I need advise... would appreciate feedback.

[S2017]

Hi everyone,

Hope all are doing the best you can in the current climate. I had some questions on vitamin D and would appreciate some advise.

Over 6 months back, my vit. D levels were 40nmol/L and I was put on high dose of 40,000IU/week by my Dr. for 7 weeks. After 7 weeks, I carried on with 2000-3000IU and after a total of 3 months, I finally reached to 80nmol/L (minimum of range).

Post this period, since we were trying for a child, I was (and still am) taking pre-conception multivitamins and that provides 800-1000IU of vit. D per day.

I wanted to increase this to 2000-3000IU of vit. D but was advised against it by my GP, head nurse and pharmacist (all were consistent in advise). Reason provided was that this daily dosage itself should already be considered sufficient and is within the recommended dosage.

I was beginning to feel light palpitations and nervousness/fear and tested my vit. D last week and found the reading has again dropped to 57nmol/L.

While I understand that nutrient dosages/studies on nutrient interaction is not covered extensively at all in the field of medicine or pharmacology, I am not exactly sure the hesitation in recommending a higher dose.

My questions are:

1)Are there actually concerns around taking say a dose of 2000-3000IU per day if coupled with a meal that contain fats, and supplements of vitamin K2 and magnesium? Has anyone read any scientific articles that recommend otherwise? I feel especially when trying for a child, one’s nutrients levels should be above minimum but I am not sure why there is so much hesitation in recommending a higher dose.

2)Does anyone understand why hypothyroidism patients have low levels of vit. D, ferritin, iron and B12. Is this entirely based on the gut not being to absorb the nutrients from food? If yes, is the solution entirely based on healing the gut and then this issue gets rectified?

3)Is the vit. D issue primarily in countries like UK with low amounts of sun. Do hypothyroidism patients in hotter countries such as Latin America, Spain, South East Asia also have issues with vit. D? Has anyone migrated and found a drastic improvement in their health?

4)Has anyone used a SAD light and found that their vit. D level increases? I know it helps fight ‘winter blues’ but does it actually help in vit. D absorption/increase in some way?

5)I’ve read that the recommended dose of magnesium is 380-400mg/day. Do you recommend this dosage/half as you do get some magnesium from food?

I would appreciate if any of you can advise me on the above or areas that you are familiar on. As always, love this group and the support it provides.

Thank you very much for your time.

[SlowDragon Administrator]

How much levothyroxine are you currently taking What are your most recent thyroid and vitamin results

Yes when hypothyroid we frequently have low stomach acid, poor nutrient absorption and low vitamins as direct result

Frequently necessary to take higher dose vitamin D than average population to maintain optimal vitamin levels

Are you on absolutely strictly gluten free diet?

[S2017 in reply to SlowDragon]

Hello SlowDragon,

I currently take 75mcg 4 days a week and 100 mcg 3 days a week. My weight is about 66kg.

I've recently experienced facial numbness so they are checking my B12 and thyroid levels and I should hopefully know my results tomorrow.

I have read a articles on low stomach acid so I tried taking 1 tbps of apple cider vinegar but I found that it gave me reflux symptoms (eg: belching and stomach feels uncomfortable, very bloated) so I stopped .

I also tried gluten free diet but gave up after 2 weeks. Strictly gluten free is not something I have tried ever as to be honest, I find it hard to give up bread. Not sure if there is any way around this but no, I haven't tried this for a good duration of 3 months to see if it makes a difference. If you are on a gluten free diet, do you take bread alternatives like sourdough (less gluten) or not at all?

Thank you for your reply.

[SlowDragon Administrator in reply to S2017]

I need to be absolutely strictly gluten free, as do many/most hashimoto’s patients

Despite zero gut symptoms before becoming GF, I have severe gluten intolerance.

There are some excellent gluten free breads these days. Look in Free from section at supermarket

Need to watch out for cross contamination, use separate GF toaster, don’t share jam, butter, separate chopping board etc

[S2017 in reply to SlowDragon]

Thank you.

I am so very bloated and I feel that every since I got hypothyrodism, my gut health is absolutely miserable (always heavily bloated after a meal, food takes a long time to digest, stomach pain & discomfort, sides hurt).

Going gluten free is something I will need to bring himself to to accept. To be honest, right now its hard for me, cause I feel like my health is sort out taking away things I enjoy at a fairly young age.

Anyhow, I will digest this and thank you for your feedback. Much appreciated.

[SlowDragon Administrator in reply to S2017]

What are your most recent thyroid results

66 x 1.6mcg suggests at least 100mcg daily as likely dose levothyroxine you would need

Slightly over 100mcg per day at 739mcg per week

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on 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.

Also here

cks.nice.org.uk/topics/hypo...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[S2017 in reply to SlowDragon]

Hi,

My results done in Nov 2020 is as below:

Serum TSH level is 2.37 miu/L (0.35-4.78)

Vit D is 80nmol/L (76-200)

Serum B12 is 573 ng/L (200-900)

Serum Folate is >24 ug/L (2-17) *** high as I was prescribed high dose Folate by the gynae

Serum ferritin is 48 ug/L (15-250)

* I cant get the Drs at my Drs surgery to test T3 and T4 as they all feel is it not necessary, so I will need to do this privately.

I see based on the above for my weight I should be taking about 105ug/daily. I will hopefully know my results tomorrow if it is within range.

I believe I had hypothyrodism a few years before and was not treated as my TSH was within the normal range.

I will share once I get the full blood results which will be in 3-4 weeks when I see my gynae.

[SlowDragon Administrator in reply to S2017]

Pregnancy guidelines

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

Important- See pages 7&8

btf-thyroid.org/Handlers/Do...

[S2017 in reply to SlowDragon]

Thanks, didn't know most on the information here. Will go through in detail! ☺️

[SlowDragon Administrator]

4)Has anyone used a SAD light and found that their vit. D level increases? I know it helps fight ‘winter blues’ but does it actually help in vit. D absorption/increase in some way?

No a SAD light won’t help

You can get vitamin D lamp....very expensive and doesn’t raise vitamin D hardly at all. Also burns skin if expose too long

[S2017 in reply to SlowDragon]

Okay great, thanks for letting me know!