Help with Levels??: QUESTION: I have uploaded... - Thyroid UK

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Help with Levels??

Minimouse1 profile image
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QUESTION: I have uploaded another photo showing recommendations for increasing my Vit D levels. Should I take the loading dose or slower route - 3m!! Are there issues with doing this faster with the loading dose?? Also how do I know if my magnesium level is low - I wasn't tested for that and how much magnesium do I need to take for the increase in Vit D?

Not been feeling great lately. Tired, feeling dizzy, aggravated, constipated, blurred vision, brain fog/memory probs. Can anyone decipher my results I just got this week - all apparently normal! Please see photo.

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Minimouse1
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SlowDragon profile image
SlowDragonAdministrator

Looking at previous posts you have Hashimoto’s

How much levothyroxine are you currently taking

Do you always get same brand of levothyroxine

What vitamin supplements are you currently taking

And as you have Hashimoto’s are you on strictly gluten free diet

Ft4 is 92% through range

But Ft3 is only 23% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So very poor conversion

Vitamin levels are very low

Improving low vitamin levels can help improve conversion of Ft4 to Ft3, resulting in lower Ft4 and higher Ft3

Minimouse1 profile image
Minimouse1 in reply toSlowDragon

PS - yes I am on a gluten free diet.

SlowDragon profile image
SlowDragonAdministrator in reply toMinimouse1

Great, have you found it helpful?

Minimouse1 profile image
Minimouse1 in reply toSlowDragon

Hi SlowDragon, I haven't really noticed any difference going Gluten free & I've been doing it over a year but I started it around same time as levo & began to feel better but I just thought it was the Levo working. All your information is very helpful. It's a lot of info to get my head around particularly with all the tiredness & brain fog. I will have to work through each bit separately. All of my tests at the GP are indicated satisfactory no further action - even the Vit D. Couldn't understand why I've been feeling so low!!

SlowDragon profile image
SlowDragonAdministrator in reply toMinimouse1

You can see from NHS guidelines that GP should have prescribed vitamin D

ouh.nhs.uk/osteoporosis/use...

ncbi.nlm.nih.gov/pubmed/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

endocrine-abstracts.org/ea/...

Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.

SlowDragon profile image
SlowDragonAdministrator

Low vitamin D obviously needs improving and GP should prescribe 1600iu everyday for 6 months

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

With your Vit D, are you also taking it's important cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

SlowDragon profile image
SlowDragonAdministrator

Low B12 and folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With such low B12 result taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/vitamins/vit...

You also need to get ferritin tested

Minimouse1 profile image
Minimouse1 in reply toSlowDragon

Hi SlowDragon I haven't been taking any vitamins or supplements as I felt ok until a few month ago. My GP did not check my ferritin levels I'm afraid. I currently take 125mg of Levo & have been on this dose for a year. Unfortunately I have been getting different brands from the chemist.

SlowDragon profile image
SlowDragonAdministrator in reply toMinimouse1

Decide which brand of levothyroxine suits you best and insist on always getting that brand

Suggest you only add one supplement at a time

Waiting at least 2 weeks to assess any changes before adding another

Starting with vitamin D

6-8 weeks after adding last vitamin supplement

Get FULL thyroid and vitamin retesting done privately including ferritin

Remember to stop taking vitamin B complex a week before ALL BLOOD TESTS

All thyroid tests should be done as early as possible in morning

List of private testing options

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

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

SlowDragon profile image
SlowDragonAdministrator in reply toMinimouse1

Unfortunately I have been getting different brands from the chemist.

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Are you currently taking Teva?

Teva, Aristo and Glenmark are the only lactose free tablets

dropbox.com/s/6h3h0qi4eqwi6...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

jgelliss profile image
jgelliss

What are your FT 3 FT 4 levels? Some hyper/hypo symptoms can over lap. And your symptoms sound just like that.

Minimouse1 profile image
Minimouse1 in reply tojgelliss

There is a photo on my post with my results. TSH 0.69, T3 4.2, T4 18.2 - been advised this may indicate possible poor conversation by slowdragon

SlowDragon profile image
SlowDragonAdministrator

Suggest you put back original photo on here with results

What was most recent vitamin D result?

Suggest you just supplement at daily dose.

Only GP can prescribe a high loading dose

Minimouse1 profile image
Minimouse1 in reply toSlowDragon

It was 31.7nmol - defo needs raising. Used a calculator recommended by you. Just got confused about daily dose or loading dose.

SlowDragon profile image
SlowDragonAdministrator in reply toMinimouse1

suggest you try 5000iu a day and retest in 2-3 months

Then reduce to maintenance dose

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