Vitamins Advice Please

[Lassithi]

Hello,

Hashimotos diagnosed July 2019 and commenced Levothyroxine. Dose in Dec 2019 100 mcg and routine bloods at that time were all in normal range except T3 which remained unchanged and at lower end of range.

Levo inreased to 125 mcg March 2020 with repeat bloods in July which showed increased liver enzymes, NAFLD , elevated cholesterol and BP and insulin resistance. Obviously very concerned to hear of this rapid deterioration when all had been normal 4 months previous.

Reduced back to 100 mcg following hyper symptoms and commenced blood pressure medication which has stabilised BP. Since commencing levo in July 2019 T3 has not increased beyond slightly over 3 and just at bottom of range-in fact no real difference before or after commencing levo.

Was supplementing with vitamins although advised to stop pre hysterectomy which I had 4 weeks ago. Bloods at that time also showing insulin resistance and pre diabetes.

All new symptoms tests between March 20 and October 20.

Now wishing to recommence vitamins and have recently had levels checked (unfortunately T3 and Ferritin were not deemed necessary by endo). Recent results were done in hospital at midday when I had already taken my morning dose.

TSH: 1.51 ( 0.35-5.00) (has been 2-3 since July 20 had been below 1 previous£

T4: 22.9 (11.00-23.00) (has been between 18 and 19 previous)

B12: 732 (200-900) ( previous in the 600’s)

Folate: 5 (3.9-19.8) (previous 11)

Vit D: 66 (50-150) (previous similar)

I have Vit D spray 3000 at 1000 per spray although looking for advice re appropriate levels for supplements for all required vitamins please. I have recently commenced berberine as this has previously reduced blood sugars and cholesterol naturally.

My endo appt has been cancelled again due to Covid and I have a private appointment booked for three weeks time although would prefer to commence vitamins asap.

Thank you 😊

[SlowDragon Administrator]

vitamin D too low

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...

NHS Guidelines on dose vitamin D required

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

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

amazon.co.uk/BetterYou-Dlux...

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 Vit D, taking 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 Administrator]

Low 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

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)

amazon.co.uk/Super-B-Comple...

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...

[SlowDragon Administrator]

As you have Hashimoto’s are you on strictly gluten free diet?

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

Hysterectomy is likely to change thyroid levels

High cholesterol is linked to low ft3

[Lassithi in reply to SlowDragon]

Thank you Slow Dragon...., I will read up on everything and make sure I start cautiously and will also discuss with private endo later on this month...., I have also subscribed for private bloods and will get full panel done prior.

I have gone gluten free and been so for some time and it has made some difference but still not quite there yet with results..., yes hysterectomy hormones are still settling although vitamins seem low still..., surgeon advised Vit D and I have the brand you advise with K vitamin also. The gynae surgeon seemed to know more about Hashimotos than the endo and gave me some sound advice too!,

Thanks again 👍

[SlowDragon Administrator in reply to Lassithi]

Often seems common that other specialists know more about recent research than endo about importance of vitamin levels, food intolerances and thyroid levels

[Lassithi]

Absolutely...., so nice when you speak to someone who is informed...,

Thanks 😊

[HashiFedUp]

Maybe a small starter dose of T3 would help. Will the endo prescribe it? I would tell anyone with hashimoto’s or similar to take a vit D supplement esp with Covid! But it needs to be the converted version and not an off the shelf version.

Why can’t your endo call you?! Rather than you going into hospital. Why are they cancelling your appointment ?!! Sounds like as excuse.

If they manage your thyroid better then your cholesterol should come down naturally. Thyroid patients will have raised cholesterol- its a direct result of badly managed or non-managed thyroid disorders. What other advice are you getting around managing your pre-diabetes? pre Diabetes is reversible with lifestyle changes.

[Lassithi in reply to HashiFedUp]

Hello,

Thank you for your help...., I agree cholesterol is related to thyroid not being under control and have had limited support from the endo team to date. I was originally referred 12 months ago and still haven’t received an active treatment plan.

First appt Feb 20 cancelled without reason given and second appt in March ( since found out with a diabetes specialist) on day of lockdown and by telephone who said nothing wrong with thyroid as TSH fine and then tested me for something totally unrelated and again said nothing wrong with thyroid or T3 levels and discharged me.

Assigned another endo following complaint to. Pals and saw in person in July..., took bloods and diagnosed NAFLD and high cholesterol although missed the diabetes diagnosis which was picked up by GP several weeks later following further unrelated bloods.

Follow up appt with Endo planned for four months later although have since been allocated a further endo who didn’t even request follow up bloods (secretary did follow up when I chased although didn’t think T3 necessary).

In fairness, I have since found out that today’s appt is cancelled because the new endo himself is off due to having contracted Covid.

I have a private appt booked in three weeks time as I have no confidence at all in this team although I will be sending my bill to the NHS via Pals.

In the interim I am hoping to start on Vit D and Folate to hopefully give me a better chance of conversion.

Via my GP practice I have spoken with diabetes nurse and levels have recently slightly reduced so we are monitoring as currently now down to borderline and I am trying to reduce with diet and berberine currently.

Thank you for taking the time to respond.., I am hoping that the private endo will prescribe small dose of T3 and that getting my vitamin levels right will also help and that other issues will then begin to improve as still shocked at how quickly everything has deteriorated.

Feel a lot better after hysterectomy though which no doubt was also contributing to ill health and hormone imbalances. I had multiple fibroid tumours removed weighing approximately 6 kg, the smallest of which was the size of a melon. My blood pressure has reduced significantly since the operation and although still early days I do feel better than before the operation.

Thank you 🙏

[SlowDragon Administrator in reply to Lassithi]

Low carb diet may help HBa1C levels and NAFLD

dietdoctor.com/groundbreaki...

The liver metabolism changed almost immediately. Instead of creating fat, it started burning it and already in the first day you could see a significant reduction in liver fat. As a great side effect, the participants also improved their cholesterol profiles.

The microbiome also changed. A surprising discovery was that it started producing more folic acid, a vitamin which is important in the liver’s metabolism. Low levels of folic acid has earlier been associated with an increased risk of fatty liver.

Interesting that low folate may be linked to NAFLD

[Lassithi in reply to SlowDragon]

Interesting article thank you...., yes I am on a low carb, nil alcohol and gluten free diet and my ALT levels have significantly reduced and Hba1c also slowly reducing although GGT is still elevated although may have been affected recently by the post operative pain killers (paracetamol) ...., the vitamins you have highlighted are on their way from Amazon so hopefully optimising Vit D (K) and B will also help.

Thank you

[Lassithi in reply to SlowDragon]

Hello,

Can I please check the timings in terms of taking vitamin supplements after thyroid meds.

Generally I take T4 at 6am, is it then okay to take B Complex, Vit C, Berberine and Vit D2 (combined with K2 spray) two hours later (I know the spray doesn’t matter in terms of gut digestion although trying to make it easier to take in two rounds of possible).

Am I right to assume that if taking the super B complex that I no longer need the Vit B12 separate supplement.

Thank you 🙏

[SlowDragon Administrator in reply to Lassithi]

Personally I prefer to take levothyroxine at bedtime....I find it more effective and can morning cup of tea and have milk at breakfast without worrying it’s too close to levothyroxine

Yes vitamin B complex after breakfast. And as your B12 is good you can drop separate B12

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 (including calcium rich foods) 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

[Lassithi in reply to SlowDragon]

Thank you for your time-much appreciated 👍

[satindoll77054]

My Rheumatologist put me on Atorvastatin, Levothyroxine. and an array of vitamins. B1, B6. B12. D3. and he included a Celiac diet that includes green veges. pork. and green beans, no bread. Do not eat pork n beans from a can. They are loaded with sugar. Sometimes, I cheat. I am 72 and I'm almost dead, anyway. Be smart, don't go off you Celiac diet plan. Do what you are supposed to do and you'll be alright.

[Lassithi in reply to satindoll77054]

Thank you....., , I hope you are not ‘almost dead anyway’..., 72 is the new 42 don’t you know...., thank you for your advice and wisdom...., much appreciated 🙏