Should I go back to GP?

[heatheruk]

I have been treated for depression for over four years - I have been placed on various anti-depressants, none of which seem to have worked.

Just over 18 months ago we moved and I had to register with GP, he did some blood tests at the time and contacted me as I had low ferretin stores (I had mentioned to him that I had been having problems with my periods - very clotty and heavy for some time) and a borderline underactive thyroid.

I had to go back after 6 months and have my blood tests repeated.

I went back and at the time I was experiencing problems with my breathing - I was very short of breath. He contacted me later that day as one of the tests he had done indicated that I may have had a blood clot - fortunately, this was not the case - I was admitted to hospital for a couple of days and they found nothing wrong. My medication had just been changed from effexor to prozac and it was thought that it the breathlessness may have been a reaction to prozac. So I was weaned of prozac and actually made the decision to come off all of my anti-depressants  I haven't taken any since, I don't feel any worse - but I don't feel any better either - but why take them??

A few days after this I was contacted again by my GP as my TSH was 8.32 and I had significant antibodies at over 800. He concluded that as I had been 'unwell' when the blood tests were taken they were not conclusive, so I had to have the tests taken again. This time my TSH came back as 4.31 - so he concluded that no further treatment was required - but as my TSH was still borderline i should have further blood tests in another 6 months.

I was quite - no very confused by this, so I went to see him as I felt I had 'symptoms' of an underactive thyroid:

Depression
Anxiety
Panic Attacks
Forgetfulness
Bad concentration
Heavy Periods
Pins Needles in wrists/hands
Constant Tiredness
Dry mouth (I have had a 'white coated tongue' now for as long as I can remember!)
Dry Skin patch - but only on one arm which has been diagnosed as ezcema (this has only just recently started)
I am always cold - heatings on, coal fire - but I still have duvet wrapped round me
Sometimes I feel that I can not swallow my food properly and othertimes I gag even when i am not eating - but I have put this down to anxiety
I am regulary feel that I am 'coming down' with something, i.e aches/shivers/cold/general rough feeling (hope you get the picture) but nothing 'develops'

He concluded that my 'symptoms' very non-specific and ordered further blood tests (sorry, can't remember what these were - but nothing thyroid related) and they all came back ok.

So after another 6 months, I have just had the tests taken again - my TSH is now 5.08 and the only other thing that was mentioned was that my ferritin levels although within range are low at 30. This time he has concluded that all my tests have come back within normal range - no mention of further tests to be done in the future. Antibodies weren't tested as my thyroid is now normal (But, they are slightly higher than when i was told they were borderline - so have ranges changed recently?)

I am still 'suffering', but am I right to question my GPs diagnosis?? Is it all 'depression' related and the fact I had borderline results is just a co-incidence?

Another nagging 'thought' is that many years ago around the time I became depressed I had to see a GP who wasn't my own, I can't remember what I went to see him about - but he looked at me and felt my neck and told me to go and see my own GP and have my thyroid tested - I did this - but at that time they came back fine too. Is it possible, that I have been treated for depression for this amount of time - when in fact it could have been thyroid related??

Incidently, my sister suffers from Hashimoto's Disease and 2 of my cousins also have thyroid related problems - my late mother had fibromyalgia (I don't know if this is relevent?)

I think the question I am trying to ask is should I pursue this with my GP, I feel very awkward and embarrased about questioning his diagnosis!

Anyway, any advise would be gratefully received & I apologise that this is soooo long  

[gimel]

Very glad that no cancer is involved.  Just wanted to emphasize that when you go back for blood test, make sure that you are tested for free T3 and free T4, not total T3 and total T4.  Also should test for TSH and antibodies for autoimmune disease.  And make sure the doc recognizes the current TSH reference range of .3--3.0.  

From what I've read it sounds like it is really difficult to get a doctor to treat a TSH under 5.0.  In fact it sounded like there was a rebellion going on, demanding that NHS doctors respond and treat patients with TSH test results above 3.0 and with hypo t symptoms.  So, good luck in your quest.  You may have to emphasize your symptoms and tell the doctor that you think that the most active component (free T3 ), along with  free T4, are much more important than TSH in determining a patient's thyroid condition and medication.  Please keep us tuned in.

[heatheruk]

Hi!

I am so sorry it has taken me so long to get back to you all!

Well, the great new is that I went to the Breast Clinic and had an examination and they don't think it has anything to do with cancer - she thought it was either inflammation between the breast and breastbone, or hormones!! I have to take anti-inflammatories and go back in about 6 weeks time.

I decided to go back, yet again, to my GP - hubby in tow. This time we saw a different GP - who to be honest actually seemed to listen to me...although he still seems to think that my 'symptoms' are not thyroid related

I spent a lot of time with him, instead of the usual 2 minute consultation and get out of my surgery routine - I spent a good 20 minutes with him.

He said that I was 'middle of the road' regarding my thyroid, but is sending me for various blood tests and a urine test to see if there is anything else - although he seems to think that there is a probablility that everything will come back ok and it's ... wait for it ... related to depression. Apparently there are various things that can mimic an underactive thyroid gland and he wants to rule them out - he was quite suprised that the tests he is requesting now haven't been requested before and I THINK he is going to re-test my thyroid - I will question this when I go for the blood test and see if there is any chance they will do a full test including T4,T3, etc

So, bascially I am back where I started!! lol

Just out of interest though..is it normal to be able to feel your thyroid gland?? I have a smallish oblong lump at the bottom of my neck - not massive!! It may not even be anything to do with my thyroid - but as you guys seems so 'informed' I thought I would ask!!

[heatheruk]

Hi,

Ok - where do I start??

Without reading my other posts - I don't know if i have mentioned that I have been experiencing pain and discharge in one of my breasts - which I thought could be linked to thyroid?

Anyway, I went to see GP - told her that about the problem with my breast and also I wanted to talk about my thyroid results.

Had a quick chat and she thought that my thyroid results maybe the least of my problems and after an examination, I have been referred to hospital (should be within 2 weeks) as she can not rule out breast cancer

But as I had built myself up to talk about my thyroid, I did!! And we had quite a good, lengthy chat. I discussed my non-specific symptoms and she confirmed that they were non-specific. She went through my results, and said they were all within range - apart from one taken last year. She said my T3 & T4 had been tested and were within range (sorry, I didn't get the results and as they were from 2007 I didn't think they were particulary relevant?) I went on to mention my sister having hashimotos, she concluded that there is no evidence to say that hashimotos is hereditary and also the fact she is my half sister would rule this out anyway.

But she suggested that I continue to be monitered every 6mths to a year.

Then she just went on to discuss hospital booking for my other problem.

Anyway - I now have the biggest headache ever - trying not to worry about things - but it's hard!!

Thank you all so much for your advice and for giving me the courage to go back and see a GP.

xxx

[gimel]

Even with an Endo, you will need to make sure of thyroid expertise.  They do not all specialize in thyroid problems. From what we've heard, that may be difficult  in your area.   If you can't get any good recommendations yourself, you might post again and  see if any members here can provide you a recommendation by PM.    

[FTB4]

I would consult with an Endocrinologist,  as stated by above, The endo's of today (At least the one s that sre up to date) are going by new standards, the old reading of 5.0 was considered average, although that was due to many more people afflicted with thyroid problems than they were aware of at the time those standards were set, now they have reduced that standard to an area of 3.0, Gp's are a lot less likely to go by new standards then an endo, even some labs that process your blood work are behind in what is high or low. I had problems with my GP when he was treating me for Underactive Thyroid and when I tried to explain the article I had read about the test results he became a little agitated and said he knew what he was doing, (I found out after seeing an endo that he did not know what he was doing) So if you can, see an Endocrinologist so you don't spend extra time being sick, it takes long enough to get to the right dosage, about 6 weeks between each blood work. Good Luck

[Super_sally888]

Hi,

don't worry about posting twice.  It happens.

Your GP is not up-to-date with thyroid testing results.

The current range is about 0.5 to 3.5.  A level of 5 would be considered hypothyroid and should be treated if there are symptoms that may be attributed to thyroid (and your symptoms could be).  A target TSH for women would be between 1 and 2, though some feel better closer to 1 than 2.0.

I definitely think that you should be getting a second opinion.  What harm would it be to provide low dose thyroid meds to get you within "normal range" and see if it helps your symptoms.  Maybe it could be suggested to your doc that way.....  

Definitely you need regular testing.  It seems that your levels are fluctuating and slowly getting worse.

Hope this helps.

Cheers

[gimel]

Patients should never be reluctant to question their doctors.  If the doctor doesn't want to listen to you and doesn't like being questioned about something as important to you as your health then you have the wrong doctor.  
My opinion is that patients need to take even more responsibility for their own health and learn as much as possible about their health issues.  This will lead to more interaction with doctors and better overall results.
From your TSH results, your doctor clearly doesn't recognize that the AACE has revised the range for TSH from .5-5.0 down to .3-3.0.  You should discuss this with him, along with your many symptoms and suggest that you need medication for hypothyroidism.  Also, the next time you are to be tested for thyroid, insist that free T3 and free T4 are checked.  These are important tests that will confirm hypo t and should be monitored as you start medication, to get you into the right range.
From your experience to date I'm not optimistic that you are going to get the response you need from your current doctor, but I would start there, but also start asking around for a good thyroid doctor.

[heatheruk]

Sorry, I am new to this and have somehow managed to post my question twice!

Please can this be removed?

Sorry again!