Pernicious Anaemia Society
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Hello I am new to this Forum

I have just received my blood results from medichecks. I am on your associated Thyroid forum and had posted the results on the site and been directed to you as there is often a crossover with symptoms. I feel my thyroid is undermedicated.

Vitamin B12 252 (140.00-724.00)

Folate (serum) 11.35 (2.91-50.00)

25OH Vitamin D 103 ( 50.00- 200.00

I had been experiencing throat pain and occasional numb tongue I have noted that I also suffer with balance problems which I have always attributed to my ears/specs. Now I am not so sure. I am mostly vegetarian and do follow a healthy diet and lifestyle.

I think my B12 is low but understand that you shouldn't supplement before checking blood levels and unfortunately I have occasionally supplemented to see if I have any improvement.

I would be grateful for any comments.

4 Replies

Cleobear - please note that the TUK is completely independent of the PAS forum - just that people often have both thyroid and B12 problems so people do tend to cross between the two forums.

Your B12 level isn't actually that low on the face of it. Serum B12 is not a test that can really be used as a single measure as people vary quite considerably. As a single measure it will miss 25% of people who are B12 deficient but also pick up 5% of people who aren't.

Evaluating symptoms can be quite difficult where there is an overlapping condition such as thyroid.

You can find a check list of symptoms here


what is happening about sorting out the thyroid? - would be better to sort that out and then come back to B12 as a possibility if the symptoms persist.

did you notice any difference when you supplemented? Supplementing with doses close to RDA isn't going to be a problem 2.5-10 or even 50mcg - except the expense if it is unnecessary because you aren't deficient - it's supplementing with very high dose supplements (1000mcg for example) that can cause problems and cloud getting an absorption problem (PA is an absorption problem) that can cause problems.


Thank you so much for your swift response and advice on dosage etc. I visited my GP this morning armed with my Thyroid results and ready for a battle. My GP was quite receptive and agreed to increase my dose and retest in one months time. I had noted that when I took the B12 I had felt better but have been so up and down due I think to a particular brand of levothyroxine. I will see if my symptoms improve with the change of dose and take things one step at a time.



Who's at risk of PA (Pernicious Anaemia) and B12 deficiency?


B12 books

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

"Could It Be B12" by Sally Pacholok and JJ. Stuart

B12 Deficiency Symptoms lists


Other B12 info

Have you read the BSH Cobalamin and Folate Guidelines?It's a UK b12 document.

Flowchart from BSH Cobalamin and Folate Guidelines

BMJ B12 article

I am not medically trained just someone who has struggled to get a diagnosis.

1 like

As you may lready know Cleobear, B12 def. and autoimmune thyroid disease* * are often interlinked and symptoms overlap, but a numb tongue, difficulty in swallowing and balance problems could very well be neurological symptoms of B12 deficiency.

The thyroid connection, vegetarian diet, neurological symptoms plus a low B12 result (deficiencies begin to appear in the cerebral spinal fluid below 550) all mean that, personally, I should want to be treated with injections without delay to avoid symptoms worsening or permanent damage.

BCSH, NICE and UKNEQAS all have guidelines on treating B12 def. and you could write or email the latest BMJ research document to the surgery - link given below.

This helpful site also has a list of symptoms, as well as templates and advice on writing to your doctor:

Cmim/BMJ document. " Summary:

* 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 the patient is of utmost importance."

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

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

Severe deficiency shows evidence of bone marrow suppression, clear evidence of neurological features and risk of cardiomyopathy.

It is important to recognise that clinical features of deficiency can manifest without anaemia and also without low serum vitamin B12 levels. In these cases, treatment should still be given."

"If there are neurological disturbances, then treatment should be expedited and started without delay - 1,000 u.g. i.m. on alternate days. This should be continued for up to three weeks or until there are no further improvements".


" The need for quick and correct treatment is emphasised further by the fact that after a year of treatment only 4 % of patients are fully recovered. Fortunately half of the patients have experienced a lot of improvement in their symptoms after a year of treatment but there are still a lot of patients with remaining symptoms, who could possibly have recovered if their treatment was started promptly and adequately."

* * This is what the BCSH guidelines have to say about autoimmune disease in general:

"Pernicious anaemia is one of a number of autoimmune diseases, including Hashimito disease, type 1 diabetes, vitiligo and hypoadrenalism, which may coexist together."


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