Hi I'm new here, recommended to come here from thyroid forum with resent results

[Nindri]

Hi,

I was referred here from the thyroid forum to seek opinion what to do next. Is there any blood test or treatment that I should enquire with next gp visit re most resent blood results done in January?

Below is the copy of the post to thyroid forum.

Update, sorry long post but getting desperate and feeling worse. As far as I've got so far is finding out that I have Hashis, not diagnosed of anything.

I saw endo couple months ago. He was very unsympathetic and really could care less. Agreed at least that my symptoms were significant. I was asking if I could get trial of thyroid meds but he just kept going on about the cardiac risks and there is no biochemical indication to start thyroid meds and we would lose the pituitary-thyroid feedback control if meds started.

Endos letter afterwards said that folate is slightly low but given normal indices he does not think that this needs supplementing. And that there is nothing more he can suggest and discharged me back to gp

First of all my symptoms, fatigue, headaches, dry skin, hungry after eating, graving sweet and salty foods, diarrhoea or constipation (every day), nausea, cold feet, low body temp, hypoglycaemia (I don't have diabetes), confusion, trouble thinking, dizziness, depression (was given sertraline) and few others.

New symptoms - trembling, muscle weakness (legs actually collapsed when tried to lift something), confusion and memory getting worse (actually asked hubby same question three times in a row inside 5mins!!!) fatigue getting worse. Diarrhoea getting worse, actually sorry not pleasant but faecally have had few accidents. Not able to work anymore

I'm seeing GP this week, is the any other tests that I should ask or anything else that could help me. She has refused to do vit D.

Not started gluten free yet but on my way to that.

Would be very grateful for any help that anyone can offer.

Here are the previous results

Bloods taken in April 2016:

Erythrocyte sedimentation rate 16mm/h (1.0-10.0)

TSH 5.44mu/L (0.27-4.2)

T4 14.0pmol/L (11.0-20.0)

Full blood count, all withing range

Liver & kidney function all fine

Bloods in beginning of July 2016:

TSH 3.47mu/L (0.27-4.2)

T4 14.6 pmol/L (11.0-20.0)

ANTI-TPO 442iu/mL (<34)

Negative for coeliac disease

Tests ordered by endo Jan 2017

Cortisol 25 nmlo/L (172 - 497 nmlo/L) after dexsamethasone suppression test.

HGB 139 (115 - 165g/L)

WBC 11.1 (10*9/L 4.0 - 11.0)

PLT 393 (10*9/L 150 - 450)

RBC 4.73 (X10*12 3.50 - 5.80)

HTC 0.426 (L/L 0.370 - 0.470)

MCV 90.0 (fl 76.0 - 98.0)

MCH 29.4 (pg 27.0 - 32.0)

MCHC 327 (g/L 310 - 360)

MEAN PV 9.0 (fl 7.0 - 12.0)

NEUT# 7.90 (10*9/L 2.00 - 7.00)

LYM# 2.50 (10*9/L 1.00 - 3.00)

MONO 0.60 (10*9/L 0.20 - 1.00)

EOS 0.00 (10*9/L 0.00 - 0.50)

BASO 0.00 (10*9/L 0.00 - 0.20)

THS 1.91 (mU/L 0.27 - 4.20)

FREE T4 12.4 (pmol/L 11.0 - 22.0)

SODIUM 138 mmol/L (133-148)

POTASSIUM 4.7 mmol/L (3.6-5.3)

UREA 2.9 mmol/L (2.5-7.8)

CREATININE 47 umol/L (44-80)

EGFR >60 ml/min (>60)

B12 193 pg/ml (191-663)

Serum FOLATE 3.0 ng/ml (>3.9)

SERUM FERRITIN LEVEL 15.4 ng/ml (13.0-150.0)

B12 was 158 pg/mL (148-900) at 2014 when it was last measured and folate 6.2 ng/mL (3.0-16.0)

[Gambit62 Administrator]

Both your folate and B12 are low which would cause most of the symptoms you have - though not sure exactly about the hypoglycemia - was your blood sugar measured to come up with this diagnosis?

Your blood work isn't showing any signs of macrocytosis (larger rounder blood cels) and some medics mistakenly think this is a necessary characteristic for a B12 deficiency - but 30% of people with B12 deficiency present with other symptoms long before any signs of anaemia show up in their blood work.

The last B12 seru test was just in normal range but as people vary so much when it comes to how much B12 they need just going by normal range is going to mean missing 25% of people who are deficient (and picking up 5% of people who aren't) so symptoms are an important part of diagnosis.

If you have both folate and B12 deficiency then B12 needs to be addressed before folate- though only by a day or so as you need folate to process B12 and the two are used together for a lot of processes.

Having tested negative for coeliacs It's unlikely that going gluten free will help though it does appear possible to have a gluten sensitivity that wasn't identified by the test.

Suggest you look through the material in pinned posts in preparation for talking to your GP - particularly at the guidelines which indicate that symptoms are an important part of evaluating a potential B12 deficiency. The BCSH guidelines also mention other tests - MMA and homocysteine which will be raised if cells don't have enough B12 to recycle them - they aren't first line tests because other things can cause them to be raised - and as part of your problem is low folate MMA would be more useful as homocysteine is also raised as a result of folate deficiency.

[taka Administrator]

Hi Nindri

I'm not a medic but it looks like a few things are low / below range that you need to talk to your GP about:

Ferritin: Very low in range and at a level that you may have some iron deficiency symptoms (even though you are not currently anaemic)

Folate: is under range so this needs to be raised especially as it works in conjunction with B12.

B12: just within range but at a level that you may well have symptoms of a deficiency. If you have symptoms in theory you should be treated but it can sometimes be hard to convince a GP of this. Symptoms of a B12 deficiency: pernicious-anaemia-society.... and b12deficiency.info/signs-an... It may be an idea print and highlight any you have and give to your GP when you discuss this.

BSH guidelines for treating B12 and folate deficiency: Fig 1 shows what your GP should do... pernicious-anaemia-society.... Your GP should test you for anti-intrinsic factor antibodies in case you have pernicious anaemia and may start you on B12 injections.

Unfortunately thyroid problems, low B12 and low iron can all have similar symptoms so it may be hard to work out what is causing your symptoms and also to convince your GP to treat these. All need treatment if they are abnormal ideally...