More test results, can anyone advise

[MrsR1412]

Hi there, I'm hoping for some advice about supplements. My vitamin D was tested and came back at 33, doctor requested further tests which she told me was to ascertain how much of a supplement I need to take. Those tests have come back with the following results

Serum parathyroid hormone 5.400 pmol/L 1.95 - 8.49 pmol/L

Bone profile Serum alkaline phosphatase 36.000 U/L 46 - 116 U/L

Serum calcium 2.220 mmol/L 2.15 - 2.6 mmol/L

Serum adjusted calcium conc 2.180 mmol/L 2.2 - 2.62 mmol/L

Serum inorganic phosphate 0.950 mmol/L 0.8 - 1.5 mmol/L

Serum albumin 43.000 g/L 34 - 50 g/L

Serum free T4 level 17.000 pmol/L 10 - 18.7 pmol/L

Is anyone able to give any advice on how much of a supplement they think I should be taking. I have managed to get an appointment next week but would like to get on something asap.

Many thanks in advance

[SlowDragon Administrator]

Did you get dose increase in Levo up from 25mcg yet?

Vitamins are low when under medicated

Look up your local CCG guidelines for vitamin D deficiency and how to treat.

Eg Oxfordshire guidelines

oxfordshireccg.nhs.uk/profe...

If she only prescribes 800iu come back here for advice, as it's very likely inadequate

What about ferritin, B12 and folate levels?

Calcium will naturally increase, once vitamin D deficiency is corrected.

[MrsR1412]

Hi SlowDragon, thanks for your reply. I have an appointment on Monday about my levo, my T4 came back as 17 so only a slight elevation. I am going to take a copy of the link you gave me and request they increase me to 50mcg. Honestly, I can’t believe how you’re made to feel like you have to beg for it.

The doctor said all my other levels were ok, although I think it was suggested on here that my B vitamins are also low.

[SlowDragon Administrator in reply to MrsR1412]

You could print out the Leeds link and NICE guidelines and take along to consultation.

Only need to produce them if GP is reluctant to increase dose.

[Clutter]

MrsR1412,

Parathyroid hormone is mid range which rules out hypo and hyper parathyroidism.

Alkaline phosphatase is low which can be due to zinc deficiency. google.co.uk/search?client=...

Adjusted calcium is mildly below range which may be due to low vitamin D. Calcium may rise when vitamin D is replete. If you are prescribed calcium take it 4 hours away from Levothyroxine.

If your GP follows guidelines for treating 'insufficiency' in cks.nice.org.uk/vitamin-d-d... she is likely to prescribe only 800iu D3 which will take forever to correct your low vitD. I would suggest 10,000iu D3 x 6 weeks then reduce to 5,000iu daily x 8 weeks and retest. My sister's GP presribed 2 x 20,000iu per week when her vitD was 40. Take vitD 4 hours away from Levothyroxine.

T4 is high in range. Do you have a TSH result?

[MrsR1412 in reply to Clutter]

My TSH is 4.86. Although it has come down very slightly since I started on the Levo I am going to request a dose increase to hopefully lower it further. Although my doctor is reluctant!!

[Clutter in reply to MrsR1412]

MrsR1412,

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

[MrsR1412 in reply to Clutter]

Thanks Clutter, I am hoping I get a better response than last week ... being told it’s normal!! Frustrating, but hopefully I will be listened to next week. I am going armed with info