Previous GP wanted to wait and see but GP I saw today has said for me to start levothyroxine 25mcg then 50mcg 3 weeks after and then 75mcg 3 weeks after that with a retest in 6-8 weeks
He felt my neck and my thyroid is swollen on one side
Ultrasound scan was done 2 years ago and thyroid was found to be enlarged he thinks my Hashimoto's thyroiditis is subacute
He has also said I am iron deficient and folate deficient and vitamin D deficient and has prescribed 210mg ferrous fumarate 3 times a day and 5mg folic once a day and 800iu vitamin D once a day B12 injection trial started because B12 looked low so GP has ordered blood test for pernicious anaemia but I am not to start folic acid until blood test for pernicious anaemia has come back and I have had the trial of B12 injections hope this all sounds ok
TPO antibody 583.3 (<34)
TG antibody >2000 (<115)
TSH 11.8 (0.2 - 4.2)
Free T4 9.5 (12 - 22)
Free T3 3.7 (3.1 - 6.8)
Ferritin 28 (30 - 400)
Folate 1.9 (2.5 - 19.5)
Vitamin B12 182 (180 - 900)
Vitamin D total 25.9 (25 - 50 deficient)
Thankyou
Written by
Lara888
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Your vitamin levels are absolutely dire and the usual offering from NHS won't do a lot to raise them!! Seaside Susie will give very good advice about what you need to take, correct dosages etc to get you to optimal levels.
Lara888 At least you got somewhere with this one, but there was no reason for a 25mcg starting dose unless you are in one of the categories I mentioned in your other thread.
Don't forget that the 6 weekly retests/increases should continue until you feel well and your symptoms abate. Also follow the advice given in previous thread about timing/fasting/leaving off Levo when having blood tests.
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Ferritin 28 (30 - 400) diagnosed iron deficient
He has given you the correct treatment for iron deficiency with 3 x ferrous fumarate daily.
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.
The recommended level for ferritin is half way through it's range, with an absolute minimum of 70 for thyroid hormone to work.
Also, you can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...
not to start folic acid until blood test for pernicious anaemia has come back and I have had the trial of B12 injections
All this is excellent.
Recommended level for folate is at least half way through range and for B12 here's 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."
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Vitamin D total 25.9 (25 - 50 deficient)
800iu vitamin D once a day
This is inadequate, it will never raise your level. Make another appointment and point out to your GP that you appear to need loading doses according to NICE treatment summary for Vit D deficiency:
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.
Once these loading doses have been completed you will need a reduced amount to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and 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
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
Don't start all supplements at once. Start with one, give it a week or two and if no reaction then add in the next one, wait another week or two and if no reaction add in the next. This means that if you do have any reaction then you'll know what caused it.
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Don't forget to check out the links about Hashi's given in your previous thread, and the advice about a strict gluten free diet and supplementing with selenium.
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