FT4 to FT3 Conversion Problem --- Doctors Do Not Order Correct Tests

[Bird_42]

Back in April 2011, I posted in a different thread that I felt I had an FT4-to-FT3 conversion
problem. My FT4 was rising, while my FT3 was staying the same. My hypothyroidism symptoms
(arthritic pain in hands, pain in knees, sluggishness, memory lapses) were bad.

Here is the thread:

http://www.medhelp.org/posts/Thyroid-Disorders/I-Stop-Taking-Vitamin-D-Free-T4-Goes-Up-Free-T3-Stays-Same/show/1500525



The poster known as gimel said that I should be tested for the following:

(vitamins A, D, B12) and (RBC magnesium, zinc, and selenium).  

gimel said that deficiencies in some or all of these can cause hypothyroidism symptoms.



I sent an email to my endo, asking for these 6 tests. The endo said that he would order the
vitamin D test but that the other 5 tests are not tests that he normally orders. The endo said
that I should ask my primary-care physician (PCP) for the other 5 tests.

I sent an email to the PCP, asking him for these 5 tests. Like the endo, the PCP said that he would
be willing to order the vitamin D test. However, the PCP wanted to see some information about the
usefulness of the other 5 tests.

So, I did some research.



I found the following website:

http://www.thyroid-info.com/articles/topsupplements.htm

This website shows the relation between thyroid function and vitamins E & D, selenium, and zinc.
The website also mentions vitamins A & C, Omega 3 & 6 fatty acids, and free-form amino acids.


I also found this website:

http://www.*************************/lab-values/

This website explains the tests for vitamin B12, ferritin, and RBC magnesium.


However, the most shocking discovery that I made was this website:

http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php

This website explains that, if a person has autoimmune disease, then vitamin D may make the
autoimmune disease WORSE. My hypothyroidism stems from autoimmune disease. If vitamin D will
make my autoimmune disease worse, then that may explain why my FT4 and FT3 levels went down
when I used vitamin D, even though I used vitamin D and Synthroid far apart from each other.



So, I sent an email to the PCP, telling him about all 3 websites. I said that I should
*definitely* be tested for vitamins E & D, selenium, and zinc. I said that *maybe* I should
also be tested for the following: (vitamins A, C, B12), RBC magnesium, ferritin, Omega 3 & 6
fatty acids, free-form amino acids, and the adrenal glands and stress hormones.

The PCP said that he sees no usefulness to any of these tests, other than the vitamin D test. The PCP
did, however, say that he suggests taking a vitamin and mineral supplement + vitamin E.



First of all, why did the endo tell me to ask the *PCP* for the following 5 tests: (vitamins A, B12)
and (RBC magnesium, zinc, and selenium)? If these tests are thyroid-related, shouldn't the *endo* be
handling them?

And why would the PCP tell me to take vitamins and mineral supplements without first testing me to
find out which vitamins and minerals I am deficient in? He tells me to take vitamin E without testing
my vitamin E levels. Without a blood test, how do I know how much of a dosage of vitamin E I need,
if any?

And the one test the PCP *does* want to give me is for the substance (vitamin D) that I can't
swallow, no matter what, because that substance makes my autoimmune disease worse.

What is going on here?

Thanks for any answers.

[Bird_42]

In my first post, the website that gives information on the tests for vitamin B12,
ferritin, and RBC magnesium, should be www (dot) stop the thyroid madness (dot) com/lab-values/

Thanks.

[ChristineMP]

Many of the substances you mentioned are water soluble which means your body doesn't retain it so testing for it wouldn't do much good...you level will change from day to day. The good needs that with water soluble vitamins and minerals, you can supplement without worrying your are over doing it...your body will just get rid of the excess.

Vitamin D is fat soluble which means your body retains it, so testing for it makes sense.

I hope this helps

[Barb135]

These vitamins/minerals are not necessarily "thyroid related" - Vitamins A, D, E and K are the fat soluble vitamins.  Even though other vitamins and minerals may not be fat soluble, testing still makes sense, because but deficiency in these vitamins/minerals are often seen in patients with thyroid conditions, and can cause thyroid like symptoms.  In addition, studies have shown that lack of selenium can affect the conversion of T4 to T3.  

All of these vitamins serve important rolls in the body and adequate amounts are needed.  Without vitamin D, calcium is not absorbed properly; magnesium helps with the muscle/joint aches/pains that are often seen in hypothyroid patients, plus it can help with the constipation.  Vitamin B12 deficiency causes a "never ending" fatigue (similar to that found in hypothyroidism); untreated B12 deficiency can also cause numbness/tingling of the hands, arms, feet and legs, along with other things. B12 deficiency (pernicious anemia) often requires supplementation in the shot form, since some of us can't absorb it through the stomach.  As I stated previously, selenium deficiency has been linked to adequate conversion of T4 to T3.  

If your doctor refuses to test for these vitamins/minerals, you might try supplementing anyway, to see if it makes a difference.  The problem with taking a "multi" is that they often don't contain enough of each vitamin/mineral to make a difference.  Many of us find that supplementing with individual vitamins/minerals makes the most difference.  

[Bird_42]

Well, in the past, I took Centrum multivitamin at night (with thyroid medicine in the morning). But Centrum gave me chest pains, and so I discontinued the Centrum. So, if I take any multivitamin, it can not be Centrum.

Taking individual vitamins and minerals is probably the best thing, but which ones? Without tests to determine where I am deficient, should I take vitamin E AND selenium AND zinc AND magnesium AND vitamin B12? That is 5 pills, PLUS Synthroid.

What about Omega 3 & 6 fatty acids and free-form amino acids? Should I take those supplements?

I suppose I could go back to the endo and show the endo the websites that I showed the PCP. But, if the endo will not order any tests either, then I'm in trouble.

And, in Chicago, there is a 4 - 6 month wait to see *any* new endo.

I know that this is a medical forum, not a legal forum. But should I threaten to sue my PCP and/or my endo with malpractice if they do not agree to these tests?

Thanks.

[Bird_42]

bump

[Bird_42]

Well, I recently reiterated to my PCP that I need to be tested for vitamins E, D, B12, and for selenium, zinc, magnesium. I stated that magnesium helps with the muscle/joint aches/pains that are often seen in hypothyroid patients and that B12 deficiency causes fatigue (similar to that of hypothyroidism).

I pointed out that I could not simply take vitamins and minerals without having blood tests to determine which vitamins and minerals I need, and in what dosages.

The PCP suggested that I have an evaluation at the Integrative Medicine clinic affiliated with the PCP's medical group.


I did some google searches on Integrative Medicine, and I found this website:

http://www (dot) webmd (dot) com/a-to-z-guides/features/alternative-medicine-integrative-medicine?

According to this website, Integrative Medicine "combines conventional Western medicine with alternative or complementary treatments, such as herbal medicine, acupuncture, massage, biofeedback, yoga, and stress reduction techniques -- all in the effort to treat the whole person. Proponents prefer the term 'complementary' to emphasize that such treatments are used with mainstream medicine, not as replacements or alternatives."


Is Integrative Medicine (IM) really what I need? Are IM doctors the only ones who can test me for vitamin and mineral deficiencies? Has anyone on this forum gone to an IM clinic for treatment of hypothyroidism? Is IM usually covered by health insurance?

I would appreciate any info. Thank you.

[Barb135]

Any doctor who is willing can order a vitamin/mineral panel.  My pcp ordered it for me.  You'd have to check with your health insurance company to find out if IM is covered under your policy.

[Totie]

Can't you just go to a private lab and have them test for you? I doubt suing your PCP will get you anywhere but in debt..

[Bird_42]

I didn't know that you could have a blood test without a doctor's order. How do I find a private lab in Chicago?

[Totie]

I wish I knew, however, I have read on here where people go and get their own private lab work if you can afford it. Have you tried google? I would research it on line.

I know here where I live you can use Lab Quest.

[Bird_42]

Well, I did some research, and I have found three online companies that specialize in private blood tests. These companies are the following:

Request A Test       requestatest (dot) com

Private MD Labs      www (dot) privatemdlabs (dot) com

Health Testing Centers    www (dot) healthtestingcenters (dot) com


For each company, you specify the tests you want, pay money, and the company generates a test order. That test order is taken to a Chicago lab (LabCorp), which draws and analyzes the blood.

Based on the comments in this forum and on my own personal research, I believe that I may need the following tests:

vitamin E (serum)
Selenium (serum)
Zinc (plasma)
vitamin D (25 - Hydroxy)
vitamin B12 and folates
vitamin A (serum)
vitamin C (serum)
Magnesium, RBC
Ferritin


I spoke to my health-insurance company, and I was told that, if a blood-test order does not come from a doctor, my insurance policy does not cover the test. The above tests cost between $600 and $900 (depending on the online company).

So, I have three options:

1) Get *all* of the tests, at my own expense.

2) Get only *the most important* tests, at my own expense.

3) Find a doctor willing to order the tests, and go to that doctor for one visit only. The purpose of the visit will be to obtain an order for the tests. Because the tests will be ordered by a doctor, these tests will be covered by my insurance. I can then go back to my usual doctors.

This suggestion actually came from a customer-service representative at my insurance company. So, the company presumably agrees with the idea. Actually, I have been receiving allergy injections for over 20 years, and I've thought about asking one of my current allergy doctors to order these tests for me.



So, which option do I go with? If I go with option #2, which tests are the most important ones? Please keep in mind that I am trying to determine what is causing my FT4-to-FT3 conversion issue.

Thank you very much for any help.

[Bird_42]

bump

[Barb135]

You might also check out healthcheckusa and ZRT labs for tests.  

If I had to make a choice of the blood tests, I'd probably choose Vitamin D, B12, selenium and magnesium.  

Selenium is most often linked to conversion issues.  

[Bird_42]

Well, it's been a while since I posted anything in this thread, but I do have some new test results to report. These tests were done during the week of July 17, 2011. First, I was tested for TSH, FT4, FT3, and Vitamin D. These tests were ordered by my endo and were done in his lab. A few days later, I took private blood tests for selenium, vitamin E, vitamin B12, etc. These tests were done at the private lab.

The results from the first group of tests came in before I took my private tests, and these results are:

TSH = 0.109, normal range = 0.340 - 5.600

FREE T4 = 1.41, normal range = 0.71 - 1.81

FREE T3 = 3.4, normal range = 2.3 - 4.2

VIT D, 25-HYDROXY = 13, normal range = 32 - 100



Compared to my test results from mid-February 2011, the current FT4 is the same, and the FT3 has risen from 3.2 to 3.4. As I previously mentioned, I took vitamin D from late May 2010 to early August 2010, and the vitamin D caused my FT4 and FT3 levels to drop. But the last two FT4 tests show an FT4 level much higher than the pre-vitamin D level (1.13), and the current FT3 level (3.4) is the same as the pre-vitamin D level. So, it would appear that my FT4 and FT3 are on the right track.

However, the TSH is 0.109, which is lower than the previous TSH of 0.500. The endo said that my TSH is suppressed and that he wanted to decrease my Synthroid dosage. Currently, I take 137 mcg 4 times a week and 150 mcg 3 times a week. The endo wants me to take 137 mcg 6 times a week and 150 mcg 1 time a week. The endo said that the low TSH suggests that I am subclinically hyperthyroid. He said that subclinical hyperthyroidism increases my risk of cardiac arrhythmias.

I told the endo the following: 1) My FT3 should be in the upper 2/3 of normal range, 3.57 or higher; 2) I wanted to make sure that my FT4 and FT3 levels did not go down; 3) The TSH is not reliable because my hypothyroidism is auto-immune; 4) I want to make sure that we do not lower the Synthroid; and 5) I don't think I've have had any symptoms of *hyper*thyroidism, such as heart palpitations. Just the opposite, I've had pain in my hands and knees, which are hypo symptoms.



As for vitamin D, my current level (13) is much lower than my level on my last test (26). The last test was done in mid-May 2010. Obviously, the current level is very low and needs to be increased. The endo recommended that I take ergocalciferol (D2), initially 50000 IU weekly for 12 weeks, then 2000 IU daily. Now, the last time I took vitamin D (late May 2010 - early August 2010), I took cholecalciferol (D3). The "Nature Made" brand that I took contained calcium. Because of the calcium or because vitamin D makes auto-immune disease worse (or because of some other reason), my FT4 and FT3 levels dropped.

So, will D2 make my FT4 and FT3 levels go down the way D3 did? If D2 is better for my FT4 and FT3 levels than D3, then is 50000 IU per week a safe dosage? Or is 50000 IU too much? I thought about taking 20000 IU or 30000 IU per week, but my pharmacy says that there is no D2 dosage between 2000 IU and 50000 IU. So, which dosage should I take?





Now we come to my private blood tests. Here are the results for selenium and vitamin E:

selenium (serum or plasma) = 150 ug/L, normal range = 79 - 326, detection limit = 10

vitamin E (Alpha Tocopherol) (serum) = 7.0 mg/L, normal range = 3.0 - 15.8


I don't know whether the selenium test measured the serum or the plasma, but it seems that the selenium test and the vitamin E test show normal levels. However, it appears that the selenium and the vitamin E levels are in the lower one-third of the normal ranges. So, should I increase my selenium and vitamin E levels with supplements? Or should I leave these levels alone?



One area where I have a definite deficiency is vitamin B12. Here is my B12 result:

vitamin B12 = 189 pg/mL, normal range = 211 - 946

So, I have to take vitamin B12 supplements, vitamin D supplements, and Synthroid, and I have to make sure that these three medications do not interfere with each other. I want the endo to regulate all three medications because I think all three medications pertain to hypothyroidism and are related to each other. But the endo wants to pass the B12 off to my PCP.

Unlike my B12 test, my folates test was normal:

folates (folic acid) (serum) = 14.4 ng/mL, normal range > 3.0



I was also tested for complete blood count (CBC) with differential for the first time since the summer of 2009, when I was first diagnosed with hypothyroidism. All CBC values were in the normal range, except for monocytes.

monocytes = 15%, normal range = 4 - 13

So, the monocytes were a little too high. I know that monocyte levels rise when someone has an infection or when there is stress. So, is my monocyte level bad?

Also, I should mention that my platelet count is 146, normal range = 140 - 415. The count is just above normal. In summer 2009, my platelet count was 121, normal range = 150 - 400. I have read that auto-immune disorders (like my hypothyroidism) can cause the destruction of platelets. So, are these low values expected for someone who has auto-immune hypothyroidism?



Finally, I also had the test for comprehensive metabolic panel. All values are normal, except BUN and BUN/Creatinine ratio.

Creatinine (serum) = 0.98, normal range = 0.76 - 1.27        (normal)

BUN = 22, normal range = 6 - 20                              (high)

BUN/Creatinine ratio = 22, normal range = 8 - 19             (high)

Is this anything to worry about?

I should mention that my last BUN test was done in December 2010 at my PCP's lab,
and that the result was BUN = 19, normal range = 7 - 23.

It seems that my current BUN of 22 would be within the normal range of my PCP's lab.



So, I apologize for the long post :), but I would greatly appreciate any comments.

Thank you.

[Barb135]

Well, you know that TSH being low, does not necessarily indicate that you are hyper; your FT3 and FT4 are good in their ranges.  In view of that, I would resist lowering dosage of thyroid med.

Your B12 is definitely too low and you should have it checked regularly.  If your deficiency is caused by pernicious anemia, you won't absorb the B12 from oral supplements and will need to inject instead.

Your D is also low.  D3 is what you need to be taking.  I really don't think taking the vitamin D is what caused your FT3 and FT4 levels to go down before.  I think that was just a coincidence, that you went hypo at that time.  To my knowledge, taking vitamin D2 will do nothing, or very little for you.  You need to space out the vitamins from your thyroid med, by at least 4 hrs, to prevent them from inhibiting absorption of the thyroid med.

You really need to talk to your doctor about all this.  Selenium is toxic if too much is taken and since your level looks good, I'd certainly want a doctor's opinion.

I'm not familiar enough with the creatinine/BUN to comment on those; you should discuss them with your doctor.

[Bird_42]

Hi, Barb.


Well, I did some research on pernicious anemia, on Wikipedia.

Pernicious anemia is a type of megaloblastic (MB) anemia.

MB anemia occurs as follows: 1) B12 deficiency causes folate deficiency; 2) folate deficiency causes MB anemia. Different types of MB anemia correspond to different causes of the B12 deficiency. In pernicious anemia, the auto-immune destruction of gastric parietal cells leads to a lack of intrinsic factor, which causes a decrease in the absorption of B12 into the blood, which causes the B12 deficiency.

To determine whether I have pernicious anemia, I first have to determine whether I have any MB anemia at all. I do have a B12 deficiency, but we can see that my folates are very normal. So, that suggests that I do not have MB anemia. Furthermore, MB anemia is identified with a high MCV and a normal MCHC (in the CBC blood test). However, my MCV and my MCHC both seem to be normal:

MCV = 91, normal range = 80 - 98

MCHC = 33.4, normal range = 32.0 - 36.0

So, these values also suggest that I do not have MB anemia. So, I probably do not have pernicious anemia.

But the real question is the following: Is it possible to have a decrease in the parietal cells, a decrease in the intrinsic factor, and the loss of B12-absorption ability WITHOUT a resulting folate deficiency and MB anemia? If yes, then my folate, MCV, and MCHC values become irrelevant, and we have to find some other test for this loss of B12-absorption ability.



As for vitamin D, I do believe that the D3 caused my thyroid levels to go down, but I am not sure WHY the D3 caused the thyroid levels to go down. Two possibilities: 1) the D3 contained calcium; 2) vitamin D causes auto-immune disease (like my hypothyroidism) to get worse, as specified in the following link:

http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php


If the calcium is the problem, the I should find a D3 product that does not contain calcium or soy. One such product may be the Bluebonnet 5000 IU vitamin D3, as described in the following link:

http://www.bluebonnetnutrition.com/product/307/Vitamin_D3_5000_IU_Vcaps

Another such product may be Healthy Origins 10000 IU vitamin D3, as described in the following link:

http://www.mynaturalmarket.com/healthy-origins-vitamin-d3-10-000iu-360-softgels.html


Maybe I can take 3 - 4 pills of the 5000 IU product per week, for a total of 15000 IU to 20000 IU per week.

[Barb135]

Yes, you can have pernicious anemia without having folate deficiency - I do.  Look on your lab report and find the RDW - this indicates the size of your red blood cells, and if they are larger than normal, this is suggestive of pernicious anemia.  Megaloblastic anemia is caused by folate deficiency OR B12 deficiency.

http://www.nlm.nih.gov/medlineplus/ency/article/000567.htm

I won't argue the point of the vitamin D with you, but we do need to be careful when researching -- bottom line is that all vitamins/minerals and other supplements should be separated from thyroid medications by at least 4 hrs.  If that simple guideline is followed, you should be able to take most supplements.

There are many good brands of vitamin D on the market that do not contain calcium or soy, which is known to inhibit absorption of thyroid medication.  

As to the dosage, that should be determined by your doctor, since vitamin D can be toxic if excess is taken.

[Bird_42]

Well, my PCP has recommended that I take 2000 mcg of vitamin B12 per day. The PCP recommends the pill version, not the injectable version. So, this probably means that the PCP does not believe that I have pernicious anemia or any other B12-absorption issues. Now I just have to find a B12 brand that does not contain calcium or soy.

As for vitamin D, I will discuss the D2-vs.-D3 issue, as well as proper dosages, with my endo when I meet with him next week.

I did speak to a pharmacist about the interactions among Synthroid, vitamin D, and vitamin B12. She said that, as long as I take each vitamin four or more hours after taking Synthroid, it doesn't matter whether I take the vitamins at the same time or separately. The vitamins can be taken at the same time without interfering with each other because vitamin D is fat-soluble and vitamin B12 is water-soluble.




Meanwhile, about 10 days ago, I had the Magnesium RBC test. I was supposed to have this test earlier, at the same time as the B12 test, but the private lab didn't notice the Magnesium RBC test on my test-order paperwork and therefore didn't analyze the blood for Magnesium RBC. So, I had to come in for another blood draw.


Here is the result:

Magnesium RBC  =  6.8 mg/dL, normal range = 4.2 - 6.8

Disclaimer: Plasma NOT separated from cells; may falsely decrease RBC Magnesium levels.


So, given the disclaimer, my actual value is 6.8 or higher. Thus, I may have excess Magnesium RBC. What does this mean? And how do I lower my Magnesium RBC? I haven't shown this result to my PCP yet because he just came back from vacation.




There is one more thing that I want to mention. In late June 2011, probably in response to this thread, I received a private message from someone on this forum. I won't mention the person's screen name, but this person's profile reveals that this person has NOT posted anything to any forum. Here is the private message verbatim:

-------------------------------------
need to lower ur dose of hormone, had the same problem. medication contain only T4. the level of T3 - T4 in my case was 1:4. i.e free T3 will be 4 and free T4 be 1, in ideal gland functioning condition. whenever my gland would function  properly, intake of medication would increase  in the body and the level of t3 will automatically reduce. when t3 is reduced you would feel less lively and would lose sharpness. hence u need to reduce your dose. however i would recommend you to see an superior endocrinologist cause many doctors as well
as not well informed endocrinologist are aware of this problem. low vitamin d3 and b12 to effect your thyroid function. get help my friend. this disease is not serious but wrong treatment can dramatically effect your life
-------------------------------------


Now, I had some trouble understanding this message, and I sent a private message to the sender, asking him to elaborate. However, I never got a response. Apparently, this person is saying that I have to reduce my level of thyroid hormone, but I'm not sure why. Do I reduce my FT4 level or my FT3 level? Can someone possibly interpret this private message? My endo actually wants me to decrease my Synthroid intake because my TSH is lower. So, this private message has become very significant.



Thanks for any comments.

[Barb135]

Many doctors will have a patient try oral B12, prior to beginning shots.  To my knowledge, most B12 supplements do not contain calcium or soy; however, do be sure to read the label carefully.

I'm not sure about the PM you got - it really doesn't make much sense. Increased medication, usually increases the levels of FT3 and FT4, if everything is working properly.  There is no "set" numbers that we should all have - your "feel good" numbers will different from mine.

In my opinion, your dose does not need to be lowered, simply because of the TSH.  That's nonsense.  Your FT3 and FT4 are good - I wish I could get mine to those levels.  My TSH is much lower than yours (< 0.01) and there's no way I'd let anyone lower my med dosage.

You only need to lower your med dose if your FT3 and FT4 are too high (yours aren't) OR if you have hyper symptoms, which you don't.

[Bird_42]

"My TSH is much lower than yours (< 0.01) and there's no way I'd let anyone lower my med dosage."

The problem is that the endo can lower the dosage because he has the authority to prescribe the medication. If the endo stops prescribing the current dosage, what can the patient do except to find a new endo? And, here in Chicago, there is maybe a 4 - 6 month (or more)waiting list to see any endo.


"Many doctors will have a patient try oral B12, prior to beginning shots."

If a patient needs B12 shots, is the patient expected to inject himself with the shots? Or will a medical professional do the injections? I already have allergy injections every few weeks. The last thing I need is another injection.

[Totie]

I take B12 orally 1000mcg daily & vid D3 daily. I take both about 3-4hrs after taking my thyroid medication. I had to start out with the B12 shots & eventually could do the oral OTC B12 tablets. For some reason people who have issues with thyroid also have issues with B12 & Vit D.


I tried following the thread, but it became to "over anyaylzed for me".

[Barb135]

Whenever my doctors try to lower my thyroid dosage, I have been able to get them to understand (sometimes grudingly) that I actually FEEL good with a TSH that's in the basement because my FT3 and FT4 are right......   of course, if your doctor refuses to listen/write the script, you have no choice but to find another who will.......  Oops, had one doctor who wouldn't listen, sent me to very severe hypoland and I kicked him to the curb in a heartbeat.

I have pernicious anemia, which means I do not absorb B12 via oral supplements.  Yes, I inject myself weekly because that's the only way I can keep my levels high enough to feel human.  I used to go to the doctor's office for the injections, but that cost me a $25 co-pay each week; I can buy the B12 for just over $2 for 10 shots, needles for about $0.10/ea, alcohol swabs are cheap, as are cotton balls....... the supplies for 3 months worth of shots are much less than 1/2 of one co-pay at the doctor's office.  

It's not that hard to self-inject; just think of a diabetic who must inject themselves multiple times/day if needed.  

You could also try a sublingual or liquid B12 that might be absorbed better.  While they will help some, there are those of us, who simply have to inject.

Totie, I'm sorry you had a hard time following the thread or thought it was over analyzed.  I'm happy to know that you can take the oral B12 supplements; unfortunately, things aren't quite so cut and dried for some of us.

[Bird_42]

Well, I went to a vitamin store, and I found three brands of B12 that contain no calcium or soy. These brands are the following:

1) Country Life

1000 mcg, pills/tablets, contains cyanobalamin


2) Solgar

1000 mcg, sublingual, contains cobalamin and a very small amount of sugar alcohol


3) Methyl B12

1000 mcg, lozenge form, contains methylcobalamin and is for vegans



The bottle for Methyl B12 says that methylcobalamin is better absorbed than cyanobalamin. Is that true? Also, I am concerned about the sugar alcohol in the Solgar brand. The guy at the vitamin store said that the amount of alcohol was so small that I wouldn't be impaired or intoxicated, but I'm not so sure. So, is Methyl B12 the best brand?

Also, each brand contains magnesium stearate. As I mentioned above, my Magnesium RBC blood test showed a probable excess of magnesium. So, will the magnesium stearate worsen the magnesium excess?

[Bird_42]

Hi, everyone. It's been a while since I posted anything, and I just wanted to update you guys on my situation. A lot has happened since I last posted. So, this post may be a little long. I apologize for the inconvenience. :)

In late August 2011, I started taking vitamin D3 vcaps, 1000 IU, brand name Bluebonnet. I took these vcaps four times per week, for three weeks. Then I started taking these vcaps every day.

In early September 2011, I started taking vitamin B12, methylcobalamin lozenges, 1000 mcg, brand name Jarrow Formulas. I took these
lozenges four times per week, for two weeks. Then I started taking these lozenges every day.

The D3 vcaps and the B12 lozenges contained no soy and no calcium.

I continued to take Synthroid as follows: 137 mcg, four times per week; 150 mcg, 3 times per week. I had been taking these Synthroid
dosages since June 2010.



Meanwhile, in August 2011, I began experiencing watery and pulsating sensations in my ears, especially my left ear. My PCP saw fluid
in my left ear. In October 2011, I saw an ear, nose, and throat specialist. The specialist performed a "surface" examination of my ears, nose, and throat, including a tympanometry with reflex threshold on my ears. He found no problems, not even ear fluid. However, he cautioned that problems could still exist and that a deeper examination might find them. A hearing test performed by an audiologist showed that my hearing was OK. The specialist suggested that my allergy-related stuffy nose might be causing the ear problems, and suggested that I take the nasal spray Nasonex. Since Nasonex causes nosebleeds, I declined to take Nasonex.

Since my visit to the specialist, some additional ear problems have surfaced. I've felt pain and clogging in my right ear. Also, when I talk, the right ear sometimes "acts up" and makes my talking sound like a static-filled radio station.  

I looked up these ear problems on the Internet, and some people suggested that the pulsating sensations in my ears could be caused by
iron deficiency. Other people suggested that the pain in my right ear could be thyroid related.



By early December 2011, I was experiencing increasing hypothyroidism symptoms again. I was having pain in my knees as I walked up the
stairs. I was experiencing pains in my finger joints. I was having memory and mental lapses. In early December 2011, I took some blood tests, and here are the results:

TSH = 0.108, normal range = 0.340 - 5.600

FREE T4 = 1.20, normal range = 0.61 - 1.81

FREE T3 = 3.3, normal range = 2.3 – 4.2

VIT D, 25-HYDROXY = 26, normal range = 32 - 100

VITAMIN B12 = 448, normal range = 180 – 914

FOLATES (SERUM) = 15.4, normal range > 5.9


Compared to my July 2011 tests, my vit D and B12 levels were up. So, the supplements were working. However the FT4 was down from 1.41 to 1.20. That's a 15% decrease. The FT3 seemed to be down slightly from 3.4 to 3.3. So, it seemed that, once again, vit D was bringing down my thyroid levels. A different brand of vit D had lowered my thyroid levels in summer 2010.

I spoke to my endo. He believed that, because my TSH was 0.109 in July 2011 and 0.108 in December 2011, I was HYPER-thyroid and my
Synthroid should be decreased. I was shocked. The vitamin D was lowering my thyroid levels, and my symptoms matched those lower
levels. And the endo wanted to reduce the Synthroid and lower my thyroid levels even further.

Well, the endo suggested that, if I disagreed, I should find a new endo.
I, too, believed that I should find a new endo. :)
So, I went to the website http://www.thyroid-info.com/topdrs/illinois.htm    This website lists doctors who treat thyroid issues based on symptoms, not based on TSH. I found a doctor who looked promising, and I made an appointment. In mid-January 2012, about three weeks before the appointment, I stopped taking the vitamin D, and I started to feel better.



As for the new endo, first of all, unlike my first endo, this new endo is open to using T3 therapy. He prefers Cytomel, but he is also open to desiccated thyroid like Armour.

On the issue of my ear problems, he suggested that my problems could be allergy related. However, between the time I saw the ear specialist and the time I saw this new endo, I spoke to my allergist, and the allergist believes the ear problems are not allergy related. I mentioned to the endo the possibility of iron deficiency, and the endo ordered a blood test for ferritin.

On the issue of vit D and my lowered thyroid levels, I told the endo about this article:
http://www.eurekalert.org/pub_releases/2009-04/arf-vdm040809.php  
This article describes how vit D exacerbates autoimmune disease like my hypothyroidism. However, the new endo does not believe that I had enough vit D in me to exacerbate my hypothyroidism. Instead, he believes the following:

1) The vit D that I took in summer 2010 lowered my thyroid levels because that vit D brand had calcium in it. He believes this, even though I took the thyroid medicine in the morning and the vit D at night.

2) The Bluebonnet vit D that I recently took (no soy, no calcium) lowered my thyroid levels because I was taking the vit D only 4 - 5 hours after taking the thyroid medicine.

The new endo also believes that, even though the lab's minimum vit D level is 32, some people can be OK with a vit D level of only 25 or 26. So, the endo suggested that it may be a good idea to take the Bluebonnet vit D (no soy, no calcium) 12 hours after the thyroid medicine, only three times a week.



After I discussed the above info with the endo, I took blood tests. Here are the results:

TSH = 0.063, normal range = 0.450 - 4.500

FT4 = 1.53, normal range = 0.82 - 1.77

FT3 = 3.3, normal range = 2.0 - 4.4

VIT D, 25-HYDROXY = 16.5, normal range = 30 - 100

VITAMIN B12 = 887, normal range = 211 - 946

ANTI-TPO Ab = 8, normal range = 0 - 34

ANTI-THYROGLOBULIN Ab < 20, normal range = 0 - 40

FERRITIN, SERUM = 281, normal range = 30 - 400 NG/ML

MONOCYTES = 16, normal range = 4 - 13

BUN = 23, normal range = 6 - 20

PLATELETS = 136, normal range = 140 - 415



The FT4 has increased from 1.20 to 1.53. This is probably because I stopped taking vitamin D. However, the FT3 is still at 3.3.

The endo says that the TSH is suppressed at 0.063 and that I am over-replaced on thyroid hormone. So, he wants to lower my Synthroid to 125 mcg for six weeks, before we add Cytomel. At first, I was shocked that he was focusing on TSH. However, I believe that FT4 should be in the middle of normal range, and my FT4 seems well above that. So, is my FT4 too high? Would lowering my Synthroid (and thus lowering my FT4) be a good idea? Is there some kind of FT4-to-FT3 conversion problem?

Also, the endo says that my vit D is low and that I should take 2000 IU of vit D per day. However, this endo had earlier stated that taking 1000 IU per day, three times a week, would be OK. So, is he being contradictory? Also, what do you guys think of the idea that vit D exacerbates autoimmune disease? The endo said that I didn't have enough vit D in me for the exacerbation, but the article that I showed him didn't say that only a *high* amount of vit D will exacerbate autoimmune disease. Theoretically, *any* amount of vit D can exacerbate the disease.

Also, what about my ear problems? My ferritin seems to be in normal range. So, it doesn't look as if iron deficiency is the cause.
Are these ear problems thyroid related?

Also, my monocytes and BUN are high, and my platelet count is low. Is that anything to worry about?



Thank you very much for any information and comments.