Hello, all. I'm a 45 year-old woman new to this forum. I'm suffering from fatigue (annoying, not debilitating) and in the last 3-4 weeks suddenly lost enough of my already thin hair that I'm now wearing a wig. I also have a history of post-partum hypothyroiditis which set in after the birth of my first child in 2006. At some point I decided I knew better than the endo and stopped taking the thyroid medication he prescribed because I'd heard women sometimes recover from this type of thyroid issue. I thought I was in the clear because subsequent tests performed by my primary care doctor showed values in the "typical" range, as I've listed below.
The recent hair loss prompted me to go to my primary care doctor who tested me for thyroid and iron. The results were:
TSH: 3.27 uIU/mL (0.24 - 4.82) --my TSH has been around this number since at least 2015
Free T4: 0.72 ng/dL (0.59 - 1.61)
Free T3: 2.50 pg/mL (2.3 - 4.2)
Vit D,25-Hydroxy Tot: 40 ng/ML (20-80) --I've been taking 2000iU VitD for a while now due to testing at 10 in 2016
Ferritin: 14 ng/mL (12 - 252)
RBC: 3.82 M/uL (3.90 - 5.40)
Hemoglobin: 12.1 g/dL (12.0 - 15.5)
Hematocrit: 35.7% (35.0 - 47.0)
MCV: 94 fL (80 - 100)
MCH: 31.7 pg (27.0 - 33.0)
MCHC: 33.9 g/dL (31.0 - 36.0)
Lymphocyte %: 22% (26.0 - 46.0)
My doctor's only comment, made online, was that my iron's low and I should start taking an over the counter supplement once a day and see if things improve in three or four months. Not feeling satisfied with this response, I decided to go to another doctor who ordered many more tests for celiac, hormone issues, lupus, and vitamin deficiency. Most came back normal, but here are the ones I think might be pertinent:
Vitamin B12: 257 pg/mL (211 - 911) --tested at 284 in 2016
Based on my reading, I think an argument could be made that I'm hypothyroid or at the very least, likely headed in that direction. I'm wondering if I could also have PA or some other reason for low-ish B12--maybe that's what's leading to my low ferritin?--and what would be the next tests I need to figure that out.
Thanks in advance for your thoughts!
Written by
aggleflaggle1045
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Serum B12 is a difficult test to interpret - particularly if there is another condition like hypothyroidism going on because of the overlap in symptoms. Its reasonably okay at saying what is happening with absorption if you have a trend over time - would expect things to be steady if you don't have an absorption problem - but in a 20% band as the test isn't that accurate and that is the variation you would expect from doing the same test several times on the same sample.
A single measure of B12 doesn't give you a trend though. It is in normal range but it is possible to be deficient at that level - as just taking the level on its own will result in missing 25% of people who are B12 deficient. So, clinical evaluation is important - which includes symptoms but overlap with thyroid makes it very difficult. One common symptom of B12 deficiency is macrocytosis but your bloods aren't showing that - all in range - however that symptom also isn't present in 25% of people who are B12 deficient. Your iron measures look on the low side but you don't have signs of microcytosis (smaller red blood cells) so that may be counteracting any macrocytosis.
Absorption problems are common in thyroid patients - with iron usually being the first to show up. There is a very high crossover between hashimotos and PA - figures for hashi's developing PA varies from study to study in the range 10-40%. PA patients developing hashi's seems to be around the 40% mark.
Sorry I can't be more specific - but at this point I don't think your GP should be ruling out vitamin and mineral deficiencies and you probably do need to (re)start treatment for Thyroid
2. your thyroid needs vitamin D and magnesium along with other nuteients to work properly
3. looks like you have hasimotos and that definitely needs addressed before more damage occurs.
4. yes your iron looks low, which can effect hair.
questions i have are
1. what is your red blood cell distribution width (rdw) on a complete blood count? if higher in range that indicates a wider variance in rbc sizes which can indicate microcytosis (low iron) and macrocytosis (low b12 or folate or both) at the same time, causing an "in range" mcv.
2. how is your folate? it works with iron and b12 to make rbc.
as for further testing, you could have an active b12 test, an mma test or a homocystein test to see if they indicate a b12 deficiency even though you have a "normal" b12 serum blood test.
Thanks so much to you and the previous poster for your responses. To answer your questions: my folate hasn’t been tested and my RDW is 12.4% (standard: <16.4%). Would you consider that higher in range?
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