Brief Answer:
Saw all the reports and will answer one by one.

Detailed Answer:
Hello,
Welcome to health care magic,

I have seen all the reports you attached here,from which you have high TSH (6.27),low vitamin D (4.66) and low normal vitamin B12 (254) which all need to get corrected by appropriate medications.

I will give answer for each significant tests one by one.

1) High TSH:

She should start with Tab.Thyronorm 25 mcg (in my opinion) once daily and get thyroid tests (TSH) again after 1 month.You can consult your physician for the same who will know about how to start thyroid medications.

It might require some time to stabilize the exact dosage initially but once her dosage will be set then she can go for thyroid testing every 3 to 6 monthly.

Also,thyroid tablet (Thyronorm) must be taken on empty stomach to get maximum absorption from the stomach as food might interfere with its absorption.

2) Her vitamin D3 is 4.66 ng/ml which is significantly low.

She can take vitamin D3 cholecalciferol in sachets forms 10,000 IU per day or 60,000 IU once weekly with water.

The major cause of vitamin D deficiency could be lack of proper sun exposure.

So,apart from treatment, she should have adequate sun light exposure preferably in morning hours around 8 AM for 15 to 20 minutes daily.

3) Vitamin B12 lab value is not low but clinically it should be above 500 pg/ml to avoid any symptoms related to its deficiency.

If she has already tried oral Vit B12 tablets and if it is not improved much then It would be advisable to take it from injections (preferably intramuscular) which will give nearly 100% improvement.

It is good that you have already consulted respective specialties to rule out any cardiac or pulmonary or gastric pathology due to her severe chest pain and short breaths.

However,hypothyroidism or vitamin D deficiency is not directly related to chest pain but it could be some muscular pain or related to ribs (costochondritis) as the ribs and chest have many muscles which can become sore and inflamed.

It may also be related to anxiety but one thing is sure she is not having any serious cardiac or lung problem.

She can take symptomatic treatment for chest pain and short breaths.

I may expect that she might start to improve with thyroid and vitamin D and B12 corrections as i suggested.

You can consult your family physician who will know better about it.

Hope this detailed information will be helpful.

Regards,

Dr.Sandip Kabra

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Brief Answer:
Vitamin B12 1500 mcg.

Detailed Answer:
Hello,
Thanks for your quick reply.

As I already told,if your wife has tried oral vitamin B12 and has not improved much then I will prefer to give it parentarally (intramuscular injection) of 1500 mcg/2 ml ampules every weekly or twice in a week which will surely help her to increase the serum vitamin B12.

In XXXXXXX it is common to have a vitamin b12 deficiency.The reason behind it could be gastric 'intrinsic factor' deficiency which is responsible for absoprion of vitamin B12 from the stomach.

So,take vitamin B12 from parenteral route.Your physician will know about it.

Regards,

Dr.Sandip kabra

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Brief Answer:
See the brand names.

Detailed Answer:
Hello,
Thanks for the reply.

You can give her cobalamine (vitamin B12) 1500 mcg daily.

I am giving some popular brand names,you can try anyone of that.She can go for serum B12 testing after 6 to 8 weeks.

1) Neurobion forte
2) Eligen B12
3) Nasocobal
4) Nervijen

Hope this helps.

Regards,

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