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Thyroid UK
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Vitamin and mineral levels

I am posting vitamin and mineral levels for my wife , she is 34 years old and has Hashimoto's. She was diagnosed with this when she was 27 and I am desperate to help her despite GPs and endos not really being much help. Her symptoms are becoming noticeable to me like sleeping during the day, loss of appetite, heavy periods, dry skin on her face and body, losing hair, bruises on her legs even though she doesn't injure herself, dizziness, breathlessness, difficulty swallowing, weight gain but she is still very much petite. She has been getting cholesterol deposits under one of her eyes, now she has been getting them under both of them.

As well as levothyroxine she takes 800iu vitamin D3 on prescription. I am quite worried about how ill she seems to be getting.

Thanks in advance.

Serum calcium 2.11 (2.20 - 2.60)

Serum calcium corrected 2.11 (2.20 - 2.60)

Serum folate 2.36 (2.50 - 19.50)

Serum vitamin B12 185 (180 - 900)

Serum ferritin 15 (15 - 150)

Vitamin D total 25.1 (<25 severe vitamin D deficiency. Patient may require pharmacological preparations)

11 Replies
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Has her GP seen these? If so what action taken?

Obviously they are all extremely low. In part due to recent dose reduction perhaps, but with Hashimoto's we tend to have very low vitamin levels due to poor gut function, low stomach acid and leaky gut/ gluten intolerance

First step is to improve vitamin levels, as when they are too low thyroid hormones can't work.

SeasideSusie is the vitamin Guru - she will no doubt be along shortly

Eg

healthunlocked.com/thyroidu...

If you wife has symptoms of low B12 I suggest you also post these results on PAS Unlocked. She probably needs full testing for Pernicious Anaemia and intrinsic factor.

b12deficiency.info/signs-an...

healthunlocked.com/pasoc

But it's quite likely B12 is low due to inadequate dose. Many medics, including endo's have absolutely no idea how ill we can be when dose is mildly out.

Vitamin D, supplementing just 800iu is never in a million years going to be enough. She will need loading dose. At least 5000iu daily, for at least 2-3 months, then maintenance dose likely to be 2-3000iu. Looking to get level up at least to 70, but 100nmol/L is better.

Go back to GP and ask why not given her loading dose of vitamin D as per guidelines

If you choose to self treat then "Better You" vitamin D mouth spray is good as it avoids poor gut. Widely available and in 3000iu or 5000iu dose options.

Retest after 2-3 months - vitamindtest.org.uk - £28 postal kit.

Improving her vitamin D will automatically bring the low calcium level up.

As soon as her vitamin levels start to pick up, she should be more able to utilise her thyroid hormones and improve, but pretty likely she really needs to add T3 in but if vitamin levels are too low, it can make it worse.

Getting "ducks in a row" first - good vitamin levels and also highly likely she would find gluten free diet helps too

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Good advice from Slowdragon, and hopefully others will come along. These are all very low results and will be causing some symptoms. The general rule of thumb is that these need to be about halfway through their ranges.

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Welcome and I hope your wife feels encouraged to join this forum. Your wife's vitamin levels are desperately low and no wonder she is feeling so unwell! Please also post her latest thyroid blood test results as it's likely that she is not optimally dosed due to the raised cholesterol.

If these are NHS tests and her doctor has done nothing about her deficiencies then that is appaling! I would find a new GP or protest loudly! Why has the doc not addressed the fact that the supplements prescribed are not raising vitamin D levels to within range?

Bruising can be a sign of vitamin B12 deficiency so although her vitamin B12 is just within NHS range, it's nowhere near where it should be. She needs to be tested for pernicious anaemia, visit the pernicious anaemia forum on Healthunlocked and post results for good advice.

I'm hoping SeasideSusie will cut in here and give you her excellent advice on vitamin supplements or you can view her posts to other people. It's appalling that your wife has been left to suffer for so long!!!!!! Grrrrrrrrrrrr, makes me feel really mad!!!

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I posted them thank you

150mcg levothyroxine

TSH 3.60 (0.2 - 4.2)

Free T4 13.3 (12 - 22)

Free T3 4.2 (3.1 - 6.8)

TPO antibodies 78.5 (<34)

TG antibodies 357.3 (<115)

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Most people feel better when their TSH is nearer to 1.0 and so I would suggest she is undermedicated. Her FT3 and FT4 are low which also indicates undermedicated. If those were my results, I would be raising my dose by 25 or 50 mcg and testing again in 6 weeks time.

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AC80 As SlowDragon has mentioned, these vitamins and minerals are all at dire levels.

Serum folate 2.36 (2.50 - 19.50)

Serum vitamin B12 185 (180 - 900)

Folate deficiency and barely in range B12. Check for symptoms of B12 deficiency here b12deficiency.info/signs-an... If your wife has any then pop over to the Pernicious Anaemia Society forum here on Health Unlocked for further advice healthunlocked.com/pasoc

(Sorry, just realised SlowDragon has already linked those)

If not (and I genuinely doubt that!) then she needs to increase her low B12 level as anything under 500 can cause neurological symptoms.

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

That's good enough for me and I keep mine around 1000. Sublingual methylcobalamin lozenges are what's needed to supplement B12 yourself (5000mcg daily to start then when the bottle is finished take 1000mcg daily as a maintenance dose) along with a good B Complex to balance all the B vitamins but I seriously think she may need testing for Pernicious Anaemia and may need B12 injections.

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Serum ferritin 15 (15 - 150)

Has an iron panel, full blood count and haemoglobin test been carried out to see if there is iron deficiency anaemia? If not inisist these are done.

Ferritin at the very bottom of range and it's recommended to be half way through it's range with an absolute minimum of 70 for thyroid hormone to work.

Ideally she needs an iron infusion so ask for one, but she may only be prescribed tablets which will take months to raise her level whereas an infusion will raise her level within 24-48 hours.

If tested and found to have iron deficiency anaemia then this is the NICE Clinical Knowledge Summary for treatment. Your local area guidelines should be the same or very similar:

cks.nice.org.uk/anaemia-iro...

Have a read through but this is the treatment:

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

•Treat with oral ferrous sulphate 200 mg tablets two or three times a day. ◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

If she doesn't have iron deficiency anaemia and is refused an iron infusion, the treatment should lbe 1 x Ferrous Fumarate once or twice daily. With her level, the maximum is surely needed.

Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

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Vitamin D total 25.1

The recommended level, according to the Vit D council, is 100-150nmol/L.

She is 0.1 away from Severe Deficiency. I cannot understand how her GP can imagine that 800iu daily will, in any way, shape or form, help raise this level.

800iu D3 isn't going to ever raise her level. It is hardly a maintenance dose for someone with a reasonable level.

Check the NICE treatment summary for Vit D deficiency:

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

Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

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)."

Each Health Authority has their own guidelines but they will be very similar. Go and see her GP and demand that he treats her according to the guidelines and prescribes the loading doses. Once these have been completed she will need a reduced amount to bring her level up to what's recommended by the Vit D Council and then she'll need a sensible maintenance dose (for life) which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

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

naturalnews.com/046401_magn...

Check out the other cofactors too.

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I'm afraid I can't comment on her calcium levels as that is not something I have any knowledge of. But as D3 aids absorpion of calcium, it's possible her level may raise without the need for calcium supplement. If calcium is supplemented, it's important to keep an eye on the level regularly. Calcium has too be taken four hours away from thyroid meds.

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Please let us know what her doctor says.

**

You may want to have a think about how negligent her doctor has been about these particular results and decide whether you want to find a new doctor and maybe give consideration to making a complaint against this one.

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Thanks yes complete blood count and iron panel results below

Red blood count 4.45 (3.8 - 5.8)

White cell count 6.14 (4 - 11)

Haemoglobin 115 (115 - 150)

MCV 73 (80 - 98)

MCHC 367 (310 - 350)

MCH 28.2 (28 - 32)

Haematocrit 0.42 (0.37 - 0.47)

Platelets 227 (140 - 400)

Iron 8.2 (6 - 26)

Transferrin saturation 13 (10 - 30)

I will go to the pernicious anaemia forum now.

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Haemoglobin 115 (115 - 150)

MCV 73 (80 - 98)

MCHC 367 (310 - 350)

MCH 28.2 (28 - 32)

This all points to iron deficiency anaemia, treatment outlined above. Speak to the GP or better still shoot him!

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How long was your wife on 150mcg and also 20mcg T3?

Was it the same endo that originally prescribed, that also then stopped the T3

Do you have test results and vitamin levels from when she was on the combined dose, did the results show over medicated?

What we see quite a lot of here on the forum, is endo adding T3 without considering or improving vitamin levels first or considering possible gluten issues. Then blood tests come back showing levels too high as body can't process the hormones and T3 is withdrawn

Vitamins MUST be at good levels first, supplementing to get and keep them high. Usually with Hashimoto's we often also need to be strictly gluten free (and sometimes dairy)

Starting with gluten free to see if it helps.

Old fashioned bone broth very good to help repair gut lining.

thyroidpharmacist.com/artic...

drbrighten.com/bone-broth-a...

outsmartdisease.com/bone-br...

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She was on the 150mcg levothyroxine and 20mcg T3 for almost 2 years. She saw a female endo who prescribed her the T3 and a male endo then took her straight off. Results were all in range.

TSH <0.02 (0.2 - 4.2)

Free T4 21.5 (12 - 22)

Free T3 5.8 (3.1 - 6.8)

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These results were absolutely perfect. TSH is always low when taking T3. This is fine as long as FT4 and FT3 are within range, which they both were.

What about vitamins and more importantly did she feel well?

When going for any thyroid blood test, in future get blood test as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, or T3 in 12 hours prior to test, delay and take straight after.

If you know name of female endo, try to see her again via NHS or privately

It's getting much more difficult to get T3 on NHS. This is due to this ridiculous attempt to remove it from NHS prescription rather than get new supplies at sensible prices. Rest of world T3 is cheap - typically €30 for 100 tablets 20 or 25mcgs.

Look up Liothyronine on your local area CCG website. See if they are already saying not to be prescribed.

Consultation is ongoing, so they are jumping the gun if banning.

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