My husband's been having symptoms for a while now - cold hands, dry eyes, fatigue, insomnia etc. and I persuaded him to have the WellMan profile done, which showed his TSH to be high. So then he did the Thyroid 11 which showed low B12 and Vit D as well. Doubt the GP will want to give him Levothyroxine, but he's thinking of supplementing the B12 and Vit D - I'd be really grateful for any other thoughts you may have. Many thanks!
19 June - TSH 5.37 (0.27-4.20)
9 July - TSH 3.53 (0.27-4.20)
T4 total - 67.4 (66-181)
Free T4 11.90 (12.0-22.0)
Free T3 4.07 (3.1-6.8)
Anti-TPO 9.6 (<34)
Anti- TG <10 (11.5)
Vit D - 51 (Deficient <25, Insufficient 25-50, reduce dose >175)
From the Thyroid Plus 11 test, his Total T4 is extremely low and his FT4 is below range. I would be looking into Central Hypothyroidism which is where the problem lies with the pituitary (Secondary Hypothyroidism) or the Hypothalamus (Tertiary Hypothyroidism) rather than the thyroid gland.
Central Hypothyroidism is suggested by low or normal or minimally elevated TSH with a low FT4. Your husband's TSH was comes into the normal range with a below range FT4 and this should prompt investigations into Central Hypothyroidism by a thyroid specialist. Make sure that he isn't referred to just any old endocrinologist because most of them are diabetes specialists, you need a proper thyroid specialist and insist that your GP finds you one.
Article for your GP to read as he will have access to the BMJ
This is very low. Does your husband have any signs of B12 deficiency - check here b12deficiency.info/signs-an... I think it is low enough for your GP to do further tests for B12 deficiency/pernicious anaemia. Don't supplement until further tests have been carried out as it will skew results. B12 injections may be necessary, plenty of people with a serum B12 result in the 300s have been started on injections when symptoms are present.
Vit D - 51 (Deficient <25, Insufficient 25-50, reduce dose >175)
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L. Your husband wont get prescribed D3 for this level so he should buy some D3 softgels and I would suggest taking 5000iu daily for 3 months then retest. Once he's reached the recommended level then you'll need a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/
There are important cofactors needed when taking D3 as recommended by the Vit D Council -
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
Thank you so much, I really appreciate your taking the time to give such a full and helpful reply. We'll read through all the links and push for a referral to an endocrinologist - mind you, getting anything out of our GP practice, even an appointment, is like getting blood out of a stone!
Make absolutely sure you know the name of whoever your hubby is being referred to, and look him/her up. The hospital's website should list their consultants and their specialities. You really must have a thyroid specialist.
You could send for the list of thyroid friendly endos from Dionne at ThyroidUK
tukadmin@thyroiduk.org
and ask on the forum for feedback on any that you can get to.
Also, you could put up a new post asking if anyone has Central Hypothyroidism, who diagnosed it, what tests were done, etc. It's nowhere near as common as Primary Hypothyroidism and finding a specialist who knows about it might be quite difficult. If you do have a recommendation, even if it's outside your area, I would push for a referral rather than risk seeing someone who doesn't know enough about it.
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