Subclinical hypothyroidism in stage 3b

[Vprp]

My 76 year old husband has ckd for the last 5 years based as a long term diabetes. He is now in stage 3b and has been stable with GFR around 38 for the past year. No proteinuria, edema, cardiovascular issues. His blood pressure and HgA1c has been normal stable throughout this period. He has been monitored by his PCP and nephrologist regularly.

His last labs indicated sub clinical hypothyroidism ( high TSH and normal T4 and T3). I note that sub clinical hypothyroidism which he just developed, is detrimental and a risk factor for CVD or arteriosclerosis.

Question… 1. should he continue with the thyroid supplement. 2. I worry about this sudden turn of his thyroid function which may result in CVD or heart attack.

Any advice or shared experience is appreciated.

[Bassetmommer NKF Ambassador]

HI Vprp.The connection to hypothyroidism is common in CKD. This is something that should be discussed with his doctor, however. Do not change any medications without talking with the doctor. There is a lot of information out there but please start with your doctor to find about specifically for your husband what treatment is available. My PTH bounces up and down between labs and has for several years. Once it was pretty high but the next lab it was back where it was before, which was elevated but not critical.

[nellie237]

Hello Vprp,

I am hypothyroid (since 2007), had a heart attack (2012), Acute Kidney Injury (2021)

"Question… 1. should he continue with the thyroid supplement"

That is a very complex question, and I agree with @Bassetmommer that you need to discuss it with his doctor. Although having said that, it is widely known that doctors are often reluctant to treat sub-clinical Hypo's, especially as we get older. I personally disagree with this, if symptomatic, but I'm a patient not a medic.

Bear in mind Thyroid replacement hormones replace thyroid function, as opposed to 'propping up' a failing thyroid. Basically, any exogenous thyroid meds will down-regulate the bodies natural production.

Doses need to be titrated slowly for those over 60yrs.

What 'supplement' is he taking?

Have thyroid antibodies been tested?

Full Thyroid Panel (ie TSH, FT4, FT3) initially 6-8 weeks after every dose change is non-negotiable

[Vprp in reply to nellie237]

Thanks for sharing. He is on levothyroxine. Thyroid antibodies test has not been performed. He sees his PCP next week and shall ensure appropriate tests are performed. Thanks for your suggestion. His TSH went down from 25 to 10 after 4 weeks on levothyroxine. My worry stems from his coexisting CKD stage 3b.

[nellie237 in reply to Vprp]

Don't stop the Levothyroxine. He'll likely get an increase in dose.

There are quite a few people on the thyroid forum who at one point or another stopped taking their Levo completely because they felt the Levo was making them feel worse. Some took many, many months to recover.

When I was first put on Levo, I occasionally forgot to take them by mistake, and one day it dawned on me that I was full of energy, with a spring in my step that I hadn't felt for a long time, and then realised that I hadn't taken my Levo that day. Hearing the stories of the people that did stop their Levo made me very glad that I'd continued to take it. I did very occasionally miss the odd day if I had an important meeting though. Its definitely 'a thing', although the Doctors won't agree.

Thyroid antibodies fluctuate, and don't need repeat testing. Antibodies don't alter treatment, but quite a few of us have other autoimmune conditions. Guidelines in the UK state that those diagnosed with autoimmune thyroid conditions should be tested for Celiac.

"My worry stems from his coexisting CKD stage 3b" It is a worry. 🤗Being Hypo slows everything in the body down, incl eGFR.

[Marvin8]

Hardly any PCP's will treat subclinical hypothyroidism. That's why you REALLY need to push your primary to give a referral to an endocrinologist. Same goes pretty much for your nephrologist. The best situation is to get a nephrologist to work with an endocrinologist, but that rarely happens. And to answer your first question, you should absolutely stay on your meds until your doctor takes you off of them.

[Darlenia]

Hi Vprp. It seems to me that your hubby is receiving excellent medical care. While a wait-and-see approach is often advocated for subclinical hypothyroidism in hopes it might normalize, levothyroxine treatment can benefit those in the CVD risk category. Your hubby's diabetes puts him in that high risk category for heart issues. So, your hubby's doctors seem to be on top of matters. I, personally, would follow their advice. My husband, also a diabetic, went through serious health issues in his early 70s - all instigated by that disease - which led to complete kidney failure heart stenting, and more. Your husband has done amazingly well at his age.

[Vprp in reply to Darlenia]

Thanks, it really helps to get feedback. Nothing like getting feedback directly from patients undergoing similar condition. Hubby is staying on levo thyroxine and has no symptoms of hypothyroidism. Good sign is that is TSH went down from 20 to 10 in a month after starting levo thyroxine.

[Darlenia in reply to Vprp]

Well done! Stay the course!