Hello,
My youngest daughter (she's 21) has recently been diagnosed with hypothyroidism.
She's been started on 50 mg Levothyroxine
Her other low result was:
Serum folate 2.2 (2.8-20 ug/L)
For this she's been prescribed folic acid - 5mg daily
I'm a little surprised that it's folic acid especially after browsing the site this morning.
What're your thought please?
That’s all NHS ever prescribes
Once she finishes folic acid prescription she can consider starting a daily vitamin B complex
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
chriskresser.com/folate-vs-...
Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.
thyroidpharmacist.com/artic...
Does she have Hashimoto’s?
B vitamins best taken after breakfast
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
IMPORTANT......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
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement
What are her vitamin D, B12 and ferritin levels ?
Thyroid will need retesting 6-8 weeks after each dose increase
Which brand of levothyroxine has she started on
Thank you. It was that article or clone of it I was reading. Hashimoto's is a moot point. Her GP requested it and the lab said she'd already been tested and they wouldn't do it again. She has never been tested.
Vit B12 was 319 (180-2000ng/L)
Ferritin and vit D not done
She's on Teva
B12 too low
Suggest she considers add separate B12 approx 2-3 weeks after starting on folic acid
Low B12 symptoms
b12deficiency.info/signs-an...
methyl-life.com/blogs/defic...
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.
once her serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
B12 drops
healthunlocked.com/thyroidu...
B12 sublingual lozenges
amazon.co.uk/Jarrow-Methylc...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
Teva
Is she lactose intolerant?
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
But for some people (usually if lactose intolerant, Teva is by far the best option)
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets
beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Posts that mention Teva
healthunlocked.com/search/p...
Teva poll
healthunlocked.com/thyroidu...
Once she finds a brand that suits, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Government guidelines for GP if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
academic.oup.com/jcem/artic...
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
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If 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
Suggest you get her a weekly pill dispenser so it’s easy to remember to take levothyroxine everyday
And get her a vitamin D test here
Test twice yearly when supplementing
What’s her diet like
Is she vegetarian or vegan
Gluten free or dairy free
She needs to request ferritin to be done at next thyroid test
Or get tested privately along with BOTH thyroid antibodies
List of private testing options and money off codes
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins
bluehorizonbloodtests.co.uk...
Thank you SlowDragon . Fab points to digest.She's on no particular diet: eats most things
ok
Come back with new post once she gets retested after 6-8 weeks on 50mcg levothyroxine
Book early morning test around 9am and last dose levothyroxine 24 hours before test
Plus push for testing iron and ferritin
You will need to test thyroid antibodies privately
But virtually guaranteed she has Hashimoto’s as you do
Coeliac blood test necessary once thyroid antibodies confirmed
Thanks, wiil do. She's not great at dealing with blood.... Soooo angry the antibody test wasn't done
I found this link to be very helpful :
takecareof.com/articles/ben...
Personally, I would never take folic acid again, I would only ever take methylfolate.
Some people come on to the forum with very high levels of folate. I wonder if they actually have lots of unmetabolised folic acid in their blood. If they switch to methylfolate their levels sometimes drop dramatically. My personal opinion is that this happens because their folate is actually getting used, whereas folic acid builds up and does nothing much or does what it has to extremely slowly.
Whether someone can metabolise folic acid well is probably mostly due to genetics. MTHFR problems are one cause for having problems. About 50% of the global population has less than ideal versions of the MTHFR genes.
One thing to consider is that vitamin B12 and folate have a strong relationship. For the body to make use of B12 it must have adequate levels of folate. But in cases of deficiency or low levels of either, it is essential to start supplementing B12 about a week before starting to supplement folate, if both are needed.
There are very high dose methylfolate supplements that can be bought on sites selling supplements. If I was deficient I might buy 30 doses of 5000mcg, but then I would reduce to 1000mcg. When my level was where I wanted it to be I would reduce again to 400mcg.
It may be that a good quality B Complex might do the job without any additional methylfolate. But I have to take an extra methylfolate supplement on top of a B Complex . If I don't my level drops into my boots.
Thank you humanbean . It's quite fascinating. How do people decide on which tests and frequency (across this forum)? It's not like it's cheap
I agree that testing is a worrying drain on most people's resources. There are certain tests that people do that crop up time and time again. The most common one are the thyroid tests done by various blood testing companies :
thyroiduk.org/help-and-supp...
...
I was going to try and help you with examples but my Firefox browser has just blown up and I can't see the Medichecks website any more, nor can I log in.
Uh!
Folic Acid And Vitamin D Timings
Folic acid tablets
Can folic acid supplement cause UTI
continuing low folate levels
Serum folate + thyroid results 
