Well, I have finally been diagnosed with hypothyroidism after 2-3 years of symptoms. Just to recap, I had a private blood test done that was a clear indication of hypothyroidism, took those results to my gp, and she had me retested with the same results as the private test. She has me taking Levothyroxine 25mg once a day 30 minutes before breakfast; Vitamin D 20,000 IU once daily for 15 days, then down to once a month; and Folic Acid 5mg once daily.
My questions are: How strict is the rule about taking the the Levo 30 minutes before breakfast, for instance, could I take it more than 30 minutes before breakfast or even at bedtime (which is quite early in the week at 9pm)?
When during the day should I be taking the vitamins? Currently I am taking them both before I eat my evening meal.
She has given me a blood form to get retested in two months time to see how I'm doing to check what is described on the form as:
(BF3) B12 and Folate
(TFT3) Thyroid Function Test
I was not given any B12, even though my B12 levels were shown to be desperately low in my private blood test. Can anyone explain why she may have done this?
Thanks in advance!
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Cherj
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You will need to ask the doctor why you have not been prescribed B12 despite low results, it's not a good idea to supplement folate before starting B12 supplements if B12 is deficient as folate supplements can mask B12 deficiency. Visit the pernicious anaemia Healthunlocked forum for best advice.
Take thyroid meds on an empty stomach and leave an hour until eating or drinking anything except water. Leave 4 hours until taking supplements. The new NHS advice appears to be to leave 4 hours after taking Levothyroxine before eating calcium rich foods. This may be a bit excessive but may help some people.
Some people take thyroid meds at night. Leaving at least 2 hours without food or drink except water before taking them. A starter dose of levo should be 50mcg unless very young, frail, elderly or with heart condition. 25mcg may make you feel worse. Ask GP for an increase unless in category listed.
How strict is the rule about taking the the Levo 30 minutes before breakfast, for instance, could I take it more than 30 minutes before breakfast or even at bedtime (which is quite early in the week at 9pm)?
Advice given by patients and members here is to take Levo on an empty stomach 1 hour before food or 2 hours after and take with a glass of water only, no tea, coffee, milk, hot chocolate, etc, and water only one hour each side, for best absorption. You can take it when you like, if bedtime suits you - and many members find this better than morning dosing - then take it then. If your evening meal is your heaviest meal then leave 3 hours after eating and remember about water only. I take mine in the early hours of the morning when I need the bathroom, keeps it away from everything else - food, supplements, other medication.
When during the day should I be taking the vitamins? Currently I am taking them both before I eat my evening meal.
General advice for supplements is vitamins in the morning and minerals in the evening. Specific advice is
Vit D - 4 hours away from thyroid meds. Take with the fattiest meal of the day, remember the cofactors - Vit K2-MK7 and magnesium - mentioned in reply to your previous post along with advice about timing.
As your level was 28nmol/L, the 15 days x 20,000iu are your loading doses. Then dropping to 20,000iu once a month is incorrect. The NICE CKS suggest 800iu daily, you will be getting 666iu daily in a 30 day month. This is nowhere near enough. I suggest you top it up and for the first few weeks take 5000iu daily and retest 8 weeks after starting the loading doses. See what your level is then and adjust your daily dose to suit, as mentioned in reply to your last thread. You wont maintain a decent level on 800iu daily, let alone 666iu daily. Vit D supplementation is generally for life after severe deficiency.
Folic Acid - please do not start this at the moment and the reason is mentioned below.
I was not given any B12, even though my B12 levels were shown to be desperately low in my private blood test. Can anyone explain why she may have done this?
Many doctors don't know much about PA or B12 deficiency you really need to be pushing for further testing before permanent damage takes place.
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."
B12 at 87pmol/L requires testing for B12 deficiency/Pernicious anaemia. This has been mentioned on Medichecks doctor's comments and you might want to ask about this on the Pernicious Anaemia Society forum
Starting folic acid before further testing of B12 will mask symptoms of B12 deficiency.
Did you check the list of signs of B12 deficiency as suggested in reply to your previous thread and did you show your GP?
When having thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It can also lower after eating. Also, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test. These are patient to patient tips which we don't discuss with doctors or phlebotomists.
Thanks for the advice, I did point out to her on the actual visit that my B12 was low, but she didn't seem overly concerned about that. I have not checked the symptom list, will do that now, and book another appointment regarding that.
As to the dosage level, I dont fall into those categories, so not sure why she has me on the 25mg as opposed to the 50mg. It was only a very short phone call with her that she gave me my test results and told me she would call in my prescriptions. I didn't know what the dosage was until I picked it up. Thought I'd give it a couple of weeks for my body to get used to it, see how I feel, then ask for a dosage increase. I've only been taking it for a few days so far.
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