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Suffering from hypo and lactose intolerance. Blood test showed normal serum calcium level. Suggest diet plan

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I have been hypo for 7 years and then Lactose intolerance for 6 years. Being lactose intolerant is quite hard. For the past 6 months I have not taken any calcuim supplementation as I have felt uncomfortable taking it(250mg). I notice that no matter how much I took the serum calcuim level was always the same. So I stopped taking it. I was a bit worried about my bone health as a result. But my blood test over the last 6 months has showed my no problem to serum calcuim level. It is the same. I do take 1000iu of Vitamin D daily and about 200mg Magesimum as well.

Am I getting enough calcuim from just my foods? Please look at my blood tests and advise me if this safe to carry on. I do get blood tests done every 3 months just to check things.
Posted Fri, 19 Oct 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 17 hours later
I have reviewed your attached reports.

The calcium levels look fine. See a gastroenterologist and a dietitian to get suggestions on how to get calcium in your diet, given that you have lactose intolerance.
Calcium carbonate may cause constipation but less so if taken with meals. We all need about 1000 mg of elemental calcium everyday. We typically get about 250 mg of calcium from a balanced diet. Which means you need at least 750 mg from supplements. Please note that calcium carbonate has only 40% elemental calcium which means that you will need to consume about 1650 mg of supplements.
Calcium citrate is easier on the stomach but has only 21% calcium which means you will need to take about 3300 mg worth calcium citrate to XXXXXX your daily requirements.
I know it may sound like a lot of calcium but your lactose intolerance makes it difficult for you to get your dietary calcium.

You comment that you did not see much change in calcium levels whether or not you took supplements. Well, it will not reflect on the bloodwork so soon. It would take several months and sometimes more before blood calcium levels drop because the body regulates blood calcium levels very tightly. The bodily system will take the calcium from the bones in order to maintain blood calcium levels in the normal range. Which means that over the years, the bones will weaken at the expense of maintaining normal calcium levels.

Regarding thyroid, I see that that the TSH is suppressed. This suggests over-replacement. The latest guidelines continue to emphasize that levothyroxine alone is the recommended treatment for hypothyroidism. Liothyronine is not needed. If you omit that it is likely your TSH will rise back into the normal range. Another key question to answer is whether or not you truly have hypothyroidism. I noted that the anti thyroglobulin antibodies are negative . It may be worthwhile checking the anti thyroid peroxidase antibodies. If these are also negative and you do not have a goiter and no family history of thyroid problems, then there is a chance you do not have permanent hypothyroidism from Hashimoto's thyroiditis. However, if your TSH at diagnosis was unequivocally abnormal then you definitely need thyroid medication for life
The current blood tests for the thyroid suggest you are getting much and this can also cause bone loss
Above answer was peer-reviewed by
Follow-up: Suffering from hypo and lactose intolerance. Blood test showed normal serum calcium level. Suggest diet plan 5 hours later
Thanks for your advice,

I have attached health.jpg, to show my thyroid history. you will see I had high Tsh and it was controlled by T4. The reason T3 is used is that I was not converting T4 properly. Without it I have no energy. I only take 7.5mcg T3 split 3 times a day and that keeps me going. As you know a little T3 causes a suppressed tsh. After 7 years of being hypo I feel the best at this level. Just to have a higher TSH at the expense of having less energy is no good to me.

So to summarise, I do need calcium supplements. My blood level only looks normal as it is taking calcium from my bones. My body is using it to make the difference that it is not getting from diet. Over time my suppressed tsh and lack of calcium in diet will lead to bad bone strength. Is this right?

How much difference does a glass of milk a day make ? How long in the present regime of suppressed TSH and low calcium will it take my bones to suffer problems?
I am 43 years old, 75 kg, and 5ft 8in tall.
Answered by Dr. Shehzad Topiwala 1 hour later
Yes you have summarized things well.

I saw the attached file. Indeed Uluru tsp was briskly off Implying you truly have life long hypothyroidism.

I will reiterate that t3 is not recommended. Please read WWW.WWWW.WW For more information and also WWW.WWWW.WW
A glass of milk has approximately 300 mg of elemental calcium

There is no published study tomy knowledge that gives a precise time frame regarding when the bone loss begins in the circustamce you are referring. But it is as owl going process that contributes to osteopenia or osteoporosis
Above answer was peer-reviewed by
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