Can you have b12 deficiency with low ... - Pernicious Anaemi...

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Can you have b12 deficiency with low normal mcv,mch and mchc?


I have slightly elevated tsh and severe vit d deficiency. I asked the Dr to test for b12 as well and he said it was unlikely because of the above.

I'm very obese, but up until oct last year i was active, cycling and horse riding (my horse is a big strong girl so i didn't flatten her) most days. I have deterioted to not being able to do much at all with out trembling from head to foot.

I'm suffering headache

severe fatigue

low mood and tearful

pins and needles in my face, feet and hands

pains in my hands and feet


inability to lose weight, despite cutting all refined carbs and sugars and eating simple home cooked meals based on non processed ingredients, eggs, meat veggies and healthy fats and cycling 10 or more miles most days until winter cut in.

joint pain

occasional tremble in my hands

I am aware that vit d can cause these but i wanted to check b12 too just in case. Dr is adamant that it's not likely so is it true that i can't have b12 deficiency?

10 Replies

you mention problems with TSH - is this being addressed? - I suspect that all of your symptoms, including weight could as easily be related to thyroid as to B12. Have you looked at the TUK forum

I would suggest trying to get the vitamin D and thyroid problems resolved/under control and then see if the symptoms are persisting - this is partly because there isn't a good test for B12 so evaluating a deficiency can be difficult at the best of times and becomes even more difficult where there are multiple conditions with similar symptoms going on - though I do recognise that treating thyroid problems isn't necessarily that straight forward.

In answer to your specific question: 30% of people with a B12 deficiency do not initially present with macrocytosis.

Also - Thyroid problems can have auto-immune causes as can B12 deficiency - and if you have one auto-immune condition that means a higher likelihood of having two or more auto-immune conditions.

banshishi in reply to Gambit62

one of the reasons i asked for b12 testing was because i was advised on a thyroid forum to have it tested to support thyroid hormone utilisation. along with folate ferritin and vit d. I understood it is common to have lower levels.Dr tested vit d and ferritin but not folate and b12

Thyroid test showed normal t4 and negative for antibodies

Gambit62Administrator in reply to banshishi

well, that would seem to rule out thyroid but still leaves vitD.

Still inclined to look at ruling one thing out at a time and at least you have the information that it is possible to be B12 deficient without having macrocytosis.

This is a link to the BCSH recommendations concerning B12 and folate deficiencies - which discusses the limitations of the various tests that can be used in diagnosing B12 deficiency - it gives the figures for patients who are B12 deficient without macrocytosis as 25%

banshishi in reply to Gambit62

Thanks for taking the time to reply and the link I will check it out.

You need T3 checking as well as normal T4 doesn't mean you are utilising properly. And it doesn't want to be just in range but towards the top end

Hey, I have hypothyroidism... went from a size 8/10 and active to a size 14 and constantly sleeping in 3 years. Ask your dr to give you a test for hypothyroidism and ask that they check T4 and T3 (they may be reluctant to do the latter but you need it for a proper check of your thyroid) and get a print out of blood test results. In my experience "slightly elevated" tsh is "elevated" tsh. If you post your results (with ranges) to the thyroid health unlocked forum, there are some people there who are great at interpreting results. What your dr has told you is nonsense, you can have a b12 deficiency without having pa and if you have hypothyroidism (which I suspect you do) you are likely to have low b12 (though this is not always the case). B12 deficiency and hypothyroidism have many of the same symptoms. Look at this list on the link below and see how many of the symptoms you have

Just read the above, they are right about vit d and b12, see if your gp will test T3 because this is the active hormone, there's every chance that your body is not converting the T4 properly

Personally, Banshishi, I would return to GP, taking someone close to you for support, and insist on B12 tests.

BCSH guidelines state you are at higher risk of PA/B12 deficiency if you have thyroid disease and, although many symptoms overlap, tinnitus, tingling, numbness, with headache and hand tremor are serious neurological symptoms of B12 deficiency, so these plus any other neurological symptoms you may have from reading the list in the B12def. link given at the bottom of this reply should be treated according to the UKNEQAS guidelines below: :

“In the event of any discordance between clinical findings of B12 deficiency and a normal B12 laboratory result, then treatment should not be delayed. Clinical findings might include possible pernicious anaemia or neuropathy including subacute combined degeneration of the cord."


Not to treat urgently and adequately according to BNF guidelines and latest BMJ research document below 'until no further improvement' would be risking irreversible neurological damage:

"the expert consensus for standard treatment in the United Kingdom is to begin parenteral treatment with intramuscular hydroxocobalamin."

"If there are neurological symptoms then 1000 μg intramuscularly on alternate days should be continued for up to three weeks or until there is no further improvement. In irreversible cases, for example, pernicious anaemia should be continued for life."

The above latest BMJ UK research document is supported by many research papers:

"Summary points:

Vitamin B12 deficiency is a common but serious condition

Clinical presentation may not be obvious thus leading to complex issues around diagnosis and treatment

*There is no ideal test to define deficiency and therefore the clinical condition of patients is of the utmost importance

There is evidence that new techniques such as the measurement of holotranscobalamin and methylmalonic acid levels seem useful in more accurately defining deficiency

*If the clinical features suggest deficiency then it is important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features"



Many of us with thyroid disease have gut problems. TOwards the end of this excellent film, it was eventually discovered that Tori Gardner had a form of colitis that affected her ability to absorb B12, leading to many problems with fatigue, brain fog, swollen, tingling tongue and a hand tremor.

Very best wishes Banshishi

Hi thanks for the replies. i will follow it up with dr

well dr has ordered b12 and folate tests along with a bone panel and autoimmune panel for arthritis and lupus as they run in the family, different gp as my usual doc was away and she suggested the tests before i even asked, she asked me for a list of all the symptoms and questioned severity and timeline for each symptom. For once it felt like a dr actually listened!

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