Next steps

[RedOne1]

HelloI have asked for advice previously in relation to my mum. She has been taking levo 25 for a while now. We have managed to get a new test completed and her TSH has increased quite a lot.

FT3/4 at the lower end of range. She is also deficient in B12. We have been waiting a while for these so as I understand the next steps would be an increase in Levo and to also commence b12 treatment by injections.

Please could I ask for opinions in relation to how much of an increase we should be asking for? Would it be advised to go slow even with the big jump in TSH. So say increase to 50 or 75? Should we wait to increase until b12 has improved?

TSH - 16.3 (0.35 to 5.50)

FT4 - 12.5 (10 - 20)

FT3 - 4.17 (3.50 - 6.50)

B12 - 166 (211 - 911)

Ferritin - 80 ug/l (15 - 291)

Test was taken at 10am, that's the earliest appt they offer, which I know is not ideal.

One of the main symptoms that mum is struggling with atm is hair loss. Will this improve with b12 treatment and an increase in levo?

Any advice appreciated 🙏 Thank you 😊

[greygoose]

Going from 25 mcg to 75 mcg is not taking it slow! lol Increases should not be more than 25 mcg at a time. So, 50 mcg should be the next step.

The hair-loss could be more to do with the low ferritin than anything else. If it were me, I would want my serum iron tested - if not a complete iron panel done.

[RedOne1 in reply to greygoose]

Thank you! 50 sounds good. We did ask for iron panel but we don't have the results for that yet. I'll double check

Thanks 😊

[greygoose in reply to RedOne1]

You're welcome.

[helvella Administrator]

Do not leave B12 untreated. When it is that low it is urgent. She needs injections to start now.

I see you have posted on the Pernicious Anaemia Society forum already - about yourself. That is best place to ask more.

And I would say do not delay an increase on the basis of B12 treatment. Adequate B12 might make some difference, but I doubt it would be a significant difference unless and until she is very close to an adequate dose of thyroid hormone.

[RedOne1 in reply to helvella]

Thank you. She has to make an appt with the nurse for b12 so we'll get that sorted asap. I've got all the info re what treatment she should be offered as per guidelines.

That's good to know that we can begin to sort out both issues at the same time. Thank you! I feel positive that we can start to see some improvements now we know what some of the issues are down to.