Advice on supplements please

[Sambi89]

Ferritin 22 (30 - 400)

Folate 1.9 (2.5 - 19.5)

Vitamin B12 201 (180 - 900)

Total vitamin D 40.3 (25 - 50)

Taking 1 iron tablet for anaemia and 800iu D3 for vitamin D deficiency both on prescription thankyou

[Clutter]

Sambi89,

800iu is insufficient to treat vitD 40.3. Your GP should refer to local guidelines or the NICE CKS recommendations for treating vitamin D deficient adults cks.nice.org.uk/vitamin-d-d...

Alternatively you can buy vitamin D3 without prescription. My sister was prescribed 20,000iu x twice a week to treat vitD 40. Vitamin D should be taken 4 hours away from Levothyroxine and T3.

If you buy on Amazon please use the affiliate link healthunlocked.com/thyroidu...

Ferritin is deficient and this may indicate iron deficiency anaemia. Usual prescription for iron deficiency is 3 x 210mg Ferrous Sulphate or Fumarate. Take each iron tablet with 1,000mg vitamin C to aid absorption and minimise constipation. Iron should be taken 4 hours away from Levothyroxine.

Folate is deficient. My GP prescribed 5mg folic acid for a couple of months to correct folate deficiency.

B12 is very low. If you have symptoms of deficiency in b12deficiency.info/signs-an... go to healthunlocked.com/pasoc for advice.

[Mary-intussuception in reply to Clutter]

Clutter, according to NICE guidelines - treatment for Vitamin insufficiency - treatment is with maintenance dose no need to start with loading dose.

[Clutter in reply to Mary-intussuception]

Mary-intussuception,

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.

Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total).

For the treatment of vitamin D insufficiency, maintenance doses should be started without the use of loading doses.

cks.nice.org.uk/vitamin-d-d...

[Mary-intussuception in reply to Clutter]

My point.

The poster has Vitamin D insufficiency.

[Clutter in reply to Mary-intussuception]

Mary-intussuception,

800iu is not sufficient dose for correcting vitD 40.3. 800iu is a maintenance dose to maintain vitD levels once they are replete ie 75 - 200nmol/L.

[Mary-intussuception in reply to Clutter]

Where are these figures

" 75 - 200nmol/L " in the NICE guidelines so I can look them up please?

Doesn't this reply contradict your previous reply.

Vitamin D is fat soluble, stored in the body. So best not to risk taking too much ?

[Clutter in reply to Mary-intussuception]

Mary-intussuception,

75-200nmol/L is the replete range on the lab report I had. I didn't say it was in the NICE guideline. How does it contradict my previous reply?

It took six months on 2 x 20,000iu per week for my sister's insufficiency to correct so I don't believe I've caused any risk of over medication.

[Mary-intussuception in reply to Clutter]

At the foot of your first reply to my query you wrote

" For the treatment of Vitamin D insufficiency, maintenance doses should be started without the use of loading doses.

Cks.nice.org.uk-d-d

Maintenance dose is 800IU according to the NICE guidelines you have refered the poster to.

Her result falls within the range 30-50nmol/L that the guidelines say to treat for Vitamin D insufficiency.

[helvella Administrator in reply to Mary-intussuception]

If you read further, you might notice the rationale for not using loading doses:

The recommendation on treating vitamin D insufficiency is extrapolated from the NOS guideline, which states that where correction of vitamin D deficiency is less urgent, maintenance treatment may be started without the use of loading doses.

cks.nice.org.uk/vitamin-d-d...

It is an extrapolation. There is a condition of less urgency. And it is optional indicated by the word "may".

As I read it, the guidance is trying to do a simple job at lowest cost. (Not necessarily a criticism.) But it leaves open the option of higher doses to start which we can infer would likely resolve the insufficiency more quickly.

I suspect those who have other issues, such as those caused by hypothyroidism, would likely consider their situations relatively more urgent. Treatment at maintenance dose could take many months or even years. But I could be wrong.

I do not believe that Clutter has written anything which is controversial or dangerous.

By including links to NICE guidance people are free to read both Clutter's responses AND formal NICE guidance.

In any case, it is to be recommended that those treating deficiency or insufficiency get regular repeat tests both to ensure that they don't go too high - but also to make sure they really are going in the right direction.

On this basis I see no reason whatsoever to change Clutter's responses. If you feel that the complaints you made have not been adequately addressed, please contact Lyn Mynott at Thyroid UK.

Clutter

[Mary-intussuception]

Extracts from

cks. nice.org.uk

"● Treat for Vitamin D deficiency if serum 25 hydroxyvitamin D (25 [OH]D) levels are less than 30nmol/L

● Treat for Vitamin D insufficiency if serum 25 (OH) D levels are in the range 30-50nmol/L and the person . . . . . . "

Under 'How to treat'

"○ For the treatment of vitamin D insufficiency maintenance doses should be started without the use of loading doses."