Thyroid UK
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Vitamin and mineral levels

Ferritin 44 (30 - 400)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 212 (190 - 900)

Vitamin D 25.6

(<25 severe deficiency

25 - 50 deficiency

50 - 75 suboptimal

>adequate)

Above results taken a month ago.

Iron stopped last year despite ongoing iron deficiency.

Folic acid given after above result.

Vitamin D 800iu given after above result.

Thankyou

7 Replies
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Your results are dire and I will add in @SeasideSusie who is very knowledgeable about deficiencies in vitamins.minerals.

What do doctors learn about nowadays regarding the importance of vits/minerals. Nothing it would seem to me.

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Josephina

Ferritin 44 (30 - 400) Iron stopped last year despite ongoing iron deficiency

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. So you need to sort your ferritin level now to give your new prescription for Levo the best chance of working. 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...

If you still have results that show iron deficiency, then you must ask your doctor to treat it (2 or 3 x ferrous fumarate daily according to the 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.

or you ask your GP to refer you to a haemotalogist - I presume you may have seen one originally. Normally a haematologist will want to give an iron infusion if ferritin falls below 50 again, or a referral back to them. Get yourGP to sort this for you.

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.

**Folate 2.3 (2.5 - 19.5) Folic acid given after above result Vitamin B12 212 (190 - 900)

It's all very well giving you folic acid but did yourGP check for B12 deficiency? You can do that here b12deficiency.info/signs-an... and you should post on the Pernicious Anaemia Society forum for further advice because I'm not comfortable suggesting that you should self supplement with a B12 level so low healthunlocked.com/pasoc Quote your folate, B12, ferritin results plus iron deficiency information and any signs of B12 deficiency you may be experiencing.

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 25.6Vitamin D 800iu given after above result

You have been prescribed too low a dose of D3. You are just 0.6 away from severe deficiency and 800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

You need loading doses - 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 maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU 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 regims 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 a paltry 800iu) 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, 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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Thankyou I still have complete blood results showing iron deficiency and no longer under a haematologist.

Reply

Ask your GP to treat you appropriately or to be referred back to haematology.

Reply

Not checked for B12 deficiency

Reply

Post on the PA forum as advised then discuss with your GP.

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You have had these results for a month, but GP has done nothing???

Sounds like you need to see different GP if at all possible

Getting started on Levothyroxine, usually at 50mcgs, plus correcting all the vitamin deficiencies will help enormously

It's not a quick fix, it takes some weeks for the hormones and vitamins to slowly rebalance.

Increases in dose likely over time

We have to always wait 6-8 weeks after each dose increase, before rechecking bloods

Hashimoto's very often affects the gut, leading to low stomach acid, low vitamin levels and leaky gut.

About 5% are coeliac, but over 80% of us find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is often poorly understood

Changing to a strictly gluten free diet may help reduce symptoms. It can also lower antibodies slowly over time

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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