25-50 nmol/L : Vit D insufficiency,consider replacement
I have completed a 6 week course of Vit D and am due to have repeat bloods, I am finding it hard to lose weight and wonder if I have an underactive thyroid, my Dr was not concerned with my thyroid results, just wants to repeat in a few months.
Will improving my Vit D levels improve my thyroid?
Thanks in advance.
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JoJoH69
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wonder if I have an underactive thyroid, my Dr was not concerned with my thyroid results, just wants to repeat in a few months.
You have an over range TSH with a barely in range FT4. If this is your first test with a raised TSH then it's normal to repeat the test in 2-3 months because TSH can be raised due to non-thyroidal illness.
vitamin D level 31.0 nmol/L
Will improving my Vit D levels improve my thyroid?
I don't think it will. Your level is extremely low, is your GP prescribing D3 for you?
As your Vit D is so low, I'd test B12, folate and ferritin as well. And if you can get thyroid antibodies tested as well that would be even better.
do you suggest I ask for treatment rather than repeat yet again?
A wide range of chronic or acute non-thyroidal conditions, starvation, and trauma can lead to abnormalities in thyroid test results. Providing that this doesn't apply to you then I would ask for treatment to be started based on these new results.
TSH level 5.8 mu/L [0.27 - 4.2]
free T4 level 11.5 pmol/L [12.0 - 22.0]
Your TSH is over range and FT4 is below range.
Your thyroid antibody levels are low so don't suggest autoimmune thyroid disease (Hashimoto's).
Was Vit D retested?
What about the other nutrient tests mentioned before?
Serum total 25-hydroxy vitamin D level (Xabo0) 78.2 nmol/L
When your level was 31nmol/L you were just 1 point away from the old level for deficiency (<30), they've moved the goalpost now and it's <25. However, because it was so low, you really need to continue supplementing. You've not yet reached the level recommended by the Vit D Council and the Vit D Society - 125nmol/L and 100-150nmol/L respectively.
To reach that level from your current level of 78.2nmol/L (31.28ng/ml), the Vit D Council suggests supplementing with 2,500iu D3 daily.
Retest in 3 months.
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.
This is low. According to 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."
pg/ml is the same as ng/L.
Serum B12 measures the total amount of B12. Active B12 is the better test as it measures what is available for the cells to use. The NHS doesn't do Active B12 normally but Medichecks to a fingerprick test for £39.
Do you have any symptoms of B12 deficiency, check here:
This is low, recommended is at least half way through range (11.5+ with that range).
If you don't have any signs of B12 deficiency from that list, you could supplement with a good B Complex containing methylfolate and methylcobalamin which should raise both folate and B12 levels. Good brands which contain the bioactive forms of ingredients are Thorne Basic B and Igennus Super B. Avoid cheap supplements from the high street, H&B, supermarkets, and any that contain folic acid and cyanocobalamin. The brands mentioned are tried and trusted and well recommended.
If you do have signs of B12 deficiency then list them to discuss with your GP and ask for testing for B12 deficiency/pernicious anaemia. In this case don't start the B Complex until further testing of B12 has been carried out and B12 injections/supplementation has started.
Ferritin - a good level for females is said to be 100-130, and a minimum of 70 for thyroid hormone to work properly. You don't really have a problem with ferritin so there's nothing to worry about there.
I've just realised I do have a diff B12 result too, an active one? (sorry they are listed in various different places on the Drs site); My dad suffered from anaemia for years.
Vitamin B12 - Active 51.300 pmol/L (Range: 37.5 - 188)
Reference range: >70*; * between 25-70 referred for MMA
Check the signs/symptoms of B12 deficiency linked to and ask GP for further testing. If your father had Pernicious Anaemia then mention the family history to your GP.
I just had my chat with the Dr, she was happy to do nothing but when I said I was having symptoms she has prescribed Levothyroxine sodium 25 microgram tablets for 6 weeks then to be re-tested (she did say I might end up staying on a 25mg dose?!)
She could have given you a starter dose of 50mcg but I suppose you're lucky to get anything by GP standards. You may feel worse with just 25mcg, but stick with it, retest in 6 weeks and hopefully you may get an increase in dose then.
But you absolutely must addresss those nutrient deficiencies.
You can increase the Vit D as already suggested, but look back at what I said about B12. Did you check for any signs of B12 deficiency? Do you have any? Did you show your GP the information from Viapath at St Thomas' Hospital and say because your Active B12 is below 70 they say you should be tested for B12 deficiency?
I think I might have a few Vit B12 symptoms but some are similar to my thyroid symptoms, the Dr wasn't interested.
I have Vit D3 ready to take and am looking at all the supplements you have suggested:
horne Basic B or Igennus Super B
Vitamin K2 MK7 Tablets
Magnesium
Do I also need (As seen suggested):
Betaine HCL
Nutri Adrenal Extra
I currently take omeprazole but I understand this doesn't go well with Levo? The Dr didn't mention about my heard condition either (SVT, supra ventricular tachycardia) and I forgot to mention it too. Will it be ok? Thank you.
I think I might have a few Vit B12 symptoms but some are similar to my thyroid symptoms, the Dr wasn't interested.
You have all the information, it's up to you what you do with it and whether you pursue what could possibly be B12 deiciency.
Do I also need (As seen suggested): Betaine HCL
Nutri Adrenal Extra
You would only need Betaine if you have low stomach acid, and you'd only need Nutri Adrenal Extra if you've done a cortisol/DHEA adrenal saliva test and it suggests you need it.
I currently take omeprazole but I understand this doesn't go well with Levo?
Omeprazole is prescribed for acid reflux and high stomach acid problems. Sometimes low stomach acid gives similar symptoms but doctors don't seem understand about low stomach acid. You may or may not be taking Omeprazole needlessly and it may or may not make things worse. From what I understand it's not necessarily a good thing to take but it's not something I've not looked into.
The Dr didn't mention about my heard condition either (SVT, supra ventricular tachycardia) and I forgot to mention it too. Will it be ok?
You need an increase in your dose of Levo, another 25mcg and retest in 6-8 weeks.
Your GP is satisfied because your TSH is within range but that's not enough. TSH is useful for diagnosis, once on thyroid hormone replacement then it's not TSH but the thyroid hormone levels that are important - FT4 and FT3. Your FT3 is very low in range at 13.3 (12-22) - only 13% through it's range.
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 reference ranges, if that is where you feel well.
As your GP for an increase, and to support this request use the following information:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
You can also refer to NHS Leeds Teaching Hospitals who say
Thank you, I am still taking all the supplements too, I am not sure they will increase anymore as didn't want to increase to 50mg but I will see what they say, thanks again.
How do you feel? If you are still symptomatic (which I imagine you probably are with FT4 barely scraping into range and a low FT3) then use the information given in previous reply to support requesting an increase in your dose of Levo.
Make sure that if you are quoting doses of Levo that you use the correct amount. Levo comes in mcg (micrograms) not mg (milligrams - there are 1000mcg in 1mg). So you will be requesting an increase of 25mcg from 50 to 75mcg.
Hi, not much difference if I am honest but then I have had a GI bleed and am now on omeprazole (take it in the before evening meal), my ferritin is low, they didn't do folate this time:
Ferritin [10 - 307]93 in April now 23
I will start all my vitamins again, still not lost any weight.
Would struggle to get an increase in Levo from my Dr, would dessicated thyroid help?
Your ferritin is dire but that could possibly be due to your GI bleed. Eat liver, that should raise your ferritin, lots of goodness in liver. No more than 200g per week though due to it's high Vit A content. Other iron rich foods include liver pate, black pudding and some listed here apjcn.nhri.org.tw/server/in...
would dessicated thyroid help
NDT contains T4 and T3. You already have very good conversion of T4 to T3 which is indicated by a higher percentage result for FT3 compared to FT4 so you don't need to take T3 in any form. If you took NDT it would very likely lower your FT4 and your FT3 would increase (the T3 in NDT would cause this).
You need to optimise all you nutrients, aim for these levels:
Vit D - 100-150nmol/L
B12 - top of range for serum B12, at least over 70 (preferably higher) for Active B12
Folate - at least half way through range
Ferritin - half way through range
Once you get nutrients optimal you go onto a maintenance dose to keep them there, yo don't stop taking the supplements.
To make sure nothing affects absorption of Levo:
Are you taking your omeprazole well away from your Levo, as far as possible?
Iron, Vit D, magnesium all need to be 4 hours away from Levo.
Any other supplements and medication should be at least 2 hours away from Levo.
Are you taking your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, and water only for one hour each side?
TSH is high and FT4 low plus you are vitamin D deficient.....yes suggests you may be hypothyroid
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
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