Re: Referals to Endocrinologists by GPs is Mandatory

[Guest guest]

,How do you persuade physicians that the symptoms you have are thyroid related when the TSH comes back normal.    They do not have a very comprehensive list which they consider can be thyroid related.   Also if you do have something on the list they blame other things.   So they will reply - she did not have thyroid symptoms or her symptoms were indicative of depression, over eating and not enough exercise, and my cousin's doctor actually told her that there was nothing wrong and she should sort her domestic life out with her husband.    And no, there is no major problems it was just that they were going through a bad patch because he was finding it difficult to find work after a brain tumour operation.   He is now back at work and is fine.

So report them to the GMC and they will have a perfectly acceptable answer (maybe not to us but to the GMC).LilianOn 26 March 2012 11:29, ekp290340 <ekpritchard@...> wrote:

 

Hello to All,

In the statement from the Royal College of Physicians (London), which is effectively law, there is a requirement for physicians to refer patients with symptoms of hypothyroidism while having a " normal " TSH to endocrinologists.

So if the physician will not prescribe T3 for fear of adverse General Medical Council action against him, then he should also honor this referral requirement. . . ! ! !

If not, you have grounds to complain to the General Medical Council.

Have a great day,

[Guest guest]

Dear Lilian,

You don't persuade them directly aside from showing the a copy of the RCP

statement/directive. Then if you still don't get a referral, then you report

the " good doctor " to the GMC for appropriate further diagnostic studies and

potential treatment which the " good doctor " is obviously incapable of

performing.

And then remind the " good doctor " and the GMC that a medical ethic is to not

make decisions for which you are not qualified to make....per the RCP

statement/effective directive.

Maybe if this happened enough times the word would get out, that patients are

beginning to standup for their options instead of rolling over and being

submissive.

This realm has 60 years of being submissive to fool doctors. It is time to

fight back in every way possible. This is one way.

The other way is for everyone who finds T4 not working to complain to NHS, to

the GMC, to NICE, and more complain to the MPs.....

I have been fighting this crap for 8 years. If medicine were half of what it

claims to be, this would have never happened. But there are three medical

monkeys who see nothing new, hear nothing new and speak of nothing new - even if

it is 60 years old.

And I invite anyone with a different slant on this idea with alternate lack of

care and capabilities or more examples, please do chime in.

Have a great day,

>

> ,

>

> How do you persuade physicians that the symptoms you have are thyroid

> related when the TSH comes back normal. They do not have a very

> comprehensive list which they consider can be thyroid related. Also if

> you do have something on the list they blame other things. So they will

> reply - she did not have thyroid symptoms or her symptoms were indicative

> of depression, over eating and not enough exercise, and my cousin's doctor

> actually told her that there was nothing wrong and she should sort her

> domestic life out with her husband.

[Ed]

[Guest guest]

In my case the GP spoke to the endocrinologist about my treatment. She told her

I also have ME/CFS, which I was annoyed about because I'm not sure there is any

such illness.

Because my blood levels were within the reference range the endocrinologist said

I was being adequately treated, despite having a long list of thyroid-related

symptoms. So my GP said she could not refer me. (This is supposed to be one of

the " good " endocrinologists from Sheila's list.) The GP is happy to think all

my symptoms are down to ME/CFS.

Miriam

> You don't persuade them directly aside from showing the a copy of the RCP

statement/directive. Then if you still don't get a referral, then you report

the " good doctor " to the GMC for appropriate further diagnostic studies and

potential treatment which the " good doctor " is obviously incapable of

performing.

[Guest guest]

>> Hello to All,> > In the statement from the Royal College of Physicians (London), which is effectively law, there is a requirement for physicians to refer patients with symptoms of hypothyroidism while having a "normal" TSH to endocrinologists.> Have a great day, >

Have you a link to this info please :-)Caz x

[Guest guest]

Dear Miriam, CAZ, and all....

Here is a link the Royal College of Physicians statement on PRIMARY

HYPOTHYROIDISM: Link:

http://www.rcplondon.ac.uk/sites/default/files/the-diagnosis-and-management-of-p\

rimary-hypothyrodism-statement-19-november-2008.pdf

Notes:

1. Paragraph 3: The statement only applies to primary hypothyroidism.

2. Paragraph 5: The only way to test for primary hypothyroidism is by blood -

TSH & fT4

3. Paragraph 12: Patients with continuing symptoms should be further

investigated.

4. Paragraph 15: Patients with normal tests should be investigated for

non-thyroid causes

Also note that non-thyroid causes include the following post thyroid causes:

1. Deficient peripheral metabolism

2. Deficient cellular hormone reception

3. Deficient intracellular function

4. Deficient supporting chemistry

5. Excessive hormone clearance into the body's waste system.

Further, since the RCP declares that " normal range readings " indicates

effectively no hypothyroidism, then the GP should start the diagnostic process

again and again until he gets it right or has excluded every potential cause.

If you want more help, look on the TPA main page, at the bottom and check out

the GREATER THYROID SYSTEM....

And by the way, I believe that Dr. Lowe recommended T3 for Chronic Fatigue.

Lets see, the mitochondria is controlled by T3. If there is not enough T3, then

it does not produce energy. So the body is not warmed and it is weak...

Have a great day,

> > You don't persuade them directly aside from showing the a copy of the RCP

statement/directive. Then if you still don't get a referral, then you report

the " good doctor " to the GMC for appropriate further diagnostic studies and

potential treatment which the " good doctor " is obviously incapable of

performing.

>

[Guest guest]

This is very interesting. I waited 13 months for a referral to an endo and

eventually saw a general physician who, without my notes, which inexplicably

hadn't reached him, he diagnosed me with ME within 3 mins, which was very handy

as he pointed out that as there were no ME specialists in Wales there was

nothing he could do! Later with the help of thyroidadvocacy I persuaded one of

the GPs in my practice to try me on an increased level of T4. (I was only on

50mcg at the time.) This worked quite well, but the GP was unwilling to continue

against the 'TSH guidelines'. I then asked for a second referral and she said

that the same thing would happen again. That's the way they do it here. So at

great personal expense I went to see an endo in England privately. (That hurt,

having worked in the NHS for 30 years!)He confirmed that I should be taking more

T4 and so, reluctantly the pratice have continued prescribing it and I've

continued working full-time in quite a stressful job (instead of having to give

up work completely.)

Sally

>

> In the statement from the Royal College of Physicians (London), which is

effectively law, there is a requirement for physicians to refer patients with

symptoms of hypothyroidism while having a " normal " TSH to endocrinologists.

>

> So if the physician will not prescribe T3 for fear of adverse General Medical

Council action against him, then he should also honor this referral requirement.

.. . ! ! !

>

> If not, you have grounds to complain to the General Medical Council.

>

> Have a great day,

>

[Guest guest]

Thanks for the information.

The RCP has revised guidelines, published in June 2011:

http://www.rcplondon.ac.uk/sites/default/files/the-diagnosis-and-management-of-p\

rimary-hypothyroidism-revised-statement-14-june-2011_2.pdf

The following is in both guidelines under Treatment for Hypothyroidism, which

members may be able to use in order to get the level of treatment they deserve

under the NHS:

" © Fine-tuning of TSH levels inside the reference range may be needed for

individual patients. "

Colin

>

> Dear Miriam, CAZ, and all....

>

> Here is a link the Royal College of Physicians statement on PRIMARY

HYPOTHYROIDISM: Link:

>

[Guest guest]

HI ERIC

How long has this been law, as it was about twelve years from when I was put on

thyroxine before I was referred to an Endo, and is it too late to complain to

the GMC.I presume a complaint would start from when it became law, or would it

be from when you find out that you should have been referred.

Kathleen

>

> Hello to All,

>

> In the statement from the Royal College of Physicians (London), which is

effectively law, there is a requirement for physicians to refer patients with

symptoms of hypothyroidism while having a " normal " TSH to endocrinologists.

[Guest guest]

Dear Colin,

I believe that tweaking is a judgment call. One tweaks when one is close, but

it the symptoms have not been substantially mitigated, then the problem is not

tweaking, it is finding another or additional plan of action.

Please also take note of the 2005 conference on the bio-equivalency of

levothyroxine sodium in which the American endocrinology associations stressed

that levothyroxine sodium has a narrow therapeutic range. A concept amplified

by creating numerous in between potency levels.

This did seem a bit odd since the peripheral conversion is supposed to have some

regulatory function, which would reduce an overdose of T4 by making more RT3.

So if a patient is like my wife, she should be referred. My wife was prescribed

50 mcg of T4. It relieved her symptoms somewhat, hardly completely, but her TSH

was in the normal range. So she suffered for nine months to see if that seven

day half-life would finally break through after nearly 40 half-lives and a

potential error of less than a billionth (30 half-lives at seven days per). So

her first endocrinologist prescribed an insignificant (5 mcg) dose of T3,

basically to shut her up. (This dose is the starting dose for small children

and old folks. The adult starting dose is 25 mcg.) She got a miniscule

improvement, but certainly not enough. So she suffered for another 14 months

before she got a referral to a second endocrinologist. He noted that the T3

should be taken three times daily, and without thinking, wrote her s

prescription for 3 times a day. Well, this made her feel much better. But

quite contrary to medical ethics, this second endocrinologist wanted her to stop

taking the T3. But a life is better than virtually no life. Eventually she

saw, yet another physician, who put her on a still more T3 in spite of a very

low TSH, but she did not have any symptoms of hyperthyroidism.

My wife learned of the life-giving benefits of T3 from her mother, who always

tested euthyroid. However, she was continually so exhausted that she barely

could get the minimum of house work done. One day, in the kitchen, she fainted,

broke a leg in the fall, was rushed to the hospital, and was informed they would

fix her leg that day and her " thyroid " tomorrow. In fact, the internist called

the residents to look at her because she had the textbook appearance. She was

prescribed T3 and in a mere 10 days had enough energy to lift the hip to ankle

cast and be discharged.

In retrospect, she had euthyroid (her thyroid measured " normal " ) hypometabolism

(she was chronically exhausted anyway).

The internist claimed that she was lucky to have broken her leg because

otherwise she would have died in a myxedema coma, but her regular doctor did not

refer her in spite of his obvious medical shortcomings.

I have also heard of physicians tweaking and tweaking as the patient suffers and

suffers. At some point, there must be a referral to a physician who knows his

physiology and medical science, and not just the filtered thyroid-gland only

stuff. As numerous researchers have published, there is more going on in the

Greater Thyroid System than primary hypothyroidism.

People like my wife, her mother, and thousands more are patient counterexamples.

In other words, they have suffered with endocrinology's prescriptions and have

been virtually resurrected by endocrinology's proscriptions.

But medicine dismisses counterexamples even though they are inherent in all

sciences. They are inherent because all sciences, including medicine, are based

upon incomplete observations. So while 80+% of patients with the symptoms of

hypothyroidism get treated reasonably with T4 only, The remaining patients'

needs are beyond the endocrinology establishment. But these patients' needs are

addressed by medical science. All physicians need to do it follow their ethics

and stay abreast of it.

Endocrinology need only heed the circa 1950 warnings by Kirk, Kvorning, and

Means, heed the studies on euthyroid hypometabolism, and heed the discoveries of

Refetoff, Braverman, and others. Endocrinology needs to do what other sciences

do, pay attention to counterexamples.

We can hope that meaningful change will come about.

Have a great day,

> >

> > Dear Miriam, CAZ, and all....

> >

> > Here is a link the Royal College of Physicians statement on PRIMARY

HYPOTHYROIDISM: Link:

> >

>

[Guest guest]

Dear Kathleen and All,

It is not really law as in created by legislation. It is effectively law

because the concept is enforced by the GMC. It is more akin to a regulation

created in administrative law. Nonetheless, it has the same sort of effect.

I don't think that there is a statute of limitations involved with this issue

because in addition to the RCP statement, there is also the medical ethic of not

practicing medicine beyond one's skill level.

Consider the situation that you are on levothyroxine sodium and your TSH is

" normal " and you still have the symptoms of hypothyroidism. Then, per the RCP

statement you effectively do not have hypothyroidism any more. So what is

causing these symptoms? Something non-thyroidal. The right and proper thing to

do is then find that cause. If the doctor can not find that cause then he

should refer you to one who can, etc., assuming that these doctors are in the

business of producing functioning patients without symptoms.

So complain. If enough folks complain, maybe the GMC might get the word.

The word is embodied in all of the patient counterexamples. These are patients

who have suffered under endocrinology's prescriptions and were virtually

resurrected by endocrinology's proscriptions.

Who are some patient counterexamples? Sheila, Lilian, (I believe), my

wife, her mother, and more than a thousand in the TPA Patient Counterexample

Registry....

Since these patient counterexamples exist, you might also complain about the

lack of information to offer a valid consent. Also any consent is invalid if

that consent is gained via misrepresentation...

Have a great day,

>

> HI ERIC

> How long has this been law, as it was about twelve years from when I was put

on thyroxine before I was referred to an Endo, and is it too late to complain to

the GMC.I presume a complaint would start from when it became law, or would it

be from when you find out that you should have been referred.

> Kathleen

>

[Guest guest]

Isn't that why so many people are being told they have Chronic Fatigue Syndrome?

I don't see that these guidelines are much use to us unless doctors are serious

about discovering what is wrong.

Miriam

> Consider the situation that you are on levothyroxine sodium and your TSH is

" normal " and you still have the symptoms of hypothyroidism. Then, per the RCP

statement you effectively do not have hypothyroidism any more. So what is

causing these symptoms? Something non-thyroidal. The right and proper thing to

do is then find that cause.