I am a 60 year old male. Diagnosed hyperthyroid in 2014. Had radio iodine treatment which made me hypothyroid. Symptoms not severe but suffer fatigue and tendon/muscle pain. Prescribed levothyroxine which took my TSH to 4.4. Persuaded GP to increase dose last year to 125 mcg per day. Reduced TSH to 2.5. Still have symptoms of fatigue and tendonitis in both Achilles and elbows. Latest results are:
TSH 2.5 mu/l (range 0.35-5.5) - same as last year
FT4 20 pmol/l (9-23)
FT3 5.0 pmol/l (3.5-6.5)
Vit D serum total 25-OH vit D level 26 nmol/L (no range given)
Should I be asking for an increase in Levo to get TSH down or leave it at current level?
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Xenephon
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Your TSH is high for a treated hypo patient. Generally, most feel best when TSH is 1 or below with FT4 and FT3 in the upper part of their ranges if that is where you feel. There is room for an increase in your dose of Levo.
However, your Vit D level is dire. A level of 26nmol/L is deficient and your GP should prescribe loading doses - see 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)."
Ask your GP to prescribe loading doses. If your GP wont then come back and I will work out what you need based on your current Vit D level when tested.
Once you've reached the level recommended by the Vit D Council - which is 125nmol/L (50ng/ml)
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
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.
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
Doc has increased my levo to 150 mcg and prescribed D3 20000 iu twice a week for six weeks. She hasn't prescribed K2 to go with it as that is not in the guidelines. Is this going to be a problem for me? Should I self supplement with K2?
That is the cheapest at the moment, and the 180 size is much better value than the 60 size.
Don't forget you need to retest your Vit D level after the loading doses so that you can work out what your maintenance dose should be. If GP wont retest (and many wont) then you can get a home fingerprick bloodspot test from City Assays vitamindtest.org.uk/
Come back with your new level and I will let you know what you need, you will have to buy your own once you reach a certain level as they don't tend to prescribe more than 800iu and that's if you're lucky.
Doc has booked for retesting vitamin D in six weeks. I will look in to the other supplements. Doc is always willing to learn when u take her in articles etc but it is depressing how little they know about thyroid related issues given how common thyroid problems are!
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