Folate

[Doris11]

Hi I’m new here just been diagnosed with Hypothyroidism in March 21! I’ve been prescribed 50mcgs of levothyroxine.. last blood test states I have a low serum folate 3.1 and would like some advice on taking folate supplements. Many thanks

[SlowDragon Administrator]

Welcome to the forum

How long have you been left on starter dose of 50mcg?

Thyroid levels should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Which brand of levothyroxine are you currently taking

Do you always get same brand at each prescription

Low vitamin levels are extremely common, especially if cause of hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

GP should prescribe folic acid for deficient folate

What are B12, ferritin and vitamin D results and ranges?

Please add latest thyroid results too if you have any

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

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

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 down to £26.10 if go on thyroid uk for code thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

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

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

[Doris11 in reply to SlowDragon]

Thank for fast reply I’ve been on levothyroxine for about 3 months and the brand is accord! I will get back to you on other stuff Many thanks x

[SlowDragon Administrator in reply to Doris11]

So you should have had repeat blood test by now Have you had one?

Dose levothyroxine is slowly increased upwards in 25mcg steps until TSH is ALWAYS under 2

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...

Guidelines are just that ....guidelines.

Some people need more ……some less

healthunlocked.com/thyroidu...

[SeasideSusie Remembering]

Welcome to the forum Doris11

last blood test states I have a low serum folate 3.1 and would like some advice on taking folate supplements.

Was this a GP test? If so, what has your GP said?

Folate deficiency is diagnosed when level is <3 according to NICE

cks.nice.org.uk/anaemia-b12...

Folate level

◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.

◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.

So you are in the "indeterminate zone" and your GP may or may not take this any further. Ideally he would as it's so close to the level classed as folate deficiency.

Folate and B12 work together so it's essential that B12 is tested. As Folate level is so low it's possible that B12 is as well so you may need testing for B12 deficiency.

If B12 hasn't been tested then I'd ask your GP about this when discussing your folate result.

[Doris11 in reply to SeasideSusie]

When I rang to talk to make appointment for 2nd blood test she said the Dr wasn’t worried about last results? my lymphocytes are high also which suggest some inflammation… but after talking to a dr over the phone she wants to see me face to face for an examination 🧐

[SeasideSusie Remembering in reply to Doris11]

Doris11

You can always buy your own folate supplement if GP doesn't want to help. It is so close to folate deficiency that you'd think they might be concerned, but to doctors as long as you are "in range" then there's no problem, they don't seem to care where in range you are.

Do ask for B12 testing but don't take anything for your low folate until after testing B12. I see Humanbean has this well covered in her reply below.

You can check for signs of B12 deficiency here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you have any then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia.

[humanbean in reply to SeasideSusie]

I'd add to the above SeasideSusie's advice...

Don't take either folic acid, any folate supplement, any B12 supplement, any B Complex, or any supplement containing any of these until your doctor has tested for Vitamin B12 deficiency. (If they agree to do the testing in the first place.) You may need testing for Pernicious Anaemia, and testing for it is very unreliable. Having supplemented before the test massively increases the unreliability.

If you end up being prescribed folic acid or Vitamin B12, please note that doctors often choose very poor quality products and their doses are often ridiculously low. So come back here with your results, what you've been prescribed (if anything) and the doses of each prescription and we can advise on OTC supplements that are likely to be better than anything a doctor will prescribe.

Some relevant links :

chriskresser.com/folate-vs-...

onlinelibrary.wiley.com/doi...

cks.nice.org.uk/topics/anae...

Please note that since people with thyroid disease don't absorb nutrients or supplements very well, the best kind of supplements for folate and B12 are, in many cases, methylfolate and methylcobalamin .

Folic acid is artificial and has to be converted in the body to methylfolate. But people with thyroid disease often can't do the conversion very well.

Similar comments apply to cyanocobalamin (a B12 supplement) which has to be converted to methylcobalamin. For people with thyroid disease avoiding the need for conversion is usually a good idea - although there are always exceptions to just about every rule.

[Doris11 in reply to humanbean]

Thank you ☺️ But my Gp I’m going to see ( not mine) my I add! Said no we don’t check vitamins 🤦‍♀️

[humanbean in reply to Doris11]

I'm replying on the assumption that your doctor is referring to "nutrients" rather than just "vitamins".

So your doctor doesn't test for Pernicious Anaemia? Iron deficiency? Haemochromatosis? Or any of the issues mentioned in this document?

irondisorders.org/wp-conten...

What a useless doctor!

[Doris11 in reply to humanbean]

My GP practise isn’t great to be honest! Pre Covid I had to wait up to 12 days to see my GP! She’s part time now so no chance 😔 will mention B12 test when I go in 🧐 thank you 🙏

[shaws Administrator]

5 months without medication is a terrible gap.

Remember that the blood draw has to be at the earliest possible but make sure you are well-hydrated a couple of days before blood draw.

It is a fasting test but your can drink water. Allow a gap of 24 hours between last dose of thyroid hormones and the test and take it afterwards.

Also request B12, Vit D, iron, ferritin and folate. Everything has to be optimal.

Post your results, with the ranges, onto a new post for comments.