Need to be top of the range for the MAGIC FIVE – Vitamin B12, Vitamin D, Iron, Ferritin and Folates

[amasufindme]

I have recently had my endocrinologist refuse to retest me on the magic five (except Vit D) with no explanation before my next consultation on the 7/2/2017. The previous tests were done 26/8/2015 [one year five months ago - I do supplement but I know its not adequate. I am on LT3/LT4]:

Vitamin B12 398 ng/L 211 -911

Folate * 18.6 ug/L 3.0 -14.4

Ferritin 25 ug/L 15-290

Iron 14 umol/L 11-31

Transferrin 2.9 g/L 1.8-3.3

Iron saturation 19% 12-55

Please can you signpost me any evidence that backs up the need, as a Hypothyroid/Hashimotos Thyroiditis/ Hypovitaminosis D patient, to be at the top of the range for the 'magic five'.

Also any citation for the need of the NHS to demonstrate duty of care by conducting regular checks (e.g. every 6 months) to monitor the levels of the 'magic five'.

I am seeing my GP on 16/1/2017 in the hope she will grant the tests and want to be very prepared!!

Thank you

[Clutter]

Amasufindme,

I'm not aware of any evidence to support that the vitamins and minerals have to be at certain levels in hypothyroid or otherwise patients or that NHS has any obligation to test them unless the endo or GP feels there is clinical need to do so.

My endo fobbed me off a few years ago and said vits/mins were fine because FBC was good. GP did the tests and I was severely vitD deficient, folate deficient and had high ferritin. Endo now tests vitD and calcium because I have mild osteopenia.

Ferritin is commonly tested instead of iron. If ferritin was abnormally low it can indicate iron anaemia, or abnormally high ferritin can indicate inflammation somewhere in the body. An iron panel might be ordered if abnormal ferritin is returned.

Most of the recommendations about vits/mins on the forum are anecdotal. I very much doubt there is random controlled trial evidence to support your view that levels need to be at the top of range. My understanding is that:

Ferritin is optimal half way through range &/or >100.

Vitamin D is replete 75 - 200nmol/L with most people comfortable around 100.

B12 is optimal >500.

Folate is optimal around half way through range but high folate is not a problem if B12 is normal.

[amasufindme in reply to Clutter]

Thanks Clutter, I had read the case study from Sue on Thyroid UK thyroiduk.org.uk/tuk/get_in... and was hoping that there is evidence available that my GP would except other than anecdotal...

"My understanding is that:

Ferritin is optimal half way through range &/or >100.

Vitamin D is replete 75 - 200nmol/L with most people comfortable around 100.

B12 is optimal >500.

Folate is optimal around half way through range but high folate is not a problem if B12 is normal."

Are these your own findings, HCP findings or this is information collated from everyone's experience on HU?

[Clutter in reply to amasufindme]

Amasyoufindit,

My opinion on B12, folate and ferritin is based on what I've read about thyroid, vits/mins since 2013.

VitD replete range 75 -200 nmol/L is the range quoted on my lab results.

[amasufindme in reply to Clutter]

Hey Clutter, thanks for your reply this is great, please can you give me those references for Vitamin B12, Folate, Ferritin?

[Clutter in reply to amasufindme]

Amasufindme,

No, they're things I've come across but aren't things I've bookmarked. I suggest you Google "What is optimal B12 level?" etc.