Newbie - blood test results - please help!

[spidernose]

Apologies for the long post. I've posted this on the thyroid page and have been advised to post it on here too in relation to low B12 and folate.

I've been on levo for 15+ years and I have felt awful for the majorty of those years, weight gain, fatigue, feeling cold, memory fog, aches and pains, depression, anxiety, carpal tunnel, thinning hair, you name it I feel it. I discovered this forum and decided to have a private blood test as I initially thought that I needed some T3. Here are my results with the Doctors recommendations at the bottom.

I'm going to make an apt to see my own GP to discuss but I don't know what to say, I'm not being fobbed off any longer so would really appreciate some advice

Biochemistry

CRP H 7.30 normal range = <5.0 mg/L

Ferritin H 273.normal range = 1 20 - 150 ug/L

Thyroid Function

TSH 4.17 normal range = 0.27 - 4.20 mIU/L

T4 Total 108.3 normal range =64.5 - 142.0 nmol/L

Free T4 17.50 normal range = 12 - 22 pmol/L

Free T3 3.43 normal range = 3.1 - 6.8 pmol/L

Immunology

Anti-Thyroidperoxidase abs 7.2 normal range = <34 kIU/L

Anti-Thyroglobulin Abs 72 normal range = <115 kU/L

Vitamins

Vitamin D (25 OH) L 21 Deficient <25 nmol/L

Insufficient 25 - 50

Consider reducing dose >175

Vitamin B12 L 202 Deficient <140 pmol/L

Insufficient 140 - 250

Consider reducing dose >725

Serum Folate L 5.76 normal range = 8.83 - 60.8 nmol/L

There is a significant Vitamin D insufficiency. Vitamin D is manufactured in our skin as a direct result of sunlight exposure. One potential complication of prolonged Vitamin D lack is osteomalacia, a disease which causes severe structural deformities to the skeleton. Lower level Vitamin D deficiency can lead to a number of non-specific symptoms, including possibly chronic fatigue (experts have for many years noted an association between sufferers of chronic fatigue syndrome or myalgic encephalitis (CFS or ME) and low blood levels of Vitamin D). It has been estimated that between 50-70% of people living in the northern Europe (where daylight length reduces your chances of receiving adequate sunlight in the winter) are deficient in this vitamin by March each year. Symptoms of vitamin D deficiency include chronic pain, weak bones, frequent infections (recent research has detected an association between vitamin D deficiency and severe pneumonia), depression and fatigue. Supplementation may be beneficial - please speak to your usual doctor about this result.

The Vitamin B12 level is insufficient. Some experts believe levels of 400-500 are desirable and that levels below this may lead to symptoms. Low Vitamin B12 levels can lead to Pernicious Anaemia (PA), a state of deficiency of the red blood cells in which there is reduced quality and number. Characteristically, the red blood cells are enlarged in this state (if the deficiency is severe and longstanding). A Full Blood Count is needed to check for this state, which is known as megaloblastic anaemia. Vitamin B12 is commonly found in many foods, particularly meats. Deficiency can develop if intake of the vitamin is reduced or if absorption from the gut is impaired. Poor absorption owing to a deficiency of Intrinsic Factor (IF) is the underlying reason for PA. Vitamin B12 deficiency in the longer run can lead to nervous system disorders - with sensation changes, loss of power or co-ordination, gut disorders and (rarely) dementia or mental illness. Lower level deficiency has been associated with a range of symptoms such as fatigue, memory impairment, irritability, depression and personality changes. Please discuss this finding with your usual doctor, supplementation may be advisable.

The Folate level is low. Folate (Folic acid or Vitamin B9) is one of the B group of vitamins, found in green vegetables, in particular. The body's reserves of Folate, unlike Vitamin B12, are low and only sufficient for about four months. Causes of deficiency include reduced intake from the diet or from poor absorption through the gut; increased demand for folate (for example, pregnancy) and side effects of some medication (for example, methotrexate). Symptoms of deficiency include fatigue, mild sensation changes and depression. Prolonged lack of Folate results in megaloblastic anaemia (a red blood cell deficiency in which the cells are characteristically large). Supplementation would be advisable - I advise you to discuss this result with your usual doctor.

The CRP is raised. A high CRP (C reactive protein) is associated with inflammation from some cause (as seen for example with arthritis or infection). It is not an exact test, and is nonspecific. An elevated CRP is not a normal finding and its presence should lead to further investigation to establish the cause. If you have any symptoms suggesting either infection (cough, fever, urinary symptoms etc) or inflammation (swollen painful joints or generalised aching, for example) is present, I advise you to speak to your doctor soon. In any event a discussion with your doctor in due course would be sensible.

The ferritin level is also high. In addition to excess iron supplementation, raised serum ferritin can be a sign of inflammation or infection - which, considering the elevated CRP, is possible here. Raised ferritin due to inflammation is not a sign of too much iron, and is not a sign of disease as such. Less commonly, higher ferritin levels can result from damage to bone marrow or liver, genetic conditions, following blood transfusion, and in chronic anaemias such as thalassaemia. Repeat testing in a few weeks’ time will enable you to spot any trends if you wish to be sure the levels are not persisting or rising - but of course you may wish to speak to your usual doctor.

[greenbexy]

Someone with more knowledge will post soon, I'm sure.

My deficiencies are similar to yourself, so I can understand how rubbish you feel! Probably loading injections of vitB12, a high dose of vit D and of course folate. These deficiencies do go hand in hand with other autoimmune disorders, your GP will have to take them seriously. Hope you feel better soon x

[spidernose in reply to greenbexy]

thank you for the reply. I'm at my wits end, I feel constantly rubbish, as if I've got the flu. Got an apt with my GP on Monday and want to be armed with information before I go as he'll just fob me off like he's been doing for years. Not sure if I should ask to see a specialist, just want someone to acknowledge how i'm feeling and to help me, seems as if its too much to ask for from most GP's

[greenbexy in reply to spidernose]

There are loads of pinned posts on here (at the bottom of the page if your on a mobile) to print off to go armed and ready. Unfortunately though, some GP's listen, some don't. It's pretty much luck of the draw! My GP just skimmed over my ammo, but he has referred me for an endoscopy to look at why I'm not absorbing these vitamins. Hopefully he/she will take you seriously and recommend a good plan of action, to get you feeling some what 'normal'! I certainty don't feel like s 42year old should!

[Gambit62 Administrator]

Sorry but there is a huge inaccuracy in the section on B12 - PA causes B12 deficiency not the other way round.

With low folate, low B12 and low D the chances are that you have an absorption problem - PA is one possibility - others include coeliacs, crohn's, a whole raft of drug interactions, lowered stomach acidity and h pylori infection.

Do you have iron deficiency as well?

A full blood count may well show signs of macrocytosis - larger rounder red blood cells - but if you have an iron deficiency as well because of an absorption problem - this will tend to make the cells smaller so mask. Either folate or B12 deficiencies will lead to macrocytosis. Also, macrocytosis isn't among the first symptoms to develop for 30% of people with a deficiency.

Follow up test would be MMA (which would be raised if you don't have enough B12 at the cell level.

Please read through pinned posts and other posts on this forum - learn as much as you can about B12 deficiency and see your doctor - chances are that they won't be very familiar with B12 deficiency and what they do know may be coloured by a couple of popular misconceptions around the role of macrocytosis (cause rather than effect), and the accuracy of the serum B12 test itself.

Please also make sure that you put together a list of symptoms as these are very important in diagnosis - though overlap with thyroid is going to make things more complex.

[spidernose in reply to Gambit62]

Do I need to be contacting the Dr from blue horizon to questions the inaccuracy in the section on B12?

I need to be armed with as much information as I can when I see my GP or I fear I will be fobbed off. I have a list of symptoms, that I've been telling him for years, all I get fobbed off with is anxiety and depression and anti-depressants. He claims that my thyroid is fine as it is regulated by levo. I fail to see how its fine as I've got all the same symptoms that I had 15 years ago before I was diagnosed with an under active thyroid

Am I asking for a full blood count test?

Am I saying that I want to be tested for coeliac, chrons and pernicious amenia?

Am I asking for a referral to a specialist, of so who?

I will read through some of the posts on here but to be honest its like a minefield and It can be overwhelming

[Gambit62 Administrator in reply to spidernose]

you could point out to Bluehorizon that some of the information in their notes isn't correct.

Thyroid and B12 problems are quite a common mix but B12 often gets overlooked because of the overlap of symptoms.

Suggest that you put together a list of symptoms, and talk to your GP about things. It might help to write to them first with relevant information ... and it might also help to take a friend with you, particularly if you have problems with anxiety.