Your thoughts please?

[Emyloulou]

I’ve recently been feeling very tired, aching, weakness, hair coming out again, some palpitations so my gp has done some bloods and I’m hoping someone might be able to help with the results. My recent thyroid results are really good (I keep a very close eye on them now) but a few things have come back borderline low, vitamin D was 46 (range 50-100) and magnesium was 0.6 (range 0.7-1), calcium is just in range, PTH was right in the middle of the range.

Normally I wouldn’t be bothered but I’ve been taking 5000iu a day of vit D3 and also magnesium bisglycinate every day for the 4 years since my hashis was diagnosed and I was expecting them to be on the high side if anything.

My gp has marked them as satisfactory and if I hadn’t been supplementing them I’d go with that but because I have been I’m a bit concerned I’m not absorbing them for some reason.

Any thoughts on what to do next should be gratefully appreciated. I’ve already doubled my D3.

[Emyloulou]

Thanks for the reply

My most recent results are

Serum free T4 level 11.4 pmol/L [10.0 - 20.0]

Serum free triiodothyronine level 4.6 pmol/L [3.5 - 7.0]

Serum TSH level < 0.03 mu/L [0.2 - 6.0]

I take 125mg levothyroxine and 50mcg Liothyronine and this was taken 24hrs post t4 and 12hrs post t3

I’m quite happy with these results and have been pretty consistent with the dose for about 2 years now.

Total Vitamin D 46 nmol/L [50.0 - 100.0]

Serum calcium level 2.09 mmol/L

Adjusted Calcium 2.33 mmol/L [2.2 - 2.6]

Serum magnesium level 0.61 mmol/L [0.7 - 1.0]

The only other blip was that my ferritin has dropped from 200+ to 55 in 2 years so I’ve been prescribed ferrous fumerate to bring that back up to 100+

I have taken 5000iu D3 for the past 4 years along with magnesium Bisglycinate, mk7 k2 and a few other supplements I was recommended to take when I was first diagnosed. Everything is taken with the recommended gaps with other meds, food etc.

[greygoose in reply to Emyloulou]

I'm afraid I don't find your thyroid results really good. You are under-medicated. And, frankly, I don't think you really find them really good because you have all those hypo symptoms.

That said, your dose isn't exactly low, but it would appear you're not absorbing your 50 mcg T3 very well. Considering that dose, your FT3 is very low. Do you always take your T3 on an empty stomach, leaving at least an hour before food, etc. just like levo? Or, it could be due to low stomach acid. Given your low vit D, it's more than likely that you have low stomach acid.

Did you not get ferritin, vit B12 and folate tested? Hair-loss could be due to low ferritin.

[Emyloulou in reply to greygoose]

I have b12 injections monthly and it was over 2000 when tested last month, my folate was 24 and I take a b-complex. Ferritin was 55 but I’ve now been prescribed ferrous fumerate to bring that back up.

I take t4 and t3 all in 1 go at night so I can avoid eating, drinking and all other medication except my hydrocortisone for 2 hours before. I have to take the hydrocortisone 5 times a day with a small dose at bedtime for adrenal insufficiency so I can’t avoid that unfortunately.

I just concerned that despite supplementing that I’m not absorbing them for some reason.

The only other thing that I can think of is that for 4 years I’ve been strictly gluten free but over the last 2 months I’ve let that slide a bit. I’m now wondering if that could be the cause?

[greygoose in reply to Emyloulou]

Well, you're not absorbing them, are you.

Could falling off the gluten-free wagon have caused this? Difficult to say. The only way to find out is to go strictly GF again. But, I do think your stomach acid needs investigation.

[Emyloulou in reply to greygoose]

How would I go about that? I was taking ranitidine until 6 months ago but haven’t taken any sort of antacid since I came of them.

[greygoose in reply to Emyloulou]

Well, an antacid would make things worse.

Have a read of this article and try the home-test at the end:

healthygut.com/3-tests-for-...

[SilverAvocado in reply to Emyloulou]

Is it more likely you need increased acid rather than less? I used to take apple cider vinegar in water with meals, but recently swapped over to tablets because I was having big trouble with my teeth. It makes a big difference to how my digestion feels.

I'm by no means an expert in improving digestion, but I'm sure a lot is written about it on the forums. You can take tablets with enzymes taken from animals, which are vital for actually digesting the food as if goes through. Thes can also be a big help.

Things like leaky gut get a lot of write ups. Things like eating fermented foods and adjusting your diet considerably are the types of recommendations.

I do think that from the pattern you're seeing the big problem here is that your body is dropping a cluster of vitamins, more than each one that's become low individually. This is a classic hypothyroid symptom, and is a bit of a vicious cycle because as vitamins drop you then pile on the symptoms those deficiencies cause

One thing I would always suggest in a situation where there isn't a clear path forward is to adjust your thyroid dose according to the conventional wisdom. According to the accepted analysis on this forum you are pretty undermedicated, as your freeT3 is well under halfway through the range.

I know you've said you felt well on that in the past, but I'm not sure that's a good reason not to at least test it and see if you feel better with freeT3 in the top third. You can always drop back again if you feel worse. Just make sure you give it at least 6 weeks before giving up, and ideally a bit longer. An increase of 5-10mcg of T3, to start, then you may need a few more increases to get it up there, or may only need the one - there is a lot of variability in how much difference an increase makes.

I definitely think our needs can shift considerably over time. Due to small lifestyle changes or even just our bodies slowly changing. Also I think sometimes we can feel fairly fine even though our body is struggling but just about holding things together so we don't get symptoms popping up, then one day quite suddenly it can all catch up with us.

[greygoose]

Then that could account for the hair-loss.