Low adjusted calcium level

[Curious123]

Is there any link between thyroid issues and a low adjusted calcium level? Vitamin D is higher in the range around 100 (I take 3,000IU per day) plus was on a multivitamin as well. It has never been a problem previously but two blood tests in the last year (since starting levothyroxine) have shown a low adjusted calcium result. Tried searching the group but no luck.

[SlowDragon Administrator]

multivitamins never recommended on here when taking levothyroxine

Instead test vitamin D, folate, B12 and ferritin at least annually and supplement individual vitamins as necessary

What are your most recent vitamin results

What are your thyroid levels

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[Curious123 in reply to SlowDragon]

The multivitamin was a high quality prenatal. I regularly take 3,000IU Vitmain D and monthly B12 IMI. Ferritin is sub optimal and trying to get an infusion at the moment (around 50 last test). Bloods were 8:50am fasting and 26 or so hours after last dose of levothyroxine.

TSH 0.68 (0.27-4.2)

FT4 19.1 (10.8-25.5)

NHS GP can’t test FT3. I’ve tried a couple of the finger prick tests but can’t seem to get enough blood no matter how hard I try, water I drink beforehand etc (seems to be an issue since Levo / thyroid issues). I know TPO are still negative and always have been and NHS doesn’t test TgAB or TRAb.

The vitamin D is optimal, parathyroid hormone supposedly ok but the adjusted calcium has been low twice now.

[SlowDragon Administrator in reply to Curious123]

NHS GP can’t test FT3. I’ve tried a couple of the finger prick tests but can’t seem to get enough blood no matter how hard I try, water I drink beforehand etc (seems to be an issue since Levo / thyroid issues). I know TPO are still negative and always have been and NHS doesn’t test TgAB or TRAb.

Both Medichecks and BH offer private blood draw at local to you clinics

Trab is Graves Disease antibodies test

medichecks.com/products/tsh...

[Curious123 in reply to SlowDragon]

Trab is Graves Disease antibodies test. Yes I know. I am postpartum thyroiditis currently but may be graves with blocking antibodies as I was TgAB positive and had one instance of TSI positive but never TPO positive.

[SlowDragon Administrator in reply to Curious123]

So you can get tested via Medication

Trab has to be done by private blood draw. Can’t be finger prick test

[Curious123 in reply to SlowDragon]

Yes I know. But I still don’t know why my adjusted calcium has come back low twice while on levothyroxine.

[SlowDragon Administrator in reply to Curious123]

Suggests your Thyroid levels may be low

[Curious123 in reply to SlowDragon]

That is what I wondered.

[radd]

Curious123,

Usually PTH (parathyroid hormone), Vit D and calcitonin maintain calcium balance but if thyroid hormones are high, calcium levels can elevate in the bloods stream and in hypothyroidism calcium levels can reduce.

However, remember PTH should help prevent low calcium levels by acting on the bones, etc (eg releasing calcium to keep equilibrium). Have you had PTH tested?

[Curious123 in reply to radd]

Yes, it was deemed normal at 5.0pmol/L (1.1-6.9pmol/L). It was tested at the same time the adjusted calcium came back low. Vitamin D was 118nmol/L (50-174nmol/L).

[radd in reply to Curious123]

Curious123,

Good, so maybe it is just your thyroid hormone levels.

Research shows elevated thyroid hormones increased bone turnover which releases more calcium from the bones, resulting in higher calcium in the blood stream and higher labs. There is much research surrounding higher calcium levels in Graves Disease.

Conversely lower levels of thyroid hormone may result in lower levels of calcium in the blood through a slowing down of metabolism and especially of calcium absorption through the intestine. (Vit D absorption also needed for calcium absorption may be impaired although appears not in your case). However, inadequate thyroid hormones can also contribute to poor renal function resulting in increased phosphorus that impairs the 1,25 (OH) 2 D Vit D conversion.

Are you optimally medicated? What are your latest FT4 and FT3 labs?

[Curious123 in reply to radd]

I am not convinced I am optimally medicated…. Anywho, last NHS result (so no FT3 as GP ordered):

TSH 0.68 (0.27-4.2)

FT4 19.1 (10.8-25.5)

I am trying to do another private test in the future as I want to see if my changes have brought down my TgAB the last little bit so they are hopefully now negative. Thyroid ultrasound showed all good - no enlargement, nodules or calcification or atrophy, so fingers crossed for the future.