Thyroid UK
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GP appointment

Hi have come back from appointment with GP today, he wasn't happy with my ferritin, folate or vitamin D levels. He has also prescribed me levothyroxine 50mcg and repeat bloods 6-8 weeks from now. Prescribed me Folic acid once a day. Vitamin D 800iu once a day does this sound ok?

Thanks

TSH 79.5 (0.2 - 4.2)

Free T4 10.3 (12 - 22)

Free T3 3.2 (3.1 - 6.8)

Thyroid peroxidase antibody 804.5 (<34)

Thyroglobulin antibody 278.3 (<115)

Ferritin 18 (15 - 150)

Folate 2.0 (2.5 - 19.5)

Vitamin D 42.6 (25 - 50 deficiency)

Vitamin B12 261 (190 - 900)

13 Replies
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Wll done and good luck give time for medicine to work. There are lots of people who will give you lots of advice even on this site. Take what you want from them. But I think you are on a journey and have taken the first positive steps. Taking another blood test is good. You may have lots more and medication up and down. But the medical profession are the best ones to give you the correct advice. This site is fab for support.

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Well, the only thing I would say is that according to the pernicious anaemia you should make sure your B12 is in a good range before supplementing folic acid but they can advise on it as they have the knowledge. Your GP won't give you supplements for B12 because it's in NHS range but please check with the Healthunlocked Pernicious Anaemia forum and ask what you should do for B12. I believe that anything under 500 can be considered deficient in many other countries. You might also want to take a good B complex along with B vitamins to keep them all in balance. Did your GP give you any advice?

800 iu vitamin D may not be enough. The NICE advice is to give loading doses and 800iu is only a maintenance dose. You could check out SeasideSusie references to NICE guidelines.

The medical profession should be the best people to give you advice as Royo says but they should be following the most up-to-date guidelines, so you need to ask your Doc to explain the reason for the amount he/she has prescribed.

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No GP just told me to take folic acid for the deficient folate, nothing about B complex.

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If that's 800iu per day, then that might not ever shift your vitamin D into the optimal range so unless there's a strong reason that you shouldn't, you might consider topping yourself up with OTC supplements (and I know SeasideSusie has very helpful suggestions about ranges, products, and appropriate dosages both for bringing up vitamin D levels and maintaining them).

Again, SS has good suggestions about how to take the ferrous fumarate (with vitamin C to aid absorption etc.) and dietary sources of iron. Plus, vital information about how to take iron - which is 4hrs away from your levo.

Folic acid is probably 400ug or similar?

You might also want to think about supplementing your B12 to bring it up into a higher range in the future. I'm saying in the future because otherwise this is a lot of stuff to be starting all at the same time, and, if you have any side-effects, it won't be easy to establish what is causing what (you'll have the levo., the ferrous fumarate, the folic acid, and the vitamin D).

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5mg folic acid and 800iu per day yes

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As an good example of Seaside Susie's vitamin D advice that looks relevant to you: healthunlocked.com/thyroidu...

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Sophy0392,

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. It is unlikely 50mcg will be sufficient but thyroid replacement has to be introduced gradually to avoid stressing the body and perhaps causing an adrenal crisis. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine to check whether dose needs adjusting. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

thyroiduk.org.uk/tuk/about_...

Vitamin D 46.25 is insufficient and 800iu is insufficient dose to treat it. 800iu is a maintenance dose prescribed to maintain vitD which has reached >75. My sister was prescribed 2 x 20,000iu per week when her vitD was 40. You can buy vitamin D3 without prescription. I suggest 5,000iu D3 daily x 8 weeks and then reduce to 5,000iu alternate days and retest in April. If you buy on Amazon please use the affiliate link healthunlocked.com/thyroidu...

Ferritin is deficient and this may indicate iron deficiency anaemia. 3 x 210mg Ferrous Fumarate is used to treat iron deficiency. Take each tablet with 500-1,000mg vitamin C to aid absorption and minimise constipation.

Folate is deficient. My GP prescribed 5mg folic acid x 1 daily for a couple of months to correct folate deficiency.

B12 is very low. If you have symptoms listed in b12deficiency.info/signs-an... go to healthunlocked.com/pasoc for advice before you supplement or see your GP.

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GP started me on 5mg folic acid is this ok?

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Soph0392,

Yes.

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It's a lot of info to take in all at once. Give your self time to let it sink in.

Starting Levothyroxine will be first step. It takes a while to build up and have effect. So you will need to be patient and get as much rest as possible

Getting vitamins improved will definitely help too

You may want to consider trying gluten free diet. When your ready. No rush or need to try everything at once

You will see gluten intolerance mentioned on here a lot. But it's unlikely your GP will be aware of how strongly it's linked to Hashimoto's.

Here are a few good websites

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

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Soph0392

Thyroid peroxidase antibody 804.5 (<34)

Thyroglobulin antibody 278.3 (<115)

You were given advice about your high antibodies confirming Hashi's, and what to do about it on your other thread and SlowDragon has also given some more links.

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Ferritin 18 (15 - 150)

3 x ferrous fumarate is a good amount to take, in fact it's the treatment for iron deficiency anaemia. Did you have an iron panel and full blood count done to confirm this?

If you'd mentioned your nutrient levels when I asked on our other thread before you went to the doctors, I would have suggested you ask for an iron infusion which would have raised your level within 24-48 hours, tablets will take many months.

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.

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.

You can also 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... Include as much as you can, you need a lot of help with your ferritin level.

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Vitamin B12 261 (190 - 900)

Do you have any signs of B12 deficiency - check here b12deficiency.info/signs-an... If so you need to post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc And if you do then you will need testing for Pernicious Anaemia and may need B12 injections. If you do have any signs, don't start the folic acid until other investigations have been carried out.

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."

If you don't have any signs of B12 deficiency then you will be safe to self supplement to get your level up, your GP wont give you anything because you're in range. You will need sublingual methylcobalamin lozenges and start with 5000mcg daily, when the bottle is finished then change to 1000mcg daily as a maintenance dose. When taking B12 we also need a good B Complex to balance all the B vitamins, highly recommended here is Thorne Basic B. Start the B12 before the folic acid.

Folate 2.0 (2.5 - 19.5)

This works with B12 and needs to be at least half way through it's range.

5mg folic acid daily is the correct treatment, but as mentioned, if you have any signs of B12 deficiency don't start taking this yet. And start your B12 supplement before the folic acid.

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Vitamin D 42.6 (25 - 50 deficiency) Vitamin D 800iu once a day

The guidelines don't allow your GP to prescribe any more than 800iu daily, your level would have to be below 30 for loading doses, but 800iu is not enough.

The Vit D Council recommend a level of 100-150nmol/L and 800iu daily is not enough to raise any level, it's barely a maintenance dose for someone with a decent level. My maintenance dose is 2000iu daily all year round.

If you want to raise your level then you'll need to buy your own supplement and I suggest D3 softgels like these bodykind.com/product/2463-b... and take 5000iu daily for 3 months then retest.

However, as you have Hashi's, and this can cause gut/absorption problems, SlowDragon usually recommends BetterYou D3 spray as it bypasses the stomach and absorption will be better. You will still need to start with 5000iu daily.

When you've reached the recommended level then you'll need a 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 helps D3 to work and 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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There a lot of supplements you are going to introduce and it's important not to introduce them all together. Start with your Levo tomorrow and leave it a week or so before adding supplements. Then add in one of your supplements, give it a week or two and if no reaction add in a second one, give it another week or two then add in the next one, continue like this adding one at a time. If there is any reaction you will know what has caused it, if you start them all at once you wont have a clue what you've reacted to.

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Unfortunately, doctors know next to nothing about nutrition as they don't study it. As long as the result is somewhere within the range then they're happy. Us Hypos need our nutrient levels to be optimal for thyroid hormone to work.

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I will post iron panel and complete blood count, not sure what they mean. I have symptoms of B12 as well. Thanks

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Soph - as you have symptoms of B12 Deficiency then you really must post on the PA forum for further advice, give all your results for B12, folate, ferritin, the iron/blood count ones, plus your symptoms of B12 deficiency, then discuss with your GP. As already mentioned, don't start folic acid yet, any other investigations need to be done first.

I see you've had replies on your other thread about your iron results with differing opinions. I would discuss it with your GP.

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