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Pernicious Anaemia Society
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Do I have vitamin B12 deficiency?

Hi everybody

I have been referred from thyroid uk member to post my blood results here to get an opinion on my vitamins levels. Please find below. I would appreciate any comments.

I do feel incredibly tired and I am overweight. Whatever I am doing I cant lose any weight. I have also developed urticaria from last October 2016.

I do have a problem with concentration at work and sometimes problem with finishing the sentence. I just cant remember the word.

Tsh 1.07 0.35-4.94

Free t3 3.67 2.63-5.70

Free t4. 13.3 9-19

Ferritin. 71.11 4.6 - 204

Folate. 18.1 7-46.40

B12. 167 138-652

Vit D. 45.5 30-80

Kortizol. 191 101-535

Atpo 475.5 <5.6

Anti thyreoglobulin 270.6 <4.1

3 Replies

Your B12 is at the bottom end, but probably not low enough for a GP to start treatment with B12 injections.

Here in the USA some diagnostic labs add a caveat to blood test results that 10% of the population may exhibit neurological symptoms when the level is below 400 pg/ml. (Same as ng/L). So you are in this range.

It sounds like you have neurological damage symptoms already.

Start a logbook of all your symptoms, but especially the neurological ones and assess a daily severity score of your own choosing. Also record your food snd drink and medications.

Prestnt the list of symptoms to your GP at each visit. He/she may think you are a total hypochondriac but this is a stage we all go through, especially when asking for more frequent injections. Best to get it over with now.

The logbook helps with short term memory loss as well. The repair of neurological, if possible at all, is very slow. Myelin sheath can get replaced but once the axon is damaged the nerve is gone.

You can start taking B12 supplements but these will impact any further blood tests and most likely delay the decision for B12 injections.

Get your GP to buy into the idea of treating you by monitoring your symptoms rather than further blood tests that may appear "normal" and tempt the GP to stop treatment.

Ask for a trial set of B12 injections. There are government guidelines on how to treat neurological symptoms.

To repair nerve damage, you want B12 levels from blood tests over the top of the range (>1500 pg/ml) you cannot overdose on B12 or have "toxic" levels as B12 is water soluble and you pee it away.

Good luck getting diagnosed and starting treatment.


As per prvanderaa's response you may or may not be B12 deficient.

Unfortunately serum B12 isn't a gold standard test - it is an indirect measure and people vary a lot in how the levels of B12 in serum relate to what is actually happening in cells. Used as a single indicator it will miss 25% who are deficient and pick up 5% who aren't - however, most GPs aren't aware of this and don't take it into account when reviewing test results.

There are a couple of tests that can help clarify which look at waste products that build up if there isn't enough B12 available at the cell level but these can also be raised by other things. Tests are MMA and homocysteine - homocysteine will also be raised if folate is low.

Macrocytic anaemia is a common symptom of B12 deficiency that doesn't overlap with thyorid but this isn't present in 25% of people who present with B12 deficiency. Again GPs are often not aware that macrocytic anaemia (larger rounder red blood cells) isn't a definining characteristic of B12 deficiency.

Suggest that you put together a list of symptoms that could be related to B12


along with an indication of when they started. B12 deficiency tends to develop very slowly over time - years or even decades - so this might help unravel whether symptoms of B12 or thyroid. The weight issue is more likely to be thyroid than B12. The tiredness and lack of concentration could be either.

if writing or starting a conversation with your GP then the source of the stats above is the BCSH (British Council for Standards in Haematology) guidelines for diagnosis and treatment of cobalamin and folate deficiencies which your GP can access through the BNF, though this link will also work if you are based in the UK


your folate is okay and your ferritin (an indicator of iron) also looks okay but to get a full picture of what is going on with iron you would need an iron panel/full blood count.

If you have neurological symptoms the standards emphasise the importance of prompt treatment of B12 deficiency to avoid permanent neurological damage. Some would count tiredness and concentration issues as neurological but many GPs don't.

If your thyroid isn't under control at the moment then I would be inclined to get it under control before taking B12 further - though that doesn't mean that you necessarily need to hold back on further investigations - the MMA test and a full blood count.



I had the problem with not being able to finish sentences and exhaustion. It went on for several years. I also developed terrible memory problems. I could not remember the story lines of dramas that I had watched on tv etc. I could not remember people's names even though they were well known to me.

Then I started to get blurred vision, extreme exhaustion, my body would go into shock and I had tinnitus if not auditory hallucinations plus a sense of euphoria. These attacks lasted about 10/15 seconds.

I had a blood test and found to be b12 deficient, had 6 loading doses and an injection every 12 weeks. I am much better now but, after 5/6 weeks after my injections, I get a return of symptoms which means that should get the injections every 8 weeks as they are neurological but my doctor refuses.

I amount taking loads of b12 on a daily basis and I feel that I am getting better but very slowly.

My feeling is that the very mention of b12 deficiency to anyone in the medical profession is treated with contempt so good luck with getting any sympathy for your condition.

Hope this helps.



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