Vitamin D Deficiency and Thyroid Disease

[Guest guest]

Hope this goes through.

Vitamin D Deficiency and Thyroid Disease

Theodore C. Friedman, M.D., Ph.D.

Vitamin D deficiency and thyroid diseases

Vitamin D is an important vitamin that not only regulates calcium, but also has many other

beneficial actions. Not many endocrinologists realize this, but several articles published

over 20 years ago showed that patients with hypothyroidism have low levels of vitamin D.

This may lead to some of the bone problems related to hypothyroidism. It was thought that

one of two mechanisms may explain the low levels of vitamin D in patients with

hypothyroidism, 1) the low levels of vitamin D may be due to poor absorption of vitamin D

from the intestine or 2) the body may not activate vitamin D properly. Other articles have

demonstrated that patients with Graves disease also have low levels of Vitamin D.

Importantly, both vitamin D and thyroid hormone bind to similar receptors called steroid

hormone receptors. A different gene in the Vitamin D receptor was shown to predispose

people to autoimmune thyroid disease including Graves’ disease and Hashimoto’s

thyroiditis. For these reasons, it is important for patients with thyroid problems to

understand how the vitamin D system works.

Sources of Vitamin D

Vitamin D is really two different compounds, ergocalciferol (vitamin D2), found mainly in

plants and cholecalciferol (vitamin D3), found mainly in animals. Both of these hormones

are collectively referred to as vitamin D, and they can either be obtained in two ways. One

is by exposure of the skin to the ultraviolet (UV) rays of sunlight or also from dietary intake.

Vitamin D is found naturally in fish (such as salmon and sardines) and fish oils, eggs and

cod liver oil. However most Vitamin D is obtained from foods fortified with Vitamin D,

especially milk and orange juice. Interestingly, as breast feeding has become more popular,

the incidence of Vitamin D deficiency has increased as less fortified milk is consumed.

Vitamin D deficiency may also occur in patients with malabsorption from their intestine,

such as in the autoimmune disease called Celiac Disease, which occurs frequently in

patients with thyroid problems. Multivitamins also contain Vitamin D, as does some

calcium supplements like Oscal-D and Citracal plus D..

Different Forms of Vitamin D and How To Diagnose Vitamin D

Vitamin D itself is inactive and needs to get converted to the liver to 25-hydroxy vitamin D

(25-OH vitamin D) and then in the kidney to 1, 25-hydroxy vitamin D. It is only the 1, 25-

OH vitamin D which is biologically active. This form of vitamin D acts to allow for

absorption of calcium from the intestinal tract. Therefore, patients with low vitamin D

levels will have low calcium and in severe cases get rickets (in children) or osteomalacia (in

adults) which is when the bone bows out and is poorly formed. In mild cases of vitamin D

deficiency, osteoporosis occurs.

The conversion from the 25-OH vitamin D to the 1, 25-OH vitamin D that occurs in the

kidney is catalyzed by parathyroid hormone, also called PTH. Therefore, patients with low

vitamin D levels will have relatively high PTH levels along with low calcium levels. This is

similar to patients with primary hypothyroidism having elevated TSH levels while having

normal thyroid hormone levels. Additionally, the 25-OH vitamin D form which is the

storage form and is much more abundant that the 1, 25-OH vitamin D form which, although

is active, is less abundant. Therefore, in states of vitamin D deficiency, low levels of 25-OH

vitamin D are found, but the 1, 25-OH vitamin D levels are either normal or actually slightly

high. They are slightly high because the excess PTH that is stimulated by the low 25-OH

vitamin D levels stimulates the conversion up to 25-OH vitamin D to the 1, 25-OH vitamin

D. Thus, patients that are vitamin D deficient usually have a low 25-OH vitamin D level, a

high PTH level, a low normal calcium, and a normal or an elevated 1, 25-OH vitamin D

level.

Dr. Friedman usually recommends measuring PTH, calcium, and 25-OH vitamin D to

determine if a patient does have vitamin D deficiency. The 25-OH vitamin D assay has a

normal range of approximately 20-60 ng/dL. However, this range may be too low for many

patients. Additionally, the assay may not be that good at measuring the low levels of

vitamin D. In general, Dr. Friedman would recommend treatment of patients that have a 25-

OH vitamin D of less than 30 ng/dL, but these patients should have a PTH in the high

normal range. Optimal levels of 25-OH Vitamin D for patients with thyroid diseases are

probably 35-60 ng/dL.

Treatment of Vitamin D Deficiency

There are several ways to correct for the depletion of vitamin D, and these would involve

either increasing sunlight exposure or increasing dietary intake. In general, Dr. Friedman

feels there is an ongoing battle between endocrinologists and dermatologists about sunlight

exposure, and mild sunlight exposure probably does not have that much of an increased risk

of skin cancer yet would be helpful to prevent vitamin D deficiency. Because of our busy

schedule, many of us do not go outside during the day much and our sunlight exposure is

minimal. When we do go outside, we are usually covered up with clothes. Blacks and other

dark skinned patients absorb less Vitamin D and need more sunlight exposure. Dr. Friedman

recommends a patient to be exposed to the sun for 15-30 minutes a day, especially in the

morning, to correct for vitamin D deficiency. However, in northern latitudes, little light of

the proper wavelength goes through the atmosphere in the winter, so this exposure needs to

occur in the spring and summer at which time stores of vitamin D are built up. The body has

mechanisms so that too much vitamin D can not be synthesized by prolonged sun exposure.

An alternative is to go to a tanning salon for approximately three times.

When it comes to replacing Vitamin D, again we have to understand the difference between

D2 (ergocalciferol) and D3 (cholecalciferol). Even though both forms of vitamin D are fat

soluble, studies have shown that if you take D2, your levels rise, but then fall back to almost

baseline in a few weeks. In contrast, after D3, the levels stay high for awhile. Dr. Friedman

and other doctors frequently prescribe a high dose (50,000 iu) of vitamin D weekly for 8

weeks, but this is D2 and in many people the levels drop down to normal after nor taking it

for a few months. This needs to be given by a prescription. Vitamins and preparations like

Oscal D contain D3, however the amount in these preparations are small. For example, each

multivitamin contains 400 international units of vitamin D3 so a total of 800 international

units of vitamin D will probably prevent Vitamin D deficiency and may correct mild cases

of low vitamin D levels. For more severe levels, the patient can take 50,000 international

units of vitamin D orally once or twice a week.

Dr. Friedman finally found a product that has high doses of D3 that could be used to rapidly

restore vitamin D levels in patients that are deficient and keep the levels up. This product

50,000 iu d3 is sold in bottles of 12 by bio-tech-pharm.com and is catalogue # 36212A. The

website is http://www.bio-tech-pharm.com/catalog/product_info.php?products_id=77.

For a 25-OH vit D level less than 20, Dr. Friedman recommends taking one pill a week for 8

weeks, then checking a 25-OH vitamin D and serum calcium level. If levels are in the

normal range, then you can take one pill a month for the next 6 months for maintenance.

After 6 months, you should be adequately treated. For patients with 25-OH vit D level

between 20 and 25, one pill a week for 6 weeks is recommended and for patients with 25-

OH vit D level between 25 and 30, one pill a week for 4 weeks is recommended. In both

cases, you should check a 25-OH vitamin D and serum calcium level. If levels are in the

normal range, then you can take one pill a month for the next 6 months for maintenance.

The main side effect of vitamin D therapy is overtreatment leading to hypercalcemia.

Patients with kidney problems cannot convert vitamin D to the active 1, 25-OH vitamin D

levels and need to take calcitriol which is 1, 25-OH vitamin D. Additionally, patients with

hypoparathyroidism are usually placed on the calcitriol as well.

Conclusion

Vitamin D appears to have many effects besides being related to calcium and bone health.

Some patients with low vitamin D levels have fatigue and bone pain, which is easily

reversible with proper replacement of vitamin D. Vitamin D may protect against heart

disease and some types of cancer. Vitamin D may also have some role in regulating the

immune system and also reducing blood sugar levels in patients with diabetes. Proper

vitamin D levels are needed to prevent osteoporosis. In conclusion, proper vitamin D levels

are essential for one’s health, especially if you have thyroid problems. Unless a patient is

exposed to sunlight or foods containing vitamin D, screening for Vitamin D deficiency is

recommended for all thyroid patients.

This article is not intended to offer medical advice and is offered for information purposes

only. Do not act or rely upon information from this article without seeking professional

medical advice. For more information about Dr. Friedman or to schedule an appointment,

please go to goodhormonehealth.com

Re: Rich Van konynenberg & Simplified Methylation Cycle Block Tx

Hi Margaret,I don't do any monitoring - just go by symptoms now. Afraid the NHS tests just don't work for me - I've always come back negative. They call us subclinicals - people obviously hypothyroid who don't show positive on conventional bloodwork. But there's a lot of debate about testing - a huge storm really and a lot of frustrated subclinicals. The tests need to monitor _free_ t3 and t4. I'm not expert - but it seems that the saliva tests are much better than blood - and also it's better to test through the day. We nearly did some 24hr saliva tests - but decided to save money for other tests for Eddie instead - and also because we'd really need to do it more than once to be worthwhile - and finally because in the end you need to treat the symptoms and not the test results.It's really awful to hear about people overdosing on thyroxine. Some of the doses seem very high. I really think patients need to know what to look for - eg symptoms of hyperthyroidism. Thyroxine works well for a lot of people but the dose needs to be monitored - and then what if T4/T3 conversion isn't working - given that something in the thyroid wasn't working before it seems a shame to assume this conversion is working. T1 and T2 are not understood and so not supplemented. This might be another reason people do better on natural thyroid because they get a little of all T1-4. But of course the argument against is that it is not as well calibrated as the synthetic T4.Best wishes,Sandy

[Guest guest]

,

Thanks for posting this it is extremely interesting for me as it fits

my 13 year old son (not many things do !)

He was definately low in calcium as he used to poke his eyes out until

I supplemented it. He definately has Thyroid problems T3 within range

but T4 low - thyroid stimulating hormone within range). He is doing

very well on D3 and I was just pondering why it seems to have

stabalised his very serious blood sugar problems (not diabetic but has

always got stressed every 2 hours(is)h, including waking up every 2

hours(ish) through the night).

Many thanks.

x

>

> Hope this goes through.

>

>

>

> Vitamin D Deficiency and Thyroid Disease

>

> Theodore C. Friedman, M.D., Ph.D.

>

> Vitamin D deficiency and thyroid diseases

>

> Vitamin D is an important vitamin that not only regulates calcium,

but also has many other

>

> beneficial actions. Not many endocrinologists realize this, but

several articles published

>

> over 20 years ago showed that patients with hypothyroidism have low

levels of vitamin D.

>

> This may lead to some of the bone problems related to

hypothyroidism. It was thought that

>

> one of two mechanisms may explain the low levels of vitamin D in

patients with

>

> hypothyroidism, 1) the low levels of vitamin D may be due to poor

absorption of vitamin D

>

> from the intestine or 2) the body may not activate vitamin D

properly. Other articles have

>

> demonstrated that patients with Graves disease also have low levels

of Vitamin D.

>

> Importantly, both vitamin D and thyroid hormone bind to similar

receptors called steroid

>

> hormone receptors. A different gene in the Vitamin D receptor was

shown to predispose

>

> people to autoimmune thyroid disease including Graves' disease and

Hashimoto's

>

> thyroiditis. For these reasons, it is important for patients with

thyroid problems to

>

> understand how the vitamin D system works.

>

> Sources of Vitamin D

>

> Vitamin D is really two different compounds, ergocalciferol (vitamin

D2), found mainly in

>

> plants and cholecalciferol (vitamin D3), found mainly in animals.

Both of these hormones

>

> are collectively referred to as vitamin D, and they can either be

obtained in two ways. One

>

> is by exposure of the skin to the ultraviolet (UV) rays of sunlight

or also from dietary intake.

>

> Vitamin D is found naturally in fish (such as salmon and sardines)

and fish oils, eggs and

>

> cod liver oil. However most Vitamin D is obtained from foods

fortified with Vitamin D,

>

> especially milk and orange juice. Interestingly, as breast feeding

has become more popular,

>

> the incidence of Vitamin D deficiency has increased as less

fortified milk is consumed.

>

> Vitamin D deficiency may also occur in patients with malabsorption

from their intestine,

>

> such as in the autoimmune disease called Celiac Disease, which

occurs frequently in

>

> patients with thyroid problems. Multivitamins also contain Vitamin

D, as does some

>

> calcium supplements like Oscal-D and Citracal plus D..

>

> Different Forms of Vitamin D and How To Diagnose Vitamin D

>

> Vitamin D itself is inactive and needs to get converted to the liver

to 25-hydroxy vitamin D

>

> (25-OH vitamin D) and then in the kidney to 1, 25-hydroxy vitamin D.

It is only the 1, 25-

>

> OH vitamin D which is biologically active. This form of vitamin D

acts to allow for

>

> absorption of calcium from the intestinal tract. Therefore, patients

with low vitamin D

>

> levels will have low calcium and in severe cases get rickets (in

children) or osteomalacia (in

>

> adults) which is when the bone bows out and is poorly formed. In

mild cases of vitamin D

>

> deficiency, osteoporosis occurs.

>

> The conversion from the 25-OH vitamin D to the 1, 25-OH vitamin D

that occurs in the

>

> kidney is catalyzed by parathyroid hormone, also called PTH.

Therefore, patients with low

>

> vitamin D levels will have relatively high PTH levels along with low

calcium levels. This is

>

> similar to patients with primary hypothyroidism having elevated TSH

levels while having

>

> normal thyroid hormone levels. Additionally, the 25-OH vitamin D

form which is the

>

> storage form and is much more abundant that the 1, 25-OH vitamin D

form which, although

>

> is active, is less abundant. Therefore, in states of vitamin D

deficiency, low levels of 25-OH

>

> vitamin D are found, but the 1, 25-OH vitamin D levels are either

normal or actually slightly

>

> high. They are slightly high because the excess PTH that is

stimulated by the low 25-OH

>

> vitamin D levels stimulates the conversion up to 25-OH vitamin D to

the 1, 25-OH vitamin

>

> D. Thus, patients that are vitamin D deficient usually have a low

25-OH vitamin D level, a

>

> high PTH level, a low normal calcium, and a normal or an elevated 1,

25-OH vitamin D

>

> level.

>

> Dr. Friedman usually recommends measuring PTH, calcium, and 25-OH

vitamin D to

>

> determine if a patient does have vitamin D deficiency. The 25-OH

vitamin D assay has a

>

> normal range of approximately 20-60 ng/dL. However, this range may

be too low for many

>

> patients. Additionally, the assay may not be that good at measuring

the low levels of

>

> vitamin D. In general, Dr. Friedman would recommend treatment of

patients that have a 25-

>

> OH vitamin D of less than 30 ng/dL, but these patients should have a

PTH in the high

>

> normal range. Optimal levels of 25-OH Vitamin D for patients with

thyroid diseases are

>

> probably 35-60 ng/dL.

>

> Treatment of Vitamin D Deficiency

>

> There are several ways to correct for the depletion of vitamin D,

and these would involve

>

> either increasing sunlight exposure or increasing dietary intake. In

general, Dr. Friedman

>

> feels there is an ongoing battle between endocrinologists and

dermatologists about sunlight

>

> exposure, and mild sunlight exposure probably does not have that

much of an increased risk

>

> of skin cancer yet would be helpful to prevent vitamin D deficiency.

Because of our busy

>

> schedule, many of us do not go outside during the day much and our

sunlight exposure is

>

> minimal. When we do go outside, we are usually covered up with

clothes. Blacks and other

>

> dark skinned patients absorb less Vitamin D and need more sunlight

exposure. Dr. Friedman

>

> recommends a patient to be exposed to the sun for 15-30 minutes a

day, especially in the

>

> morning, to correct for vitamin D deficiency. However, in northern

latitudes, little light of

>

> the proper wavelength goes through the atmosphere in the winter, so

this exposure needs to

>

> occur in the spring and summer at which time stores of vitamin D are

built up. The body has

>

> mechanisms so that too much vitamin D can not be synthesized by

prolonged sun exposure.

>

> An alternative is to go to a tanning salon for approximately three

times.

>

> When it comes to replacing Vitamin D, again we have to understand

the difference between

>

> D2 (ergocalciferol) and D3 (cholecalciferol). Even though both forms

of vitamin D are fat

>

> soluble, studies have shown that if you take D2, your levels rise,

but then fall back to almost

>

> baseline in a few weeks. In contrast, after D3, the levels stay high

for awhile. Dr. Friedman

>

> and other doctors frequently prescribe a high dose (50,000 iu) of

vitamin D weekly for 8

>

> weeks, but this is D2 and in many people the levels drop down to

normal after nor taking it

>

> for a few months. This needs to be given by a prescription. Vitamins

and preparations like

>

> Oscal D contain D3, however the amount in these preparations are

small. For example, each

>

> multivitamin contains 400 international units of vitamin D3 so a

total of 800 international

>

> units of vitamin D will probably prevent Vitamin D deficiency and

may correct mild cases

>

> of low vitamin D levels. For more severe levels, the patient can

take 50,000 international

>

> units of vitamin D orally once or twice a week.

>

> Dr. Friedman finally found a product that has high doses of D3 that

could be used to rapidly

>

> restore vitamin D levels in patients that are deficient and keep the

levels up. This product

>

> 50,000 iu d3 is sold in bottles of 12 by bio-tech-pharm.com and is

catalogue # 36212A. The

>

> website is

http://www.bio-tech-pharm.com/catalog/product_info.php?products_id=77.

>

> For a 25-OH vit D level less than 20, Dr. Friedman recommends taking

one pill a week for 8

>

> weeks, then checking a 25-OH vitamin D and serum calcium level. If

levels are in the

>

> normal range, then you can take one pill a month for the next 6

months for maintenance.

>

> After 6 months, you should be adequately treated. For patients with

25-OH vit D level

>

> between 20 and 25, one pill a week for 6 weeks is recommended and

for patients with 25-

>

> OH vit D level between 25 and 30, one pill a week for 4 weeks is

recommended. In both

>

> cases, you should check a 25-OH vitamin D and serum calcium level.

If levels are in the

>

> normal range, then you can take one pill a month for the next 6

months for maintenance.

>

> The main side effect of vitamin D therapy is overtreatment leading

to hypercalcemia.

>

> Patients with kidney problems cannot convert vitamin D to the active

1, 25-OH vitamin D

>

> levels and need to take calcitriol which is 1, 25-OH vitamin D.

Additionally, patients with

>

> hypoparathyroidism are usually placed on the calcitriol as well.

>

> Conclusion

>

> Vitamin D appears to have many effects besides being related to

calcium and bone health.

>

> Some patients with low vitamin D levels have fatigue and bone pain,

which is easily

>

> reversible with proper replacement of vitamin D. Vitamin D may

protect against heart

>

> disease and some types of cancer. Vitamin D may also have some role

in regulating the

>

> immune system and also reducing blood sugar levels in patients with

diabetes. Proper

>

> vitamin D levels are needed to prevent osteoporosis. In conclusion,

proper vitamin D levels

>

> are essential for one's health, especially if you have thyroid

problems. Unless a patient is

>

> exposed to sunlight or foods containing vitamin D, screening for

Vitamin D deficiency is

>

> recommended for all thyroid patients.

>

> This article is not intended to offer medical advice and is offered

for information purposes

>

> only. Do not act or rely upon information from this article without

seeking professional

>

> medical advice. For more information about Dr. Friedman or to

schedule an appointment,

>

> please go to goodhormonehealth.com

>

> Re: Rich Van konynenberg &

Simplified Methylation Cycle Block Tx

>

>

> Hi Margaret,

>

> I don't do any monitoring - just go by symptoms now. Afraid the NHS

> tests just don't work for me - I've always come back negative. They

> call us subclinicals - people obviously hypothyroid who don't show

> positive on conventional bloodwork.

> But there's a lot of debate about testing - a huge storm really and a

> lot of frustrated subclinicals. The tests need to monitor _free_ t3

> and t4. I'm not expert - but it seems that the saliva tests are much

> better than blood - and also it's better to test through the day. We

> nearly did some 24hr saliva tests - but decided to save money for

> other tests for Eddie instead - and also because we'd really need to

> do it more than once to be worthwhile - and finally because in the

> end you need to treat the symptoms and not the test results.

>

> It's really awful to hear about people overdosing on thyroxine. Some

> of the doses seem very high. I really think patients need to know

> what to look for - eg symptoms of hyperthyroidism. Thyroxine works

> well for a lot of people but the dose needs to be monitored - and

> then what if T4/T3 conversion isn't working - given that something in

> the thyroid wasn't working before it seems a shame to assume this

> conversion is working. T1 and T2 are not understood and so not

> supplemented. This might be another reason people do better on

> natural thyroid because they get a little of all T1-4. But of course

> the argument against is that it is not as well calibrated as the

> synthetic T4.

>

> Best wishes,

> Sandy

>

[Guest guest]

I downloaded the study today but I cannot find it at the moment but in brief Vitamin D deficiency lowers insulin production in the pancreas and in rats by 50%.

Yes and definately a low calcium will arise from D deficiency as one needs it for intestinal absorption.

If the governments were really concerned about deficiencies, they would have doubled RDAs for Vitamin D in light of the extreme sun avoidance requirements particularly for pregnant women who need double the amount. Many pregnant women are very deficient by the time delivery comes around. I ached from top to bottom for years after my daughter was born. After loading up in Vitamin D and teh soreness went, I realized what I had was NOT in my head as everybody would have me believe.

Re: Rich Van konynenberg & Simplified Methylation Cycle Block Tx> > > Hi Margaret,> > I don't do any monitoring - just go by symptoms now. Afraid the NHS > tests just don't work for me - I've always come back negative. They > call us subclinicals - people obviously hypothyroid who don't show > positive on conventional bloodwork. > But there's a lot of debate about testing - a huge storm really and a > lot of frustrated subclinicals. The tests need to monitor _free_ t3 > and t4. I'm not expert - but it seems that the saliva tests are much > better than blood - and also it's better to test through the day. We > nearly did some 24hr saliva tests - but decided to save money for > other tests for Eddie instead - and also because we'd really need to > do it more than once to be worthwhile - and finally because in the > end you need to treat the symptoms and not the test results.> > It's really awful to hear about people overdosing on thyroxine. Some > of the doses seem very high. I really think patients need to know > what to look for - eg symptoms of hyperthyroidism. Thyroxine works > well for a lot of people but the dose needs to be monitored - and > then what if T4/T3 conversion isn't working - given that something in > the thyroid wasn't working before it seems a shame to assume this > conversion is working. T1 and T2 are not understood and so not > supplemented. This might be another reason people do better on > natural thyroid because they get a little of all T1-4. But of course > the argument against is that it is not as well calibrated as the > synthetic T4.> > Best wishes,> Sandy>