Thyroid tests

[237SJ]

I`ve just been to the doc to check up on my thyroid as they`re keeping an eye on it. I`ve got fed up just having the TSH test done and told him I wanted the T3 and T4 done as well. He said "they" don`t do it anymore. "They" only test the TSH and that gives a good enough picture. I presume he means the lab (Kingston or West Middlesex in my case). I`m not inclined to believe him. I`m often reading on the internet about people who can quote their T3 etc. Could it be the GP practice who have decided that only the TSH need to be done?

[Sqad]

237SJ.....the great medical debate..........T3 hypothyroidism.

You will have no shortage of contributors to this thread......I guarantee.

My opinion? I agree with your GP.TSH is a good indicator, although in Spain they do measure T3 T4 TSH.

[237SJ]

Thanks sqad. Trouble is, it keeps coming out borderline (I can`t remember the last one, something like 4.8 I think) so nothing gets done. At least I`ve managed to get a test tomorrow (I`m on the dreaded stand by for work after that so it could be weeks before I can get there). I`ll let you know the result (if I don`t end up in Australia or somewhere God forbid).

[LazyGun]

I think all the indications are that in uncomplicated hypothyroidism,monitoring of TSH is all that is routinely required.

Are there some issues of your disorder or treatment that you have concerns with?

[Sqad]

It varies from lab to lab, but I would consider 4.8 to be normal.

[237SJ]

Thanks Lazygun. There is no treatment. That`s the issue. I have symptoms (thinning hair, cold, tired and now peeling nails) but nothing`s done. I will accept the TSH result now though as you and Sqad have persuaded me that the doc is correct in what he says.

[LazyGun]

?Ahh SJ - had not fully appreciated that. Have they ever offered you a fT3 or an fT4 test ? I would have thought, from a differential diagnosis point of view, that it would be worth establishing your fT4 and especially fT3 levels....

[237SJ]

LazyGun. No they haven`t which is why I asked him today for one. His answer was as above. I did see a locum doctor there and after she tested my TSH she told me to come back and she would test the T3 and T4 but when I went back she must have forgotten she said that because she just tested the TSH again and I was no further forward. It`s a very busy practice (and a training practice) and I`m getting a bit fed up with it TBH. I might go back and see a different doctor (or change - there`s another practice up the road which gets really good reviews). I did walk into a private hospital in Delhi (when I was working) and got a complete profile done but that was a few years ago and I wanted to know what the situation is now. The first ever TSH test I had was 7.8 so I`m wondering if thyroid function can fluctuate.

[LazyGun]

The TSH value can change from lab to lab, SJ - nature of the types of tests used - although this variance has decreased markedly in recent years.

I would have thought, given your symptoms, and a TSH on the upper threshold of the UK reference range (0.4-4.5/5.0) that it would be worth benchmarking your T3 and T4 levels.

Actually, there is still some heated discussions over what the reference range should be. There are a large number of people who think that the reference range should actually be 0.3- 3.0.

[237SJ]

Thanks LazyGun. I think benchmarking T3 and T4 is a good idea too but the doc just doesn`t want to do it so I don`t know what to do. I believe 0.3 - 3 is the guidance they use in the US? I thought the UK was going to use the same range. I think I`ll just have to see a different doctor.

[LazyGun]

If you have lost faith in your GP you are perfectly within your rights to try another, either from the same surgery, or from a different one if you have one local enough for you.

Were I in your position, I would certainly be seeking a benchmark test for T3 and T4, either by asking your current GP to authorise the test or explain very clearly why not, or by finding another GP..

[Sqad]

237SJ....do be careful here.....I agree with all that LazyGun has said, but please address the following before losing confidence and changing your doctor.

IF the T3 is low...IF...what can be done about it and more crucially.....is it responsible for your symptoms.

If there is no treatment for a low T3, then there is no point in assaying it.....is there?

Certainly I have seen no medical evidence that giving thyroxine to a patient with a low T3 and normal TSH does any good whatsoever to ameliorate his or her symptoms.

Don't misunderstand me, i am not decrying LazyGuns post which is excellent, but i do not want you to be exposed to unrealistic hopes of a cure for your symptoms but even more to changing your GP for no good scientific reason.