Hi, I have posted my blood results and it would appear that my B12 is within range but low in range, the Thyroid Group have suggested I ask for advice on this Group to see if I should supplement oral B12 tablets. My GP won't test for pernicious Aneamia as she says my results are in range. I have purchased B12 but not started to take them as yet. I am supplementing other things to assist with Hashimotos Thyroiditis with positive antibodies. GP has agreed to give me 25mg of Levothyroxine but not started them yet as I need to be sure I am doing the right thing as if my B12 needs to be optimal I would prefer to address that before Levo. Could anyone please advise, many thanks.
serum B12 isn't a gold standard test. used as a single measure it will miss 25% of people who are not B12 deficient, but also pick up 5% who aren't, so symptoms are important - but also problematic as they overlap with a number of other conditions - including hypothyroidism.
This is a link to the BCSH guidelines on diagnosis and treatment of cobalamin and folate deficiencies which your GP can find on the BNF but can also be found here
your GP should also be aware that macrocytic anaemia is not a defining characteristic of B12 deficiency - 25% of people first present with neurological and other symptoms and show no sings of macrocytosis. This is even more likely if the patient has problems with iron levels as this would tend to lead to microcytosis and the two would mask each other when looking at a full blood count - though may show up as a higher RDW than normal.
From your other posts you have been taking PPIs - presumably you have had problems with stomach acidity such as acid reflux. Acid reflux can also be a symptom of low stomach - which seems to have been on-going for you for some time.
The exact links between thyroid problems and absorption problems isn't well understood - it could be related to slow gut transit or it could be the result of an auto-immune condition such as PA. As the symptoms of PA - caused by B12 deficiency manifest very slowly and it can take a while for an absorption problem caused by PA to manifest as a B12 deficiency it may be that you have had PA undiagnosed for a significant amount of time - your serum levels would have been slowly dropping over time but as yet haven't fallen outside the normal range - though, as above that doesn't mean that you won't be deficient at the cell level. There is a strong cross over between PA and hashimotos - 40% of people with PA go on to develop hashis, including myself One theory for this is that that the cells that form the thyorid start off from the same cells as form the gut so antibodies that attack one, easily change to attack the other. This relationship is known as thyro-gastric syndrome and discussed quite helpfully in this article which you might want to share with your GP
You certainly appear to have general absorption problems as you have also had problems with iron deficiency and your folate looks as if it may be a little on the low side.
personally I found that 25mcg of levo made me feel a lot worse. Unless you are old and/or have a heart condition the normal starting dose is, I believe 50mcg - on which I felt marginally better but was pretty dead (and worse than I was before I started). It reduced my TSH but that didn't mean that it had replaced the T4 my thyroid was producing before ... however, GPs tend to be as challenged on the biochemistry of thyroid hormones as they are on the biochemistry of B12 and tend to focus on TSH as the measure of what is going on rather than actually asking their patient (rant, rant and off topic ranting).
If you have problems with stomach acidity then you are also going to have problems absorbing levo so recommendation would be to start on a higher dose rather than a lower dose anyway.
Personally I'd advise trying to get your GP to think again about the B12 situation before supplementing, using the above materials. I'd also suggest you make a full list of symptoms that could be related to B12 and when they started
if you have had previous levels of B12 etc measured then it would be useful to do a comparision - a significant drop would be indicative of an absorption problem as generally levels of B12 in serum are well regulated in the blood by using stores in the liver which means that it isn't very responsive to diet.
you could also try pointing your GP at the area on the PAS website specifically aimed at helping medical professionals improve the standards of diagnosis and treatment of PA (and the B12 deficiency it causes).
Thank you so much for your detailed reply, I have had to go alone on supplements with help from members on this site and research links etc so I am going to try the B12 supplements if only for the month until my next bloods and see if I feel any better. Drs don't seem to be interested in nutrients and vitamins which I find really odd.
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One theory for this is that that the cells that form the thyorid start off from the same cells as form the gut so antibodies that attack one, easily change to attack the other. This relationship is known as thyro-gastric syndrome and discussed quite helpfully in this article which you might want to share with your GP
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