I've rang up for my latest blood test results and seeing the GP nxt week. I wanted some advice please before I go for my appt. Blood tests; on 2.5 grains NDT and magensium & probiotics daily.
TSH 0.01 ..Range 0.35 to 5.00 mu/L
Free T4 11.1...Range 9.00 to 22.00
Free T3 4.1...Range 2.60 to 5.70
Vitamin D 20...Range 50 to 200
B12 190...Range 200 to 910
My folate last time 5.3 range 3.00 to 20.00
The receptionist told me the gp wanted to see me about vit d and tsh ...but b12 was satisfactory!! Do you know how much I should be supplementing with each to be optimal and how many hours after I take NDT so that they absorb? I was also thinking about supplementing with zinc, selenium and chromum? I take a low dose HRT gel too ...ok to apply at approx same time as NDT? A lot of tablets to take but read that multi tablets are not that good.
Any comments would be grateful 😊
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Anniejw
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Many, many people with a result like yours have been found to need B12 injections. Ask to be tested for B12 deficiency/pernicious anaemia.
Your folate is far too low in range. Ask about that too. If prescribed folic acid, don't start taking it until investigations into your B12 have been done.
Vitamin D 20...Range 50 to 200
You should be prescribed loading doses according to 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 local guidelines or this summary and prescribes the loading doses. Once these have been completed you will need a reduced amount (more than 800iu so post your new result at 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, maybe more or less, maybe less in summer than winter, 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/
Your doctor wont know, because they are not taught nutrition, but there are important cofactors needed when taking D3 as recommended by the Vit D Council -
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
Have you had thyroid antibodies tested, were they raised (autoimmune thyroid disease aka Hashimoto's)? That can cause gut/absorption problems which result in low nutrient levels or deficiencies.
Was ferritin tested - very important.
When on NDT (or T3) then TSH will be low or suppressed. You are not overmedicated, your FT3 is well within range at, in fact only 48% through range. If you feel symptomatic, plenty of room to increase your dose.
All supplements at least 2 hours away from thyroid meds, magnesiu, calcium and iron should be 4 hours away.
I don't know if HRT gel affects absorption of NDT, possibly not as it is topical rather than oral, but it wouldn't be a bad idea to keep it as far away as possible just in case. Others may have more information.
Thanks so much for the advice and information, I will get a full print out next week and will look at the ferritin too. No I didnt have any test for thyroid antibodies done ...I can ask the doctor or I might have to have this done privately if they wont.
So difficult isn't it ...but it's great to share and learn from other peoples experiences who have hypothyroidism and want to educate myself as doctors aren't very knowledge on this subject.
Just wanted to give an update on my visit to the doctors this morning regarding my blood test post a few days ago. She mentioned that my Vitamin D was low and I should take 4,000iu for a month and then drop down to 2,000.
Vitamin D, mine was 28...Range 50 to 200
nmol/L
My B12 she said that it had a normal active B12 so don't need to supplement
B12, mine was 190...Range 200 to 910
.00 ng/l
Se holotranscobalmin conc (trip472) was 39 pmol/L ( range >30.00pmol/L)
My folate was 4.2 ug/\L range 3.00 to 20.00 - she said this was okay.
So I will start supplementing as follows;
Vitamin D 4,000 and will purchase a K2 M7 supplement to be taken together 4 hours away from NDT. I know I have to be careful not to overdose on this supplement.
B12 Jarrow Formulas Methylcobalamin 5000 mcg - how much do you think I need of this per day please? Also I need to take a B complex, if so how much and I can take together - 2 hours away from NDT?
I will purchase zinc (15mg daily) to take with magensium in the evening
...and perhaps was thinking of purchasing selenium - do you think this is a good idea? if so how much per day and can I take with any supplement (not NDT)?
I just want to feel more human and struggling to get through the day as so fatigued and no energy. I'm hoping with reading other peoples experiences these supplements will help. Also about getting the timings of when to take so I get enough absorption.
She said that i don't need any more blood tests before the autumn.
Vitamin D, mine was 28...Range 50 to 200 I should take 4,000iu for a month and then drop down to 2,000.
It's going to take a long time to reach the recommended level with those doses. You are within the range where loading doses should be prescribed, as I mentioned above, 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 she treats you according to the local guidelines or this summary and prescribes the loading doses. If not, come back and I will work out how much you should take to equal them. Once these have been completed you will need a reduced amount 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, maybe more or less, maybe less in summer than winter, 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/
**
My B12 she said that it had a normal active B12 so don't need to supplement
B12, mine was 190...Range 200 to 910
.00 ng/l
Se holotranscobalmin conc (trip472) was 39 pmol/L ( range >30.00pmol/L)
I really can't comment on that, you would be best asking on the Pernicious Anaemia forum
Check for signs of B12 deficiency (link in previous post) and list any in your post on the PA forum.
Hold back on the melthylcobalamin lozenges until you've had an answer from the PA forum.
**
My folate was 4.2 ug/\L range 3.00 to 20.00 - she said this was okay.
She's saying that because it's within the range but it is too low.
The B Complex should be taken 2 hours away from thyroid meds, and as it can be stimulating then take it no later than lunchtime. Good brands are Thorne Basic B (1 capsule) and Igennus Super B (2 tablets) and both will give 400mcg methyfolate which will raise your folate level.
**
Have you tested zinc? It should be about half way through range. Zinc and copper need to be balanced.
**
Selenium can be a helpful supplement, it helps with conversion of T4 to T3, and for Hashi's patients it can help reduce antibodies. Selenium l-selenomethionine 200mcg daily is usually recommended, but 100mcg may be enough if you don't have Hashi's. Avoid the selenite and selenate forms as they aren't absorbed as well as l-selenomethionine. As it's a mineral, it's generally said minerals are best taken in the evening. Take 2 hours away from NDT and it's OK to take with other supplements but not iron.
**
Your Vit D is playing a big part in your symptoms, not sure about B12 but you need advice from the PA forum now because of the "holotranscobalmin conc (trip472) was 39 pmol/L ( range >30.00pmol/L)" result.
You really need ferritin tested because low ferritin plays a big part in fatigue and other symptoms. If your GP wont do it then I would do the iron deficiency test from Medichecks
Thanks so much for your time and advice, I will certainly take this on board and go from there - as looking on my blood test results and previous ones I can't seem to find any tests/results for ferritin - so I will check with the doctors first.
Hi Susie sorry just wanted to update about ferritin. ..., my doctor rang me back and the last ferritin blood test I had done was Nov 2016 and was 36 (ranges 10 to 200)
Again they said was in normal range so I will do a private testing and post them when I know the results.
Yes we all rattle, and have difficulty finding a timetable to fit in various drugs, supplements and food/drink in so they not interact etc with each other! I do not take NDT, so don't if there are any specific needs. Your Vit D is dire, needs to be more in 100-150 range. It is the Vit D3 that has the 4 hour window of conflict re absorption in my regime. Your B12 serum of 190 which the Gp seems to think Ok, despite falling below the 'normal' range is also woefully low and would be better at c500-550ng/L. I have a record folate should be at least halfway through the range ( though my range of folate serum was different to yours at 2.91-50, so perhaps not comparing like with like). It looks like many of your vitamins might be low. Perhaps your folate too will be low. SeasideSusie will be along soon too with details and advice, eg taking VitK2( mark7) with Vit D, probably recommending remedies/doses. Lots of members have indicated preferences to specific brands, but these can become pricey, see what the NHS will offer.
Got interrupted as I wrote this... pleased to see Seasidesusie did reply with lots of very good info.
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