Hello, I am a 53 year old female. My trips to the GP began originally due to multiple tendon, muscle and joint soreness, stiffness, exhaustion etc. Blood tests and Xrays ruled out inflammatory causes. I jog, muck out and ride my horse, cycle, walk dogs and have a physical job but have been finding it tougher and tougher to keep going and have continued to gain weight as well. I had viral pneumonia in the New Year and have now been suffering from regular (2-3 times a week) headaches that last all day and are rarely helped by any sort of painkillers. I am full of fluid and my face is so puffed up!
I had blood tests done in October 2018 and then again on 14/05/19. These are the main results;
Oct 18
TSH 1.68 miu/L (0.27 - 4.20)
Free T4 12 pmol/L (12.0-22.0)
Vit D 60 nmol/L (50-75 adequate)
May 19
TSH 1.15 miu/L(0.27-4.20)
Free T4 10.9 (12.0-22.0)
Vit D 29.2 (25-50 insufficient)
I was a nurse practitioner for 10 years before leaving the NHS to work with my husband so I have a generally good understanding of the workings of the Thyroid/ pituitary/ hypothalamus but have read so much now about how complicated the results are to interpret! I’m currently wondering about central/secondary hypothyroidism. My doctor has asked for another TSH and T4 in 2 months and told me to take Vit D.
Thanks😃
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Pashanut
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That certainly looks like Central hypo (Secondary is a problem with the pituitary, Tertiary is a problem with the hypothalamus, when you don't know which it is, it's called Central ).
I cannot see the point of your doctor leaving it another two months before doing anything, because in the FT4 has now dropped well below range - how bad does he want it to get? He should refer you to an endo now, so that the endo can test FT3 and do other pituitary testing. I can understand you must feel absolutely dreadful!
Another one who agrees. October 18 and your FT4 is bottom of the range, May 19 and your FT4 is below range. And he wants you to wait another 2 months! Disgraceful and cruel. Your results scream Central Hypo. I'd see a different GP, get sorted and make a complaint about this one.
Vit D 29.2
told me to take Vit D.
Did he say how much? If your result was 25 you'd be prescribed loading doses. If I were you I'd follow the NICE treatment summary for Vit D deficiency: cks.nice.org.uk/vitamin-d-d...
"Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 25 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 maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU 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 regimens 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)."
I'd go for the 50,000iu weekly for 6 weeks, and I'd spread it out daily.
Retest when you've finished the loading doses, this is essential so that you know what dose to continue with.
The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).
When you've reached the recommended level then you'll need a maintenance dose to keep it there, 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 an NHS lab which offers this test to the general public:
Your GP won't know, because they're not taught much about nutrients, 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 taking tablets/capsules/softgels, no necessity if using an oral spray
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 taking tablets/capsules, no necessity if using topical forms of magnesium.
Check out the other cofactors too (some of which can be obtained from food).
Don't start all supplements at the same time. Start with one, leave it 1-2 weeks and if no adverse reaction then add the second one. Continue like this. If you have any reaction then you will know what caused it.
Did you also have ferritin, B12 and folate tested?
I'm really interested in how you got on after your latest results. My most recent Endocrinologist now suspects that I may have Tertiary (Hypothalamus) HPT axis Hypothyroidism and I'm not sure what the treatment options might be. It's been a long journey for me already to get here after over 15 years of consultations with a range of different specialists. I'd be very grateful for any insights you may have after your diagnosis and treatment. Many thanks in advance. Kind regards and very best wishes.
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