StarFlower2. Your granddaughter has a severe vitamin D deficency which should be treated with high dose vitamin D supplements - her doctor should prescribe them.
No expert on thyroid but the TSH looks high - also note that the TSH has gone up significantly from the last results you posted (1.62 up to 3.29). But you'd get better advice about thyroid results by posting the results on the thyroid forum:
They will advise you to get a full thyroid panel (TSH, FT3 and FT4, together with
Thyroid antibodies TPO and Tg - to test for Hashimoto's, autoimmune hypothyroiditis.
Lots of cross-over symtpoms between hypothyroiditis and B12 deficency - B12 is not particularly low (unless she has been supplementing with B12), though it is possible to get a 'false' normal or high normal B12 - and still have B12 deficiency - and hence the symptoms of B12 deficiency. So not impossible to have B12 deficiency with this level of B12 (as others have commented in your previous post...so please refer back there for more discussion on this).
In particular, see the previous suggestions about MMA blood test: this will be raised if there is not enough B12 getting into the cells - where it's needed - and may help clarify the position as to whether B12 deficiency is present, or not.
(Note: Viapath Nutris are currently offering 10% discount on all blood tests for PAS members - and they offer MMA tests. More information can be found at this link :
Note that you had previous concerns about diet induced B12 deficency and that the serum B12 has gone from 253 (in the last posted results) to 302 this time. So just wondering if your granddaughter is trying to improve her diet and whether this has had an impact in terms of the rising B12 level?
Based on the new thyroid results and significantly higher TSH, I'd suggest you get further advice from the thyroid forum, look at thyroid first, and then come back to B12 if things don't improve.
Hope all goes well for you granddaughter.
👍
P.s. As previously noted in past posts, it's important not to supplement with B12 tablets, sprays or injections prior investigations and diagnosis - this can skew all the test results and make it almost impossible to get an accurate diagnosis and appropriate treatment, even if a B12 deficient does exist 😉.
We spoke to the doctor who suggested she uses over the counter Vit D 1000 daily! This seems a very low dose conciderimg my granddaughters levels. I wonder if she should take more?
I will get a full thyroid panel privately for her. I’m hypothyroid and I know GP’s in the Uk don’t test for FT3 and antibodies the private route is the only way. I can then post on thyroid uk for advice.
She’s supplemented with B12 for 2 days I’ll get her to stop. I’ll look at Viapath Nutris for a MMA blood tests. I’ve talked to her about diet and it’s possible she’s paying more attention to what she eats.
Hi Starflower. When a severe deficiency exists, it's more usual (and in line with guidelines) to prescribe what are called 'fixed loading doses' of vitamin D to bring levels up, before going on to a maintenance regime (usually 400 - 800IU daily), so what your GP has suggested as a daily dose sounds very low to me.
Incidentally, your GP may assume that a level of 50.5 is in the insufficient range, rather than deficient, as many guidelines and reference sites refer to that level as being insufficient rather than deficient.
However, all results have to be interpreted within the reference range set by the laboratory - these are adjusted locally according to machine calibrations etc. - so the level of 50 with the quoted 'normal' range of 70 - 150 most certainly demonstrates a definite vitamin D deficiency. (Just saying this in case you read that a level of 50 is considered either insufficient - or normal - depending on who you're reading 😉). And in case you re-visit the GP and they say the same!
So...think the GP has missed a treatment step - the fixed loading doses - and put your granddaughter on a maintenance regime instead. Might be worth re-visiting this with the GP.
Note: the target for replacement of vitamin D in those who are deficient is between 150,000iu - 300,000iu, in total (as divided doses over six to eight weeks), before going on to maintenance doses.
Incidentally, the symptoms of vitamin D deficiency can be quite horrid - weakness, fatigue, bone pain, back pain, muscle pain, hair loss, frequent infections, depression... so I think your granddaughter will notice a marked improvement once her vitamin D levels start to rise (usually three and possibly up to six months to achieve 'steady-state' vitamin D levels - after fixed loading dose regime and the maintenance.
Haven't really answered your question 'should I give her more'...think the honest answer is that her GP should...because the high dose vitamin D usually given as fixed loading doses is only available on prescription. (GP notebook recommends treatment with Cholecalciferol).
1000iu might do the trick - but it will take a lot longer to address the deficiency. And if there is an underlying absorption issue, then the dose may not be high enough to fully address the deficiency.
Good luck with the thyroid panel and MMA tests. Hope your granddaughter finds some answers and begins to feel better very soon.
Hi again StarFlower2. Hmm...I know that the NHS is cutting down on prescriptions for vitamin supplements but I'd say very poor practice where a severe deficient is concerned. And the GP doesn't seem very clear on what they should be doing! Poor.
I think the main thing is that your grandddaugther gets treated with appropriate doses of vitamin D, and sooner rather than later. So...
Suggest you consult with a pharmacist. They're usually much better then doctors and will be able advise about appropriate dosage, length of treatment, and what form of vitamin D to take (there are, apparently, many options - it's a bit of a minefield 😉).
Also - it's suggested by some that it's advisable to take vitamin K2 when supplementing with vitamin D. However, K2 should not be taken by those with clottting disorders (including bruising easily), anyone taking Warfrin (or similar blood 'thinners'), by those who have suffered from blood clots before (DVT, pulmonary embolism etc), or where any form of shunt has been inserted. Also not sure of the position re: contraceptive pills (or even if that's relevant 🤫). A pharmacist will be able to advise about this too. Incidentally, when I asked my pharmacist about supplementing with vitamin K2, she said that this was 'something they didn't like). So...hmm...no idea really...just making you aware 🤔😉.
Suggest that your granddaughter gets her vitamin D levels checked again in three months to see how things are going. Also, be aware - over supplementation with vitamin D can lead to vitamin D toxicity - so really important to test again (and keep,in mind, she may or may not need maintenance doses of vitamin D once the initial deficient has been addressed). Again, GP (😖) or pharmacist can advice about this.
And well done you for being on the ball...and being so persistent (never easy having to chase GPs - and sad bad that we have too). Your granddaughter's a very lucky lady to have you watching out for her.
Good luck to you both...be interested to hear how she gets on.
Ive been to the surgery and requested a prescription. The health shop I go to in London suggested she gets it on prescription too. The gps calling me tomorrow morning to discuss.
I’m interested in the K2 debate. I take it daily as I have osteopenia but take 4 hours away from Vit D as I believe it competes for uptake.
Today Chloe’s taken 4000 Vit D but I’m very aware it’s not enough.
I’ll let you know what comes of the call with the GP..fingers crossed again!
Well, that was an interesting chat with the GP! Different doc this morning but following the same pattern and don’t prescribe Vit D for results over 40!! I told him I would have to question that and feel chloe should be prescribed. Not only because she’s deficient in D but also a student who would have to spend £25 for tube of Vit D 25000ui!
I’m picking up the prescription today
Thank you for your help, I wouldn’t have stuck to me guns if you weren’t there with your knowledge to help.
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