Help with my test results. Low folate.

[Lisa157]

This is the first time I've got private blood tests done. I had them taken 8.30am no foods or meds before. Stopped multivit and mineral 3 days before. I take 75g levo. I've given these results to my GP and waiting for an appointment in 3 weeks time. Any advice on what to do I'd be grateful. I've started by cutting out all gluten, dairy and additives and increased nutrient dense foods. And reducing PPI and Naprox. Ordered a MTHR gene test.

[Lisa157]

Please? I should also add that I always feel overly achy and tired, even before my TSH went up.

[SlowDragon Administrator]

GP needs to increase levothyroxine dose to 100mcg daily

Which brand of levothyroxine are you currently taking

Ideally don’t change brand, especially when changing dose

What vitamin supplements are you currently taking

Folate is deficient

B12 is far too low

Start on a daily B12 for a week before adding a separate folate

Vitamin D needs improving as well

Retest again 6-8 weeks after dose increase in levothyroxine

[Lisa157 in reply to SlowDragon]

Teva levo. Tesco A-Z Multivitamins and Minerals.

[SlowDragon Administrator in reply to Lisa157]

Multivitamins never recommended on here

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Get yourself a GOOD quality vitamin D and a separate B12 and separate vitamin B complex

Improving nutrients improves conversion

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to Lisa157]

Do you always get Teva Levo

Are you lactose intolerant

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

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)

Aristo (currently 100mcg only) is lactose free and mannitol free.

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

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 you find a brand that suits you, 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 in support of patients 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).

Discussed here too

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

Note that improving folate when B12 is very low is not a good idea. Taking folate before B12 is good enough can lead to severe neurological problems.

en.wikipedia.org/wiki/Subac...

It is vital if you intend to supplement both B12 and folate that B12 is started a week before the folate.

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 separate B12 supplement and add a separate methyl folate after a week

Swap folate to a separate vitamin B Complex after about a month

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

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

healthunlocked.com/thyroidu...

Once folate is no longer deficient and changed to vitamin B complex

supplement a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

[greygoose]

My advice would be to get rid of the multi-vit! If it contains iodine, it could be making you worse, rather than better.

Multi-vits are pretty useless things for a number of reasons:

* Not enough of anything to do any good

* Not the most bioavailable form of most nutrients

* If it contains iron that will block absorption of the vitamins

* If it contains calcium it will bind with the iron and you won't absorb either

* Often contains thing you don't need like calcium and iodine

* Usually contains the cheapest ingredients but even so, they're a waste of money

Your nutrients are low to very low, despite taking a mult-vit, so far better to take what you need, according to these results, plus their cofactors.

[Lisa157 in reply to greygoose]

Thankyou. That's interesting about the iodine, iron and calcium. When I did a crude iodine patch test at home after these tests, I absorbed it and wondered if I was iodine deficient as well. I'm confused.

[SlowDragon Administrator in reply to Lisa157]

Iodine patch test has been completed debunked as totally unreliable test

[greygoose in reply to Lisa157]

Highly unlikely you're iodine deficient because you're getting about 48 mcg a day from your levo, plus what you get from your food,. And, when you're taking thyroid hormone replacement, you need less iodine, not more. In excess, iodine is antithyroid.

[Lisa157 in reply to greygoose]

Why/how do I get 48mcg from levo?

[greygoose in reply to Lisa157]

Because that's what levo is: it's the thyroid hormone T4. It's called T4 because it contains 4 atoms of iodine for every molecule. When it is converted into T3, one atom of iodine is removed and recycled in your body. T3 is eventually converted into T2, and that other atom of iodine is recycled. Then into T1, another atom recycled. And finally the last atom is recycled and you have T0.

So, 100 mcg levo contains about 65 mcg iodine, therefore 75 mcg gives you about 48 mcg.

[SlowDragon Administrator]

we never recommend multivitamins

Most contain iodine not recommended for anyone on levothyroxine

And as shown by up your low results ……no where near enough vitamins to correct low levels

Only add one supplement at a time….starting with B12, then folate …then vitamin D

Vitamin D

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[Lisa157 in reply to SlowDragon]

Ok thankyou. I'll look into separate supplements and what I can continue to afford.

[SlowDragon Administrator in reply to Lisa157]

cheaper tests going forward

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

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

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

[Lisa157 in reply to SlowDragon]

Thankyou. x

[HealthStarDust]

That’s a very thorough test. Is it Blue Horizon?

[Lisa157 in reply to HealthStarDust]

Yes it is. It had to be done by proper blood draw.