Help for my sister please

[MNDA3]

I have been suggested to come here by the helpful people on the Thyroid UK forum. My sister has Hashimotos and stopped taking her supplements due to her feeling like giving up with continuing to feel unwell. She has symptoms of B12 deficiency. Any advice appreciated. Thanks

Ferritin 27 (15 - 150)

MCV 77.2 (80 - 98)

MCHC 385 (310 - 350)

MCV 28.2 (28 - 32)

Haemoglobin 121 (115 - 150)

Haematocrit 0.44 (0.37 - 0.47)

Red blood cell count 4.42 (3.80 - 5.80)

White cell count 7.13 (4.00 - 11.00)

Platelet count 252 (150 - 400)

Iron 9.3 (6 - 26)

Transferrin saturation 15 (12 - 45)

Folate 2.0 (2.5 - 19.5)

Vitamin B12 263 (190 - 900)

Before stopping her supplements she was taking 5mg folic acid once a day and 3x 210mg ferrous fumarate a day. She did supplement B12 but her level hardly rose on this, she was taking 1000mg (sublingual) for 2 years.

[Gambit62 Administrator]

your sisters results are showing clear signals of microcytosis - smaller red blood cells - suggesting iron deficiency. She is obviously folate deficient - which seems more likely to be the current issue as the symptoms actually seem to have come on in a relatively short time-scale - her B12 is really in the grey zone. Test that might actually help with B12 is MMA - would be raised by lack of B12 but not affected by folate being low (which homocysteine would be).

However, the presence of problems with absorption of iron and folate suggest that even if your sister isn't deficient now she will become deficient in the future - would be useful to see what has been going on with B12 over a period of time - if it was done previously and dropped significantly then that would be a very good indicator that B12 absorption is a problem as well.

From your last paragraph on supplementation it does sound as if high dose supplementation might be an option for maintaining levels of B12 - but isn't an option for raising levels if she is genuinely deficient.

I'd suggest - talking the above through with her GP - going back on the supplements and see if that resolves the supplements or gives any improvement - and if it doesn't pushing for formal treatment of B12 - though you could argue for formal treatment of B12 to start off with - just that the sudden onset is pointing to folate being deficient but that B12 isn't quite there yet and high dose oral seems like a potential way of ensuring it doesn't get there

Exact treatment would depend on exactly where you are based as currently high dose oral isn't a licensed treatment for B12 absorption problems in the UK but B12 shots are.

[MNDA3 in reply to Gambit62]

Thanks she had B12 levels dropping before. We are based in UK.

[Gambit62 Administrator in reply to MNDA3]

suggest you put all the evidence together in a letter to the GP and then make an appointment to follow up.

[Ryaan]

Low Folate, Iron and B12 look to be on the low side and will make you feel quite unwell. Looks like you could benefit with these 3.

If your levels of B12 don’t raise by oral supplement you may have an absorbtion problem and need B12 injections.

You can talk to your GP about why your levels are low and possible tests for absorption problems or possible treatment.

You will feel much better when these levels are higher.

B12 injections work much quicker if your GP is willing.

I would make an appointment with GP and talk through this first, see how that goes and let us know how it went.

Wish you well.