I would like some advice on supplements to improve folate , B12 and ferritin. I think my Vit d is ok. Current levels are:
Roche Serum B12 592 ng/l this was 2 months after a B12 injection previously was 327 in May 2023
Folate 10 .2 ng/l (previous test in May 2023 was 6.2)
Ferritin 34
Vit D 81nmol/l
I think B12 and vitamin D are ok? I plan to get B12 injections every 2/3 months.
Need to up folate to 20? Should I take a Vitamin B complex with folate or as I’m having B12 injection just a folate supplement?
ferritin I’ve requested GP to run full iron test in 2 weeks time as part of my bloods for thyroid med review! Been on 25mg of Levo for 2.5 months and thyroid levels being reviewed .
Currently classed as subclinical autoimmune thyroid.
see profile for info.
Any help on supplements much appreciated. I don’t have horrendous symptoms but I don’t want things getting worse !!
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Ellen70
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25mcg levothyroxine is only half the standard STARTER dose levothyroxine
Make sure you book 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)
Folate
As you have B12 injections it’s recommended also to 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 may help maintain B12 levels between injections
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
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
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)
Post discussing how biotin can affect test results
Are there symptoms of low stomach acid? Does acidity normalise once thyroid medication is working effectively?
My vit levels and ferritin are within “normal “ nhs levels so I’m hoping I’ve caught my autoimmune thyroid disease early enough to avoid serious depletion and associated symptoms. I realise I need to increase vits/ferritin to optimal levels.
I will order the b vits you recommended and up iron intake. Will not commence b vits until after my blood test on 16 Oct.
Levothyroxine doesn’t top up your own thyroid, it replaces it
As your TSH reduces in response to adding levothyroxine, your own thyroid stops working so hard. So you can actually become more hypo if on too low a dose
Also with Hashimoto’s TSH is often slow to respond/sluggish, especially if vitamin levels are low and especially if ferritin is low
Absolutely ESSENTIAL to test TSH, Ft4 and Ft3
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
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)
See on previous post your coeliac test was ambivalent
Are you being retested
Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.
Most common by far is gluten. Dairy is second most common.
A trial of strictly gluten free diet is always worth doing
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
Yes retesting 3 months after last test which will be end of Oct. I had similar results 3 years ago and paid had an endoscopy using private healthcare. This came back negative,
Continuing to eat gluten until blood test ! Must then decide if it’s positive whether I have another endoscopy or just go gluten free ? Hoping I’m just gluten intolerant rather than coeliac
Diagnosis largely irrelevant to you if you benefit from being on gluten free diet
Getting coeliac diagnosis can (sometimes) make medics take more notice
I certainly found although I tested negative for coeliac, endoscopy found damage as if coeliac…..and it helped get liothyronine prescription alongside levothyroxine on NHS eventually
ferritin I’ve requested GP to run full iron test in 2 weeks time as part of my bloods for thyroid med review!
Good
Come back with new post once you get results
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
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.
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