Re: Thyroid complications

January 16, 2012

This is awful. I had a telephone call from somebody who's GP has

put her on steroids because she is getting palpitations and feeling 'fuzzy

headed' and pretty dreadful on 125mcgs levothyroxine which is making no

difference to her whatsoever, and her GP told her it could not possible be the

thyroid hormone replacement, because that is the dose that everybody takes. She

was asking for a trial of T3 and T4, but was told nobody needs T3. I could

scream in despair at what some of these doctors are doing to their patients.

Certainly, when I had severe backache (and I mean severe) with

pains in shoulder and under both heels, it was only when I stopped taking

125mcgs T4 and started taking Armour Thyroid which contains T4, T3, T2, T1 and

calcitonin, that the pains eventually completely subsided. I was not converting

and my muscles were going into severe spasm.

Ann, as far as I am aware there is no blood test that will tell

whether you can convert T4 into the active thyroid hormone T3. However, if you

have a thyroid function test done for free T4 and free T3, or you do the 24

hour urine test through Genova Diagnostics, if you are not converting the T4 to

T3, the T4 level would be quite high in the reference range and the T3 level

would be low in the range. The T4 would be high because it is not converting so

it stays in the blood with nowhere to go causing eventually, symptoms of

thyroxine toxicity and the T3 would be low because the T4 isn't making any T3.

I think those doctors who will give their patient some form of

T3 would also check out a patients symptoms and signs. Did the secretary say

what other blood tests they would want done?

Do you have any recent results for iron, transferrin

saturation%, ferritin, vitamin B12, vitamin D3, magnesium, folate, copper and

zinc. I ask because if any of these are low in the range, no amount of thyroid

hormone whether T4 alone or T3 is able to be fully utilised at the cellular

level until whatever is low has been supplemented. Also, low adrenal reserve,

systemic candidiasis, mercury poisoning through amalgam fillings will also have

the same effect. It is not always the thyroid hormone replacement that is

wrong, and other associated conditions MUST be checked for by way of a process

of elimination.

Luv - Sheila

I am now thinking that I can't convert T4 at

all to T3 as I still have joint pains,especially my hips which get very painful

and I have been having steroid injections in them. I am trying to get an

appointment with one of the recommended doctors to see if one of them can try

me on T3 only to see if this works and it might be an answer to the joint pain.

I rang the secretary of one of these doctors who said I might need other blood

tests etc., but does anyone know if there is a blood test that would prove that

some people can't convert T4 to T3 or do these doctors just go on symptoms, I

really don't know and I'm not going to talk to my G.P. about it as I already

sent him some info. on NDT through the post and when I went to see him he

didn't say anything about it so I don't want to broach the subject with him at

present, he didn't seem that knowledgeable regarding thyroid complications. Any

help would be appreciated. love Ann.

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January 20, 2012

Hi Sheila and everyone. I have just been to my G.P. for a referral to see a

doctor on the list of good doctors that requires a letter of referral,

unfortunately my G.P. would not refer me but has sent me for a blood test

himself, this is what it says on the form 'clinical details':

TATT on thyroid replacement but normal TSH and free T4? Low Free T3 (and I don't

know how he knows all this as I haven't even had a free T4 with him before and

haven't had a TSH test for nearly a year or over).

He has not sent me for a Free T4 as I asked and I asked him why not and he said

the TSH should tell him what the Free T4 is, and I thought that was peculiar.

I asked why he wouldn't refer me to this doctor I wanted to see on the good

doctors list and because it didn't say NHS next to it he said 'it could be any

old doctor setting himself up' and I was confused. When I got home I thought

'how can a doctor refuse to refer you to another doctor' and of course this

doctor I want to see is actually registered with the GMC so whats the problem?

I can't see how the blood test this G.P. wants me to have is going to do

anything as I don't suppose he knows the slightest about endocrinology and when

I spoke to him about this some months ago he said he was not allowed to

prescribe T3 unless an endocrinologist had told him, so why is it now that he

thinks he can act like an endocrinologist and do the T3 test etc., he, this G.P.

also wants me to have X-rays of my hips again, when I only had X-rays of them

about 18 months ago. What on earth is going on?

I tried to ring the practice manager to ask her as to why this doctor won't

refer me to a doctor I want to see but she is in a meeting. I am very annoyed.

Also I have been able to make an appointment with another doctor on the good

doctors list, who is actually a professor, and he costs a lot of money indeed,

and guess what I don't even need a letter of referral to see him, but he will

cost me about 500 to 700 pounds (sorry haven't got the pound sign on this

keyboard) which I haven't really got, all because my G.P. won't refer me to the

doctor I want to see because this doctor needs a letter of referral, it doesn't

make sense at all! Fed up - Ann x

January 21, 2012

Hello Ann, this is all very strange. I am not quite sure what

your second paragraph means and don't know what TATT means? Are you saying that

he has written that these are the results of your last thyroid function test of

a year ago, but that you only ever had TSH tested and never free T4 and free

T3, so he is making these results up?

There is no way on earth that anybody can tell what your free T4

level is by looking at your TSH - they are two completely different hormones.

I would write a letter to this doctor telling him that you want

TSH, free T4 and free T3 and that you need to see the results when they are

returned together with the reference range for each of the tests done. Tell him

in the letter that if he checks the Guidelines for Thyroid Function Tests, he

will see that it is recommended by the British Thyroid Association and the

Royal College of Physicians that TSH should be tested together with a measure

of free T4 - and quote him http://www.british-thyroid-association.org/news/Docs/hypothyroidism_statement.pdf

and also http://www.british-thyroid-association.org/info-for-patients/Docs/TFT_guideline_final_version_July_2006.pdf

Tell him also that you wish to see the results of your last

thyroid function tests together with the reference range. Remember Ann, no

doctor is allowed to withhold any information that is in your medical notes

under The Data Protection Act 1998.

I think perhaps he also needs reminding about 'The Duties of a

Doctor Registered with The General Medical Council' http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

As far as his refusal to refer you to the doctor you have chosen

on your list, were there any qualifications after this doctors name? If there

were not, check this doctor out on Google and get his qualifications form there

or from the Dr web site. In your letter, I would again request that he

refers you to this doctor and tell him that if he believes this could be

" any old doctor setting himself up " to first check his qualifications

and registration with the GMC before refusing to refer you. Tell him also, that

if he still refuses to refer you to him, that he puts his reasons for his

refusal down in writing to you.

I would also tell him in your

letter that HE IS ALLOWED TO PRESCRIBE T3, this is at a doctors discretion, and

if patients are not doing well on levothyroxine only and their free T3 level is

low, then Liothyronine (T3) is a licensed thyroid hormone that is in the

British National Formulary and he will see there that he can prescribe from

20mcgs to 60mcgs. If he insists that he is not allowed to prescribe it, again,

ask him to provide written evidence to this effect. He won't be able to

do it because no such evidence exists. However, id does appear that doctors are

using the RCP, BTA et al statement on the Diagnosis and Management of Primary

hypothyroidism as recommended treatment for ALL FORMS of hypothyroidism - where

their statement for PRIMARY hypothyroidism ONLY states " … the inclusion of T3

in the treatment of hypothyroidism should be reserved for use by

accredited endocrinologists in individual patients " - note,

how in their conclusion, they have missed out the word 'Primary' and also, note

the word 'should' - leaving this to the doctors discretion. If this was

mandatory, they would have written 'must'. It is this one statement (i.e.

opinion only because it is not backed up with references to the

studies/research/science) that doctors appear to now be basing all their

management of everybody with symptoms of hypothyroidism, whatever type it is.

I think at times many such

doctors need reminding that they are GP's and not specialists and that

specialists are there to help find the cause of the problem when a GP is still

unable to give their patients back their optimal health.

In your letter, state

categorically that you want a response in writing from this GP within the next

7 days giving his reason why he refuses to refer you to this specific doctor

and giving you an explanation of how he can tell what your free T4, free T3 is

from a TSH only blood test result.

Last, ask that he places your

letter of requests into your medical notes.

Good luck Ann