(<25 severe vitamin D deficiency. Patient may need pharmacological preparations
25 -50 vitamin D deficiency. Supplementation is indicated
50 – 75 vitamin D may be suboptimal, and long-term may lead to clinical effects. Advise on safe sun exposure and diet. Supplementation may be indicated
>75 adequate vitamin D)
Only taking 800iu vitamin D3 and 3 210mg ferrous fumarate since 2013, above results done last month. Thanks
Below the reference range, as is your serum iron, along with some out of range results in your FBC so I'm going to ask humanbean to comment on this. Particularly as the ferrous fumarate doesn't seem to be doing much for you.
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Vitamin D total 26.1
You've tottered out of the severe deficiency category by 1.1 and made it into the heady heights of being vitamin D deficient. SeasideSusie has very helpful suggestions around vitamin D levels, products, and supplementation to achieve recommended levels. NB - the dosage you've been taking since 2013 is not doing anything for you.
You are folate deficient and your B12 is just over the bottom of the range. Seaside Susie has lots of guidance around this.
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As mentioned on your linked post, your thyroid results indicate that you could use an increase in the dosage of your levo. - and it would be useful to have a chat with your GP about any guidance that human bean and Seaside Susie give.
Chantele I'm afraid I haven't been around so couldn't respond before your GP appointment. How did it go?
I'll reply about your vitamins and minerals and hope that your GP is doing the right thing.
Ferritin 22 (30 – 400)
MCV 77.6 (80 – 98)
MCHC 378 (310 – 350)
MCH 28.1 (28 – 32)
Haemoglobin estimation 114 (115 – 150)
Iron 5.3 (6.0 – 26.0) Transferrin saturation 16 (12 – 45) 3 x 210mg ferrous fumarate since 2013
All this suggests iron deficiency anaemia, for which the correct treatment is 2 or 3 x ferrous fumarate daily. If prescribed iron tablets we need to take each one with 1000mg Vitamin C to aid absorption and help prevent constipaton. Have you been doing this? If you have been taking your iron tablets with Vit C then maybe you have an absorption problem which needs investigation.
[Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.]
However, with a below range ferritin I would have suggested also asking for an iron infusion which would raise your level within 24-48 hours whereas tablets will take many months.
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...
You need to post on the Pernicious Anaemia Society forum for further advice. Post folate, B12, ferritin and all results which show iron deficiency, plus information on how long you have been supplementing without success, also any signs of B12 deficiency you may be experiencing. You will probably need to be tested for Pernicious Anaemia and maybe need B12 injections.
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Vitamin D 26.1 800iu vitamin D3
You are just 1.1 away from severe deficiency and you need loading doses, not a paltry 800iu daily which will never raise your level. See NICE treatment summary for Vit D deficiency:
"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 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
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
I see from your previous post that you have raised antibodies:
Thyroid peroxidase antibodies 303.5 IU/mL (<34)
Thyroglobulin antibodies 258.3 IU/mL (<115)
and these confirm autoimmune thyroid disease aka Hashimoto's which is where antibodies attack and gradually destroy the thyroid. The antibody attacks cause fluctuations in symptoms and test results. You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
You need to read and learn about Hashi's so you can help yourself because very few doctors know anything about it and most dismiss antibodies as being of no importance.
Hashi's and gut/absorption problems go hand in hand and dire nutrient levels are often the result, which appears to be the case where your nutrients are concerned. SlowDragon has information and links which can help.
How did the appointment go. Your GP should have agreed to 25mcg dose increase and arranged for retest in 6-8 weeks
To be left on only 50mcg for so long is very poor. What was last year's test results? Were they as bad
All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results
SeasideSusie has already given you excellent advice on supplementing your dire vitamins. These are so bad as you are under medicated but also Hashimoto's is a disease of the gut as much as it is the thyroid
But with Hashimoto's we are extremely likely to also need to be on strictly gluten free diet
Hashimoto's very often affects the gut, leading to low stomach acid, low vitamin levels and leaky gut. About 5% with Hashimoto's 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 very poorly understood and/or therefore ignored
Changing to a strictly gluten free diet may help reduce symptoms and slowly lower antibodies
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Ferritin, folate, vit D and vit B12 help please
GP says no further action required
