Hi I am new here, I have low B12 and under active thyroid and doctors have mainly been dismissing my symptoms saying there is nothing causing them - vertigo, dry skin, lumpy feeling in throat, tiredness, memory loss, pins and needles, trapped wind, heavy periods, hair loss, puffy eyes and feet. Wondering if anyone could feedback as to what I need to do? Results for vitamins and minerals are private and I am not supplementing anything. Thankyou
Hi demi2 re the B12 and Folate levels you need to show these results to your own doctor and ask him/her to treat you for "Vitamin B12/Folate Deficiency" in accordance with the N.I.C.E Guidelines below.
Click on the link, then on "Scenario: Management" and scroll down.
There are other issues highlighted in the report such as Vitamin D deficiency and your thyroid problems which I cannot comment upon as I'm not a medically trained person but there are others on here who can give you good advice.
The results indicate that you are iron (ferritin and low MCV) deficient, folate deficient and B12 deficient. You need to share them with your GP
Multiple deficiencies implies an absorption problem which could be PA or could be coeliacs, crohn's, h pylori infection or low stomach acidity - which could be related to PA. Ideally the cause needs to be investigated.
Your GP may want to redo tests - that's fine but if he does and B12 comes back in range then that doesn't necessarily mean everything is okay. People vary a lot with B12 and B12 serum test will miss 25% of people who are B12 deficient (and pick up 5% who aren't) so evaluation of symptoms is important.
Some facts and figures for you to share with your GP, as well as the results and a checklist of your symptoms in terms of B12:
Note: treatment protocols are those that apply in UK - protocols elsewhere may be different.
25% of patients with B12 deficiency present without signs of macrocytosis - this is a common symptom but not a defining characteristic of B12 deficiency
iron deficiency would tend to microcytosis rather than macrocytosis, giving a confused position - though RBDW (Red blood cell distribution width) should be high if both are going on at the same time
treatment for B12 deficiency should be started 24-48 hours before treatment for folate deficiency
treatment for B12 deficiency in the presence of neurological symptoms is loading shots 3xweekly until symptoms stop improving (review at 3 weeks) followed by maintenance shots every 8 weeks.
treatment for B12 deficiency - particularly if there are neurological symptoms - should not be delayed as there is a risk of neurological damage becoming permanent
given the limitations of the serum B12 test treatment should be based on symptoms rather than test results if there is a discrepancy between the two
IFA test for PA is prone to false negatives - 40-60% of the time depending on the assay method so a negative result is a long way from showing that you don't have PA.
Symptoms of low stomach acidity are basically the same as high stomach acidity
considerable overlap in symptoms of thyroid, iron deficiency, and folate/B12 deficiency may make the situation confused
Source of info for facts on B12 deficiency is the BCSH standards on cobalamin and B12 deficiency
BCSH guidelines mention a higher risk of B12 def. If you also have thyroid disease. Dr John Midgley, 'Diogenes' recently posted this important research on the TUK forum, which explains the progression of Hashimoto's autoimmune thyroid disease to gastric atrophy, (which many patients on this forum also suffer from and can be silent) to eventual PA/B12def.:
"Clinical autoimmune gastritis is characterized by a partial or total disappearance of parietal cells implying the impairment of both hydrochloric acid and intrinsic factor production. The clinical outcome of this gastric damage is the occurrence of a hypochlorhydric-dependent iron-deficient anemia, followed by pernicious anemia concomitant with the progression to a severe gastric atrophy."
"Clinical signs of this disease appear after several years of its onset, when the progressive reduction to disappearance of the parietal cells leads to atrophy of the gastric mucosa, impairing the absorption of iron, vitamin B12 (cobalamin), folate, and other nutrients (22)."
"In the initial phase of the atrophic gastritis, the damage of parietal cells can lead to iron deficient microcytic anaemia as the only clinical sign (38). When the gastric atrophy becomes severe and/or the IFA is no longer produced, even the absorption of cobalamin becomes compromised. "
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Your low B12 and other test results would seem to indicate an absorption problem. You could print out the above research paper, as well as the latest BMJ research document below and write or ask GP (taking someone close for extra support) for B12 injections for neurological symptoms as per the BNF - 'every other day until no further improvement'. Treatment should begin without delay to avoid permanent damage.
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