I recently visited the doctor due to poor energy levels, achy limbs, dizziness, breathlessness, restless legs etc etc. My GP did loads of blood tests but the only clear red flags were ferritin and Vit D levels. I've been on 400mg of ferrous sulphate and 500ug of Vit D (three times a week) since the start of July. The only improvement I've seen so far is a reduction in restless legs. Now that school has ended, I'm getting at least 12 hours sleep each night and it isn't enough. I have put on 10 pounds since Easter even though my appetite has decreased.
I'm currently awaiting a stool sample test (calprotectin??) and have another blood test on Friday to test for Coeliac Disease. There isn't a diagnosed history of Coeliac disease in my family but my brother has chosen to follow a gluten free diet to minimize bloating - I think this is why my GP has decided to investigate. My sister has been diagnosed with hypothyroid - I share alot of the symptoms that she has.
I asked one of the receptionists at the GP surgery for a print out of my blood test results - they are mostly gobbledy gook to me as I'm a Physics teacher. The thyroid results look fine to me TSH 1.33 miu/L [0.27 - 4.2} and Serum T4 13.5 pm/L [12.0 - 22.0] - no other thyroid related tests performed; Other results included red blood cell count 4.9 10*12/L [3.8 - 4.8]; Mean cell haem level 24.1 pg [27.0 - 34.0]; Red cell distribution width 17.0 [10.0 - 15.0]; Serum 25-Hydroxy Vit D3 27.6 nmol/L [25 - 50 = insufficient]; serum ferritin 6 ng/mL [13 - 150]. Everything else is well within the quoted normal ranges.
My periods are fairly normal. The GP has admitted he doesn't know what is wrong and has said that he would only do colonoscopies and endoscopies as a last resort.
Any ideas?? I would like to have adequate energy levels before I return to work at the start of term. Any advice would be much appreciated.
Written by
PhysicsTeacher
To view profiles and participate in discussions please or .
Serum T4 13.5 pm/L [12.0 - 22.0] is far too low when it should be towards the upper part of the range.
The T3 test is more informative.
If I were you I'd get a Full Thyroid Function Test from one of our labs, it has to be the earliest blood draw, fasting (you can drink water) and if taking thyroid hormones you'd allow a 24 hour gap between dose and test and take afterwards.
You need TSH, T4, T3, Free T4, Free T3 and thyroid antibodies tested. The frees are the most important and more informative. GPs usually only take TSH and T4 and if TSH is in range they state we're not hypo.
We have two private labs who will do all of the tests you need. They are home pin-prick tests so make sure you are well-hydrated a couple of days before blood draw.
Post your results on a new post for comments.
Medichecks have a special offer of some sort every Thursday and Blue Horizon is the other lab
Not surprising you feel terrible and doc is not helping you very much.The dosage for disasterously low Vit D is pathetic. You need loading doses to get you up to about 100. Your T4 is low in range and we really need to see your T3 result as it is T3 which the cells in the body need. Your iron is also terrible. You need to have Vit B12 tested too. Have a look at Seaside Susie's posts on here. She is very knowledgeable about Vitamins etc. Hope things improve for you but it will take a while!
It might be your very low ferritin and Vit D that are your problem, but the supplements your Gp has provided are very low doses to boost them up to optimum levels. Look up SeasideSusie's recent replies to posts on good supplementation- doses, brands etc. It might be worth getting two thyroid autoimmune antibody tests done( TPO and TgAb) too, to see if you have Hashimoto's where antibodies attack the thyroid gland mistakenly believing it is 'alien' , resulting in dead cells , complete with hormones , being dumped into blood stream periodically....thyroid hormones go up, TSH goes down when attacked in a 'flare', then return to 'normal'. A series of blood tests can appear to show the sufferer is hypo- thyroid one test, and hyper- the next, which rather confuses Gps. Most hypothyroid patients are Hashi too- is your sister? Your low T4 suggests your thyroid is struggling, but your TSH is low too...others might advise about that.
Autoimmune thyroid disease is possible. It often runs in families and gluten intolerance (not necessarily coeliac) is very common
Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results for B12 and folate when you have them, members can advise
Obviously your Vitamin D and ferritin are dire. Low vitamins can affect TSH making it lower than it should be
Vitamin D should probably be treated with higher dose - minimum of 1600iu per day according to guidelines. But you were only 2.5 points away from needing loading dose
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Ideally ask GP for coeliac blood test first and for both TPO and TG thyroid antibodies tested
Wow! Your replies are so informative. Thank you everyone. I have looked at the blood test results and it appears B12 wasn't tested or any other vitamins/minerals for that matter (apart from sodium, potassium, calcium and Vit D). I have started taking a slow-release Vitamin B complex from Holland and Barrett so hopefully I'll see some improvements soon. My next GP appointment is 17th Aug and I return to work on 28th Aug. I'll ask my sister for details for thyroid diagnosis. Thanks again.
Just checked with my sister. She doesn't have Hashimoto's - just what her GP describes as a sluggish thyroid or underactive thyroid. However, she does have fibromyalgia (as does another maternal cousin).....Not sure if this autoimmune condition has links???
You might want to think about a different brand when next buying supplements. H&B own brand are pretty naff, they tend to use the cheapest and wrong form of ingredients, eg. in the B Complex cyanobalamin instead of methylcobalamin, folic acid instead of methylfolate. They are full of unnecessary fillers and there are much better supplements available. Good B Complex brands are Thorne Basic B and Igennus Super B, they contain the bioavailable forms of the ingredients.
As for your Vit D, 500ug three times a week, that totals 60,000iu. Have you been given these for 5 weeks? Guidelines state that for Vit D deficiency loading doses should total 300,000iu over a number of weeks.
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L so you will need retesting and once you've reached this level 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 such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, (D3 four hours away from thyroid meds if taken).
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium 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 if taken)
serum ferritin 6 ng/mL [13 - 150] on 400mg of ferrous sulphate
With a ferritin level so far below range, you really should have been given an iron infusion which would bring your level up in 24-48 hours whereas tablets will take many months.
Is that 3 x ferrous sulphate tablets daily? That's the normal dose for iron deficiency anaemia, was that confirmed?
You should take each iron tablet with 1000mg Vit C to aid absorption and help prevent constipation. Iron tablets should be taken 2 hours away from any other supplements or medication as it interferes with their absorption (and 4 hours away from thyroid meds if taken).
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...
The GP has admitted he doesn't know what is wrong
I think it's pretty obvious that your dire Vit D and ferritin levels are what's wrong and I don't understand how a doctor can say that.
There's a possibility that you could be looking at Central Hypothyroidism here. It's not that common and many GPs wont know about it. Central Hypothyroidism is where the TSH can be low, normal or slightly elevated with a low FT4. It's caused by a problem with the pituitary (Secondary Hypothyroidism) or the hypothalamus (Tertiary Hypothyroidism) rather than the thyroid gland.
Some reading about Central Hypothyroidism so that you and your GP can consider it
bestpractice.bmj.com/topics... - you can read the Summary (Click on READ MORE to read all of it), your GP will be able to access the whole article.
This would need to be investigated by an endocrinologist who specialises in thyroid rather than diabetes which is what most endos specialise in. If you wish to pursue this and get a referral, then ensure that your GP seeks out a proper thyroid specialist who understands Central Hypothyroidism or you will be wasting your time.
I was given 24 x 500 mcg Vit-D3 capsules - the GP said it was a 2 month supply. Would you suggest taking more than 3 per week until I return to the GP in August? I take a total of 400mg of ferrous sulphate per day - one tablet in the morning and one at bedtime. I wasn't prescribed Vit C but I have increased my citrus fruit intake. Would you suggest increasing the ferrous sulphate dosage in addition to eating more liver?
I'm probably a little harsh on my GP. He knows that ferritin and Vit D are the likely culprits but he can't explain why my ferritin so low as my diet has plenty of iron in it. This is why he is investigating coeliac disease
I'm thinking of getting some independent thyroid testing done. Which Medicheck test would you suggest? I was thinking that Thyroid Check Plus looks quite thorough???
I was given 24 x 500 mcg Vit-D3 capsules - the GP said it was a 2 month supply. Would you suggest taking more than 3 per week until I return to the GP in August?
No. Your GP has been amazingly generous actually. Each 500mcg capsule = 20,000 x 24 = 480,000iu which is a lot more than the normal loading doses of 300,000iu. I would just take what he has given you then retest to see what your level is. Post your new level on here for suggestion of maintenance dose.
I take a total of 400mg of ferrous sulphate per day - one tablet in the morning and one at bedtime. I wasn't prescribed Vit C but I have increased my citrus fruit intake. Would you suggest increasing the ferrous sulphate dosage in addition to eating more liver?
The Patient Information Leaflet (PIL) says that Vit C increases the absorption of iron but you wont get it prescribed and it's patient experience that suggests taking each iron tablet with 1000mg Vit C, this will help with any constipation problem caused by the iron as well as aiding absorption. There may not be enough Vit C in fruit. Check the PIL where it says Ferrous Sulfate tablets with food and drink so that you don't eat or drink anything within the time limits that affects it's absorption.
I can't suggest you increase what has been prescribed. Iron is a complicated thing, and if you have been diagnosed with iron deficiency anaemia - typically low MCV with low ferritin confirms this and your " Mean cell haem level 24.1 pg [27.0 - 34.0]; Red cell distribution width 17.0 [10.0 - 15.0]" may possibly confirm it - then treatment is 3 x iron tablets daily with a total elemental iron amount of around 195mg. 2 x ferrous sulphate gives 130mg elemental iron.
I would eat liver anyway, it contains lots of valuable vitamins and minerals that can only help.
I'm thinking of getting some independent thyroid testing done. Which Medicheck test would you suggest? I was thinking that Thyroid Check Plus looks quite thorough???
I can't see that you've had B12 and Folate tested. If not then I would go for the Thyroid Check UltraVit. It's repeating your ferritin and Vit D, but it's the cheapest way to get everything done if you order before the 3nd of July as at the moment it has £20 off at £79
Don't supplement B12 until tested, as this will skew any results and make it virtually impossible to get the correct treatment with injections if you are found to have an absorption problem.
PA/B12 def. is very common and often coexists with thyroid problems and other autoimmune conditions and runs in families. Digestive disorders, e.g. Crohns, coeliac, H/Pylori, low stomach acid, etc. can all make it difficult to absorb B12, the vitamin with the most complex pathway.
SeasideSusie's advice is excellent. I totally agree that having some liver should help as it is a 'haem' source of iron and more readily bioavailable than the iron in your tablets. I expect it may be tempting to drink tea/coffee when you're so tired, but please try to avoid drinking these (especially tea) near iron as it will impair it's absorption.
Also, wrt. Vit C it's cheaper and more efficient to buy in powdered form as straight ascorbic acid and to take with water and your iron tablets. Low stomach acid (common in hypothyroidism) is a possible reason behind your iron absorption issues and vit C will help if you have it with meals as well.
Thank you! I have ordered the ThyroidCheck UltraVit that Seaside Susie suggested but I need to wait a week before the sample can be taken - my B vitamins contain B12 which could skew the results. I quite like liver so I'll definitely stick more of that in my diet. Thanks for the advice on ascorbic acid.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Feel rubbish, all blood results "normal"
blood test results 
Blood test results advice
Results help please
Underactive Thyroid and IVF- Blood results-advice needed please.
