Pernicious Anaemia Society
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b12 result of 256 advice please

Hi i am newbie on this forum and would appeciate some advice

. My husband has recently recieved his some private test results for his thyroid ( he has hypothyroidism but is quite poorly at times and his doctor has recently stopped his T3 although he is still taking this and sourcing it privately as without this he is virtually bed ridden). His B12 test results are 256 which the doctor at the private testing company has said is normal within range.

However i understand that this result is low and i wondered if this could be the reason for some of his symptoms.

12 Replies

It is in range and it is 'normal'.

However, a lot of people still have the symptoms of a B12 deficiency with a 'normal' result for serum B12.

That's why it's recommended to treat the symptoms if a B12 deficiency is suspected.

What are his symptoms?



Brain fog, joint pain, total exhaustion, forgetfullness, confusion, the problem is that these could also be attributed to his hypothyroidism which makes it more difficult to treat. He is currently taking T4/T3 combination but i am not convinced that all his health problems are all due to his thyroid.


Well, the best way to tell if it's B12 is to try a course of injections. But the doc is unlikely to agree.

You could ask for an MMA test. Raised levels of methylmalonic acid are a good indicator of a B12 deficiency.


Thanks for e reply where can i get a private MMA test? I know his gp will never agree to any tests when his result is normal



I'm not sure. Let me have a look...

Blue Horizons do it, but it ain't cheap...


Have you looked at lists of b12 Deficiency Symptoms?

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

My understanding is that in the UK people who are symptomatic for b12 deficiency should be treated even if B12 blood levels are normal range. See following documents...

1) BCSH Cobalamin and Folate Guidelines page 29. I read the whole document.

2) See 5th summary point.

I have read that it is possible to show signs of severe B12 deficiency with normal range blood results.

More info about B12 deficiency.....






5) Pinned posts on this forum

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

7) Book "Could it be B12" by Sally Pacholok and JJ. Stuart

Has your husband got any relatives with B12 deficiency?


I was highly symptomatic for B12 deficiency with multiple neuro symptoms with results in the 300s. Has he had an IFA (Intrinsic Factor Antibody test)? This can help to diagnose PA (Pernicious Anaemia) but is not always reliable. It is possible to have PA even if IFA test is negative. See page 29 BCSH Cobalamin and Folate Guidelines.

B12 testing

Has he had recent tests for folate, ferritin and full blood count as well? there can sometimes be clues on the FBC that can indicate the possibility of B12 deficiency and/or folate deficiency.

There are quite a few on this forum who have both thyroid problems and B12 deficiency. PA is an autoimmune condition and once someone has developed one autoimmune condition it increases their chances of developing another.

I am not a medic just a patient who has struggled to get a diagnosis.


Thank you

A lot of information for me to read and try to understand


Hypothyroidism also causes low stomach acid, which leads to poor nutrient absorption, making it hard to know whether low B12 is due to the hypoT or to autoimmune atrophic gastritis which coexists with Autoimmune Thyroiditis in many cases, so it is very hard to know what is going on.

If you can get the thyroid optimally treated you are then able to look at the remaining symptoms.

If you go down the private testing for PA antibodies etc that might give you a result. May be worth it if you can afford it. But it is not definite.

You could otherwise try patches or nasal sprays of B 12 to see if there is a treatment effect.

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Unfortunately his Gp stopped his prescription for T3 even though he has been taking this for four years because his tsh was suppressed and this is when the problema started. However we buy his medication privately now but his health is still not what it should be for his age (64). I think we may consider private testing in the meantime he has now started taking subliminal b12 to see if this makes any difference.


My B12 level was 267 and I felt many of the same symptoms as your husband. I was in bad shape! Fortunately, weekly loading doses have been making me feel human again. You can't overdose on B12, so it wouldn't hurt to try it -- just be sure to give it some time to work. Best of luck to you!


I also have Hypothyroidism, I'm a 60 year old female, and when I was tested for my B-12 levels, the numbers were 333. My doctor started me right on the injections because of tingling in my hands and feet, and I just didn't feel good. I have now been on the shots for 4 1/2 months, the tingling is pretty much gone. And my numbers are n the 800's which my doctor said is very good....

Hope this helps, all doctors are different with the ranges....

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Thanks. You are lucky to have such a good GP

I am afraid that my husbands gp wont treat unless his results are outside the range.


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