But what's the thinking behind these recommendations?
I had a chance to have a brief Q&A with Richard Shames, MD -- who is a practicing physician, author of a number of popular books on thyroid disease, and a thyroid coach -- on the topic of why he considers Vitamin D so crucial for thyroid patients.
Mary Shomon: Why do you feel vitamin D is so important to thyroid sufferers?
Richard Shames, MD: This particular vitamin is so crucial to thyroid function that its status has now been elevated by researchers to co-hormone. We now know that the variability of thyroid to work or not work in your body is dependent upon the presence of Vitamin D, making it not just of benefit, but absolutely essential.
Mary Shomon:Where does Vitamin D fit, in terms of the other nutrients that can useful for thyroid health, for example, selenium, copper, and zinc, and issues like avoiding too much soy, and balancing iodine intake?
Richard Shames, MD: Last month I was coaching a very careful and conscientious low thyroid patient. She was taking optimal amounts of the minerals just mentioned; and in addition, was taking herbal medicines to promote her thyroid health, as well as the pro-hormone pregnenolone (to increase availability of cortisol). Moreover, she was also taking prescription thyroid medicine, consisting of a T4 / T3 combination, with a small amount of natural desiccated thyroid for completeness. Even with all of this effort, she was not getting good results in terms of symptom relief. After checking her Vitamin D level, I found it to be in the low-normal range, and we boostied it up to mid-to-high normal range. Only then did she begin to do well.
Mary Shomon:Why did this work?
Richard Shames, MD: Thyroid treatment isn't optimal -- and may not work -- if you do not have adequate Vitamin D for the crucial final metabolic step, which takes place at the site where thyroid hormone actually works. This happens inside the nucleus of the cell. Vitamin D needs to be present at sufficient levels in the cell in order for the thyroid hormone to actually affect that cell. That is why vitamin D is so crucial.
Mary Shomon:Do we get enough Vitamin D from sunshine or multivitamins, or do we need to supplement?
Richard Shames, MD: These days people are using sunblocks, and staying inside at their computers much more frequently. Therefore we are getting less Vitamin D from the sun. In addition, multivitamins typically have about 400 IU of Vitamin D, which was the RDA standard from research done in the 1940s and 1950s. Today, this research is being questioned, with many researchers now recommending a minimum of 1000-2000 IU daily, an amount that exceeds most multivitamins. In the case above, for example, my patient needed 4000 IU daily to achieve her good results.
Mary Shomon: How can Vitamin D be tested?
Richard Shames, MD:I believe that a blood test for Vitamin D is essential for anyone dealing with hypothyroidism. The typical normal range for Vitamin D levels is from around 30 to 100. Keep in mind in mind that just being in the low end of normal range will not do an adequate job for someone with an underactive thyroid person. Thyroid patients need to be "replete" -- and that means alevel of at least 50 - 60 level, or greater.
Mary Shomon: If you are low or low-normal; is there a particular type of Vitamin D you recommend?
Richard Shames, MD:Make sure it is Vitamin D3. I usually recommend that my patients take at least 2,000 IU per day for maintenance, 4,000 per day if they are at the lowest end of the low-normal range, and 6,000 per day if their tests showed Vitamin D levels below normal. I typically recommend patients supplement for two to three months, and then get retested to monitor improvement. I usually have patients who were low or borderline move to the 2,000 IU maintenance dose when blood levels have reached 50 to 60 or better.
Learn More About Vitamin D
- All About Vitamin D (From About.com's Alternative Medicine Site)
- How much sun exposure do I need for vitamin D? (From About.com's Nutrition Site)
- Midday Sun is Good for Health
- Top Five Supplements for Thyroid Support
- Dr. Steven Langer Discusses Vitamin D and Thyroid Disease