Thyroid UK

Vitamins and minerals

Hi as per first post

I am 25 years old and as well as diagnosed with an underactive thyroid in March 2017 I have vitamin and mineral levels. Results below.

Symptoms are mainly dizziness and blood rushes to the head when standing from bending down/sitting, seems to be worse during periods? Pins and needles in my feet. Weight gain around my middle. Dry skin all over my legs. Dark patches in skin creases and on back. Vitiligo on arms and legs. Hair growing on face and body in male pattern and have got an increase in hair around my nipples and my breasts are swollen no matter where I am on a period.

If anyone could advise on bloods I would be grateful thankyou.

AUG 2017

Ferritin 15 (30 - 400)

Folate 2.1 (2.5 - 19.5)

Vitamin B12 104.5 (190 - 900)

Vitamin D 22.7 (<25 severe vitamin D deficiency. Patient may need pharmacological preparations)

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So, as suspected you are very B12 deficient as well as your other deficient vitamin levels. What is your GP doing about them? When did you have these tests done and has your GP contacted you about them? If not, then why not because you need urgent treatment. You are severely deficient in Vitamin D.

Your GP should be checking for pernicious anaemia too.

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I was hoping the GP would discuss these results with me but she hasn't. The tests were done a month ago.

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Your GP is negligent if she hasn't contacted you in a month when you have such low results. Visit another GP in the practice and point out that you have not been contacted and all your vitamin levels are well below range. I see SeasideSusie has responded, that's great as she's got the best advice and you're going to need it. Your old GP will make you very ill so find a new one.

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Please make an urgent appointment with your GP to discuss these results and ask him/her to rule out pernicious anaemia. Post your results and symptoms on the HealthUnlocked Pernicious Anaemia forum to get their advice about the best tests. Do not supplement B vitamins until you have had further tests.

Read SeasideSusie advice to others on this forum for best advice on vitamin supplementation and so you can discuss your treatment knowledgeably with your doctor. You can see some of her advice on the post below.

healthunlocked.com/thyroidu...

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Lauren190 I assume that you haven't been given anything for these dire results or you would have said so, therefore I will reply as if your GP has done nothing about them.

Ferritin 15 (30 - 400)

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. With a level this low, ideally 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.

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.

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...

Ferritin this low often accompanies iron deficiency anaemia. Have you had a full blood count and iron panel done to see if you do have iron deficiency? If not then you need to ask for them to be carried out.

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Folate 2.1 (2.5 - 19.5) Vitamin B12 104.5 (190 - 900)

You are both folate and B12 deficient, your B12 is so low that I wouldn't be surprised if you have Pernicious Anaemia. Do you have any signs of B12 deficiency b12deficiency.info/signs-an...

You need to post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc quoting your folate, B12 and ferritin results, plus iron deficiency information if you have any, plus any signs of B12 deficiency you may be experiencing. You probably need testing for Pernicious Anaemia and I imagine you'll need B12 injections for life.

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."

Folate should be at least half way through it's range.

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Vitamin D 22.7 (<25 severe vitamin D deficiency. Patient may need pharmacological preparations)

You have severe Vit D deficiency and you need loading doses of D3. See 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 your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount (not the paltry 800iu you will be prescribed) 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 800iu), 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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If your GP has ignored these results, I suggest you see a different GP, point out the serious deficiencies, get treatment sorted, then seriously consider reporting this GP for negligence. It wont be just you he has mistreated, he will surely be doing it to other patients too.

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Iron 5.7 (6 - 26)

Transferrin saturation 18 (10 - 30)

Red blood cell count 4.4 (3.8 - 5.8)

White cell count 7.12 (4 - 11)

Haemoglobin 114 (115 - 150)

MCV 76.3 (80 - 98)

MCHC 398 (310 - 350)

MCH 28.2 (28 - 32)

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Yes, these suggest iron deficiency anaemia so you need to ask for this to be treated. See 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.

I would still ask for the iron infusion as well.

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