17 year old daughter has complained of headaches and fatigue for years. Chalked it up to teenager, pandemic, and irregular sleeping patterns. As all those things resolved, and the headaches and fatigue didn't, I ordered bloodwork to rule out Hashis and Hypo; and hopefully pinpoint a treatment to get her better.
I think I've done just that - I don't think she's hypo, and looks like she is just iron anemic and needs a D supplement. Dr. recommended 60 mgs of iron a day + 1000 IUs of Vit D.
Can someone take a look at her bloods and confirm what appears to be completely normal thyroid results? Any other thoughts on iron or D helpful, but I know this is the thyroid forum, so really just looking for that reassurance.
Attaching one image here, and a second in the comments.
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Thank you, always!!!! I am so grateful, and also full of some remaining questions to simply my next steps.
First, for background - her diet is excellent (my husband is a great healthy cook with meats, veggies, carbs... we are lucky)! No heavy periods. Looking at the Celiacs list - doesn't feel like a direct hit on the surface, just FYI (ie, she's had no growth issues at 5' 11'' (1.8 meters) and a healthy weight; no mouth sore problems, and never complains of GI stuff (although is constipated a lot). Also - generally forget to mention along with fatigue and headaches, she does have trouble getting a good night's sleep.
OK. Action plan time.
RE VITAMINS/MINERALS/SUPPLEMENTS I am in the US, so vitamins are over-the-counter and - although pricey I guess - I can get what I want. I just buy them at the store. Is it the same in the UK? So can I pile on all the vitties she needs at once, or should I change only a few things at a time like when we adjust our other meds?
Should I:
* Iron 60 mgs daily - YES
* D - YES - doctor recco'd 1000 iu daily
- I have gummies with 2500 IU (62.5mcg) - can I just start out and give her those?
- Or should I jump all in right away and get her ones with the K too?
* Magnesium: Great links (great to know connection to D & relationship to B as well) I'm inclined to immediately get her those.
- How much?
- Noting from article - will take with food and 2 hours on either side of other meds
* Lastly, Bs. Which and how much? Can I throw them into her mix right away? Or do I need to go slowly adding so much new stuff?
- B12?
- Folate/B9?
- Other Bs?
Celiac Test-for future, noting I will also add Celiac test to her next bloods in 3 months. Also noting this part of the article you shared "advise the person not to start a gluten‑free diet until diagnosis is confirmed by a specialist, even if the results of a serological test are positive. 1.1.4Advise people who are following a normal diet (containing gluten) to eat some gluten in more than 1 meal every day for at least 6 weeks before testing."
OR
Should I do a Celiac test right away? Does it matter in the meantime?
Also next blood test timing - is 3 months the right time to wait for next blood tests or should I do sooner?
Her ferritin is so low she likely needs iron transfusion
Discuss with Dr
Certainly they should prescribe iron if not having transfusion
Iron is complicated and toxic in excess
Gluten intolerance, not coeliac can cause poor nutrient levels
You don’t need any obvious gut issues
Vitamin D, magnesium, folate, and B12
Only add one vitamin supplement at a time
Wait 2 weeks to assess before adding another
Suggest starting with vitamin D, followed by magnesium
Then B12, then vitamin B complex
Calm vitality Magnesium powder is great for helping with constipation. Take bedtime or late afternoon. Start on half dose initially and increase until get desired results. Too much can cause diarrhoea
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes:
Males 16-60: 30-400 ug/L
Female's: 16-60: 30-150
Both >60: 30-650
The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘
I get migraines. Before I was diagnosed I knew nothing, and even then not much.
But I found that when my vitD level was raised my migraines did calm a little. Also, I was given 3000 per day for 10 weeks. Then nothing! It dropped low again. So I just sorted myself like you do.
Low iron and folate can cause terrible fatigue. This is also a trigger for migraines. I really hope that once her levels are improved that she gets fewer migraines.
When my thyroid levels drop, I get more frequent and more severe migraines. So again, something to keep an eye on down the line. ☺️
My son is in a similar position at the moment and there is (what was) pernicious anaemia in the family. His doc has offered him folic acid and Vit D tablets but not tested him for PA, nor offered any B12. I think they may be looking at coeliac.
I think that he should be tested for PA before he takes any vitamins but when he does take them I'm going to suggest that he takes pre-methylated ones (like me) in case he can't process folic acid easily. I've heard it can stick around becoming toxic in the body if one can't.
I notice that no-one's yet answered your question as to whether hypothyroidism can be ruled out.
I'm just a novice here, but from what I've read on this forum, a TSH of 2.79 isn't "normal". Hypothyroidism could also explain your daughter's low vitamin levels.
Perhaps someone with more knowledge and experience could comment further.
“TSH bang in the middle is unconditionally bad. A euthyroid (i.e. no thyroid problems) TSH is around 1, never over 2, and when it reaches 3 you are hypo - and in some countries treatment would start at that point.”
My daughter’s TSH in her Oct bloods was 2.799 (0.480-4.170).
SlowDragon Any reason you didn’t flag this when you read my post?
My daughter had similar results and we are tackling the low folate, ferritin, B12, Vit D etc to then retest her thyroid once it has a better environment to function 🤞she also used Three Arrow to great effect and it is the first thing she reaches for when a headache threatens 🤗
I'm guessing SlowDragon didn't tackle the thyroid results as the title "Second opinion for my daughter (ruling out thyroid, opinion on vitamins)" suggested you'd already dealt with that aspect?
Ah, maybe! But no - this is all new. Since the doctor wasn’t concerned at all about the thyroid numbers and since her Oct numbers were in range, and her ferritin is so terribly low I decided tackling the iron/ferritin was the best first step in any circumstance.
Like you I have fingers crossed that it’s not thyroid in the long run.
But then reading that SD comment today about TSH made me start thinking about it again.
As a comparison we tested my daughters boyfriend and his TSH was also around 2.5.... so needless to say we sent him to the GP for all the other tests and have got him on supplements too! Also switched them to iodized salt...
They have both perked up considerably in the last 3 months even having moved house, I ought to get on and nudge them to test again but it's so good to see their energy levels are better than ever 🙂
I think the supplements have done the trick
Such a shame that GP's aren't more switched on to the importance of good levels of vit's and min's 😕 I wonder if they run their cars with the oil at the bottom of the dipstick, soft tyres and minimum water in the radiator 🤷♀️
TiggerMe Thank you! Also, it's funny how even reading your post makes me feel a bit more community : ) Unfortunate that we are bonding on an illness, but at the same time, kind of nice!
What's the rationale for having iodized salt... I read a lot here about avoiding iodine? What should us hypo people do regards to eating foods with or without iodine, and is that different than taking iodine supplements?
Also SlowDragon Any thoughts on the fact that her TSH is 2.799 (0.480-4.170) in October (it was only 1.217 (0.480-4.170) in March). Should I begin emotionally preparing that she has what I have... or ... are there too many variables to say yet?
It is a rather wonderful community of broken folk fighting back, it certainly saved my sanity and we often have a good laugh 🙃
Iodine is necessary for a healthy thyroid to function, once on medication there is a lot of iodine in the tablets.
I would say her results are showing signs that it is struggling but you have also identified the vits and mins it is desperately in need of to be given a chance to, I would concentrate on getting those sorted and then retest 🤗
Hormones often fluctuate so I wouldn't worry unduly as maybe she was stressed or recovering from another virus at the time and these things all have an effect
Let's give her a chance with all the right ingredients 🤞
Just as a side note, I noticed that EBV is waiting additional tests. This can also cause a lot of fatigue or feeling that you are drained of energy + lots of other issues. Not sure if this can also tie in with bad absorption of vits & minerals. Maybe it’s another avenue to look at if things don’t improve
Thank you everyone! The one good thing about needing to go slow with new treatments is that I only have to decide on the FIRST/NEXT step.
For the next two weeks my daughter will take:
* 1 capsule a day of the Three Arrows heme iron, increasing to 2 a day in the second week (SD’s links to the posts on three arrows taught me a lot, and give me confidence to try something that does indeed look like an untrustworthy website! I also found this video on their website super educational: threearrowsnutra.com/pages/... The more one reads about the low absorption and awful fillers in the “synthetic” Iron, it’s another jaw dropping eye opener about our medical industry.)
* 1000 ius vitamin D 2x a day
I think magnesium will be next, but I don’t have to think about this puzzle again for about 2 weeks!
Ps. SD per your recco on an infusion, my daughter is absolutely terrible with needles/shots/gtg blood drawn. Absolute panic when it happens. She would rather suffer a few months more and hope the supplements work before even considering an infusion. So that will be on the list of considerations in a few months depending on next bloodwork, at which point I will re-read and sequence the other recommendations from everyone above.
I feel so fortunate to have everyone’s experience and expert knowledge. Thank you!!!
Have you considered sleep apnea, its often thought as a condition for aged obsese men who snore but its much wider in the population than this including children and thin people.
There is much advancement in the last 10 years in understanding this condition especially with something called UARS which on the spectrum of obstructive sleep apnea. Sleep apnea can also lead to an elevated TSH and thyroid antibodies without triggering overt hypothyroiddism (see sub clinical hypothyrodism) so can muddy test results. Things like teeth grinding and large tonsils are also linked to this condition as well as small and weak a throat, tongue etc.
There are some great you tube videos by Vik Veers (NHS surgeon) that explain this condition and what to look out for if you observe her in sleep. Also look at the "stopbang" questionnaire online though its just a screening tool.
I have both hypo and sleep apnea and suffer from headaces and fatigue before and during treament The headaches can come from oxygen desaturations arising from airway obstructions or micro arousals where your brain wakes frequently destroying sleep.
Low vitamin D linked to both though it seems to be linked to everything.
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Thyroid levels and second opinion
Thyroid problems ruled out?
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Daughter's vitamin/mineral results
Thyroid ultrasound was fine. Does that definitely rule out Hashimotos?
