Vitamin B12/folate/vitamin D

[maddie111]

Taking 800iu D3 for 3 years thank you

Vitamin B12 203 (180 - 900)

Folate 1.9 (4.6 - 18.7)

Vitamin D 25.6 (25 - 50 deficiency)

[ITYFIALMCTT]

I see from your other post that you're undermedicated on levo. at present tho' without antibody information it's not known whether you have Hashimoto's which is the commonest underlying reason for hypothyroidism in the UK.

It's common for someone with Hashimoto's to have deficiencies like yours in vitamin and mineral levels because of poor gut absorption. And, round here, the general advice is that it's difficult for thyroid hormones (whether your own or prescription ones) to work effectively unless your vitamins and minerals are in optimal ranges, not just within range. And, to state the obvious 4/4 of yours are below the reference range and not one of the 4 is anywhere near the optimal range. So, perhaps it's not surprising that you're not doing well with levo. at present.

"Taking 800iu D3 for 3 years thank you

Vitamin B12 203 (180 - 900) Near the bottom of the reference range

Folate 1.9 (4.6 - 18.7) Below the bottom of the reference range

Vitamin D 25.6 (25 - 50 deficiency)" Deficient category

These are horrible and I'm surprised you're managing to get up in the morning. You don't have ferritin or iron status information?

Plainly, after 3 years in which you are 0.6 out of the severe deficiency range and a whole 0.6 up from the floor of the 'deficiency' range, the 800IU of vitamin D supplementation is doing nothing for you and you need to discuss loading dosages of vitamin D with your GP to rectify this.

You are folate deficient. However, altho' your B12 is just above the bottom of the range, it's not unknown for folate deficiency to mask B12 issues (particularly as we don't know if you have iron anaemia and that's another potential confounding issue), so you might need to be evaluated for B12 deficiency *before* supplementing with folic acid. Again, you need to talk with your GP about addressing this.

I'll add in a link to one of SeasideSusie 's helpful replies to someone with numbers like yours in which she quotes relevant guidelines. ETA: healthunlocked.com/thyroidu...

Do you have an appointment scheduled with a reliable GP in the very near future to discuss these results?

[maddie111 in reply to ITYFIALMCTT]

Not sure I have Hashimotos

TPO antibody 475 (<34)

TG antibody >4000 (<115)

Thanks

[ITYFIALMCTT in reply to maddie111]

Yes, those antibody results indicate Hashimoto's - and that is a fellow traveller (as above) with poor gut absorption.

[maddie111 in reply to ITYFIALMCTT]

I have iron deficiency and no appointment booked

Thanks

[ITYFIALMCTT in reply to maddie111]

Book the first appointment you can get, please - you can't leave those deficiencies at those levels.

[maddie111 in reply to ITYFIALMCTT]

Ok will do this

[Treepie in reply to maddie111]

You might want to go to the pa forum for advice.

[maddie111 in reply to Treepie]

Posted on pa forum thanks

[maddie111 in reply to Treepie]

I plan to see GP tomorrow and hopefully I will be armed with more information from the pa forum by then

[ITYFIALMCTT in reply to maddie111]

As you're known to have iron deficiency then you need to read SeasideSusie's advice (same link) about supplementation or even infusions if your levels are bad enough.

All of this makes it more important that you discuss an evaluation for B12 deficiency with your GP as having both iron and folate deficiency will add to the complex difficulty of establishing whether or not you also have B12 deficiency that is masked by the other conditions.

[maddie111 in reply to ITYFIALMCTT]

Ok will ask for GP appointment first thing tomorrow thanks

[maddie111 in reply to ITYFIALMCTT]

Iron deficiency is quite bad at moment, had iron infusion last year but ferritin is in the 40s again and complete blood count shows haemoglobin below range

[ITYFIALMCTT in reply to maddie111]

You're not on ferrous fumarate or similar as a maintenance regime to keep up your levels after the infusion?

Given the advice on your other thread about needing to request an increase in your levo. you need a very good chat with the GP

Good Luck and let us know how you get on, please.

[maddie111 in reply to ITYFIALMCTT]

Thanks nothing given as maintenance dose after infusion. Haematologist was happy with ferritin being in triple figures after infusion and said I didn't need iron anymore but now I am back to being iron deficient surely I need treatment again. I plan to have a chat with the GP tomorrow

[SlowDragon Administrator]

Your antibodies are high this is Hashimoto's, (also known by the medics here in UK mainly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

With Hashimoto's, until it's under control, our gut can be badly affected. Low stomach acid can lead to poor absorption of vitamins. Low vitamin levels stop thyroid hormones working.

As is obvious, you vitamin D, folate, ferritin and B12 are all far too low. In part due to being under medicated.

Will need significant levels of supplements to improve

But also gut issues tend to cause gluten intolerance

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% 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

Your GP has been very poor leaving you on such a low dose for years

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

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

drknews.com/changing-your-d...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

If GP is reluctant to increase dose of Levo this article may help

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your doctor.

Once you get Levo dose increase of 25mcg then bloods should be retested after 6-8 weeks

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