I am after some advice please regarding medication adjustments following recent surgery after an accident.
As well as thyroxine, hydroxychloroquine, methotrexate and folic acid I was also taking the following:
Vit D3 / K2
Thorne Basic B complex
Cod liver oil
Magnesium spray
I have been given some tinzaparin injections to reduce risk of blood clots to take for 6 weeks whilst I am in a half leg cast with no weight bearing and a nurse enquired and advised me not to take the D3 with K2 as the K2 could counteract the injections.
I am also due for repeat thyroid bloods next week following a reduction in my dose from 175 to 150 a couple of months ago. The GP has also agreed to re test ferritin, folate, B12 and vit D.
I know I should stop the Thorne Basic B complex for the next few days before my bloods on Thursday as it contains biotin but I am wondering if I should take an alternative B complex which I have - Igennus super b complex in the meantime or not?. Also should I look to find some Vit D without K2 or just stop these for now?
On the day of my bloods I do not know what time they will be done as the district nursing team will be calling on me at home to do this and don't give an appointment time. I would normally take my thyroxine in the early hours but not sure when best to take it under these circumstances.
Any advice appreciated as usual!
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I know I should stop the Thorne Basic B complex for the next few days before my bloods on Thursday as it contains biotin but I am wondering if I should take an alternative B complex which I have - Igennus super b complex in the meantime or not?.
The Igennus Super B Complex also contains biotin, as do the majority of B Complex supplements (if not all), so no don't take that in place of the Thorne.
Also should I look to find some Vit D without K2 or just stop these for now?
Do you know what your most recent Vit D result is and when you were tested?
As it's now summer you could make sure you get outside for a while each day and get sun on your skin (no sun protection) for about 20 minutes or so and you may be able to make plenty of Vit D that way.
I would normally take my thyroxine in the early hours but not sure when best to take it under these circumstances.
As it's FT4 that is affected by time of taking Levo do you know if FT4 will be included in your thyroid test or just TSH? If you think FT4 will be tested and your GP may adjust your dose of Levo if he sees the spike in FT4 due to taking Levo before the test then personally I would leave it off until after the nurse has been and taken the blood rather than risk a reduction in dose. If you are stable on your current dose and bloods are normally within range then you don't want anything to cause adjustment of your dose.
Thank you for the swift reply - I will stop B complex completely until after my bloods are done.
Unfortunately I will probably not be able to go outside daily due to my surgery and the fact I am mobilising with a zimmer frame.
From last June :
Serum total 25-hydroxy vitamin D level 63 nmol/L [> 50.0]
Vitamin D adequate 50-75 nmol/L, optimal >75 nmol/L
Serum vitamin B12 level 466 ng/L [150.0 - 1000.0]
Serum ferritin level 85 ug/L [12.0 - 250.0]
Serum folate level > 23.4 ug/L [2.0 - 18.8]
The GP usually does T4, T3 and TSH. For background I had a total thyroidectomy approx 2006 due to multi nodular goitre. They had temporarily increased levo to 175 but reduced it back to 150 after my latest bloods which were done in March this year. At that time they had referred bloods results to endocrinology at my request but the reply was that I was not a candidate for T3 and also I was converting fine. Hence the reduction back to 150.
Serum TSH level < 0.01 mIU/L [0.3 - 4.5]; Thyroxine replacement may be excessive; Below low reference limit
I will not take thyroxine until after bloods done, but perhaps will delay the day before dose to try to ensure I am not too much more than 24 hours after last dose? Does that sound like a plan? I certainly don't want any further reduction in levo ..
Unfortunately I will probably not be able to go outside daily due to my surgery and the fact I am mobilising with a zimmer frame.
Any chance you can get into the garden and sit out for a while if the weather is good?
Have you not tested Vit D since last June? When supplementing we should test twice a year - best times April and late October/Nov, that should tell us if we need seasonal adjustment to dose. One would hope your level has improved from 63nmol/L if you've been regularly supplementing, but what dose have you been taking?
I will not take thyroxine until after bloods done, but perhaps will delay the day before dose to try to ensure I am not too much more than 24 hours after last dose? Does that sound like a plan? I certainly don't want any further reduction in levo ..
If it was me I'd just take as normal the day before and not worry about trying to get close to 24 hours. If it's measuring a bit lower than normal you shouldn't get a further reduction in dose, the reduction you had should have brought your FT4 into range and leaving a bit longer than 24 hours might give a bit lower result so there would be no reason to reduce dose unless they go by TSH and that shows below range - then you argue that your FT4 is well within range, also FT3, and that's what they should be going by.
In that case I think I wouldn't worry too much, 4,000iu daily for a year should have given your level a good boost so maybe just leave the supplement off for a while. Do you know how long you'll be on those injections?
It might be a good idea to test Vit D when things get back to normal, do it before going back on to your supplement perhaps.
I will not take thyroxine until after bloods done, but perhaps will delay the day before dose to try to ensure I am not too much more than 24 hours after last dose?
If you 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
but yes …..if you leave 36 hours between last dose levothyroxine and test ….that would ensure Ft4 as low as possible
Thanks - I've been told on here following past queries that I am a poor converter so tried to convey that to the GP, hence the enquiry to endocrinology but they told me I was converting fine and not a candidate for T3.
I’m in the north east. I did look a while ago and no one near here. That’s why I asked GP first for increase in Levo but was told that if I didn’t see a huge benefit it would be reduced back to 150. That was a couple of months ago. So now bloods due again to see where we are at.
hi, just a quick note to add that Ferritin rises after surgery (usually for a couple of weeks at least) and will then fall again so if getting bloods post-op it will not be accurate.
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