Help with husband’s results

[Girlslovescifi]

I’ve thought my husband might be hypo for a while but the doctor has only just tested him and only tsh. The result was 4.69 (0.2-4.3). The only blood test time he could get was 6.45pm and of course he’d eaten beforehand. His b12 result was 344 (110-900). He lost his outer eyebrows years ago and he’s very chilly, itchy skin occasionally, tired and has disturbed sleep. They are going to retest in 6 months. Would the timing and food have given an inaccurate result? Thank you.

[PurpleNails Administrator]

the TSH is over range.

Waiting another six months is a long time if symptomatic & it’s not known how low levels are.

If TSH over range 2x - 3 months apart treatment can be started.

Might move things along if you arrange private test including antibodies & FT4, FT3.

[Girlslovescifi in reply to PurpleNails]

Thanks. My husband is stubborn. I’ll try and convince him. My endo told me years ago that most people feel optimum if tsh is around 2 or even bit lower.

[Jaydee1507 Administrator in reply to Girlslovescifi]

If he's been hypo that long then he needs to get his vitamin levels checked ASAP and he can start working on those and feel a little better before he starts levo. You can ask GP to do this and might get lucky with a helpful GP.

Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

There is also a new company offering walk in & mail order blood tests in Crawley, Hove and Reigate areas. onedaytests.com/products/ul...

[Girlslovescifi in reply to Jaydee1507]

Thank you. He had his b12 done at the same time and that was 344 (110-900). I would say that’s on the low side.

[Jaydee1507 Administrator in reply to Girlslovescifi]

Definitely low. How has he been carrying on life for years? Men are terrible at asking for help.

B12 - does he have symptoms of B12 deficiency? The reference range for B12 is very wide and cut off point too low. theb12society.com/signs-and...

If he does then you should discuss this with your doctor for further tests for Pernicious Anaemia.

If not, then start with a B12 sublingual spray or lozenge for a week, then add a good B complex.

gb.pipingrock.com/methylcob...

This B complex has all the right vitamins at a not unreasonable cost for 90 days supply(also contains folate). Once B12 is good you can stop the stand alone B12 and just continue with the B complex.

amazon.co.uk/Liposomal-Soft...

The B complex will hopefully cover him for folate too but need to recheck bloods after a few months.

Vit D likely to be low.

Ferritin likely to be low.

[Girlslovescifi in reply to Jaydee1507]

I try to get him to take an over 65 multi daily that has decent b12 and D but he often takes his Metformin & bp medication late, which means he has to wait 4 hours to take his supplements and then it’s time to take the next Metformin. 🙄 I’ll look into your suggestions. He never used to feel the cold - teeshirts and shorts even in winter!

[Jaydee1507 Administrator in reply to Girlslovescifi]

Metformin can lower B12 levels. Best he starts addressing that.

gov.uk/drug-safety-update/m...

[Girlslovescifi in reply to Jaydee1507]

I discovered this months ago and told him.

[helvella Administrator Thyroid UK]

As I've said several times, I had a series of TSH tests - each one higher than the one before - over quite a number of months. Started just over 2 and ended up over top of local reference interval. Plotted them on an extremely basic Excel chart.

That is what convinced my GP - eventually. The straight line going up!

[tattybogle]

6 months is too long to wait for a re - test when symptoms that could be caused by hypothyroidism are already causing problems ,

to confirm a diagnosis of sub-clinical hypothyroidism the NHS guidelines suggest 3 months :

("sub-clinical hypothyroidism" means "TSH over ref range, while fT4 is still within range" )

Strictly speaking the fT4 should have been tested automatically when the lab saw this TSH was over range.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"Tests when thyroid dysfunction is suspected

1.2.8Consider measuring thyroid-stimulating hormone (TSH) alone for adults when secondary thyroid dysfunction (pituitary disease) is not suspected. Then:

if the TSH is above the reference range, measure free thyroxine (FT4) in the same sample"

1.2.10Consider repeating the tests for thyroid dysfunction in recommendations 1.2.8 or 1.2.9 if symptoms worsen or new symptoms develop (but no sooner than 6 weeks from the most recent test).

nice.org.uk/guidance/ng145/...

1.5 Managing and monitoring subclinical hypothyroidism

Tests for people with confirmed subclinical hypothyroidism

Adults

1.5.1Consider measuring TPOAbs for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.

Treating subclinical hypothyroidism

1.5.2When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.

Adults

1.5.3Consider levothyroxine for adults with subclinical hypothyroidism who have a TSH of 10 mlU/litre or higher on 2 separate occasions 3 months apart. Follow the recommendations in section 1.4 on follow-up and monitoring of hypothyroidism.

1.5.4Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:

a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and

symptoms of hypothyroidism.

If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment."

So as they now have one over range TSH result .... they should be rechecking in 3 months (to make sure it's not just a transient raise in TSH from some other cause) , and if TSH is still over range then they should also be testing fT4 level to see if fT4 is below range, and TPOab (to see if there is an autoimmune cause for the thyroid problem)

If TSH is still over range in 3 months , and there are symptoms of hypothyroidism , then they could consider starting levo at that point.

If TPOab are positive it helps the decision to start levo , but starting levo is not dependent on having a positive TPOab test ~ they only need 2 over range TSH 's + symptoms .

As you already know , his TSH may well have been a bit higher if tested early am /fasting.. but hard to know how much higher as it does start to rise again after about 3 /4pm anyway.

[Girlslovescifi]

Thank you. That’s very informative. Apparently the doctor said they’d retest in 3-6 months.

[tattybogle in reply to Girlslovescifi]

Shove him towards 3 , not 6

[tattybogle in reply to tattybogle]

And make sure he has an AM/ fasting test.

[tattybogle in reply to tattybogle]

if he's the 'non-persuadable/ don't make a fuss' variety of husband , get him to read this post : healthunlocked.com/thyroidu....

and look at the link to the graph for 'TSH levels in healthy people' ... that will show him how bad his TSH over 4 actually is.

in the replies there are links to studies explaining why it's best practice to test TSH in AM/ fasting .

[Girlslovescifi in reply to tattybogle]

Thanks

[SlowDragon Administrator]

And make sure he gets vitamin D, folate, ferritin and B12 plus thyroid antibodies tested

Or test privately yourselves NOW

Then at least he could be improving low vitamin levels between now and retesting at GP in 3 months

ALWAYS book early morning test, ideally no later than 9am….and just water before test

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

what vitamin supplements is he currently taking

[Girlslovescifi in reply to SlowDragon]

Thank you. I’ll try to convince him to have private tests for all. 🙈

[Girlslovescifi in reply to SlowDragon]

He occasionally takes a Viridian over 65 multi with 100ug b12, 15ug d3, 200ug folic acid, 7mg iron and lots of other bs and other vitamins. Because he’s bad at taking his Metformin & bp medication on time, it means it’s hard to find a 4-hour window, which is why he doesn’t take it more regularly. I do my best but…

[SlowDragon Administrator in reply to Girlslovescifi]

Metaformin lowers B12

gov.uk/drug-safety-update/m...

Metformin also lowers TSH

cureus.com/articles/50564-e...

Multivitamins never recommended on here

Come back with new post once he gets results

[Girlslovescifi in reply to SlowDragon]

I know about Metformin and b12, which is why I’m trying to get him to take it, but I didn’t know about it lowering tsh. I understand about Multis but it’s hard enough to get him to take 1 extra tablet. I’ll try and get him to take the same as me. Thank you yet again. 🙂

[Girlslovescifi in reply to SlowDragon]

his b12 was 344 (110-900)

[SlowDragon Administrator in reply to Girlslovescifi]

So far too low

He likely needs separate B12 and add a separate vitamin B complex a week after starting B12

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), he may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops very effective

natureprovides.com/products...

Or

B12 sublingual lozenges 

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when stop vitamin B complex, might want to consider taking a separate methyl folate supplement and continue separate B12

[Girlslovescifi in reply to SlowDragon]

bless you!