My daughter is 17 and has been struggling with low energy, constipation and difficulty concentrating in class.
I have Hashimotos and recognised some of these symptoms so had her tested privately.
She takes Better You spray 3000 with K2 / day at the moment but no other supplements).
Blood test was taken at night so I appreciate TSH could be even higher at 9am.
I would appreciate any advice.
We have a GP appointment on Monday at 9am and am not sure what to ask / hope for.
Thank you so much.
Hi, the results are difficult to interpret since her aTSH is certainly too high but T4 & T3 are within range. Since the NHS test only the TSH you may find that a GP may prescribe a starter dose of T4 if you can persuade them to do an NHS TSH test. Don’t show them your full test results!
It’s essential that the next test is done in an ideal way. Before 9am, fasted, only water to drink, no B vitamin supplements especially biotin for a week before. This will give the highest TSH reading.
She needs to boost her iron and all B vitamins. I use Ignneus Complete Bs from Amazon which has the correct methyl folate form. Post for more info about iron as I don’t take it. I also take an Vitamin D in olive oil supplement which I’ve found to be better absorbed. Magnesium citrate is the best solution for constipation & is important to take alongside Vit D for bones. If thyroxine T4 is prescribed make sure to take it an hour away from food & 4 hours away from Vit D & magnesium.
Good luck at the GPs. I think ThyroidUK website has a list of symptoms which you could check before your appointment
Thank you for replying Bertwills .
I gather from googling around that her tsh puts her in the subclinical hypo range and nhs only prescribes T4 if it’s over 10.
I will get her tested under better protocol once she’s back from holidays (this was last minute as she’s about to go away for a month)
I’m wondering if there’s anything we can do to improve her position and perhaps not need t4 - we will supplement D3, B complex, magnesium and iron - and test for selenium and copper perhaps too.
What should we be asking of GP at this point?
Her ferritin is virtually deficient
B12 is insufficient
Folate deficient
Vitamin D inadequate
What’s her diet like
Is she vegetarian or vegan
Suggest she spend next 2-3 months improving low vitamin levels
Then retest
Low vitamin levels will affect thyroid
Low thyroid levels will result in low vitamin levels
First step get vitamin levels up to optimal levels then retest thyroid
With two separate tests with TSH over 5, and symptoms she could/should be offered trial on levothyroxine
perhaps look at ultrasound scan of thyroid too if next test TSH is still over 5
Blood test was taken at night so I appreciate TSH could be even higher at 9am.
TSH might be significantly higher testing before 9am
only add one supplement at a time, then wait at least 10-14 days before adding another
Vitamin D
NHS Guidelines on dose vitamin D required
panmerseyapc.nhs.uk/media/2...
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 improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once Improve level, likely to need on going maintenance dose to keep it there.
Test twice yearly when supplementing
Can test via NHS private testing service
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 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...
Recipe ideas
bbc.co.uk/food/articles/mag...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once her serum B12 is over 500 (or Active B12 level has reached 70), she 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
Highly effective 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...
Low folate
supplementing 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...
B vitamins best taken after breakfast
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
Post discussing different B complex
healthunlocked.com/thyroidu...
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 can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 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 she stops vitamin B complex, might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until Active B12 over 70
Post discussing how biotin can affect test results
Low ferritin
Get FULL iron panel test as next step
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
Stop iron supplements 5-7 days before testing
Medichecks iron panel test
medichecks.com/products/iro...
Look at increasing iron rich foods in diet
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
List of iron rich foods
Links about iron and ferritin
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
drhedberg.com/ferritin-hypo...
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.
healthunlocked.com/thyroidu...
Posts discussing Three Arrows as very effective supplement
Great replies from @FallingInReverse
re ferritin and Three arrows
healthunlocked.com/thyroidu......
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Great reply by @fallinginreverse
healthunlocked.com/thyroidu...
Iron patches
healthunlocked.com/thyroidu...
Thyroid disease is as much about optimising vitamins as thyroid hormones
healthunlocked.com/thyroidu...
restartmed.com/hypothyroidi...
Post discussing just how long it can take to raise low ferritin
healthunlocked.com/thyroidu...
Iron and thyroid link
healthunlocked.com/thyroidu...
Posts discussing why important to do full iron panel test
healthunlocked.com/thyroidu...
Good iron but low ferritin
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Chicken livers if iron is good, but ferritin low
healthunlocked.com/thyroidu...
Shellfish and Mussels are excellent source of iron
healthline.com/nutrition/he...
Iron deficiency without anaemia
healthunlocked.com/thyroidu...
Ferritin over 100 to alleviate symptoms
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Great research article discussing similar…..ferritin over 100 often necessary
ncbi.nlm.nih.gov/pmc/articl...
Low Iron implicated in hypothyroidism
healthunlocked.com/thyroidu...
Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue
healthunlocked.com/thyroidu...
Inflammation affecting ferritin
healthunlocked.com/thyroidu...
Updated reference ranges for top of ferritin range depending upon age
healthunlocked.com/thyroidu...
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
Thank you so much SlowDragon .
She's not great at taking tiny pills never mind large capsules! So I will try to get her to take higher dose Vit D spray for next few weeks (I've discovered she was only taking 1 spray not 3), then B12 drops, then Thorne Basic B a few weeks later for the folate - or is that doubling up on B12?
And get her eating more iron rich foods.
Is it possible that simply by improving all the vitamins and minerals her body will manage to make more thyroid hormones and she won't need levo at all?
Trying to understand why a 17 year old (not vegan or vegetarian) would have low levels of all of these. Do her antibodies suggest no autoimmunity?
Thanks again for your time and thorough advice.
PS we saw GP today and he is sending her for blood tests, suspecting low iron and low vit d and has prescribed something to help with constipation for now. We will do GP blood tests in the morning and fasted.
initially she can take both B12 and vitamin B complex ….once Active B12 over 70-100….reduce then stop separate B12
Thorne B complex is large capsule
If she can’t swallow large capsules and doesn’t like taste of Thorne B complex powder …try Igennus B complex…..nice small pills
Is it possible that simply by improving all the vitamins and minerals her body will manage to make more thyroid hormones and she won't need levo at all?
That’s the million dollar question
Improving vitamin levels is first step
We will do GP blood tests in the morning and fasted.
Good plan, is GP retesting thyroid
GP has prescribed something to help with constipation for now.
Calm vitality magnesium powder is good for improving constipation. Starting on low dose (half teaspoon in small cup water in evening….drink while fizzing) Increase dose slowly over week or so until get desired effect….too much can cause diarrhoea
Do her antibodies suggest no autoimmunity?
20% of Hashimoto's patients never have raised antibodies
healthunlocked.com/thyroidu...
Paul Robson on atrophied thyroid - especially if no TPO antibodies
paulrobinsonthyroid.com/cou...
Gluten intolerance is often a hidden issue too.
Request coeliac blood test BEFORE considering trial on strictly gluten free diet
ask GP for coeliac blood test first as per NICE Guidelines, because she has good diet but low vitamin levels
nice.org.uk/guidance/ng20/c...
Thank you so much. All so helpful! 🙏
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