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Is It Necessary For People With Graves Disease and Hashimoto’s Thyroiditis To Supplement With Vitamin D?

Many people are aware of the benefits of vitamin D, as this “vitamin” plays an important role in bone health, neuromuscular function,  immunity, and it has many other important functions.   As a result, it’s no surprise that many of my patients are already taking vitamin D3 upon consulting with them for the first time.  Some are taking 1,000 IU per day, others 5,000 IU, and some even 10,000 IU per day.  Just as is the case with most other supplements people take, most people who take vitamin D on their own don’t know how much they should be taking.  In many cases the person is taking too small of a dosage for their needs, while every now and then someone will be taking too much.  And some people don’t need to take any vitamin D through supplementation.  But since vitamin D is extremely important for a healthy immune system, it is necessary for people with Graves’ Disease and Hashimoto’s Thyroiditis to have adequate levels.

Before I discuss how to determine the dosage of vitamin D one should take if they choose to supplement with this, I’d like to briefly discuss some of the different forms of the supplement.  Vitamin D3, also known as cholecalciferol, is what people should be taking when supplementing with this vitamin.  Vitamin D3 is the same substance the body manufacturers when being exposed to sunlight.  Even though it’s called a “vitamin”, it actually is a hormone.  Vitamin D2 is a different form of vitamin D, and is not the same as the vitamin D3 that is manufactured by the body.  Some medical doctors prescribe vitamin D2 to their patients who show a deficiency on the blood tests.  Sometimes they will prescribe synthetic calcitrol.  If you have a vitamin D deficiency, ideally you want to supplement with vitamin D3.  I typically recommend the brand by Biotics Research Labs to my patients, which is a high quality emulsified form of vitamin D.  But many times you can find something equivalent in a local health food store.

Don’t Pay Attention To The Typical Reference Ranges

When you get your vitamin D levels tested, in most labs, the lower end of the reference range will be around 30 ng/mL.  And so if your vitamin D levels are at least 30 ng/mL, most medical doctors won’t consider you as being deficient.  But as I’ve been telling my patients for years, according to the Vitamin D council and other reputable sources, one ideally wants these levels to be at least 50 ng/mL.

So with that being said, if someone’s vitamin D levels are below 50 ng/mL, is it necessary to supplement with vitamin D3?  With most people it probably is a good idea, and this is especially true for those who have levels below 40 ng/mL.  But if someone hasn’t been getting much sun and wants to try increasing their levels without taking supplements, then they of course can give this a try.  So they can spend 15 to 30 minutes daily in the sun for a few months (without sunscreen of course, as this will block the absorption of vitamin D) and then retest, and if their levels are above 50 ng/mL then there probably isn’t a need to supplement with vitamin D3.  However, they will need to continue getting regular sun exposure in order to maintain these levels.

Although getting regular sun exposure is ideally the best method of manufacturing vitamin D, some people seem to have problems absorbing it, even when getting plenty of sun exposure without putting on any sun screen.   I’ve consulted with numerous patients in sunny areas (Florida, California, etc.) who claim they get plenty of sun exposure, but still are deficient in this vitamin.  Sometimes this can be due to deficiencies of one or more of the cofactors that are important for the proper absorption of vitamin D, such as magnesium.  But I wonder whether in some people there is a genetic problem with absorbing this vitamin.  One’s skin color also will determine how well one absorbs vitamin D from the sun, as the darker the person’s skin, the longer they will need to be exposed to the sun in order to get an adequate amount of vitamin D manufactured.  In any case, if someone is getting adequate sun exposure and doesn’t have a deficiency in any of the cofactors, then supplementation usually is necessary.

Determining The Proper Dosage Of Vitamin D3

So if someone has a vitamin D deficiency and needs to supplement with vitamin D3, how much is it necessary for that person to take?  Well, it admittedly can be challenging to know exactly how much vitamin D3 someone needs to take, which is why retesting is important.  For example, if someone has a moderate to severe deficiency, then I’ll commonly have them take 10,000 IU per day for a few months, and then reduce the dosage in half for a few months, and then have them retest.

If someone has a mild deficiency and if we determine that supplementation is the best course of action, then I will start them with a lower dosage (i.e. 4,000 to 6,000 IU per day), and of course will still have them retest after a few months.  Some people are concerned about vitamin D toxicity due to taking too high of a dosage.  This is rare, as if someone has a deficiency they would need to take extremely high dosages of vitamin D3 for many months before it would reach toxic levels.  And while some people would consider 10,000 IU per day to be too high, I personally have never encountered a problem with a patient taking such a dosage.  Once again, you want to have the person retest after a few months just to make sure the blood levels don’t go too high.

So while it is important for anyone with a vitamin D deficiency to get this addressed, it arguably is even more important for anyone who has an autoimmune thyroid condition, such as those people with Graves’ Disease and Hashimoto’s Thyroiditis, to make sure they have adequate Vitamin D levels.  If you haven’t been tested recently to determine if you have a vitamin D deficiency, then I highly recommend you doing so, as increasing these levels can be a very important part of your recovery.  For more information on vitamin D, I highly recommend visiting the Vitamin D Council website at www.vitamindcouncil.org.


 

9 Comments

  1. Holly says:

    Hi, I have a question. I was diagnosed with extremely low vtamin D levels around a year ago. It was a random test around my physical nd my level came back with a 4! My GP became very concerned, because of other symptoms I was having and sent me for a camcer screening lab (C125), which came back negative. She then put me on prescription vitamin D, 3x a week at 50,000 IUDs for three months. When she rechecked my levels, it had only gone up to 28 (still low), but she claimed I should be okay on 4,000 IUDs, OTC, daily. After 3 months, she re-checked my levels and it had gone down to the teens (14), even being on daily vitamin D. My doctor put me back on prescription level vitamin D again, but this time for a shorter period, and my levels still go down after my prescription pills run out. In the meantime, due to some hypothyroid symptoms (inexplicable weight gain, irregular menstrual cycles, low energy levels), I have been tested numeous times for hypothyroidism and my TSH levels go up and down. At one point, my TSH level was at a subclinicsl levl (3.89), so my GP put me on Synthroid, until my TSH got to 1.02. Long story short, not only did it make me have hot flashes (or sweating 24/7, at any rate), but made my once full head of hair to fall out by the handful, did not help my menstrual cycle, and made me edgy. After putting up with it for 6 months with only side effects – hair loss and sweating being major ones – I weaned off Synthroid and have been off of it for 1.5 years. The overheating eventually calmed down (took 13 months) but the hair loss has never subsided. But my vitamin D levels are still vacillating, always on the low side WITH supplementation, and my TSH goes up and down anywhere from 2 to 6 on any given day, and doctors don’t know what is going on. And yes, I was tested for Hashi’s and my level was normal…my sex hormones are also normal, so everyone is at a loss.

    I’m wondering if all of this is somehow related to Vitamin D and why my body is so low on it, despite supplementation? FYI, I live in a sunny state and get enough sun, eat eggs, some fish, so I don’t understand it. And all doctors, including endocrinologists I have seen, claim low vitamin D is “normal,” which I HIGHLY doubt.

    Any thoughts would be appreciated.

    • Dr. Eric says:

      Hi Holly,

      Low vitamin D levels are definitely common, but not “normal”. I’m not sure if you’re still taking the prescription, but if so then you might want to consider switching to a different form of vitamin D3. You also might need a higher dosage then 4,000 IU, perhaps up to 10,000 IU for a few months. But even if you supplement with vitamin D3 and get plenty of sun exposure, if you’re deficient in some of the cofactors necessary for the absorption of vitamin D, such as Magnesium, then your levels will remain on the low side. So this is something to consider.

  2. Holly says:

    Thanks, Dr. Eric. I have recently been taking Magnesium for its calming abilities, but not along with vitamin D3. I have run out of the 50,000 IU prescription vitamin D, and my GP suggests since my levels are at the very bottom part of the “normal” range (30), I’m okay. What no one can figure out is why my levels keep dropping after the prescription runs out, in spite of OTC supplementation.

    I will try taking OTC D3 at the higher level you recommended along with the Magnesium I already take and see how it works.

    Your articles are very helpful for someone like me who has had terrible experience with synthetic thyroid meds (Synthroid) and prefers doing things the natural way.

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