Multi-Vitamins/Supplements

[LFP_]

Evening Everyone,

I was diagnosed with mild hypothyroidism recently and started on 25mcg of Levo.

My question is, can anyone recommend if there are any multivitamins/supplements that can benefit patients suffering with hypothyroidism.

Many thanks in advance.😊

[SeasideSusie Remembering]

LFP_

Multivitamins aren't recommended. They contain too little of anything to help raise low levels or deficiencies, they tend to use the cheapest and least absorbable form of active ingredients, and they usually include things we should be tested for first and only supplemented if found to be deficient, eg iron, calcium, iodine.

We always advise testing and then supplement where necessary at the appropriate dose, we can make suggestions if you post results with their reference ranges plus units of measure for Vit D and B12. Core nutrient tests are

Vit D

B12

Folate

Ferritin

[LFP_ in reply to SeasideSusie]

Hi Susie,

Thanks so much for the speedy reply. I have my results from 2 months ago and my most recent ones from last week.

My symptoms are:

Tiredness

Tearful (the whole world situation isn’t helping)

Dry skin (especially my face and legs)

⬆️Weight

Inflamed oesophagus/sore throat for months (cancer ruled out)

Easily strain muscles

Bleeding in between periods (cancer ruled out)

Having bouts of swollen lymph nodes

Vit D 62 nmol/l (⬆️70 now)

B12 489 ng/L

Folate 15 ug/L

Ferritin 12 ug/L

TSH 6 mlU/L(⬇️4.3)

FT4 12 pmol/L (⬆️14)

Calcium 2.1 mmol/L (being re tested next week)

I’d be really interested in your opinion. Thanks again so much.

[SeasideSusie Remembering in reply to LFP_]

Reference ranges please to be able to interpret them, ranges vary from lab to lab.

[LFP_ in reply to SeasideSusie]

Unfortunately I don’t have them. I was given them over the phone.

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after each dose increase

Roughly how old are you?

What were thyroid results BEFORE starting on levothyroxine?

As said in Previous post

Standard starter dose of levothyroxine is 50mcg

healthunlocked.com/thyroidu....

GP should test vitamin D, folate, B12 and ferritin

[LFP_ in reply to SlowDragon]

Hi Slowdragon,

Thanks for replying,

I’m 46, with the mind of a 25yr old. That’s why this is all so frustrating because I’ve always been so active and now I feel so dreadful.

I put my results above on the reply to Susie.

I’d also be interested in your opinion.

I take a multi vitamin for women, 2 sprays of sublingual Vit D every morning.

Many thanks

[SlowDragon Administrator in reply to LFP_]

Vit D 62 nmol/l (⬆️70 now)

B12 489 ng/L

Folate 15 ug/L

Ferritin 12 ug/L

TSH 6 mlU/L(⬇️4.3)

FT4 12 pmol/L (⬆️14)

Calcium 2.1 mmol/L (being re tested next week)

Please add ranges on these results

Clearly TSH is too HIGH and you need next 25mcg dose increase in levothyroxine up to 50mcg

Bloods should be retested 6-8 week later

Unless very petite you are likely to need at least 100mcg daily

Have you had TPO and TG thyroid antibodies tested?

If not they need testing

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Vitamins

We never recommend taking multivitamins. Too little and often cheap least absorbable ingredients

Ferritin is extremely low

GP should be doing full iron panel test for anaemia. Likely to need iron supplements

Heavy periods are classic sign of being hypothyroid and will often lead to low iron and ferritin ask for full iron panel testing for Anaemia

Never supplement iron without doing full iron panel test for anaemia first

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

[LFP_ in reply to SlowDragon]

Thank you so much slowdragon.😊 Im going to get the ranges from the local hospital lab where they were tested & repost my results later. Your help is much appreciated.

[penny]

Unless you have contra-indications 25mcg is too low a starter dose, it should be 50mcg. (I learnt this on here.)

[LFP_ in reply to penny]

Hi Penny,

Thanks for your reply, I know it’s a very little amount. I just wanted to see first if I had any Vitamin/ mineral deficiencies first before I had to up the dosage.

[penny in reply to LFP_]

The problem with starting on such a low dose is that it is not a sufficient replacement dose so your thyroid stops producing a certain amount of thyroxine but the dose doesn’t take up the slack; hence you are almost in a worse position than before.

[SlowDragon Administrator]

As penny explained ....levothyroxine doesn’t “top up” failing thyroid it replaces it

our thyroid controls our metabolism

As an example....if, when perfectly healthy, your own thyroid made the equivalent of 125mcg levothyroxine....and this metabolism is controlled by pituitary sending messages - TSH (Thyroid stimulating hormone)

Then as your thyroid starts to fail (usually due to autoimmune thyroid disease) ....you might get diagnosed when your thyroid has reduced output to roughly equivalent of 75mcg levothyroxine

Pituitary has noticed there’s a drop in thyroid hormones in the blood....(that’s Ft4 and, most importantly, the active hormone Ft3) ....so to try to make more thyroid hormone ...pituitary sends out stronger message to thyroid - TSH rises up

When GP starts you on 50mcg ....initially you feel a bit better ....as you have 75mcg from your own thyroid and 50mcg levothyroxine

But (here’s the bit some GP’s don’t understand)....levothyroxine doesn’t “top up” your own thyroid output.....well it does very briefly....but the pituitary very soon “sees” the levothyroxine in the blood....and TSH starts to drop

So at the end of week 6 ....TSH has dropped a lot. Your thyroid takes a rest ....has a holiday

So at this point you are now only mainly using the 50mcg levothyroxine....which is actually a dose reduction down from managing on 75mcg from your own thyroid before you started on levothyroxine

So you start to feel worse .....and are ready for next 25mcg dose increase in levothyroxine

Modern thinking ....and New NICE guidelines suggests it might actually be better to start on higher dose .....but many medics just don’t read guidelines ....and many patients can’t tolerate starting on more than 50mcg and need to increase slowly.

Starting on 50mcg and stepping dose up in 25mcg steps, retesting 6-8 weeks after each increase. But we still very often need to increase up to around a full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Aim is to bring TSH down under 2.5 as absolute maximum.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...