Blood results and vitamins: Hi all In my first... - Thyroid UK

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Blood results and vitamins

Vegan3 profile image
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Hi all

In my first post a week ago I asked about my thyroid results so far and vitamins: healthunlocked.com/thyroidu.... I had lots of useful advice on the interpretation of my thyroid results and a recommendation to do some bloods to look at vit D, B12, ferritin and folate.

I am vegan and 47. I am on HRT. I'm not taking any supplements - I wanted a baseline before starting.

So I did the Monitor My Health Full Health test on Monday and these were my results:

Thyroid:

TSH: 7.29 (0.27-4.2) This is 178.6%, up from 4.8 or 115% 9 days ago, but test was done at 07:20 compared to 09:30.

FT3: 4.7 (3.1-6.8) This is 43.2%, from what I've read >75% is ideal.

FT4: 15.7 (12-22) This is 37% from what I've read ~50% is ideal.

I know I fall in the subclinical hypo category at the minute and I tested positive for TPOAb, Hashis, earlier in the month. I'm not on levothyroxine. I've developed rosacea at the same time and been given metrosa gel to try. I plan to start an elimination diet from 10th Feb.

Vitamin D:

Vit D: 28nmol/L - very low/deficient. Wasn't surprised, I did think it would be. I think I should be aiming for >75nmol/L (optimal), is that right?

Anaemia:

They have said the results below are all 'normal', however I'm aware there is a difference between normal and optimal. They also said they don't have reference ranges for the tests below, just cut off points which I've added below:

Haemoglobin: 124g/L (<120 suggests anaemia) I may have 'passed' but it is at the low end, is there an optimum?

Ferritin: 89ug/L (<15 suggests iron deficiency) I found a website which suggested low is 15-29 ug/L, indeterminate is 30-99 ug/L, normal is 100-310 ug/L and high is >310 ug/L. So is this a bit low?

Transferrin saturation (TSAT): 37% (<16% suggests iron deficiency)

Folate: 5.4 ug/L (<3 suggests folate deficiency) I found a website which suggested indeterminate zone is 3-4.5 ug/L. I can't find an optimal. So is this OK?

Active B12: 58pmol/L (<38 suggests deficiency). I'm vegan, so I thought it would be low. Is optimal >70? I found a website which suggested average female levels are 114pmol/L?

So I'm going to supplement vitamin D (with K2-MK7) and B12, but I'm not sure about iron. If you could confirm that I've understood this properly I'd appreciate it! Any suggestions of good quality supplements or other next steps would be welcomed too.

I'm hoping that when my GP appointment comes through I'll be better informed and able to advocate for myself. It's been suggested I find out my iodine levels, which I'll ask for. Are there any others important ones I should request (selenium, magnesium, potassium, zinc) or interactions?

Many thanks

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SlowDragon profile image
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Only started on one vitamin supplement at a time

Then wait 10-14 days to assess before adding another

Suggest you start with vitamin D

GP should prescribe 1600iu everyday for 6 months but that’s unlikely high enough dose

NHS Guidelines on dose vitamin D required

panmerseyapc.nhs.uk/media/2...

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

Suggest you start with 3 or 4 sprays per day

3000iu - 4000iu daily

Retest in 2-3 months

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 you Improve level, very likely you 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

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...

SlowDragon profile image
SlowDragonAmbassador

How long have you been vegan

What vitamin supplements have you been taking up until this test

Yes B12 and folate are too low

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.

As vegan likely to need ongoing separate B12 at least a 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...

Great reply by @humanbean on B12 here

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...

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 if last test result serum B12 was below 500 or active B12 (private test) under 70

SlowDragon profile image
SlowDragonAmbassador

Previous post

healthunlocked.com/thyroidu...

With TSH at 15 on first test by GP you should have been started on Levo last year

Now TSH is still significantly over 5

High thyroid antibodies and low vitamin levels

Print this flow chart out to take to consultation

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

Push to be starting on Levo or if GP won’t agree see thyroid specialist endocrinologist privately

standard STARTER Dose is 50mcg and 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)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

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 always be below 2 on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

FallingInReverse profile image
FallingInReverse

By the way, Rosacea was one of my first symptoms years before diagnosis. It resolved once I got on thyroid hormone replacement. And it will only flare up when there’s something going on with my hormones overall. Right now it’s my perimenopause causing issues : )

Metrogel didn’t work for me. Not sure if there’s an equivalent to Soolantra available where you are. It’s an ivermectin cream that works for me and a couple other people I know where metrogel didn’t work.

Separately - your iron status is good right now. It needs to be monitored over time when you’re hypo, but you can drop it to the bottom of your priority list until you take care of your other more pressing needs!

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