Increasing Levo dose (until TSH is around one and FT4 towards top of range), improving vitamins and going absolutely strictly gluten free will all help
Once stable, if FT3 remains low you may need addition of small amount of T3 (many of us with Hashi do) But essential to get the rest sorted first.
Email Louise at Thyroid UK for list of recommended thyroid specialists, some are T3 friendly
*Ferrritin 26 (30 - 400) GP comments - no action required
*MCV 78.3 (80 - 100) GP comments - just out of range - satisfactory
*MCHC 375 (310 - 350) GP comments - just out of range - satisfactory
*Haemoglobin 110 (115 - 150) GP comments - just out of range - satisfactory
Your GP is a total tool. All these results point to iron deficiency anaemia. I am certain that your GP wouldn't be happy with these results himself, in fact he should be made to live with them! See a different GP and ask for treatment - see NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines):
•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.
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.
In addition, 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 need an iron supplement and as your level is so low you should ask for an iron infusion which will raise your level within 24-48 hours, tablets will take many months. 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...
**
*Folate 4.1 (4.6 – 18.7) GP comments - just out of range - satisfactory
Stuff and nonsense. You are folate deficient.
Vitamin B12 202 (190 - 900) GP comments - normal - no action
Were you checked for signs of B12 deficiency - check now b12deficiency.info/signs-an... Then you need to post on the Pernicious Anaemia Society for further advice healthunlocked.com/pasoc Quote Folate, B12, Ferritin and all those results above which point to iron deficiency anaemia.
You will probably need testing for pernicious anaemia and may need B12 injections. You will need folic acid prescribing but don't start that until further investigations have been completed, and B12 should be started before folic acid.
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 30.1 (<25 severe deficiency 25 – 50 deficiency 50 – 75 suboptimal >75 adequate) GP comments - might benefit from vitamin D supplementation
Your GP has said that so he can either (1) prescribe just 800iu De or (2) prescribe nothing and tell you to buy your own.
You are just 0.1 away from needing loading doses - 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 (more than 800iu so post your new result as the time for members to suggest a dose) 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/
If your GP wont prescribe the loading doses then come back and we will tell you what to buy. 800iu daily, if prescribed, will never raise your level.
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 think you should ask your GP why there are ranges if he is just going to ignore them.
**
I would see a different GP, get treatment sorted, then consider making a formal complaint for negligence against this one, who probably would be better off in a different job which didn't involve looking after people's health.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Best Vitamins etc. for joint pain?
Vitamins etc what levels should I be aiming for?
Daughter's vitamin/mineral results
