Advice please

[AngieAsh]

Hi. I have recently been told that I have subclinical Hypothyroidism with high antibodies. Plus :-

B12 196 (197-771)

Folate 2.1 (2.0-16.7)

Ferritin 60.9 (13-150)

The Endocrinologist suggested with my vegetarian diet that I ask my GP for a vitamin B12 injection with these results but the GP doesn't want to let me have one without a second test for B12 and gastric parietal cells test as he said that tests can give false results and he needs to know if I am definitely low on B12 and able to absorb B12. Should I be doing anything in the mean time while I wait? Thanks in advance. Angie

Oh and I am taking levothyroxine 50mg for the UAThyroid, furosemide 40mg for Oedema and Losartan potassium 50mg for high blood pressure.

[clivealive Forum Support]

Hi AngieAsh I think your doctor is being rightly cautious wanting to have you tested for gastric parietal cells before giving you B12 injections although I'd have thought he would have wanted you tested for Intrinsic Factor Antibodies if he wanted to rule out Pernicious Anaemia.

On the other hand.... the N.I.C.E guidelines opening paragraph on how doctor should treat patients says:

Assessing B12 deficiency

How should I investigate a person with vitamin B12 deficiency anaemia in primary care?

Determine whether there is an underlying cause for the serum vitamin B12 deficiency (for example pernicious anaemia), by checking for serum anti-intrinsic factor antibodies.

Note that testing for anti-intrinsic factor antibodies is recommended in people with strong clinical features of B12 deficiency, such as megaloblastic anaemia or subacute combined degeneration of the cord, despite a normal vitamin B12 level. For more information, see the section on Interpreting results of investigations.

Checking for gastric anti-parietal cell antibodies is no longer recommended to diagnose pernicious anaemia.

Determine whether the person has experienced complications of anaemia, or of vitamin B12 deficiency.

How long before the test are to be carried out? Was Intrinsic Factor mentioned?

The N.I.C.E guidelines are

google.co.uk/url?sa=t&rct=j...

Click on the link then on "Scenario Management" and scroll down.

I am not a medically trained person so I cannot "second guess" what your doctor's intentions are but there are others on here who will be able to give you good advice.

[AngieAsh in reply to clivealive]

Thank you for the reply Clivealive and the information.

I had the test for B12 folate today along with something called GFR calculated abbreviated MDRD and urea and electrolytes. The last ones I know are to check my Kidney function to see if I can stay on the blood pressure tablets and diuretics or not. There was no mention of the intrinsic factor antibodies.

None of the GP's I have seen have mentioned anaemia to me and hadn't even suggested that I need supplements, just the Endocrinologist did. The GP today just said that he was checking to see if I can absorb the B12. It was a mod on the Thyroid group that suggested I ask for advice here about the B12 and folate after I posted my last results because they were low and people on here have more knowledge/experience with it.

It will be a different doctor when I go back next week, our practice has 3 surgeries and they rotate between them so we just get to see whoever is on the day you go. That one might do the intrinsic factor test so does anyone think I should I ask about it when I go back then with the levels I have?

I guess I should maybe leave off starting to supliment anything myself until then.

[clivealive Forum Support in reply to AngieAsh]

Both your thyroid problems and vegetarian diet "put you at risk" of developing a B12 deficiency but having said that I'm puzzled by your low Folate level as that is sourced naturally by eating leafy green vegetables, sprouts, broccoli, asparagus, spinach, peas, beans etc. which presumably are part of your daily diet.

You might want to query your low Folate with your next doctor.

Oh and yes! Hold off any supplementing until the results are in.

[AngieAsh in reply to clivealive]

Thank you.

Actually the low folate might be self inflicted then, I'm not a fan of green leafy veg. I do eat beans and Asparagus but Asparagus can be very expensive out of season so I don't get much of that either and I only like peas raw so only get them in season too.

Maybe that is something that I should supplement once the B12 is sorted out.

[clivealive Forum Support in reply to AngieAsh]

Definitely.

There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

Folic acid is crucial for proper brain functioning and plays an important role in mental and emotional health and it also works closely with vitamin B12 in making red blood cells and helps iron function properly in the body.

Vitamin B9 (Folic acid) University of Maryland Medical Centre

Folic acid is also being "fortified into" many breakfast cereals.

[AngieAsh in reply to clivealive]

Thanks again. I do like cereal so I can look for a fortified one that doesn't have too much salt or sugar.

[KimberinUS]

Please know that once you start receiving B12 your thyroid medication may need adjusting.

hypothyroidmom.com/10-nutri...

I hope you feel better soon

[AngieAsh in reply to KimberinUS]

Oh I didn't know that, thanks.