TSH110 Well, she's not going to get it on prescription, the guidelines are probably being followed to the letter, and if the GP didn't follow the guidelines there may be consequences for him. She is not severely deficient where she would be prescribed loading doses, she is just a bit below the replete range. Over the counter Vit D isn't expensive - for example - a year's worth of D3 softgels at a dose that would be too high for your friend once she reached the recommended level (so they would last well over a year in that case) is £13.95 bodykind.com/product/2463-b... With the NHS in the state that it's in, personally I think it's fairly reasonable in this case to suggest OTC supplements. I think the money that would be spent on prescribing D3 supplements for this level would be better spent on prescribing T3 (and other medications) to those people who desperately need it and are having it taken away due to how expensive it is.
The recommended level, according to the Vit D Council, is 100-150nmol/L. With her level at 63.8 she could take 5000iu daily for 6-8 weeks then retest, and if she has reached the recommended level she could take 5000iu alternate days. When supplementing, it's recommended to retest once or twice a year to keep within the recommended range. If the GP wont do this then she can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/
There are important cofactors needed when taking D3
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
Check out the other cofactors too.
I can just about see the thyroid results now I'm on my PC, and I think her FT4 is 26.5 (9-23) with a TSH of <0.01. According to the results, that would make the GP reduce her dose. However, she may be interested in the article in the doctor's magazine Pulse, written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist, which states
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
If she would like a copy of the article, email email@example.com , print it and highlight question 6 to show the GP.
So she should ask for FT3 to be tested to see whether she is actually overmedicated. If FT3 is in range and she feels well with those levels, then she isn't overmedicated, but convincing doctors of that is not easy.
Bear in mind that continuing with a high dose of Levo with continually over range FT4 can actually result in reverse T3 being made instead of FT3. This happened to me.
It would be a good idea for the other vitamins and minerals to be tested, many of us Hypos are low or deficient in them and they need to be optimal for thyroid hormone to work properly and good conversion of T4 to T3 to take place. If GP won do the FT3 and the vitamins and minerals, she can do a fingerprick test with Blue Horizon or Medichecks that covers everything - Blue Horizon Thyroid Plus Eleven or Medichecks Thyroid Check Ultravit.