Hello doctor my husband is 71 had total hip replacement surgery in 2010 is diabetic takes glycomet gp 1 twice a day is hypertensive takes envas 5 mg twice a day takes eltroxin 10 mg for thyroid problems now blood test tsh serum third generation shows 23.600 whereas normal values are between .0to 5 he has trembling of hands severe fatigue sleep problems is this hypothyroidism or hyperthyroidism please? What should we do apart from consulting general physician? Diet? Thank you for your time doctor rose.