Thyroid UK

Sister's vitamin and mineral levels

FERRITIN 26 (30 - 400)

MCV 78.1 (80 - 98)

MCHC 365 (310 - 350)

HAEMOGLOBIN ESTIMATION 116 (115 - 150)

RED BLOOD COUNT 4.41 (3.80 - 6.80)

WHITE CELL COUNT 7.12 (4.00 - 11.00)

HAEMATOCRIT 0.40 (0.37 - 0.47)

PLATELETS 250 (150 - 400)

IRON 6.1 (6.0 - 26.0)

TRANSFERRIN SATURATION 12 (12 - 45)

MCH 28.2 (28 - 32)

FOLATE 2.3 (2.5 - 19.5)

VITAMIN B12 144 (180 - 900)

VITAMIN D TOTAL 30.5

(<25 SEVERE

25 - 50 DEFICIENT

50 - 75 SUBOPTIMAL

>75 ADEQUATE)

She takes 800iu D3 only, thank you

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So did the GP do these and what has been said about them and what has been prescribed? When did she get these results?

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Other thread for reference healthunlocked.com/thyroidu...

LouiseBarrett

We know from our other thread that your sister's GP has been very negligent in ignoring her high TSH and below range FT3 and FT4, and now we see that s/he has also been very negligent regarding these vitamin and mineral levels, they are absolutely dire and will be causing her many problems.

FERRITIN 26 (30 - 400)

MCV 78.1 (80 - 98)

MCHC 365 (310 - 350)

HAEMOGLOBIN ESTIMATION 116 (115 - 150)

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.

She needs an iron supplement and as her level is so low she should ask for an iron infusion which will raise her level within 24-48 hours, tablets will take many months. She can also help raise herr 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 her diet apjcn.nhri.org.tw/server/in...

She has iron deficiency anaemia and needs to be treated appropriately - see NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines):

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.

**

FOLATE 2.3 (2.5 - 19.5)

VITAMIN B12 144 (180 - 900)

She should check for signs of B12 deficiency here b12deficiency.info/signs-an... then go and post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc (click FOLLOW to post on there). She should quote these results, her ferritin and iron/full blood count results, and mention any signs of B12 deficiency she may be experiencing from the list linked to.

She will most likely need intrinsic factor antibodies testing, she may well have Pernicious Anaemia and she may need B12 injections. She certainly needs folic acid prescribing for the folate deficiency but other investigations should be done before starting folic acid, and B12 must be started before the 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 TOTAL 30.5 800iu D3

She is 0.5 away from the level where loading doses are normally prescribed - 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. She should go and see her GP and ask that he prescribes the loading doses. If he wont give her the loading doses, come back and say so and we can tell you what she should buy and how much she should dose with. Once these have been completed she will need a reduced amount (more than 800iu so post her new result at the time for members to suggest a dose) to bring her level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then she'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. She 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.

**

From your other thread

TPO antibody 558 (<34)

TG antibody >1200 (<115)

Her high antibodies mean that she is positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

She can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. She needs to read, learn, understand and help herself where Hashi's is concerned.

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

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies which has obviously happened to your sister. She needs to address the absorption problem so that nutrients can be absorbed and levels improved. When she is prescribed replacement thyroid hormone, the nutrient levels need to be optimal for it to work. To address absorption problems, check out SlowDragon's reply to this post, it contains links and information which will help healthunlocked.com/thyroidu...

**

There has been some extremely serious negligence on the part of your sister's GP. He is dangerous and she should see a different GP, get treatment sorted for her thyroid and her nutrient levels, then give serious consideration to making a formal complaint against this GP.

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LouiseBarrett,

Looks like your sister's GP passed bottom of his class. He is an entirely useless specimen and I strongly recommend your sister sees someone else and makes a formal complaint about her GP's negligence if he has seen those results and not treated her.

Ferritin and MCV are below range which are indicative of iron deficiency anaemia even though iron is bottom of range. Treatment for iron deficiency is 3 x 210mg Ferrous Fumarate iron tablets daily. Each tablet should be taken with 1,000mg vitamin C to aid absorption and minimise constipation.

Vitamin B12 and folate are severely deficient. Your sister needs B12 injections to prevent neuological damage and they should be initiated 48 hours prior to administering 5mg folic acid which should be taken daily. Investigation should also be done to see whether pernicious anaemia is causing B12 and folate deficiency. Signs of deficiency are in b12deficiency.info/signs-an... healthunlocked.com/pasoc are the experts on PA, B12 and folate deficiency if you want more advice.

Vitamin D is deficient and 800iu is totally insufficient to treat deficiency. It is a maintenance dose prescribed once deficiency is corrected and vitD is >75. Your sister's GP should refer to local guidelines or the NICE CKS recommendations for treating vitamin D deficient adults cks.nice.org.uk/vitamin-d-d... My GP prescribed 40,000iu daily x 14 followed by 2,000iu daily x 8 weeks which raised vitD from <10 to 107.

Iron and Vitamin D should be taken 4 hours away from Levothyroxine.

Your sister must be feeling incredibly unwell with her low thyroid and deficient vitamins and minerals. It will help her if you or another family member or friend can support her at GP appointments until she is feeling stronger.

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With results as such, your sister is seriously anemic. She may be experiencing some heart palpitations and is at the bottom range of the weakness spectrum, perhaps it is best for her to check into A & E as she may get an immediate attention which her GP is refusing to address.

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