Thyroid UK
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Vitamins and minerals

Hi everyone, I feel like my symptoms are driving me round the bend. I was diagnosed with hypothyroidism now found to be Hashimotos in 2012 with TPO antibodies of 667.3 (<34) and TG antibodies of >1500 (<115) and I have been getting symptoms of racing heart, weak pulse, sweats, difficult swallowing, goitre, trapped wind, tiredness, pain around my collarbones and chest, puffy eyes, pale looking face, numbness and tingling, hair loss, constipation, joint and bone pain, muscle cramps and I just don't know what to do anymore. Currently taking 100mcg levothyroxine but also 210mg ferrous fumarate once a day for iron anaemia (since Feb 2017) and 5mg folic acid once a day (since Nov 2016). Also vitamin D 800iu once a day (since Nov 2013). Results below were done in May 2017. Thanks for reading.

Sammy

Ferritin 68 (30 - 400)

Folate 2.1 (2.5 - 19.5)

Vitamin B12 195 (190 - 900)

Vitamin D total 38.4 (25 - 50 vitamin D deficiency. Supplementation is indicated)

Magnesium 0.75 (0.70 - 1.00)

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SammyN

Ferritin 68 (30 - 400)

Ferritin needs to be at least 70 for thyroid hormone to work, and it's recommended to be half way through it's range.

210mg ferrous fumarate once a day for iron anaemia

You appear to be undertreated for your iron anaemia.

NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines): cks.nice.org.uk/anaemia-iro...

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.

You should ask your GP to treat you appropriately.

**

Folate 2.1 (2.5 - 19.5)

Vitamin B12 195 (190 - 900)

5mg folic acid once a day (since Nov 2016)

You seem to be treated appropriately for your folate deficiency but not much has happened to your level (although you don't say when these tests were carried out).

Before you started the folic acid, were you checked for signs of B12 deficiency? It's important to do so before starting folic acid as it can mask the signs. Check now and think back if necessary b12deficiency.info/signs-an... If you do have any signs then further investigation will be necessary. Post on the Pernicious Anaemia Society forum for further advice, they will be able to tell you what tests need carrying out - quote your folalte/B12/ferritin results plus iron anaemia information and any signs of B12 deficiency you are experiencing healthunlocked.com/pasoc

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."

**

Vitamin D total 38.4 (25 - 50 vitamin D deficiency. Supplementation is indicated) vitamin D 800iu once a day (since Nov 2013)

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

If your original level was less than 30nmol/L you should have been given loading doses but it's unlikely you'll get them now. Instead, I suggest you buy your own D3 softgels like these bodykind.com/product/2463-b... and take 10,000 daily for 4-6 weeks then reduce to 5000iu daily. Retest after 3 months.

When you've reached the recommended level of 100-150nmol/L (according to the Vit D Council) then you'll need a sensible maintenance dose 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.

**

Magnesium 0.75 (0.70 - 1.00)

This will be taken care of by supplementing with magnesium as a cofacor of D3.

**

As you have Hashi's it's very likely you have an absorption problem which could be why your levels aren't improving. Slow Dragon has lots of information about this and you should check her reply in this thread (currently the last message) healthunlocked.com/thyroidu...

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Tests were done in May 2017 and I was not checked for symptoms of B12 deficiency thanks

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So check now with that link I posted, and then pop over to the PA forum. It's quite likely you may need testing for Pernicious Anaemia, you may need B12 injections. Your B12 level is dire.

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Level of vitamin D was below 30 before being given loading doses

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Ah, so you did have loading doses then went straight onto 800iu daily? Do you know what your level was after the loading doses?

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Thanks yes my level after loading dose was

Vitamin D total 56.3 (50 - 75 suboptimal)

then put onto 800iu once a day

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This makes me so cross. Your level was still suboptimal and yet you were prescribed a measly 800iu daily. That wont do anything except maybe for a child. I believe the guidelines state that 800iu is the prescribed maintenance dose, but really your GP should have suggested you buy your own at a higher dose. With your current level I'd do what I suggested in my other reply.

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