Hi. You kindly signposted me to medichecks. I have very low Vit D 27 nmol/L normal range 50 - 200 and lowish B12 (65.1 pmol/L range 37 - 150 which the GP suggested I address.
The thyroid tests came back as in the normal range, but I would appreciate it if there is anything worth remarking on here, that someone could let me know, as I know you have vast knowledge of these type of tests. Thanks. Louise
TSH 2.03 m U/L (range 0.27 - 4.2)
Free T3 4.58 pmol/L (range 3.1 - 6.8)
Free thyroxine 14.5 pmol/L (range 12 - 22)
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LouiseMorgan
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I think you are not on any thyroid meds, please correct me if I am wrong. It's just that thyroid test results are interpreted differently when on thyroid meds.
If not on thyroid meds then a normal healthy person generally has TSH no higher than 2, often around 1 with FT4 around mid-range-ish. That is a generalisation so of course it's possible that you may fall outside these levels for your normal level, but as we are never tested for a baseline when well none of us know what is normal for us.
As you can see your TSH is slightly over 2 and your FT4 is 25% through range, so FT4 on the lowish side.
I have very low Vit D 27 nmol/L normal range 50 - 200 and lowish B12 (65.1 pmol/L range 37 - 150 which the GP suggested I address.
A Vit D level below 25 is Vit D deficiency in some areas, and below 30 in other areas. With your level of 27nmol/L one would hope that the GP would realise this is just 2 points above deficiency and may consider giving loading doses to correct this. At the very least he should really have prescribed some D3 at maybe 800iu or 1600iu daily to try to bring you into the Adequate/sufficient bracket.
If you have been left to deal with this yourself then for your information the following is the NICE guideline for Vit D deficiency:
If rapid correction of vitamin D deficiency is needed, for example in people with symptoms or about to start treatment with a potent antiresorptive agent (zoledronate, denosumab, or teriparatide), prescribe a fixed loading dose followed by regular maintenance vitamin D therapy 1 month after loading.
The loading regimen should provide a total of approximately 300,000 international units (IU) of vitamin D, given either as separate weekly or daily doses over 6–10 weeks. See the section on Loading dose regimens in Prescribing information for more detailed information.
Maintenance therapy of vitamin D equivalent to 800–2000 IU daily (up to a maximum of 4000 IU daily for certain conditions such as malabsorption following specialist advice), given either daily or intermittently at a higher equivalent dose.....
If correction of vitamin D deficiency is less urgent and when co-prescribing vitamin D supplements with an oral antiresorptive agent, maintenance therapy (800–2000 IU daily) may be started without the use of loading doses.
Several vitamin D loading dose treatment regimens are available, including [ROS, 2018]:
50,000 IU once a week for 6 weeks (300,000 IU in total).
40,000 IU once a week for 7 weeks (280,000 IU in total).
1000 IU four times a day for 10 weeks (280,000 IU in total).
800 IU five times a day for 10 weeks (280,000 IU in total).
Note: this list is not exhaustive.
So one option would be to follow this regime yourself.
The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L so you may want to make this your aim and you could supplement with D3 at a dose of 5,000iu daily to start with.
Whatever you decide to do then you should retest after 3 months to check your level. Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form
Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
If you do have any then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results. If you don't have any then you may just want to supplement yourself.
It might be a good idea to supplement with sublingual B12 plus a good quality B Complex until your level reaches 100. Once it reaches 100 then stop the B12 and just continue with the B Complex at a maintenance dose.
Suggestions for B12 supplements which include two forms of bioactive B12 - methylcobalamin and adenosylcobalamin which you might want to check out:
Note that the Nature Provides supplement contains a much higher dose than the Cytoplan one.
Remember to leave off B Complex (or any supplement containing biotin) for 3-7 days before any blood test as this can cause false results when biotin is used in the testing procedure (which most labs do).
Hi SeasideSusie. Thank you for your very comprehensive reply. Really appreciated.
Re the thyroid results. You are correct I am not currently on any Thyroid meds.
You stated that if not on thyroid meds then generally speaking "a normal healthy person has TSH no higher than 2, often around 1 with FT4 around mid-range-ish. As you can see your TSH is slightly over 2 and your FT4 is 25% through range, so FT4 on the lowish side".
Im just wondering what that means? Sorry, I don't know how to interpret these results. Do you think it might indicate a slightly overactive/underactive thyroid? (or something else ?) I don't think the GP will assist or possibly even understand, so apologies for bothering you again.
Im just wondering what that means? Sorry, I don't know how to interpret these results.
It means that your TSH is a touch higher than what can be expected generally with a normal health person it is definitely not hypERthyroidism (TSH would be below range and FT4 above range) and wont be diagnosed as hypOthyroidism because TSH is not over range and FT4, although only 25% through range, is not low enough. You would generally need 2 x TSH over range with raised antibodies to confirm autoimmune thyroid disease (the most common cause of hypothyroidism), or 2 xTSH over 10 without raised antibodies to confirm non-autoimmune hypothyroidism. There is also Central Hypothyroidism where the problem lies with either the pituitary or the hypothalamus rather than the thyroid gland and this is diagnosed when TSH is normal, low or minimally elevated along with below range FT4 (this is not as common as other forms of hypothyroidism).
Do you think it might indicate a slightly overactive/underactive thyroid? (or something else ?)
There's a possibility that it might progress to hypOthyroidism if FT4 goes lower or TSH goes over 3 (TSH of 3 is the threshold where hypothyroidism is diagnosed in some countries). It's a case of keeping an eye on your levels.
Have you had thyroid antibodies checked? Raised antibodies confirm autoimmune thyroid disease (Hashimoto's) and antibody levels can fluctuate, so even if you test negative then the next time it could be positive. Just to complicate things, you can also have Hashi's without antibodies being raised.
Maybe check out ThyroidUK (this is their forum) and go through the different pages about hypothyroidism to give you a better understanding:
Very interesting. My previous NHS results on 8th March were different. TSH 2.91 and T4 9.2 (on a range 7.70 - 20.60). Medichecks antibody tests seems fine.
I suspected ?Thyroid due to symptoms and also a family history with Gran/mum/brother all having thyroid issues. I will just keep an eye on things and thanks once again for all your help.
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