise people and say "don't believe everything your doctor says" but you need to seek information from somewhere! So, where? How do I know that you very nice people on here aren't as wrong as my doctor.

I had an illness that presented unusually and had a bad experience with a consultant, so I am not naive nor do I blindly believe every word I am told. You do have to place your trust somewhere and no disrespect to anyone here but there are some properly bonkers people online.

Ed that's a very valid question and one I used to ask myself often. When I told my (hideous) story at the GP conference in Barcelona, some GPs asked me that very thing. All I could tell them was that I placed trust in clinical papers, learned the hard way that the abstract wasn't always the whole story (there's a great book on how to sort the wheat from the chaff, Doctoring Data, by Dr Malcolm Kendrick who wrote The Great Cholesterol Con) but also couldn't dispute the before and after stories and pictures of people I'd followed online. I have my own before and after images on my facebook. The bloated and ill me is a classic face of hypothyroidism, and yet I was now on 100mcg of Levothyroxine and told my bloods were normal!

You get a feel for groups or charities and quickly find one you trust instinctively. I settled on Thyroid UK. I felt they were sensible, didn't thrust any dogma down your throat and actively worked to change the situation from the top. They never let me down. Fellow patients shared their hard won experience with me, but only if I asked.

At the very basic level Ed, I had sunk so low, was so entirely desperate, enough to plan my suicide, that I had nothing left to lose. Find someone you feel is sensible and read, but question everything.

Although I have developed an odd aversion to blogs and forums with super graphics, bright logos and anyone selling supplements

There's a fair bit of good evidence from doctors backing my petition in the Scottish Parliament, some of it well worth a read.

www.scottish.parliament.uk/GettingInvolved/Petitions/PE01463

The Health Unlocked forum which is run by Thyroid UK is excellent. I regained my health because of the incredible help and support I got there. My endo had never prescribed NDT before so I needed a bit of extra guidance from somewhere else and I got all there. Fantastic people, especially the Admins