Help with supplements please

Hi I have Hashimotos and my GP won't increase dose even though endo recommends it. Diagnosed hypothyroid 2012 and taking 75mcg levothyroxine, feeling unwell with tiredness, hard stool, pins and needles, joint pain, shortened but heavier periods.

Diagnosed with pernicious anaemia 2016, iron deficiency 2014, vitamin D deficiency 2014, folate deficiency 2016.

Thankyou

TSH 8.3 (0.2 - 4.2)

Anti TPO 107.5 (<34)

Anti TG >1300 (<115)

Free T4 12.9 (12 - 22)

Free T3 3.0 (3.1 - 6.8)

Total 25 OH vitamin D 44.1 (25 - 50 vitamin D deficiency. Supplementation is indicated) taking 800iu vitamin D since 2014

Ferritin 46 (15 - 150) taking 1 iron tablet since 2017, iron infusion done 2016

Folate 1.9 (4.6 - 18.7) taking 1 folic acid a day since 2016

Vitamin B12 209 (190 - 900) taking B12 injections once every 3 months, result 2016 before injection

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Well that just confirmed your GP is incompetent

These are all so low - impossible for thyroid hormones to work

Your Levo needs to increase by 25mcg - tested after 6 weeks - likely to need further increase , you need serious amount of supplements and to work on healing your gut - gluten free etc

SeasideSusie will respond I am sure

TSH should be around one and FT4 towards top of range

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What possible reason has your GP given for ignoring your endo?

Please insist on seeing a different GP and complaining to CCG about the incompetence of your GP.

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Elliza9

Total 25 OH vitamin D 44.1 (25 - 50 vitamin D deficiency. Supplementation is indicated) taking 800iu vitamin D since 2014

It would be interesting to know your level in 2014 when you were prescribed 800iu D3. If your level was less than 30 you should have had loading doses according to cks.nice.org.uk/vitamin-d-d...

Anyway, 800iu isn't going to ever raise your level to that recommended by the Vit D Council which is 100-150nmol/L. It is hardly a maintenance dose for someone with a reasonable level.

You wont get any more prescribed by your GP as they're not allowed to with your level, so I suggest you buy your own, and as you're Hashi's then for better absorption SlowDragon recommends BetterYou oral spray. You can get it in 1000iu and 3000iu and to start with I would take 6000iu daily for 3 months then retest. 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.

BetteYou do a combined D3/K2-MK7 oral spray which you might want to consider rather than two separate supplements.

**

Ferritin 46 (15 - 150) taking 1 iron tablet since 2017, iron infusion done 2016 Diagnosed with iron deficiency 2014

Has your iron deficiency been monitored? Is your MCV and MCHC now in range?

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. 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...

**

Folate 1.9 (4.6 - 18.7) taking 1 folic acid a day since 2016

Not a lot seems to be happening to improve your folate level despite taking folic acid. Perhaps discuss this with your GP. Not everyone gets on with folic acid and need methylfolate instead.

Vitamin B12 209 (190 - 900) taking B12 injections once every 3 months, result 2016 before injection Diagnosed with pernicious anaemia 2016

Hard to comment when the result is from before injections. Some people find that 3 monthly injections aren't enough and need to top up between them.

You could ask for further advice on the Pernicious Anaemia Society forum healthunlocked.com/pasoc

**

Anti TPO 107.5 (<34)

Anti TG >1300 (<115)

Are you gluten free and supplementing with selenium l-selenomethionine 200mcg daily to help reduce the antibodies?

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

And I see SlowDragon has given lots of information and links about gut/absorption problems associated with Hashi's in your previous thread.

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Yes level of vit D was below 30 in 2014 and MCV below range and MCHC above range and haemoglobin below range thanks

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You can see that the guidelines I linked to say

"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].....

You may want to take it up with your GP. But I don't think you'll get any further help now your level is 44.1 so I would just buy your own supplements.

MCV below range and MCHC above range and haemoglobin below range

So that still points to iron deficiency anaemia and the NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines) states:

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.

So you might want to take that up with your GP as well.

All in all your GP is well in line for "Jerk Doctor of the Day Award" and if I were you I'd see a different GP.

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If your GP is ignoring advice from an endo he should be reported to GMC for negligence 75mcg levo wont treat a fly much less your horrendous low levrls

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