I would be truly grateful for your thoughts on this. My daughter is 24 year olds and works as a nurse in an exceptionally busy vet’s practice - lunches are snatched and some days the hours are hugely long. She is exhausted and some days she is really struggling with fatigue. So she made a gp appointment. She is very slim, has a good appetite but struggles to put on weight - people comment on her weight - she’s just over 6 stone and around 5’4”. She’s seen a dietician who basically told her to eat as many snacks between meals and basically suggested that she had a hidden eating disorder!
She has a phobia about blood being taken from her (no qualms with animals in a busy theatre!), but plucked up courage when gp suggested he gets her bloods done. The results are attached: the gp who ran the bloods suggested she get them rerun (and some liver tests) in a month’s time. When she rang the surgery tonight to prebook, another gp said there was no point and immediately prescribed 50mcg Levothyroxine
Thoughts please. Thank you all so much.
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Lost_Girl
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Her elevated TSH suggests her thyroid is failing, especially with her symptoms. Prescribing 50 mcg levothyroxine is an excellent (and nowadays unusual) idea. If her problem is hypothyroidism she should start to feel better after about a week.
Ideally they would measure fT3 also but its more important to try levothyroxine and she doesn't like blood tests.
If she responds to the levothyroxine she will need dose increases in time and follow up blood tests. It's important to let the GP know how she is doing so they dose by symptoms rather than blood tests.
Usually people gain weight in hypothyroidism but a minority lose weight for unknown reasons.
The GP who prescribed is enlightened, hold onto them.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
TSH is high...need thyroid antibodies tested too
Low vitamin levels are extremely common, especially if have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
What’s her diet like?
Vegetarian or vegan?
Ferritin is low
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Ask GP to test vitamin D levels ...or buy an NHS test kit
Guidelines recommend 2 abnormal tests before starting on levothyroxine ....in case this is temporary blip
Perhaps consider getting thyroid antibodies tested first ....
Bloods should be retested 6-8 weeks after starting on levothyroxine
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
If she's rushing around all the time that'll effect digestion and she'll have malabsorption issues due to Hashi's anyway. I'd ask to get her tested for Coeliac disease and have liver function tests to see if she's producing enzymes properly. (A friend has Crohn's and used be very thin.) Gut issues can also occur with Ehler's Danlos - people with it are typically thin and are very 'bendy' with fragile skin and can get perforated guts. I suspect something else is going on as well as Hashi's, but at least you've got started.
Fatty liver disease can occur in thin people who accumulate fat on their livers as they cannot process it properly or put on weight. Liver issues are very common in Hashi's.
Here is a link explaining how underweight patients with IBDs including Crohns are more susceptible to fatty liver as well.
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