Guidance appreciated

[febstar]

Hello all,

I was diagnosed with hypothyroidism last year after feeling unwell for maybe two years previously. I take 75 mcg of levothyroxine daily, and my TSH has come down significantly. However, brain fog and peripheral neuropathy is still an issue for me. My vitamin D is slightly below normal, and my B12 is low, which my doctor will now be giving me injections for.

I read elsewhere on here about other things to try and proactively address, and my questiona are, going forward with a condition I need to manage is:

1. Can anyone recommend a good multivitamin or supplement to keep me within the range I should be for other vitamins?

2. Any other advice going forward on how to be proactive about keeping myself as well as I can be?

Many thanks in advance.

[SeasideSusie Remembering]

febstar

1) There is no good multivitamin. They all contain too little of anything to be of help, often they contain the wrong form and least absorbable of active ingredients, and if they contain the following the all should be tested and only supplemented if found to be deficient:

calcium

iodine (kelp)

iron

Also, including iron in a multivitamin means that absorption of everything else will be affected. Iron needs to be taken at least 2 hours away from other supplements and medication (some need longer).

my B12 is low, which my doctor will now be giving me injections for

After you've started the B12 injections, take a good B Complex to balance all the B Vitamins, one that contains methylfolate not folic acid. Good ones are Thorne Basic B and Igennus Super B.

My vitamin D is slightly below normal

What is your level and is your GP doing anything about it?

Have you also had folate and ferritin tested? Often when one of the important nutrients are low, we find that the others are too.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well. Doctors often only test TSH, but that's not a thyroid hormone (it's a signal from the pituitary that tells the thyroid to produce hormone when it detects there's not enough). The thyroid hormones are FT4 and FT3, some doctors also test FT4 but FT3 isn't normally tested, which is a shame because that's the most important result. Many of us here do our own private tests when we want to know where FT3 is in relation to FT4.

Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, for an hour either side as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

When booking 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 a diagnosis, 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 and coffee also affects TSH. 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.

Have you ever had thyroid antibodies tested - do you have Hashimoto's (autoimmune thyroid disease confirmed by raised antibodies)?

Do you have your latest test results? If you post them, with their reference ranges, we can see if you are optimally medicated. As you still have brain fog, you could be undermedicated. If you don't have them, just pop along to your surgery's reception and ask for a print out. Always get a print out, don't accept hand written or verbal results as mistakes can be made. In the UK we are legally entitled to our results. It's a good idea to keep a note - either on a spreadsheet or in a book - and record

Date

Test

Result

Reference range

Dose of Levo

Notes on how you feel

This will come in useful if you don't feel well on a particular dose if you have it changed, you can refer back to how you were on a previous dose.