Thyroid UK
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Advice on "sub-clinical" hypothyroidism

Hi am a nurse in Glasgow and have had a nightmare getting a diagnosis. I went into a neurological crisis and it has been hell - someone on here advised I may have B12 deficiency and it has taken weeks of battling with Drs to get treatment.

However, an excellent retired GP, who has given me lots of advice & is on the ball, said my lack of B12 has likely had a knock on effect on my thyroid and I should treat, just start with 25mcg thyroxine. There is no way I will get treated on the NHS until my TSH reaches 10, which is crazy. Thyroid UK say optimal TSH should be between 1 and 2. My results are

FT4 15.09 (12-22)

FT3 4.00 (3.1-6.8)

TSH 3.34 (0.27-4.20)

T4 total 85.7 (64.5-142.0)

I would appreciate some advice and the best/cheapest place to source. Thanks

Recommended sources via private messages please, as per posting guideline #23, thank you.

15 Replies

Babygodmother, you will probably get treatment when TSH is over 4.20 but it could take some time for that to happen.


Thanks I don't want to wait. I know of patients who are way over that and still not getting treated and they are worse than me. I have now discovered I have severe B12 deficiency (originally thought was my thyroid) but I guess it seems a lot of ppl have both. This was a private test as I new something was going on and no one prepared to treat me. Thanks


Babygodmother, you may want to get your GP to check ferritin and vitD too, they're commonly low/deficient in hypothyroid patients and being so far north makes vitD deficency likely.


Hi, would you be kind enough to let me know (out of interest) what your B12 level is?.

My husband, type 2 diabetic on Metformin has B12 level 186. Diabetic nurse says borderline but when I asked doc. with husband present he said no need to treat. We live in Wales but from Glasgow. Husband also has memory probs. and I understand low B12 can cause this, just wanting your opinion if you would be so kind. Thanks


My B12 went from 419 to 264 in two weeks, it had to beg for treatment! I was in a very bad way, the doctors are useless.

Anything less than 200 is classed as a proper deficiency. He must be treated now, he has another autoimmune condition and is at high risk, also metformin reduces absorbency of B12.

He has to be treated and treated now. Your doctor must refer to the new guidelines. If you look on Pernicious Anaemia Society website there is a summary of them. Or ring them for advice. Also, look at - another charity, who have supported me.

Google "Guidelines for the diagnosis and treatment of cobalamin and folate deficiency" (BCSH) it will take you to the website. Look under "General Guidelines" I think the cobalamin (B12) guideline is about 4th or 5th one down.


Thanks already have, Vitamin D is fine (have been supplementing for years anyway). My ferritin is low and on iron replacement, prob caused by my B12 deficiency and not absorbing. Cheers


Yeah, don't panic. It's easy to do at the beginning. B12 will boost your energy. Then your thyroid ought to kick in because aside from the highish TSH, the rest of the results are pretty well okay.


Thank yo for that


I would disagree with gabkad, your free T3 may be within range but it's at the bottom, and towards the top would be much more optimal, and likewise FT4. So your figures could all be better. And I fully understand feeling desperate, but you do realise that you are condemning yourself to a lifetime of self medication?

I don't suppose your retired friend could write you a private prescription?

I am sure there are sources of levo, and you will get a PM but most of us self-medicators are on either natural dessicated thyroid or on T3. That is because a substantial minority have trouble metabolising the synthetic T4. And that minority ends up on boards like this, of course.


Ruthi, the body slows things down when vitamins and minerals are low. Chances are, if this lady is low in iron and B12, she's probably low in zinc, copper, magnesium, selenium, iodine, and other vitamins, like A. Nurses have notoriously poor diets because they work shift and are challenged in re: circadian rhythms. Ever seen a thin, middle aged nurse? Take a picture and send it to me.

Generally, nurses get overweight the longer they work in hospitals. Literally, their health and lives are sacrificed caring for patients. On nightshift, cafeterias are not open and nurses snack on junkfood most of the time. And being awake all night makes for distorted appetite and need for immediate fuel to feel better. Of course over time this results in nutritional deficiencies. It doesn't matter what a person does, metabolism is slowest about 4 a.m. The body doesn't adjust to shift work regardless how long a person is doing it.

Babygodmother needs to start supplements, boost her energy and start eating a good diet. The staff cafeterias in hospitals are no longer what they were. It's very, very difficult to manage self care when all the energy is used up by doing a job. Baby steps. One day at a time and small changes add up.


FYI I am a thin middle aged nurse.... I will not take offence :-) I work in general practice part time. No night shift, not for a long time. I have never been overweight, I don't drink or smoke & I cycle and dance.

My health is a nightmare and I am just back from hospital as I felt absolutely awful. I am suspecting something going on with the adrenals as well. My neuro symptoms have improved but I think there is something else going on. Thanks


You have 'lucked out' in certain respects. Not having to do night shifts is a bonus.

Why do you think your iron is so low? Heavy periods? Bleeding from the GI tract? Diet deficient in iron sources?

I just watched a video last night (Netherlands) of a guy who decided to see what improvement he'd get healthwise by changing the diet for a month. He lost weight, his blood pressure went lower but he started with Hb 10.5 and a month later it was 10.0..... ??? That's low and lower. I don't know how he has the energy to exercise at all.


I agree with that Gabkad, but its not what you said in your first reply. What I read it as was 'now you are on B12 your thyroid will be fine', which is unlikely to be true. In general people (and my dog) who are low on B12 feel an immediate improvement on B12, and that has presumably not been the case.

So, Babygodmother, here is my longer and more considered reply!

Your thyroid levels are indeed low, and supplementing to get the T4, and even more importantly free T3 into the top of the range should make a significant difference to how you feel.

But its not a long term fix. Nurses gain weight because they flog themselves, they do a hugely stressful job, and they work shifts. All of that hammers the adrenal system which is the other master endocrine system that rules the way the body runs. Adrenal and thyroid problems often go hand in hand. And while its easy to supplement thyroid hormones, either naturally or synthetically the adrenal system is much more delicate and long before the adrenal glands fail, they can go horribly out of sync. There is a simple quiz that you can take to give an indication of how your adrenal system is doing at

You probably won't get fully well until you move to a less stressful job. There! I've said it. I wish I didn't have to, because of course, we all need nurses at some point in our lives.

In the mean time you should be eating as well as you can, no junk, no sugar, no caffeine, no alcohol (I am assuming you don't smoke) - all things that make it possible to cope in the short term and destroy you in the long term. Go gluten free. Gluten looks like thyroid to the immune system. If, as is likely given your history, there is autoimmune stuff going on, you don't want gluten messing things up even if it has no obvious ill effects at the moment. Eat lots of vegetables, leafy, colourful, ones. Cut back on the starch and natural sugars. Eat good quality protein and good quality fats (animal fats, olive oil, butter). ALL the hormones are made from fat, usually with cholesterol as a precursor, so you don't want to be low fat.

I bang on about the book 'The Adrenal Reset Diet', its a diet worth following whether or not your adrenals are yet shot. Dr Christianson, who wrote the book also has a lot to say about thyroid, so far mostly on his blog.

As far as supplements go, the most critical is probably magnesium. Take it with vitamin B6 and food source Vitamin C. I'm not a lover of synthetic vitamin D. There is some evidence that it looks good on the blood tests, but does nothing good for the human body. Take Cod Liver Oil instead. Likewise Ascorbic acid, the synthetic form of vitamin C has been shown to interfere with copper regulation. You need copper, and iron in your diet - eat liver at least once a week.

Well! that wasn't as long as I feared, but its packed with stuff that isn't good news of an easy fix, I'm afraid.

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Maybe she's a vegetarian or a vegan who won't eat liver and won't take cod liver oil. We don't know anything about this person other than she has a slightly struggling thyroid at this time, middle aged, does not work night shifts and is not overweight. Probably anemic.

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I think you should get tested to find out if the thyroid problem and b12 are due to an autoimmune cause - like hashimoto's for thyroid and pernicious aneamia for the b12.

For the latter you need to get tested intrinsic factor.

B12 deficiency causes all sorts of symptoms - and it takes time to rectify. It's not just a quick fix if the deficiency has been going on for a long time. So be patient. If your b12 is due to an autoimmune condition then you will need injections of b12 for the rest of your life. So worth finding out.

I was found to be b12 deficient and also my thyroid numbers were a bit out of whack and the advice from the endocrinologist was to first get the b12 in order to see if that would make the thyroid settle spontaneously. He also said give it time.

I was diagnosed with both pernicious anaemia and hashimoto's. I haven't gone hypo yet from the hashimoto's, I'm actually slightly hyper.

I'd advice you go to the Pernicious Anaemia Society (PAS) forum on healthunlocked and ask questions. You'd get lots of advice and info on what the symptoms and damages are of B12 deficiency.

Good luck!


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