Hi wondering if doctor should be acting on the vitamin and mineral results done 2 months ago since I had to get private tests done for thyroid and they were done a week ago and I plan to go to the doctor today with the private test results thanks
Vitamin B12 needs to be at the top of the range and D3 around 10, so you need to supplement with this. I take Jarrow B12 and Bit Vits is a good company which sells American supplements in the UK.I am not an expert on folate, but your ferritin is under range so your doctor needs to act on that, by supplementing. Seaside Susie is the vitamin expert so hopefully she can post you some information.
What happened about your thyroid results? Has your doctor done anything about prescribing you levothyroxine and what was his reaction to the results after refusing to test for all that time?
Good luck with the doctor today. Your vitamin results are dire as well as your thyroid results and if your doctor has not done anything about this then they are negligent.
I would definitely point out you have not had the care and treatment you need and deserve and that you want to be treated according to NICE and CCG local area guidelines for your vitamin D deficiency and iron deficiencies. Everything needs to be at least half way in range and B12 needs to be high in range for optimal functioning. Levothyroxine won't work effectively and you won't feel well until they are.
Before you visit your doctor please read SeasideSusie posts to other people about recommendations for treating vitamin levels and go armed and prepared with the correct information so there is no get-out for your GP. Dreadful to leave you suffering needlessly.
Please come back and tell us what treatment you've received.
Well with a TSH as high as that, you will be offered Levothyroxine which should help with your symptoms, but vitamins need to be optimal, as I have already mentioned. Make sure he doesn't ignore the ferritin either as it is under range. Let us know how you get on.
However as your vitamin B12 is in range don't expect the doctor to do anything. The NHS's job is to treat severe deficiencies not those who are just not optimal.
You want:
1. A full blood count to rule out iron deficiency anaemia. Ideally you want an iron panel but as it is the NHS you will be lucky to have that. You need the full blood count before supplementing folate and B12, whether they are prescribed or you self-medicate. So don't take any folate and B12 supplements until you have had the results and they have been looked at by the doctor.
2. To ask the doctor to put you on a loading dose of vitamin D3. If the doctor says you need 800IU per day tell him/her you want them to follow the local guidelines for severe vitamin D deficiency so you want a loading dose:
a. As it is clear from your other tests that you have nutrient absorption problems, and,
b. You are 0.9 of a point away from severe deficiency, and,
c. It is autumn so there is no chance you can make up that amount from sunlight alone.
3. The doctor may decide to refer you to an endo due to your dire results and your high TSH level. However the GP can actually treat your nutrient deficiencies themselves and should so don't be fobbed off with just a referral as the referral can take months and by that time you will be in agony.
3. The doctor should prescribe folate supplements but many doctors due to their ignorance say it doesn't matter unless you are planning a pregnancy. This is completely wrong as low folate levels make your red blood cells larger plus cause vitamin B12 deficiency symptoms. (On the other hand low iron levels make your red blood cells smaller. There are other measures in a full blood count which indicate that you have problems with iron, vitamin B12 and folate so don't worry about this fact.)
Once you have been to the doctor come back and start a new thread. In the thread:
Thanks complete blood count came back with MCV 75.4 (80 - 98) and MCHC 367 (310 - 350) and haemoglobin estimation 116 (115 - 150) doctor I saw before about this wrote comments that said no action
1. Follow up on the vitamin D advice already given, and,
2. Go back to the GP and point out you have MCV below range and MCHC above range. Ask them what are they going to do about it. If s/he says nothing ask politely why they have test ranges. Point out you are aware MCV below range indicates iron problems and MCHC indicates vitamin B12 or folate problems.
Then post a completely new thread with what they said.
Often doctors concentrate on the major nutrients because of the limited time they have. Therefore as a patient if you notice they have missed things you need to question them.
For most people this is difficult but luckily there are good web resources. The site labtests online UK (Google them) is one of them which explains what out of range test results may mean.
Natalie84 Bluebug has given you lots of good advice, the only things I would add are;
FERRITIN 27 ugl/L(30 - 400)
Ferritin need to be half way through it's range, although I have seen it said that for femalses it should be 100-130. It has to be a minimum of 70 for thyroid hormone to work (our own or replacement).
Make sure you're tested for iron deficiency anaemia as Bluebug says, and if you are diagnosed with this ensure you get the correct treatment, quite a few doctors don't give enough ferrous fumarate. Check ou the following - NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines)
•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.
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.
As your ferritin level is below range, odeally you need an iron infusion so ask for one, but you may only be prescribed tablets which will take months to raise your level whereas an infusion will raise your level within 24-48 hours.
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...
**
FOLATE 3.5 ug/L (4.6 - 18.7)
VITAMIN B12 203 pg/L (190 - 900)
You are folate deficient with very low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so then you need to post on the Pernicious Anaemia Society forum for further advice. Quote your Folate, B12, Ferritin levels and any signs of B12 deficiency that 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 25.9 nmol/L (25 - 50 VITAMIN D DEFICIENCY. SUPPLEMENTATION IS INDICATED)
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.
As Bluebug has pointed out, you are 0.9 away from severe deficiency so ask for the loading doses. Once these 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 maintenance dose which may be 2000iu daily (not the paltry 800iu you will be prescribed), 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
Hi I have been reading your posts about thyroid and blood tests .I have had a problem with pain in my jaw for over 20 yrs now .I have had a thyroidectomy and wondered if it was linked could it be a vitamin or mineral deficiency. Thankyou regards linda
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