Vitamins and minerals

[Rosa1]

Calcium 2.16 (2.20 - 2.60)

Calcium adjusted 2.15 (2.20 - 2.60)

Ferritin 27 (30 - 400)

Vitamin D total 25.5

Vitamin B12 181 (180 - 900)

Nothing prescribed

Thanks

[SeasideSusie Remembering]

Rosa1 You need to speak to your GP about all of these.

Ferritin 27 (30 - 400)

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...

A low ferritin level can suggest iron deficiency anaemia, so you need an iron panel and full blood count and if iron deficiency anaemia is confirmed then the appropriate treatment is 2 or 3 x ferrous fumarate daily. 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.

**

Vitamin D total 25.5

You are 0.5 away from severe deficiency and you need loading doses (do not accept a prescription for 800iu D3, it must be the 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 (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/

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.

As you have Hashi's, once you are buying your own D3 you would be best buying an oral spray for better absorption, eg BetterYou. They do a D3 spray and a combined D3/MK-7.

**

Vitamin B12 181 (180 - 900)

Where is your folate result? Folate and B12 work together.

Do you have any signs of B12 deficiency - check here b12deficiency.info/signs-an... then post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc quoting B12/Folate/Ferritin results, iron deficiency information if you have any, and any signs of B12 deficiency you may be experiencing. You will probably need testing for Pernicious Anaemia and may require B12 injections.

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."

Folate should be at least half way through it's range.

[Rosa1 in reply to SeasideSusie]

No longer taking folic acid

Thanks

FOLATE 2.1 (2.5 - 19.5)

[SeasideSusie Remembering in reply to Rosa1]

Rosa

Presumably that is your latest result without folic acid? I think you should be discussing that with your GP. You can either ask to have your folic acid reinstated or you can buy your own methylfolate or there may be enough in a decent B Complex eg Thorne Basic B. However, any further investigations into your B12 must be carried out before taking folic acid and B12 must be started before the folic acid.

[Rosa1 in reply to SeasideSusie]

Yes latest result. Will discuss with GP

[ITYFIALMCTT]

Are you vegan?

If not, your slightly lower than the reference range calcium is not surprising given your vitamin D level but it bears monitoring so this is a case where your GP should push for follow-up testing even if your local CCG doesn't ordinarily consent to it. The results of those should be assessed in conjunction with your FBC, bone function tests etc. but it should be mentioned when chatting to your GP.

[Rosa1 in reply to ITYFIALMCTT]

Hi not vegan. I have abnormal bone function tests and full blood count as well. No action taken.

[ITYFIALMCTT in reply to Rosa1]

You could do with discussing the abnormal bone function etc. with your GP as part of the plan to improve your vitamin D level. Bringing up the vitamin D level with supplementation should alter the calcium, bone function etc. in a straightforward manner but it would be good to have it monitored.

[HLAB35]

I can't argue with any of the great advice re: supplementation.

I'm concerned that your gut is pretty inefficient. Are you on PPI's by any chance for an ulcer?

One thing that could be investigated is coeliac disease and low stomach acid (due to under treated hypothyroid) as you're clearly not absorbing much from your diet, or you don't have the enzymes that'll aid that absorption. Taking Betaine HCl with meals can increase your stomach acid to aid absorption of trace minerals.

Others on the forum may have other things that help them..