Pernicious Anaemia Society
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Help with interpreting test results please

Hi, I've been wondering for a while if my symptoms (many and varied) might be thyroid related so have just got results from a private blood test but need help to work out what I need to do to feel right again. I originally posted these on the thyroid community of HU but they suggested my B12 and folate were low and possibly causing most of my symptoms and I should post here for more help and advice....

Any suggestions would be hugely appreciated :)


Thyroid Function


FREE THYROXINE 14.62 pmol/L (12.000 -22.000)

TOTAL THYROXINE(T4) 87.6 nmol/L (59.000 -154.000)

FREE T3 4.33 pmol/L (3.100 -6.800)

REVERSE T3 19 ng/dL (10.000 -24.000)

REVERSE T3 RATIO *14.84 (15.010 -75.000)


THYROGLOBULIN ANTIBODY 26.270 IU/mL 0.000-115.000




VITAMIN B12 215.8 pg/ml 191.000 -663.000

FOLATE (SERUM) 8.29 ug/L 4.600 -18.700

25 OH VITAMIN D 80.57 nmol/L 50.000 -200.000

Interpretation of results:

Deficient <25

Insufficient 25 -49

Normal Range 50 -200

Consider reducing dose >200


Inflammation Marker

CRP -HIGH SENSITIVITY 0.5 mg/L 0.000 -5.000

Iron Status

FERRITIN 127.6 ug/L 13.000 -150.000

Many thanks in advance

6 Replies

If my brain was functioning properly I'd have also mentioned that I had a gastric bypass a year ago and am on lifelong omeprazole 40mg daily.....


A gastric bypass will make it much more difficult for your body to absorb several things - including B12. As will PPIs like omeprazole.

You could try taking sublingual B12 - 1000 ug a day - and see how that works. If your symptoms recede and your B12 level rises then you could drop back to one a week and see how that goes.

If it doesn't work then you may have to look at getting regular injections. Indeed, I would ask the doc for that first of all.


Thanks fbirder, I'll ask the GP again but was told about 6 weeks ago that my B12 level was 'perfect' by a new registrar who decided I was depressed, which I have been in the past but most certainly am not at present.... If I can't get anywhere with the GP I'll try the sublingual B12.

Thanks again for your help and advice


Your B12 test results are low and, as Vitamin B12 is absorbed through through the ileum, gastric surgery will have affected absorption. It's, therefore, essential that your GP ensures levels do not drop lower and should treating with B12 injections for life as per the guidelines below :

See the BCSH B12 deficiency guidelines on page 4 :

(Bottom of page 10) under Poor absorption due to gastrointestinal surgery or disease.:

Patients who have had gastric surgery have a high preva- lence of cobalamin deficiency (Sumner et al, 1996), "


Also latest BMJ research document : :

(Page 2). Box 1 Common causes of vitamin B12 deficiency:

* Gastrectomy—partial or total

(Page 5 ) under Summary of treatment and management of vitamin B12 deficiency

"Prescribe lifelong maintenance parenteral vitamin B12 treatment with hydroxycobalamin 1 mg intramuscularly every three months if no neurological deficit, or every two months if there is neurological deficit to all those with irreversible malabsorption or after gastric surgery, pernicious anaemia, and any other irreversible cause "


Sorry, just noticed links in the first reply didnt work.

1 like

Have you looked at b12 symptoms lists? My understanding is that people who are symptomatic for B12 deficiency in UK are supposed to be treated even if b12 blood levels are within range.

pernicious-anaemia-society.... click on Symptoms Checklist

See page 8 and page 29 in the BCSH Cobalamin and Folate Guidelines. page 29 is a diagnosis flowchart showing recommended process doctors should follow with someone who may have B12 deficiency. page 8 gives details of UK b12 treatment.

Causes of b12 deficiency

Lots of info about b12 in pinned posts on this forum. If you have time it might helpful to read some of the other posts and responses.

b12 books

"Could it Be B12" by Sally Pacholok and JJ. Stuart

"What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

b12 websites



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