To state what you know already, these results are indicative of multiple deficiencies. SeasideSusie has replies that are full of guidance from clinical sources as to how deficiencies should be treated so it would help to know how long you have been taking these supplements, please?
And, have you had any investigations such as those to rule out Coeliac's Disease, H Pylori, Intrinsic Factors antibodies etc. Are you taking any medications like metformin or NSAIDs that would affect your vitamin and mineral levels?
You are iron deficient but you are taking 3 x Ferrous Fumarate which is the correct treatment. If you take 1,000mg vitamin C with each tablet it will aid absorption and minimise constipation. Ferrous Fumarate should be taken 4 hours away from Levothyroxine.
800iu is totally insufficient to treat deficiency. It is a maintenance dose to maintain levels once deficiency is corrected. Your GP should refer to local guidelines or the NICE CKS recommendations for treating vitamin D deficient adults cks.nice.org.uk/vitamin-d-d... If your GP won't prescribe more buy your own and supplement 10,000iu D3 for 6 weeks and then reduce to 5,000iu and retest in late March. VitD should be taken 4 hours away from Levothyroxine.
If you'd been given loading doses of vitD when it was deficient it could have been cleared up quickly. My GP prescribed 40,000iu x 14 days followed by 2,000iu x 8 weeks and it raised my vitD from <10 to 107.
You appear to have malabsorption causing deficiencies. Has your GP checked tissue transglutaminase to rule out Coeliac Disease (gluten intolerance) which commonly causes malabsorption in hypothyroid patients? If Coeliac disease is ruled out your GP should refer you to gastroenterology for investigation.
OMG, how many more of these donkey-brained doctors are we going to hear about. There seems to be an epedemic lately!
Jerma
FERRITIN *14 NG/L (15 - 150) Taking 3 x ferrous fumarate 3 years
HAEMOGLOBIN *112 G/L (115 - 150)
MCV *77.2 FL (83 - 98)
MCHC *386 (310 - 350)
MCH *27.7 (28 - 32)
IRON *5.8 UMOL/L (6.0 - 26.0)
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 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...
But you need to ask your GP why, after 3 years of taking 3 x ferrous fumarate daily, are you still suffering iron deficiency anaemia and why hasn't your ferritin risen.
So your folate deficiency is being treated, but again ask why you are still folate deficient when you've been taking folic acid for 1 year.
And considering how low your B12 is, were you checked for signs of B12 deficiency? Were intrinsic factor antibodies tested?
Check for signs of B12 deficiency here but bear in mind that taking folic acid can mask them, so think back to before you started taking it b12deficiency.info/signs-an...
Then you can post on the Pernicious Anaemia Society forum for further advice, healthunlocked.com/pasoc quoting these results, your ferritin/iron deficiency results, plus any signs of B12 deficiency you may be experiencing (or did prior to the folic acid). You should be tested for Pernicious Anaemia, you may need B12 injections, and you should not be taking B12 when further investigations take place or before B12 is given.
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."
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TOTAL 25 OH VITAMIN D 25.5 NMOL/L (25 - 50 DEFICIENCY) 800iu vitamin D 5 years
I have to say that it would be obvious to an idiot that 5 years of taking 800iu D3 has done nothing to help you so there must be something wrong. Ask your GP why, after all this time, you are still only 0.5 away from Severe Vit D Deficiency. He wont admit it but the answer is because 5 years ago you should have been given loading doses of D3 not 800iu. 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, simply refuse to continue with the 800iu, using the fact that you've been on it for 5 years with no improvement and now you want to be treated appropriately. 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
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
The fact that you have Hashi's means that when you buy your own supplements as a maintenance dose, for better absorption you should get an oral spray, eg BetterYou.
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Hashi's and gut/absorption problems go hand in hand and very often nutrient deficiencies are the result, as in your case. Malabsorption means the nutrients can't be absorbed. The nutrient deficiencies mean your thyroid hormone can't work. So you need to address the absorption problem, rectify the nutrient deficiencies and that will give the building blocks for thyroid hormone to do it's job. See this reply by SlowDragon which contains information and links to help with absorption problems healthunlocked.com/thyroidu...
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You have two choices, you book an appointment with this GP and tackle him over his neglect of your continuing deficiencies and investigations into why they have not improved. Or you book an appointment with a different GP, sort out treatment, then make an official complaint about this GP and his negligence over the lack of investigation into your continuing deficiences.
Well you can check for signs of B12 deficiency on the link I gave, and you can ask for intrinsic factor antibodies to be tested. The best thing you can do about B12/folate is post on the PA forum for further advice, then discuss with your GP.
You won't have been checked for symptoms because B12 is still in range, just. That's why you should look at the link and see for yourself whether you have symptoms, and if you do, go to PAS forum for advice.
I'm linking to SeasideSusie 's response to someone with numbers that are similar to yours where she discusses the supplements and how they should be taken: healthunlocked.com/thyroidu...
FERRITIN *14 NG/L (15 - 150) Below the reference range
HAEMOGLOBIN *112 G/L (115 - 150) Below the reference range
HAEMATOCRIT 0.40 (0.37 - 0.47) Within the reference range
IRON *5.8 UMOL/L (6.0 - 26.0) Below the reference range
TRANSFERRIN SATURATION 12 % (12 - 45) Floor of the reference range
Your levels are just below range or at the floor of their ranges: given you've been taking the ferrous fumarate for 3 years, I wonder if your GP would consent for a referral to a haematologist?
MCV *77.2 FL (83 - 98) Below the reference range
MCHC *386 (310 - 350) Above the reference range
MCH *27.7 (28 - 32) Below the reference range
You can see for yourself that none of the above are within range. One of the complications is that iron, folate, and B12 anaemia overlap and each have their own impact on these results. And, you have these overlapping conditions for both iron and folate, and it leads me to be wary of your B12 level.
FOLATE *2.0 NG/L (2.5 - 19.5) Below range despite supplementation
VITAMIN B12 197 PG/L (190 - 900) Very low in the range and therefore ??? as you'll see from Seaside Susie's links and discussion.
If you've been taking 400μg or even 5mg of folic acid for a year, it doesn't seem to be doing much for your folate levels and I wonder if this is being hampered by your history of poor iron. However, it's strongly advised that where there is a low in range or low B12 level, then this should be investigated *before* supplementing with folic acid because otherwise you interfere with results. These investigations are typically to rule out things like Coeliac's Disease, H Pylori, Intrinsic Factors antibodies etc.
You need to discuss with your GP whether it's appropriate for you to receive some loading doses of B12.
TOTAL 25 OH VITAMIN D 25.5 NMOL/L (25 - 50 DEFICIENCY) What supplement dosage have you been using for 5 years to find that you are 0.5 of a point away from the severe deficiency category and 0.5 from the floor of the 'deficiency' category? It's plain that the dosage is not effective for you. You qualify for loading doses as you'll see from Seaside Susie where she quotes the guidelines used by the NHS to bring you up to an appropriate level - and the advice on how much to take when you are in maintenance.
Please make notes of the treatment advice and clinical guidelines in Seaside Susie's reply that I've linked: when you discuss your vitamins and minerals with your GP it can be helpful to mention these.
In some areas, haematologists set a floor even when they discharge people - i.e., if your ferritin, iron etc. fall below a particular level then you're supposed to be assessed for an infusion. It's worth discussing this with the GP, particularly as there already seem to be concerns about your weight.
Thanks I was under haematology before for iron deficiency which was treated with iron infusion then I was discharged and asked to come back if ferritin is under 50
It looks like you have a clear basis for requesting further investigation either to confirm H Pylori or auto-immune conditions like the above or to rule them out.
I had a known b12 deficiency for over 30 months, during whch i took b12 tablets, with little serum level improvement and no symptom improvement. I was finally diagnosed with h pylori in August 2017. This is the treatment i recevied.
You need to get tested 8 weeks after trratment to verify it is gone. The blood test after treament will give a positive for h pylori antibodies for 12 -24 months, so it is not reccommended. you will need either the breath or stool sample test to see if the h pylori treatment worked.
After treatment, if your doctor will give you b12 injections along with your current suppliments, you will improve dramatically and rapidly.
Without b12 injections you will still improve but it will take much much much longer as your b12 is on the floor.
For future knowledge, you can get h pylori again so you should be tested as a regular part of an annual exam.
I know having low b12 made me feel like i was losing my life so i will get tested annually no matter what.
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