Advice unmedicated friends results

[klaea]

My friend is unmedicated with low b12 but D and ferritin so she has started those. Does she need levothyroxine too? Her results areTSH 5.6Ft3 3.8 (3.5-6.5)

Ft4 11,7 (10-19.8)

[Jaydee1507 Administrator]

Is this a private or NHS test?

They need 2 TSH results above range on the NHS, 3 months apart to get a diagnosis and begin treatment.

Suggest she shows private results to GP who will retest.

Exactly which supplements has she started tking? She will need high dose supplements, not ones to be found on the high street.

[klaea in reply to Jaydee1507]

She is supplementing with ones we searched on this site. So good ones with enough in them to make a difference.

She has had another test a month earlier that showed

TSH 4.66

Ft4 12.3 same range

Do you think she needs levothyroxine or just improve vitamin levels?

[Jaydee1507 Administrator in reply to klaea]

Thats quite a wide TSH range going up to 6.5, which means so far her TSH is within range.

She will almoost ceertainly need Levo at some point but for now the NHS is unlikely to begin treatment.

Make sure she is testing as early in the morning as possible before 9am and fast that morning before the test, only drinking water.

Improving vitamin levels will help how she feels in the mean time.

[SlowDragon Administrator]

What are her actual B12, folate, vitamin D and ferritin results

Was thyroid test done early morning for highest TSH

Retest again in another 6 weeks including thyroid antibodies

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

[klaea in reply to SlowDragon]

B12 350Vit D 50

Ferritin 35

She has had another test a month earlier that showed

TSH 4.66

Ft4 12.3 same range

Do you think she needs levothyroxine or just improve vitamin levels?

[SlowDragon Administrator in reply to klaea]

How old is she

What’s her diet like

Any obvious reason for low vitamin levels

Eg vegetarian or vegan or gut issues

Improving vitamin levels likely to reduce symptoms

If cause of low vitamin levels is thyroid on the blink, often TSH will rise once vitamin levels are good, so it’s easier to get diagnosed as needing Levo

[klaea in reply to SlowDragon]

She's 36 Do you mean if she gets her vitamins higher in range her TSH will increase?

[SlowDragon Administrator in reply to klaea]

Yes …often low vitamin levels “hide” how hypo we might be, especially low ferritin

Improving vitamin levels is first step

Many medics reluctant to start levo until TSH is over 10

But guidelines are clear …2 separate tests with TSH over 5 and symptoms….especially if thyroid antibodies are high ….patient should be offered trial on levothyroxine

TSH over 10 ….must be started on Levo

Ideally……Only add one vitamin at a time and wait 10-14 days to assess any effects before adding another

Retest thyroid including BOTH thyroid antibodies 6-8 weeks after adding last vitamin supplement

Test early morning, ideally before 9am and only drink water between waking and test

[SlowDragon Administrator in reply to klaea]

no folate result?

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 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

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

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

cytoplan.co.uk/shop-by-prod...

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

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...

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

thyroidpharmacist.com/artic...

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 and may need separate methyl folate couple times a week

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 you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until over 500

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[SlowDragon Administrator]

she needs FULL iron panel test for anaemia ideally via GP

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

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

meanwhile

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

dailyiron.net

[SlowDragon Administrator]

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

Test twice yearly when supplementing

Can test via NHS private testing service

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 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

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...