RE: So GP not gonna help me

[Guest guest]

>

> In a nutshell My GP practice do not treat anybody with normal TSH

> (mine was 1.72) and the one I saw today says TSH will be altered if

> there is a problem with either T4 or T3.

Well he's wrong there.

So you have some choices.

1) Stay with, and be untreated by, a GP who clearly does NOT know

his stuff;

2) Find a different doctor who DOES know his stuff; or

3) Learn the stuff yourself and become your own doctor.

(I'm not saying that all of these choices are equal).

Rosie

[Guest guest]

> So you have some choices.

>

> 1) Stay with, and be untreated by, a GP who clearly does NOT know

> his stuff;

>

> 2) Find a different doctor who DOES know his stuff; or

>

> 3) Learn the stuff yourself and become your own doctor.

>

> (I'm not saying that all of these choices are equal).

>

> Rosie

>

Rosie - Dont you think its dangerous to become your own doctor? I know

there are some very incompetent doctors out there and its sometimes

difficult to find a good one - but I wouldn't have the confidence to be

my own doctor lol.

And to the original poster --- I understand what you are dealing with -

- I have perimenopausal issues too and like you, I'm concerned that the

symptoms of peri/menopause can closely mimic those of thyroid disease --

thats one of my dilemas too. However -- I feel that it wouldn't hurt

to treat my thyroid since its at 3.12 and borderline high - I guess

you have to start somewhere -

Blessings to all.

[Guest guest]

> Rosie - Dont you think its dangerous to become your own doctor?

Yes I do. You'd have a fool for a patient, to start with :-)

However, learning all about this stuff, by reading reading reading, is

kinda essential, don't you think?

Rosie

[Guest guest]

>

> > Rosie - Dont you think its dangerous to become your own doctor?

>

> Yes I do. You'd have a fool for a patient, to start with :-)

>

> However, learning all about this stuff, by reading reading reading,

is

> kinda essential, don't you think?

>

> Rosie

>

yes it is essential but it can be a big effort when you're feeling so

mentally drained. Thats where I am at the moment - Sometimes I find

it difficult to stay focused -- thats why I need to prioritise my

health and get this thing sorted before I get any worse.

Thanks Rosie )

[Guest guest]

Oh dear Kim - another dumb-pot of a doctor. I bet you he will not even bother to read our comments and references about T3/T4 combination treatment - he sounds like a throw-it-in-da-bin-man. Is there no way you can change doctors - or are you the one who has tried several and found them all lacking?OK- so I'm going to get technical and serious now. Here are some studies to show that TSH may NOT be sufficient to diagnose for thyroid disease and other studies to show where a LOW TSH within the reference range may be associated with increased pathology. Perhaps all members who are being refused blood tests other than TSH should copy these out and ask your doctor why he insists TSH is the ONLY test. These are just a sample.Luv - Sheila

________________________________

SERUM TSH: IS THE TSH SERUM MEASUREMENT ALONE SUFFICIENT FOR DIAGNOSIS AND FOLLOW-UP OF THYROID DEFICIENCY?

Claim: TSH is the first line test to do. It is sufficient to diagnose all forms of eu-, hypo- and hyperthyroidism. No other test is necessary for the diagnosis.

Facts: TSH is often insufficient on its own to diagnose between eu-, hypo- and hyperthyroidism, particularly to diagnose milder, borderline states of hypothyroidism. Other tests are necessary, as is a complete clinical evaluation (medical history, actual complaints, physical examination) of the patient.

Some arguments that may explain why the TSH test alone is insufficient to diagnose all forms of hypothyroidism, including the borderline forms.

The frequency of abnormal TSH values

1. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000;160:526–34

2. Warren RE, Perros P, Nyirenda MJ, Frier BM. Serum thyrotropin is a better predictor of future thyroid dysfunction than thyroid autoantibody status in biochemically euthyroid patients with diabetes: implications for screening. Thyroid. 2004;14:853–7

Longitudinal studies indicating a rate of progression of mild thyroid failure into overt hypothyroidism of about 5% per year (50% or more in 10 years!): they have to be treated

3. Vanderpump MPJ, Tunbridge WMG, French JM, Appleton D, Bates D, F, Grimley J, Hasan DM, Rodgers H, Tunbridge F. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995; 43:55–68

4. Parle JV, lyn JA, Cross KW, SC, Sheppard MC. Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf). 1991;34:77–83

5. Huber G, Staub J-J, Meier C, Mitrache C, Guglielmetti M, Huber P, Braverman LE. Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab. 2002;87:3221–6

6. Kabadi UM. ‘Subclinical hypothyroidism:’ natural course of the syndrome during a prolonged follow-up study. Arch Intern Med. 1993;153:957-61

The pituitary 5’-deiodinase type 2 that converts thyroxine into triiodothyronine (T3), is different than the liver and kidney 5’-deiodinase type 1 that provides the T3 for the rest of the body. This difference may explain why TSH secretion and thus serum TSH secreted by the pituitary gland may be normal, while the rest of the body may be in a thyroid deficient state.

7. Koenig RJ, Leonard JL, Senator D, Rappaport N, A, Larsen PR. Regulation of thyroxine 5'-deiodinase activity by 3,5,3'-triiodothyronine in cultured anterior pituitary cells. Endocrinology. 1984 Jul;115(1):324-9.

In fasting, hypothyroidism or selenium deficiency for example, the 5‘-deiodinase of the pituitary gland increases or remains unchanged, while that of the liver decreases.

8. Suda AK, Pittman CS, Shimizu T, Cambers JB. The production and metabolism of 3,5,3'-triiodothyronine and 3,3',5'-triiodothyronine in normal and fasting subjects. J Clin Endocrinol Metab. 1978 Dec;47(6):1311-9

9. Larsen PR, Silva JE, Kaplan MM. Relationships between circulating and intracellular thyroid hormones: Physiological and clinical implications. Endocr Rev. 1981 Winter;2(1):87-102.

10. Chanoine JP, Safran M, Farwell AP, Tranter P, Ekenbarger DM, Dubord S, Arthur JR, Beckett GJ, Braverman LE Dubord S, S, Arthur JR, Beckett GJ, Braverman LE, Leonard JLl. Selenium deficiency and type II 5'-deiodinase regulation in the euthyroid and hypothyroid rat: evidence of a direct effect of thyroxine. Endocrinology. 1992 Jul;131(1):479-84

A normal or low serum TSH may reflect in elderly persons hypothyroidism in peripheral tissues, and not anymore eu- or hyperthyroidism, because the pituitary gland has aged. Progressively with increasing age, the serum TSH test becomes less reliable as a diagnostic test.

11. Urban RJ. Neuroendocrinology of aging in the male and female. Endocrinol Metab Clin North Am. 1992;21(4): 921-31.

Necessity for other tests than the TSH to diagnosis thyroid dysfunction, e.g. the serum free T4

12. Ladenson PW. Diagnosis of hypothyroidism. In Werner and Ingbar's The Thyroid, 7th edition, Braverman LE and Utiger RE, Lippincott-Raven Publishers, Philadelphia. 1996; 878-82

13. Pacchiarotti A, o E, Bartalena L, Aghini Lombardi F, Grasso L, Buratti L, Falcone M, Pinchera A. Serum free thyroid hormones in subclinical hypothyroidism. J Endocrinol Invest. 1986 Aug;9(4):315-9

14. Surks MI, Chopra IJ, sh CN, Nicoloff JT, Salomon DH. American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. JAMA. 1990 Mar 16;263(11):1529-32

15. JR, Black EG, Sheppard MC. Evaluation of a sensitive chemiluminescent assay for TSH in the follow-up of treated thyrotoxicosis. Clin Endocrinol Oxf. 1987; 27(5): 563-70

Serum thyroid hormone levels may not reflect the cellular thyroid status

16. Escobar del Rey F, Ruiz de Ona C, Bernal J, Obregon MJ, Morreale de Escobar G. Generalized deficiency of 3, 5, 3'-triiodothyronine in tissues from rats on a low iodine intake, despite normal circulating T3 levels. Acta Endocrinol (Copenh) 1989; 120: 490-8

Need to analyse valuable indicators of peripheral activity such as the serum levels of plasma binding proteins SHBG, TBG, CBG, or of thyroid-dependent enzymes such as alkaline phosphatase, osteocalcin

17. Smallridge RC. Metabolic, physiologic, and clinical indexes of thyroid function. In Werner and Ingbar's The Thyroid, 7th edition, Braverman LE and Utiger RP, Lippincott-Raven Publishers, Philadelphia, 1996

18. Foldes J, Tarjan G, Banos C, Nemeth J, Varga F, Buki B. Biologic markers in blood reflecting thyroid hormone effect at peripheral tissue level in patients receiving levothyroxine replacement for hypothyroidism. Exp Clin Endocrinol. 1992; 99(3): 129-33

Doubts on the usefulness of the serum TSH test alone for diagnosis

Overreliance on laboratory tests without clinical evaluation may lead to considerable diagnostic errors

1. Nicoloff JT, Spencer CA. The use and misuse of the sensitive thyrotropin assay. J Clin Endocrinol Metab. 1990;71:553-8.

2. De Los Santos ET, Mazzaferri EL. Sensitive thyroid-stimulating hormone assays: Clinical applications and limitations. Compr Ther. 1988; 14(9): 26-33.

3. Becker DV, Bigos ST, Gaitan E, JCrd, rallison ML, Spencer CA, Sugarawa M, Van Middlesworth L, Wartofsky L. Optimal use of blood tests for assessment of thyroid function. JAMA 1993 Jun 2; 269: 273 (“the decision to initiate therapy shoul be based on both clinical and laboratory findings and not solely on the results of a single laboratory test”)

4. Rippere V. Biochemical victims: False negative diagnosis through overreliance on laboratory results—a personal report. Med Hypotheses. 1983; 10(2): 113.

When data for subjects with positive TPOAb or a family history of autoimmune thyroid disease are excluded, the normal reference interval becomes much tighter, i.e. 0.4–2.0 mU/liter. This tighter reference range may certainly be more applicable to African-Americans, who have a lower mean TSH

1. Hollowell JG, Staehling NW, Flanders WD, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87:489–99

Demers LM, Spencer CA. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. Clin Endocrinol (Oxf). 2003;58:138–40

STUDIES WHERE A LOW TSH within THE REFERENCE RANGE MAY BE ASSOCIATED WITH INCREASED PATHOLOGY

Maniaco-depression: low TSH is a risk factor for switch over to manic state

STUDIES WHERE A LOW TSH within THE REFERENCE RANGE MAY BE ASSOCIATED WITH INCREASED PATHOLOGY

Maniaco-depression: low TSH is a risk factor for switch over to manic state

Bottlender R, Rudolf D, Strauss A, Moller HJ. Are low basal serum levels of the thyroid stimulating hormone (b-TSH) a risk factor for switches into states of expansive syndromes (known in Germany as "maniform syndromes" in bipolar I depression? Pharmacopsychiatry. 2000 Mar;33(2):75-7. Department of Psychiatry, Ludwig Maximilians University, Munich, Germany. bottlend@...

Postmenopause: increased osteopenia in women with low TSH (0.39 versus 1.8 mIU/L)

MS. The association between serum thyroid-stimulating hormone in its reference range and bone status in postmenopausal American women. Bone. 2007 Apr;40(4):1128-34. Epub 2007 Jan 22 Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St., Room 901D, Boston, MA 02111, USA.

Two studies where the low TSH may be due to central hypothyroidism and not to mild hyperthyrodisim

Septic shock: Nonsurvivors had significantly lower TSH serum level (0.37 mU/I) than survivors (1.27 mU/I): probably due to central hypothyroidism (and not mild hyperthyroidism)

Borkowski J, Siemiatkowski A, Wolczynski S, Czaban SL, Jedynak M. [Assessment of the release of thyroid hormones in septic shock—prognostic significance] Pol Merkur Lekarski. 2005 Jan;18(103):45-8 Klinika Anestezjologii i Intensywnej Terapii Akademii Medycznej w Bialymstoku. jecekbor@...

Nonthyroidial illness: A low or undetectable TSH COMBINED TO a low T3 and T4 (= severe central hypothyroidism) may be associated mortality

AH, Ganie MA, Masoodi SR, Laway BA, Bashir MI, Wani AI, Salahuddin M. Prevalence and pattern of sick euthyroid syndrome in acute and chronic non-thyroidal illness--its relationship with severity and outcome of the disorder. J Assoc Physicians India. 2004 Jan;52:27-31 Department of Endocrinology and +Immunology, Sher-i-kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir.

In a nutshell My GP practice do not treat anybody with normal TSH (mine was 1.72) and the one I saw today says TSH will be altered if there is a problem with either T4 or T3. So basically the only thing to do is test TSH once a year because of my history. He was quite disparaging of the Endocrinologist who also deals with Diabetes at local hospital. He also feels that treating with T4 or T3 messes everything about. Hmme! not sure which road to take because my symptoms could be due to depression or being postmenopausal. When I have some money I will get the bloods checked by NPTech. I guess they all think this is part of my being nuts now!! Doesn't affect my willingness to help you out and Jon is still on the case so Sheila especially dont think Jons help is dependant on my diagnosis. If nothing else I have made some good friends who help me stay sane!!Luv you allKim

[Guest guest]

Hi sheila

Yes I have seen at least four of the GPs in my practice now - two

females and two males. I think this has to be their policy - he told me

they had a whopping 300 patients with Thyroid problems but still

maintained that treating with T3 or T4 (not both) messed things up and

made it more complicated. Can you check your lists and see if you have

a doctor called Hoare or something similar in the Rugby/Coventry area?

lots to read - thanks

Kim

>

> Oh dear Kim - another dumb-pot of a doctor. I bet you he will not

even bother to read our comments and references about T3/T4 combination

treatment - he sounds like a throw-it-in-da-bin-man. Is

[Guest guest]

Hi Geraldine

If you cannot get a doctor to treat you within the NHS and you cannot afford to see a private doctor and there is no other doctor that will help you, sadly, you have no other choice than what Rosie has set out.

This is why I opened TPA-UK, to help others, who, like me,remained so ill within the NHS to find the information they need, what tests they can do themselves, what tests other laboratories can do to help them reach a diagnosis and help them understand that there are choices of supplements and thyroid hormone medications (if that is what they need). We have collected lots of information in our Files and links to help such people. Lne of the greatest things, is to be able to talk to fellow sufferers and find out what helped them, and what didn't.

Personally, I see this as being no more dangerous (in fact in most cases, less dangerous) than relying on an incompetent medical practitioner to look after your health. Sadly, this is the reason there are thousands of members of Internet Hypothyroid forums, and until changes are made, these numbers will continue to grow.

Luv - Sheila

> So you have some choices.> > 1) Stay with, and be untreated by, a GP who clearly does NOT know > his stuff;> > 2) Find a different doctor who DOES know his stuff; or> > 3) Learn the stuff yourself and become your own doctor.> >Rosie - Dont you think its dangerous to become your own doctor? I know there are some very incompetent doctors out there and its sometimes difficult to find a good one - but I wouldn't have the confidence to be my own doctor lol.And to the original poster --- I understand what you are dealing with -- I have perimenopausal issues too and like you, I'm concerned that the symptoms of peri/menopause can closely mimic those of thyroid disease --thats one of my dilemas too. However -- I feel that it wouldn't hurt to treat my thyroid since its at 3.12 and borderline high - I guess you have to start somewhere -Blessings to all.

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.516 / Virus Database: 269.19.2/1224 - Release Date: 14/01/2008 17:39

[Guest guest]

Hi Kim,

Can you go see Dr. Peatfield?

In a nutshell My GP practice do not treat anybody with normal TSH (mine

was 1.72) and

..........the one I saw today says TSH will be altered if there is

a problem with either T4 or T3.

******** This isn't quite right as TSH won't rise if there is a problem with

your pituitary- supposedly rare, but it does happen.

Messages are not a substitute for professional medical advice. Always

consult with a suitably qualified practitioner before changing medication.

[Guest guest]

Hi Kim

I only have a database for endocrinologists - not GP's. There are over 36000 GP's in the UK.

Luv - Sheila

Hi sheilaYes I have seen at least four of the GPs in my practice now - two females and two males. I think this has to be their policy - he told me they had a whopping 300 patients with Thyroid problems but still maintained that treating with T3 or T4 (not both) messed things up and made it more complicated. Can you check your lists and see if you have a doctor called Hoare or something similar in the Rugby/Coventry area?lots to read - thanksKim>> Oh dear Kim - another dumb-pot of a doctor. I bet you he will not even bother to read our comments and references about T3/T4 combination treatment - he sounds like a throw-it-in-da-bin-man. Is

No virus found in this incoming message.Checked by AVG Free Edition. Version: 7.5.516 / Virus Database: 269.19.2/1224 - Release Date: 14/01/2008 17:39

[Guest guest]

My GP wouldn't help me either, after 20 years of suffering. I treat

myself and I know I'd be terribly debilitated (if not dead) if I

hadn't taken my health in to my own hands.

Sheila gave me the courage to treat myself and thank goodness she

did.

Luv Bella

>

> Hi Geraldine

>

> If you cannot get a doctor to treat you within the NHS and you

cannot afford to see a private doctor and there is no other doctor

that will help you, sadly, you have no other choice than what Rosie

has set out.

>

> This is why I opened TPA-UK, to help others, who, like me,remained

so ill within the NHS to find the information they need, what tests

they can do themselves, what tests other laboratories can do to help

them reach a diagnosis and help them understand that there are

choices of supplements and thyroid hormone medications (if that is

what they need). We have collected lots of information in our Files

and links to help such people. Lne of the greatest things, is to be

able to talk to fellow sufferers and find out what helped them, and

what didn't.

[Guest guest]

Hi Kim, how are you doing? Not responded to you before as Ive been 'under the weather' with a rotten sinus infection! I just wanted to say dont give up - my TSH was 2.5 and I was told exactly the same as you - I was depressed, or menopausal - my aches and pains were cos i was depressed, my memory loss was cos i was depressed, even putting on weight was cos I was depressed! I had my bloods done through NPTech and my T3 and T4 were very low but still just in range - the endo asked me (after I had insisted on a referral and the GP saying 'T3? oh this is out of my league') what I thought it was and i told him I thought I was hypothyroid - my face was puffy, Id gained weight for no reason, I couldnt concentrate and my memory was terrible and I was so tired. He said "and I agree with you" and started me on thyroxine there and then! Spend the money on the bloods doing instead of a treat - it was the best £33 I have ever ever spent.

Gill

In a nutshell My GP practice do not treat anybody with normal TSH (mine was 1.72) and the one I saw today says TSH will be altered if there is a problem with either T4 or T3. So basically the only thing to do is test TSH once a year because of my history. He was quite disparaging of the Endocrinologist who also deals with Diabetes at local hospital. He also feels that treating with T4 or T3 messes everything about. Hmme! not sure which road to take because my symptoms could be due to depression or being postmenopausal.

..

Internal Virus Database is out-of-date.Checked by AVG Free Edition. Version: 7.5.516 / Virus Database: 269.17.6/1192 - Release Date: 21/12/07 13:17