Draft Letter To Send To Your Doctor
If you are not being given a diagnosis because your thyroid function test results are returned within the normal reference range, and your doctor tells you these results show that you do not have a problem with your thyroid, or, if you have already been given a diagnosis and prescribed L-thyroxine-only therapy, but you are still suffering symptoms and your doctor refuses either to increase your dose or give you a trial of the active thyroid hormone T3 – then consider writing a letter to her/him. Adapt the letter according to your specific needs. You may wish to send a copy of your letter to the Head of Practice too, but remember to keep a copy for yourself in case this needs to be referred to at any time. Ask that your doctor place your letter into your Medical Notes.
As I have been suffering with symptoms of hypothyroidism for a long time without anybody apparently knowing the reason why, I am now more determined than ever to do whatever is necessary to find the true cause, and hope that you will work with me.
The present symptoms I am suffering are: (here, list all your symptoms and list your signs too. You can check these against those under Hypothyroidism’ HERE. The present SIGNS I am showing alongside the symptoms are: (You can check the full list of possible signs HERE.)
My basal temperatures before getting out of bed on a morning and before having anything to eat or drink for the last four mornings have been (here, list these if they were 97.8 degrees F (36.6 degrees C) or less.
(If this applies) There are members of my family who have a thyroid and/or autoimmune disease and I am aware this can run down the family line (here, list those members of your family and their relationship to you).
Please would you arrange for me to have the tests to check my levels of TPO and Tg antibodies as well as free T4 and free T3.
I have learned that there are specific minerals and vitamins that should be checked to see whether any are low in the reference range as low levels can stop thyroid hormone from being fully utilised at the cellular level. Would you please arrange for my levels of iron, transferrin saturation%, ferritin, vitamin B12, vitamin D3, magnesium, folate, copper and zinc levels to be tested? I would appreciate a copy of the results together with the reference range for each test done please.
(If your doctor doesnt know about these, or s/he tries to tell you there is no association between these nutrients and low thyroid, copy out the references to research/studies in the Minerals/Vitamin list below, and enclose these with your letter. You don’t have to give any reason to a doctor why you want these results. Remember, that doctors cannot withhold any information that is in your medical notes under The Date Protection Act 1998).
I would like a referral to a specialist in thyroid disease for a thorough clinical examination and an assessment of my clinical history, as well as the results of serum thyroid function tests.
Please will you place my letter of requests in my Medical Records?
I await hearing from you in due course.
Hopefully, this will start the ball rolling. Once doctors become aware that you are very determined to do whatever is needed to find the cause of your symptoms, and once they have been requested in writing for the above information/tests/requests for a referral etc, they usually take much more notice.
Do remember to keep a copy of the letter yourself.
LOW LEVELS OF SPECIFIC MINERALS AND VITAMINS CAN STOP THYROID HORMONE FROM BEING FULLY UTILISED AT THE CELLULAR LEVEL.
Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (1-4). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present (1-4)).
- Dillman E, Gale C, Green W, et al. Hypothermia in iron deficiency due to altered triiodithyroidine metabolism. Regulatory, Integrative and Comparative Physiology 1980;239(5):377-R381.
- Smith SM, Johnson PE, Lukaski HC. In vitro hepatic thyroid hormone deiodination in iron-deficient rats: effect of dietary fat. Life Sci 1993;53(8):603-9.
- Zimmermann MB, Khrle J. The Impact of Iron and Selenium Deficiencies on Iodine and Thyroid Metabolism: Biochemistry and Relevance to Public Health. Thyroid 2002;12(10): 867-78.
- Beard J, tobin B, Green W. Evidence for Thyroid Hormone Deficiency in Iron-Deficient Anemic Rats. J. Nutr. 1989;119:772-778.
Vitamin B12: (5) Jabbar A, Yawar A, Waseem S, Islam N, Ul Haque N, Zuberi L, Khan A, Akhter J.Vitamin B12 deficiency common in primary hypothyroidism. Department of Medicine, Aga Khan University, Karachi, Pakistan. 2008 May;58(5):258-61. Clinical Chemistry September 2001 vol. 47 no. 9 1738-1741
Jabbar A, Yawar A, Waseem S, Islam N, Ul Haque N, Zuberi L, Khan A, Akhter J. Vitamin B12 deficiency common in primary hypothyroidism. Department of Medicine, Aga Khan University, Karachi, Pakistan. 2008 May;58(5):258-61.
IMPORTANT NOTE: To get an accurate result for b12 LEVEL, people should be off supplements for a month. If that is not possible (because of pernicious anaemia for example) I believe it may be possible to get levels checked despite supplementing, but the laboratory needs to know what supplements have been taken.It makes sense to check before paying for a test, otherwise you may be wasting your money. You should also be aware that there are two different tests that can be done. The standard NHS one does NOT give accurate results – it measures all B12 in the blood, even that which is bound to other substances and unavailable for the body to use. What is accurate is the Active B12 test. As far as I know it can only be got privately. For info about it : http://gsts.com/ — http://www.active-b!2.com – – http://www.tdlpathology.com/test-inf…sts/active-b12 – –http://bluehorizonmedicals.co.uk/sho…Active%29.html
Julia Brsony, P. Lakatos, J. Fldes and T. Fehr. Effect of vitamin D3 loading and thyroid hormone replacement therapy on the decreased serum 25-hydroxyvitamin D level in patients with hypothyroidism: Acta Endocrinol November 1, 1986 113 329-334
B. CATARGI, F. PARROT-ROULAUD, C. COCHET, D. DUCASSOU, P. ROGER, and A. TABARIN. Thyroid. December 1999, 9(12): 1163-1166. doi:10.1089/thy.1999.9.1163. Published in Volume: 9 Issue 12: January 30, 2009
Bjrn G. Nedreb, Ottar Nygrd, Per M. Ueland, and Ernst A. Lien; Plasma Total Homocysteine in Hyper- and Hypothyroid Patients before and during 12 Months of Treatment. Clinical Chemistry September 2001 vol. 47 no. 9 1738-1741
JOHN E. JONES, PAUL C. DESPER, STANLEY R. SHANE, AND EDMUND B. FLINK .Magnesium Metabolism in Hyperthyroidism and Hypothyroidism: Journal of Clinical Investigation. Vol. 45, No. 6, 1966
Lawrence Wilson, MD .COPPER TOXICITY SYNDROME Revised, July 2011, The Center For Development. http://www.drlwilson.com/articles/copper_toxicity_syndrome.htm” COPPER TOXICITY SYNDROME
Vivek R Joshi, Ayaz K Mallick, Manjunatha Goud B K, Ravindra Maradi, Maheshwar G Reddy, Raghavendra Tey, Gaurav Shorey. Effect of serum copper concentration and ceruloplasmin on lipid parameters leading to increased propensity to cardiovascular risk. Department of Biochemistry, Melaka Manipal Medical College, Manipal University. ISSN: 0975-8585.
Iham Amir Al-Juboori , Rafi Al-Rawi, Hussein Kadhem A-Hakeim. Estimation of Serum Copper, Manganese, Selenium
Zinc in Hypothyroidism Patients. IUFS Journal of Biology Short Communication 121 IUFS J Biol 2009, 68(2): 121-126