Is my Dad hypothyroid?

[Melodica8]

Hello again, it’s been a while since I last posted on here, and I’m back again as I’m sure my poor Dad needs a diagnosis… I’ve written about him before, and we still haven’t got anywhere.

He turned 70 in December. For the last 10 years he has been steadily feeling worse, very tired, no energy, poor mental function and memory, depression, severe peripheral neuropathy in his feet. My dad was always vibrant and full of energy until the last 10 years. He’s been seen by so many specialists and no-one can find any answers. Has been on antibiotics for the last 10 weeks to try and get the prosatitis under control, but is also not working. He has a mulinodular goitre which has been cleared.

I really feel his thyroid function is below what it should be, his t4 is always bouncing around near the bottom of the range, TSH is middle. He has vitamin b12 injections regularly too. For a bit of context, I have hypothyroidism but had to go privately as I was always in range but near the bottom. My eldest also has hashimotos, and my uncle (Dad’s brother) is hypothyroid.

I’m asking the hive mind to see what you think, could a thyroid problem be causing some or even all of this? He’s looking to go to see a private endo. He recently had a memory assessment which thankfully ruled out early onset dementia or Alzheimer’s, but he does have impaired cognitive function. This was a man who has worked as a quantity surveyor/purchaser all his working life, and has been involved with some very high profile projects. It’s just heartbreaking to see him suffering, and so frustrating that no-one is joining up the dots and looking at the whole picture.

many thanks

[SlowDragon Administrator]

Recommend he get FULL thyroid and vitamin testing

Essential to include testing thyroid antibodies

TSH, FT4 and FT3  plus both TPO and TG thyroid antibodies tested at least once 

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

When were Vitamin D, folate and ferritin last tested

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease 

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

Recommended that all thyroid blood tests early morning, ideally just before 9am

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 all relevant vitamins

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...

Test early Monday or Tuesday morning

[Melodica8 in reply to SlowDragon]

Thank you. He had a full panel done around 4 years ago (the results are on a previous post) and I have also recommended he gets another one done before he sees an endo. I knew there were discount codes too, so thank you for posting them as well. I’ll check when vit d, ferritin and folate were last done, but don’t think it was long ago.

[SlowDragon Administrator in reply to Melodica8]

can you add most recent vitamin results

Within range is not necessarily optimal

[SlowDragon Administrator in reply to Melodica8]

This are results from 4 years ago

healthunlocked.com/thyroidu...

[Melodica8 in reply to SlowDragon]

Dec ‘22

Folate: 5.5 uh/L (range 4.8-19) so pretty low

Vit B12: 439ng/L (range 189-883)

October ‘22

Ferritin: 113 ug/L (22-275)

No recent Vit D

[Melodica8 in reply to SlowDragon]

Hi, my Dad got his test results back, they’re within range- what are you thoughts?

TSH 1.93mU/L(range 0.27 - 4.20)

T4 Total 86.7 nmol/L (66-181)

Free T4 16.8 pmol/L(12-22)

Free T3 5.10pmol/L (3.1-6.8)

Anti-Thyroidperoxidase abs <9.0 IU/mL ( <35)

Anti-Thyroglobulin Abs 12 IU/mL ( <115)

Vit D 80nmol/L (75-200 optimal)

B12 348pmol/L (145-569)

Folate 14.8nmol/L (8.83-60.8)

Ferritin 219 ug/L (30-400)

Magnesium .97mmol/L(.66-.99)

[SlowDragon Administrator in reply to Melodica8]

most obvious thing is low B12 and folate

How long since his last B12 injection?

Is he also taking daily vitamin B complex…..if not suggest he starts now ….this would improve folate also help maintain B12 in between injections

As he’s having B12 injections it’s recommended to also supplement a good quality daily vitamin B complex,

one with folate in (not folic acid) may be beneficial.

Low B12 symptoms 

b12deficiency.info/signs-an...

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

With serum B12 result below 500, (Or active B12 below 70) he may need more frequent B12 injections

Plus daily separate vitamin B Complex 

Is he Vegetarian or vegan

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 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 folate supplement (eg Jarrow methyl folate 400mcg) p

Post discussing how biotin can affect test results 

healthunlocked.com/thyroidu...

Improving low B12 and low folate should help significantly

 

[Melodica8 in reply to SlowDragon]

Thank you so much, that’s really helpful, I have forward this on to him. Makes sense if the range is too big, most of his symptoms are covered by b12 deficiency 👍🏼

[Melodica8 in reply to SlowDragon]

his last b12 injection was 2 months ago, he always says it doesn’t make him feel any better 🤷🏻‍♀️ could it be a malabsorption issue? If his b12 gets to where it should be, will that reverse the peripheral neuropathy or is that damage permanent now do you think?

[Hidden in reply to Melodica8]

Probably more to do with the fact that the injections are too far apart. Some with PA inject daily but I think most find the 8 or 12 weekly ones from the NHS are too far apart.

[SlowDragon Administrator in reply to Melodica8]

injection is to get around malabsorption issues

Many people need more frequent injections

At least monthly

Considering he’s on injections his B12 is extremely low

Does he have Pernicious Anaemia or “just” low B12 as result of his Hashimoto’s

He could try adding daily B12 drops as well.

If levels increase then he can absorb B12 via gut

B12 drops 

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...

Ask on PAS Healthunlocked re increasing frequency of injections on NHS

Many people self medicate if need more than monthly

healthunlocked.com/pasoc

[Hidden]

it’s possible that his memory and cognitive problems are related to hypothyroidism, particularly as his TSH is higher than it should be and there is other symptomology.

You may get a better response to your queries if you approach mental health / geriatric services. They do tend to be a bit more open minded

[Melodica8 in reply to Hidden]

thank you

[Gingernut44]

You say his multinodular goitre has been cleared. Can you tell us how it was “cleared” as this could give us a clue to his problems.

[Melodica8 in reply to Gingernut44]

As far as I remember, he was seen by an endo but they didn’t have any concerns about the nodules/enlargement so he was discharged.

[radd in reply to Melodica8]

Melodica8,

A goitre develops when the body can't produce enough thyroid hormone and the thyroid gland has to work extra hard to make enough. Sometimes with inefficient  production a substance called colloid results results in cysts and nodules. 

Cancerous cysts and nodules are rare but it is usual to be checked by an endo. Your Dad has been ‘cleared’ of cancer and not necessarily hypothyroidism. This may need pointing out to his GP. 

[Melodica8 in reply to radd]

Thank you, that is really useful information. I’ve recently discovered I have one too, so I’m sure it must be hereditary!

[Tlflom]

Is he refusing to go in for testing? His primary refusing to order labs?

A physical sign of hypothyroid is loss of hair on the outer third or fourth of the eyebrows.

[Melodica8 in reply to Tlflom]

No, he’s desperate to find answers. He’s been seen by many different consultants for the various different problems. (Neurology, urology etc) Because his TFT’s are always within range they’ve never considered his thyroid. I’m sure if he went back they would maybe consider referring him back to endo, but he’d prefer to go privately to get seen quicker, and hopefully not get fobbed off. Like I mentioned in my op, I had to go privately because my TFT’s were in range- and I had to really fight to get the consultant to check my eldest’s thyroid antigens (again, very symptomatic, really struggled with weight- t4 in range mostly but down the bottom. They just kept blaming his diet and it was incredibly damaging to his mental health) lo and behold he has hashimotos.

[Tlflom in reply to Melodica8]

Hashimotos is tough to deal with. Any answer is better than no answer.

[Melodica8 in reply to Tlflom]

any advice on dealing with hashi’s? I don’t think he’s on enough levo anyway, seeing the endo again in July

[Tlflom in reply to Melodica8]

Hashi is all over the place, tough to keep up with its changes.

[SlowDragon Administrator in reply to Melodica8]

any advice on dealing with hashi’s? I don’t think he’s on enough levo anyway, seeing the endo again in July

Sorry I thought he was not on levothyroxine…..but trying to get diagnosed

TSH 1.93mU/L(range 0.27 - 4.20)

T4 Total 86.7 nmol/L (66-181)

Free T4 16.8 pmol/L(12-22)

Free T3 5.10pmol/L (3.1-6.8)

With these thyroid results he definitely needs dose increase in levothyroxine

How much is he currently taking

Which brand

Was test done early morning, 9am and last dose levothyroxine 24 hours before test

[Melodica8 in reply to SlowDragon]

no sorry, this is my son! 🙈 not quite sure what happened with that response, it got mixed up. I was talking about my dad, then went on talking about my eldest who is diagnosed with hashi’s - I must have edited it badly 🤦🏻‍♀️

[SlowDragon Administrator in reply to Melodica8]

That’s why I was confused then!