Come from Thyroid UK forum

Hi I have come from the Thyroid UK forum to ask for advice about these results:

SEP-16

Serum ferritin - 9 (15 - 150 ng/L)

Serum vitamin B12 - 137 (180 - 900 pg/L)

Serum folate - 1.6 (2.5 - 19.5 ng/L)

Total 25 OH vitamin D - 29.6 (25 - 50 nmol/L vitamin D deficiency. Supplementation is indicated)

Thyroid results

Serum TSH - 2.84 (0.2 - 4.2 mIU/L)

Serum free T4 - 15.7 (12.0 - 22.0 pmol/L)

Serum free T3 - 3.2 (3.1 - 6.8 pmol/L)

Thyroid peroxidase antibodies - 681 (<34 kIU/L)

Thyroglobulin antibodies - 755.3 (<115 kIU/L)

Symptoms

tiredness

forgetfulness

brain fog

pins and needles in fingers

cold hands and feet

aches and pains

constipation

heavy periods

hair loss

pale skin

So what do I need to ask my GP to do please?

Thank you

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1 Reply

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  • Hi Blue33. Hello and Welcome.

    Your results show that you have vitamin B12, folate, and vitamin D deficiencies and your low ferritin suggests iron deficiency anaemia.. Your GP should treat you for all of these.

    If these blood tests were done privately, your GP may wish to do them again so it's important that you do not take any oral vitamin B12 supplements - take care if you take a multi-vitamin because B12 is often hidden in these. Taking supplements before testing and investigations are complete can skew blood results and it may then prove difficult to get an accurate diagnosis and, more important, the correct treatment. If you have taken any B12 supplements, tell your GP so this can be factored into the interpretation of any new blood tests.

    The thyroid forum will be better placed to advise on your thyroid results. However, I note that you have high positive results for both of thyroid antibody tests, which would indicate that you have Hashimoto's thyroiditis - an autoimmune condition. Autoimmune conditions tend to come in clusters, so you may well have pernicious anaemia, another autoimmune condition.

    Your GP should therefore test anti-IF antibodies to see if you have pernicious anaemia. If the test is positive, you definately have PA, if it's negative you could still have PA since this element of the test is only 50% accurate. Your GP may not know this.

    Your GP might also like to do a full blood count (FBC) to check for macrocytic anaemia (large red blood cells) and other factors assocIted with B12 / folate deficiencies and pernicious anaemia.

    Full treatment guidelines for the diagnosis and treatment of B12 and folate deficency can be found at the following link. Well worth reading because it will tell you all you need to know about what your GP should be doing for you:

    onlinelibrary.wiley.com/doi...

    From what you say, you have neurological symptoms so after testing (if your GP insists on doing it again) you should be treated immediately with B12 injections and folate supplements should be started 24 hours after your first B12 injection (giving folate before or at the same time can cause neurological damage - your GP may not know that). It's worth noting here that B12 and folate work together so if your folate levels are too low, your body will not be able to utilise B12 properly. Bumping along the bottom of the range is not good enough (though your GP may think so). Levels need to be in the top third of the reference range.

    Here's the B12 regime of treatment for those with neurological symptoms: 6 x 1mg Hydroxocobalamin on alternate days (the loading doses - to get your B12 levels up quickly), then 1mg Hydroxocobalamin every other day until no further improvement (for up to two years) then 1mg Hydroxocobalamin every eight weeks (though that is not frequently enough for some people - but that's another story).

    Your GP may not know about this regime - not many do. It's in a book on your GP's desk - called the BNF - he/she can look it up while you're there. It's the second item down so they may have to read further than usual. You may be told ah ha, but you don't have macrocytic anaemia or pernicious anaemia. That's a mute point. The treatment for PA and B12 deficeny are the same: B12 injections. And there are many other causes of B12 deficiency, apart fro PA, which your GP should try to determine (the most common cause is a problem with absorption - for a possible variety of reasons).

    Many GP's are not well-informed about these conditions so the best thing to do is learn as much as you can before you see your GP. Read the three PAS pinned posts to the right of this page when you log on (at the bottom if using a phone) - they will give more information about the diagnosis and treatment of B12 deficency, together with lots of other useful information (including a symptom checklist - you tick many of the boxes 😖).

    I would hope that you don't have a problem getting treatment (some do) because your levels of B12 and folate are so very low, and obviously deficient - and you have neurological symptoms too - so you should be treated immediately. But if you do have problems getting treatment, come back here and we can offer more help and advice.

    B12 deficiency and PA are quite complex conditions and you'll probably have lots of questions and to begin with, and not many answers (for instance, taking the right vitamins and minerals is very important, so you'll need to know about that).

    A tip: GP's often say that blood tests are okay when they're not. Good idea to get copies of all tests (it's your right to have these). You can always post results here if you want help with interpretation.

    So Blue33...really just covered some basics here so that you can get started 😀.

    Very good luck with your GP...lots of people here to help if you need it...and take heart...treatment really does make a difference and though the rate of improvement differs for everybody...you can expect to start feeling better once treatment commences.

    Take care and let us know how you get on 👍

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