I am a 36 yr old male with an underactive thyroid, currently taking 125/150mg levothyroxine (alternating 125/150 daily).
I had a blood test Friday last week and I am currently looking for any advice and guidance related to the results. Blood test done at 09.30am with no food or thyroxine prior, just water. Test results as follows:
Vitamin D - 42nmol/L (range: 50-125) - below range
Any advice on the above results and vitamin levels (optimum levels) and supplements (types, brands etc.) would be greatly appreciated in addition to how to lower thyroid peroxidase.
Many thanks in advance.
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Mjpp84
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Thanks for the points. I am currently taking no vitamin supplements for the moment and I am not on a strictly gluten free diet but probably do this 70% of the time and will try and adopt this further.
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
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.
Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.
The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.
For someone taking Levo your TSH is too high suggesting that you are undermedicated. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well. You may not be able to get your FT4 and FT3 tested by your GP, if that is the case then you might want to do them privately. Cheapest test is from MonitorMyHealth which tests TSH, FT4 and FT3 for £26.10 using the code given here:
Presumably you know that your raised antibodies confirm autoimmune thyroid disease aka Hashimoto's. The antibodies aren't the problem, it's the immune system that attacks the thyroid and the antibodies come along and clear up the mess.
Supplementing with selenium may reduce antibodies.
Folate is low, it's recommended to be at least half way through range.
B12 is OK.
To improve the Folate level you can eat Folate rich foods and supplement with a good quality B Complex, eg Thorne Basic B or or Igennus Super B. You should look for one that says "bioavailable" and has methylfolate rather than folic acid. 400mcg methylfolate will be the right amount. It will also contain B12 (should be methylcobalamin) but you don't need a high amount of B12 due to your already decent level. I found that Thorne Basic B raised my Folate from bottom of range to top of range in 2.5 months (1 capsule daily) but because it only contained 400mcg methylcobalamin it didn't take my B12 too high (it was already a pretty good level).
Ferritin is low, it should be half way through range. Eating liver regularly will help raise this, no more than 200g per week due to it's high Vit A content, also liver pate, black pudding and other iron rich foods.
Don't consider taking iron tablets without doing an iron panel to check serum iron and transferrin saturation, if these are already at a good level then taking iron tablets will take them too high and too much iron is as bad as too little.
Your Vit D is too low, recommended level is 100-150nmol according to the Vit D Society and Grassroots Health. Your GP may be willing to prescribe but usually only until it reaches 50nmol so you may as well buy your own.
To reach the recommended level you will need 5000iu D3 daily, retest in 3 months. When you've reached the recommended level then you will need to find your maintenance dose by trial and error, it may be 2000iu daily, maybe more, maybe less, maybe more in winter than summer. Retest twice a year to ensure that you keep within the recommended range.
There are important cofactors needed when taking D3, magnesium and Vit K2-mk7. 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 tissue where it can be deposited and cause problems such as calcification of arteries and kidney stones. Magnesium helps the body convert D3 into it's usable form.
A good D3 supplement is Doctor's Best D3 softgels, no excipients and oil based to aid absorption. D3 should be taken 4 hours away from thyroid meds.
For Vit K2-mk7 I like Vitabay or Vegavero. They are tablets so will need to be taken with some fat for absorption.
For magnesium you will need to find which form is right for you, check here:
Vitamin D - 42nmol/L (range: 50-125) - below range
I think it makes sense to start to supplement with vitamin D and assess after 2 weeks. Want to optimize my vitamin levels without taking too many tablets if possible. It seems that you can't necessarily take one vitamin without others to support ….
I have given you the information about Vit D in my reply above. It needs fat for absorption so either take with the fattiest meal of the day or a full fat yogurt or chunk of cheese, or buy the softgels based in olive oil that I have mentioned.
I have also given you information about the important cofactors that you need to take when supplementing with D3.
This is meaningless. Antibodies don't 'improve' and they don't get worse. They just are. And, if they're over-range, then you have Hashi's, which won't go away, whatever your antibody level. They fluctuate all the time, but they are harmless. They are not the disease, nor the cause of the disease, just an indication that you have it.
I'm really not sure what you mean, there. Is what a sign? Antibodies reducing? No. It's not a sign of anything at all. And, I don't think the body does fight the disease in any way. It's not an infection.
Hi all, many thanks for all of your comments, feedback and advice, this is very useful! I'm keen to act on this and improve my health as I have been feeling particularly unwell in recent months. My thinking on the way forward is to:
1. Increase levothyroxine from 125/150 alternating days to 150 daily to get TSH under 2.0
2. Look at getting T4 and T3 tested
3. Take a vitamin D supplement - maybe a good multivitamin would work ?
4. Eat more folate rich foods
5. Adopt a stricter gluten free diet
Where possible, I would like to try and avoid taking a lot of tablets daily but recognize the importance of optimal vitamin levels. Any further advice on the above actions would be appreciated.
3. Take a vitamin D supplement - maybe a good multivitamin would work?
No, it wouldn't. Absolutely not. We never recommend multi-vits on here because there's no such thing as a good one, for many reasons:
* If your multi contains iron, it will block the absorption of all the vitamins - you won't absorb a single one! Iron should be taken at least two hours away from any other supplement except vit C, which is necessary to aid absorption of iron, and protect the stomach.
* If your multi also contains calcium, the iron and calcium will bind together and you won't be able to absorb either of them.
* Multi's often contain things you shouldn't take or don't need : calcium, iodine, copper. These things should be tested before supplementing.
* Multi's often contain the cheapest, least absorbable form of the supplement : magnesium oxide, instead of magnesium citrate or one of the other good forms; cyanocobalamin instead of methylcobalamin; folic acid instead of methylfolate; etc. etc. etc. This is especially true of supermarket multis.
* Multi's do not contain enough of anything to help a true deficiency, even if you could absorb them.
* When taking several supplements, you should start them individually at two weekly intervals, not all at once as you would with a multi. Because, if you start them all at once, and something doesn't agree with you, you won't know which one it is and you'll be back to square one.
* Most supplements should be taken at least two hours away from thyroid hormone, but some - iron, vit D, magnesium and calcium (should you really need to take it) should be taken at least four hours away from thyroid hormone.
* The magnesium you take - and just about everybody needs to take it - should be chosen according to what you want it to do:
Magnesium citrate: mild laxative, best for constipation.
Magnesium taurate: best for cardiovascular health.
Magnesium malate: best for fatigue – helps make ATP energy.
Magnesium glycinate: most bioavailable and absorbable form, non-laxative.
Magnesium chloride: for detoxing the cells and tissues, aids kidney function and can boost a sluggish metabolism.
Magnesium carbonate: good for people suffering with indigestion and acid reflux as it contains antacid properties.
Worst forms of magnesium: oxide, sulphate, glutamate and aspartate.
With a multivitamin, you are just throwing your money down the drain, at best, and doing actual harm at worst. Far better to get tested for vit D, vit B12, folate and ferritin, and build up your supplementation program based on the results. A vitamin or a mineral is only going to help you if you need it, anyway. More of something you don’t need is not better, it's either pointless or even dangerous, as with iodine, calcium, iron or vit D.
Only do thyroid testing 6-8 weeks after any dose or brand change in levothyroxine
Do you always get same brand of levothyroxine
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
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva
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
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, 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
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