Thyroid UK

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Vitamin/mineral results

Hi am posting for my 30 year old wife. She has iron deficiency diagnosed 2013 and she underwent iron infusion in 2016. Her ferritin has since dropped into double figures from triple figures. She was also vitamin D deficient diagnosed 2013 and this was addressed with 800iu vitamin D3. She is feeling unwell with increased thirst, dry skin, dizziness, hair loss, dry skin, muscle cramps, heavy menstrual bleeds, tiredness. A locum GP she spoke to thinks she might have coeliac disease. Below results done in Aug 2017.

Ferritin 53 (15 - 150)

Folate 2.1 (2.5 - 19.5) GP said folate only slightly below range

Vitamin B12 203 (180 - 900)

Vitamin D (25 OH) 49.2 (25 - 50 vitamin D deficiency. Supplementation is indicated)

Thanks for reading.

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12 Replies

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Thyroid??

TSH 0.02 (0.27 - 4.20)

Free T4 20.8 (12 - 22)

Free T3 4.0 (3.1 - 6.8)

Thyroid peroxidase antibody 278 (<34)

Thyroglobulin antibody 253.5 (<115)

(175mcg levothyroxine, previously on T3 added to levothyroxine which she felt better on)

She was also vitamin D deficient diagnosed 2013 and this was addressed with 800iu vitamin D3.

Your wife's vitamin D deficiency must have taken for ever to fix with 800 iU. Her current result is still far from optimal for someone with a thyroid problem. People on here often aim for a level of 100 - 150 nmol/L. Vitamin D supplements are easily sourced online, with no prescription required. There are a variety of doses available, and in comparison to many other supplements vitamin D isn't terribly expensive.

To work out a suitable level for dosing vitamin D, see this link :

First you have to convert a result in nmol/L into ng/mL :

grassrootshealth.net/?post_...

49 nmol/L = 19 ng/mL

Then you need to find out a suitable dose with the help of this link :

grassrootshealth.net/?post_...

I stuck in the current level as 19 ng/mL and used a weight of 140 lbs to get a suggested dose for supplementing of 3000 iU per day of vitamin D3.

Obviously you'll have to put in the appropriate weight and re-do it to get an accurate figure.

You'll find that vitamin D3 is available in doses from 400 iU up to 10,000 iU on Amazon or other supplement sites.

Vitamin D3 can be toxic in overdose, so after about 3 months you may want to do a finger-prick test privately :

vitamindtest.org.uk/index.html

Once your wife has got her vitamin D3 up to an optimal level she will need to find her maintenance dose which could be around 1000 iU - 2000 iU, or less or more - it differs from person to person.

Chronic iron deficiency could be due to celiac's. Your wife has also Folate, Vit D, and b12 deficiencies. The symptoms that you have listed are also pointing towards hypothyroidism.

Celiac (auto-immune within the guts) and Auto-immune hypothyroidism (Hashimoto's) can be present at the same time.

All these deficiencies ought to be corrected as soon as possible.

It is best to ask the GP to do a full thyroid function test (TSH, T4, T3, and Anti-Thyroid peroxidase and Anti-Thyroglobulin). If the antibodies are high then this is indicative of Hashimoto's.

Once you have the test results, post them in here along with their ranges and many in here will share with you their views and recommendations for the way forward which are based on their personal experiences and knowledge.

TSH 0.02 (0.27 - 4.20)

Free T4 20.8 (12 - 22)

Free T3 4.0 (3.1 - 6.8)

Thyroid peroxidase antibody 278 (<34)

Thyroglobulin antibody 253.5 (<115)

(175mcg levothyroxine, previously on T3 added to levothyroxine which she felt better on)

Any ideas please?

The high levels of antibodies came to confirm Hashimoto's.

She has felt better on T3 because she is not converting properly. T4 levels high are near the top of the range whereas T3 is very low and accordingly she will continue to feel poorly without T3.

Unfortunately, most doctors will look at the TSH levels and T4 and will believe that she is over-medicated. She is not! T4 alone will not help and there is no more scope for any more of thyroxine.

She needs to be on a combination of T4 and T3 either in their synthetic form or switch to NDT. The likelihood for the doctors to support this treatment is not very good. Self-medication could be the way forward.

However, her GP should be on the case and ought to refer her for celiac's investigation (blood tests and endoscopy with biopsies taken from 3-4 areas within the small intestine.

Once the tests are done (she needs to be on gluten during the tests), she can move to the next stage which is to reduce antibodies.

To do so, it is recommended and has been proven with research and patients' experiences, she needs to give up all sort of gluten. Gluten can be found in all grains within different amounts. Wheat, Rye, and Barley have the most gluten content. She also needs to add 200mcg selenium/daily for 6 months to help with the reduction of antibodies, then moves to 100 mcg.

Once she off gluten, her absorption of iron will be better, and the same for most minerals.

Meanwhile, a gentle iron supplementation, iron bisglycinate, 25 -30 mg daily with vitamin C and 4 hrs away from her Thyroxine medication, for 6 months then retest.

Vitamin D: as we are approaching winter, a dose of 5000 iu per day taken with her main meal (Vit D is fat soluble) until January, then move to one 5000 iu every other day.

B12: methylcobalamin is the natural form of b12 and a dose of 5000 mcg per day for 6 months then reduce to 1000 mcg a day. Optimal levels of b12 are near 900-1000.

To balance all her B levels, an additional b-complex (most have 400 mcg of folate) I am not in favour of pushing more folate along with high methylcobalamin in case she has methylation issues.

Dr Izabella Wentz' publications and videos are very informative. She has documented her journey with Hashimoto's and her recovery.

I hope this helps for now!

She has iron deficiency diagnosed 2013 and she underwent iron infusion in 2016. Her ferritin has since dropped into double figures from triple figures.

It's difficult to suggest what your wife should do with her current level of ferritin. It is safer to have more information on iron than just a ferritin level because supplementing if/when serum iron is already high would be a bad idea, but you don't know what her serum iron is, or her transferrin satuation. (If saturation was high that would be another reason for not supplementing.)

You can find out more about your wife's iron with this finger-prick test :

medichecks.com/tests/iron-s...

Prescription-strength iron supplements can be bought in pharmacies or online without a prescription, but you have to know what to ask for or buy. You have to know what is available, and what dosage to take.

I was very low in iron, I still lose it quickly when I stop supplementing, and I was forced to raise my level with pills. It took me nearly two years to get my levels to optimal. I have found that I can raise my level more quickly now that I have gone 100% gluten-free, and I lose it more slowly. You don't have to be coeliac to benefit from going gluten-free. It is worth experimenting with for 3 months in someone with a thyroid problem. It isn't a life sentence. People can always go back to eating it again if they get no benefits.

Iron 10.3 (6 - 26)

Transferrin saturation 13 (10 - 30)

Please advise

Ferritin 53 (15 - 150)

Iron 10.3 (6 - 26)

Transferrin saturation 13 (10 - 30)

You'll find optimal results for iron-related test results here :

rt3-adrenals.org/Iron_test_...

Serum iron

• 55 to 70% of the range

Doing the arithmetic, gives an optimal serum iron of 17 - 20 with the reference range provided, and your wife's is clearly too low, suggesting she can safely supplement.

Saturation

• optimal is 35 to 45%

I've seen the reference range you supply for Transferrin Saturation i.e. 10 - 30 appearing for the first time in people's posts fairly recently. I've never seen such a low saturation appearing in my own tests, nor have I seen such a range appearing anywhere else on the web. It baffles me, it really does. Because the idea that 35% to 45% is optimal is fairly widespread. But if the reference range stops at 30, what on earth (or how on earth) are they measuring it in some labs in the UK?

Anyway, your wife's transferrin saturation is low in range, which adds to the evidence that she needs to supplement iron.

Ferritin 53 (15 - 150)

Patients on this forum have found that they feel best with ferritin mid-range or a smidgen higher.

So - with the reference range you've supplied, you're aiming to get ferritin to around 80 - 100.

Supplementing iron can be done in various ways. If you were to get a supplement prescribed by a doctor in the UK, they would probably prescribe ferrous sulfate or ferrous fumarate (on the basis of cost).

Note with all iron supplements that the important thing is how much iron each tablet or dose contains.

Ferrous fumarate 210mg (FF210), which is what I'm familiar with, contains 69mg pure iron per tablet, and I was prescribed 1 tablet, 3 times a day, making a total of 207mg pure iron per day. You should consider that to be an approximate maximum.

See these pages for info from the British National Formulary - the doctors' prescribing bible. You're looking for the therapeutic dose, not the prophylactic dose :

bnf.nice.org.uk/treatment-s...

bnf.nice.org.uk/drug/ferrou...

Ferrous sulfate and ferrous fumarate 210mg are the most commonly prescribed by doctors, and can be bought in pharmacies in the UK without a prescription. You can also buy online. It is up to the pharmacist whether they sell it to you or not. Boots frequently insists on a prescription, but I've successfully bought ferrous fumarate 210mg from Tesco Pharmacy and Lloyds Pharmacy. Don't try and buy more than a couple of boxes at a time.

multipharmacy.com/images/P/...

terrapharma.co.uk/media/cat...

I've bought both of the above - other brands are available. Ferrous fumarate 210mg come in boxes of 84, which is enough for 1 tablet, 3 times a day, for 28 days. Your wife's results aren't that bad, so I would suggest 1 tablet, 2 times a day would probably be the right dose.

Some people prefer ferrous sulfate to ferrous fumarate, some are the other way around.

Alternatives to the above...

It is the amount of iron in an iron supplement that makes it more or less tolerable. The higher the iron, the fewer people tolerate it. Oddly enough, the lower the iron content the more expensive the supplements seem to get.

Ferrous gluconate - contains roughly half the iron of FF210.

Ferrous or iron bisglycinate - also sold under the name Gentle Iron - contains roughly 20mg - 25 mg iron per tablet.

All the above are referring to iron salts but iron can be supplemented in other ways.

Eating liver is a good way to improve iron for people who don't tolerate iron salts and who eat meat. The suggested maximum is 200g per week.

For more alternatives see this document by helvella, one of the admins on this forum :

dropbox.com/sh/3waycnbzhywi...

Iron supplements often cause constipation. Taking 500mg - 1000mg vitamin C with each dose of iron will help in two ways - it reduces the risk of constipation and helps the body to absorb iron.

Take iron and thyroid meds at least 4 hours apart. Iron will reduce the absorption of thyroid meds.

Keep iron supplements well away from children. Iron is highly poisonous and overdoses can be fatal.

It is essential to avoid supplementing for too long and overshooting the desired levels, so test every 2 - 3 months, depending on the speed that levels go up. A good test to use which isn't outrageously expensive is this finger-prick test :

medichecks.com/tests/iron-s...

Once your wife has got her levels up to optimal then she should reduce to a maintenance dose or eat some iron-rich foods every week.

Bear in mind that making a massive change to the diet could alter absorption, so test more frequently. For example, I went gluten-free and my iron absorption improved a LOT.

Folate 2.1 (2.5 - 19.5) GP said folate only slightly below range

Vitamin B12 203 (180 - 900)

For good advice on B12 and folate, join the Pernicious Anaemia Society forum on this site :

healthunlocked.com/pasoc

and post the above results plus also mention the fact she has thyroid problems and has an iron absorption problem.

Btw if your wife is 30 so she is of child bearing age and your GP should have at least told her to self supplement her folate.

In regards to this and her other nutrient levels what many people don't realise is the NHS is there to treat you if you have a severe deficiency, but if you are just sub-optimal it is up to you to treat yourself even if you have an underlying cause for sub-optimal levels. If you don't you find like with your wife's vitamin D level it doesn't get better for years. Anyway Humanbean et al have given you great advice on what you need to do.

Your wife has multiple vitamin and mineral deficiencies

The symptoms you mention are symptoms of iron deficiency - they are also symptoms of a number of other conditions - her folate is low and her B12 may be low (please see PAS forum on HU in relation to B12 deficiency healthunlocked.com/pasoc)

Possible absorption problems include coeliacs, PA, h pylori infection, low stomach acidity (symptoms of which are more or less the same as low stomach acidity) and a whole raft of drug interactions.

Has GP done anything about investigating an absorption problem

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