Confused by blood test results

[PurpleThyroid]

Hi there, new to this forum!

Had Hashimotos for about 15 years, bloods up and down, now fully gluten free. At last GP blood test was told to reduce Levothyroxine dose as GP believed I was over-medicated. I feel that the GP is focused entirely on the numbers and not on how I might be feeling.

So, I had a private blood draw (with Medichecks as recommended by Thyroid UK) on 9th August. Results were:

Inflammation CRP HS 1.33 mg/L (range:<5)

Ferritin 28.1 ug/L (range: 13 - 150)

Folate - Serum 3.66 ug/L (range: > 3.89)

Vitamin B12 - Active 30.100 pmol/L (range: 37.5 - 188)

Vitamin D 51.1 nmol/L (range: 50 - 175)

TSH 0.014 mIU/L (range: 0.27 - 4.2)

Free T3 4.12 pmol/L (range: 3.1 - 6.8)

Free Thyroxine 19.300 pmol/L (range: 12 - 22)

Thyroglobulin Antibodies 18.400 kIU/L (range: < 115)

Thyroid Peroxidase Antibodies 162 kIU/L (Range: < 34)

I'm exhausted, have constant headaches, tinnitus, aching legs, poor balance, amongst other things. Suspected possibly Pernicious Anaemia. Saw the GP who was unimpressed about having private blood tests, but eventually agreed (despite his initial suggestion that "a multivitamin would do the trick") to do further tests, and that if these showed decreased B12 they would consider injections.

Had an NHS blood draw on 16th August. These are the results:

Serum Vitamin 12 201 ng/L (range 197.00-771.00)

Serum Folate 9 ug/L (range 3.80-9999.00)

Serum Ferritin 15 (range 13.00-150.00)

Full Blood Count:

Haemoglobin estimation 136 g/L (range 120.00-150.00)

Total white cell count 4.8 10*9/L (range 4.00-10.00 10*9/L)

Platelet count 257 10*9/L (range 150.00-410.00 10*9/L)

Haematocrit 0.43 L/L (range 0.36-0.46 L/L)

Red Blood Cell Count 5.04 10*12/L (range 3.80-4.80 10*12/L)

Mean corpuscular volume 84.3 fL (range 83.00-101.00 fL)

Mean corpusc. haemoglobin 27 pg (range 25.00-33.00 pg)

Mean corpusc. Hb. conc. 320 g/L (range 315.00-345.00 g/L)

Red blood cell distribut width 14% (range 11.60-14.00%)

Neutrophil count 2.2 10*9/L (range 2.00-7.00 10*9/L)

Lymphocyte count 1.8 10*9/L (range 1.00-3.00 10*9/L)

Monocyte count 0.4 10*9/L (range 0.20-1.00 10*9/L)

Eosinphil count 0.4 10*9/L (range 0.00-0.50 10*9/L)

Basophil count 0.01 10*9/L (range 0.00-0.10 10*9/L)

Immature granulocyte count 0 10*9/L (range 0.00-0.30 10*9/L)

Nucleated red blood cell count 0 10*9/L (range 0.00-0.20 10*9/L)

Spoke to GP today who said my results were ok and so no B12 injections, and again said about taking a multivitamin. I pushed back a bit and he's prescribed:

Ferrous Sulfate 200mg (one twice a day)

Cyanocobalamin 50mcg (one a day)

Folic Acid 5mg (one a day)

To be honest I don't know what a lot of this means, and I don't really understand how my B12 (for instance) can be below range in the first test and fine in the second just a few days later. GP clearly thinks I'm a hypochondriac...

Any advice gratefully received!

[EllieMayNot]

"Serum Vitamin 12 201 ng/L (range 197.00-771.00)"

I wouldn't call the B12 at 201 fine as it is just a tiny bit above the cut off point. In my mind, based on a lot of reading and research, your number could very well mean low B12 and the only way to rule it out is with either a trial of B12 injections or a methylmalonic acid test (MMA). My B12 was right in the middle of normal yet I tested with high MMA and Hcy (homocysteine) and positive for parietal cell antibodies so a definite diagnosis of PA all with a perfectly normal serum B12 level. You are substantially lower on your serum B12 than I was!

Hopefully, someone else on here can give you a good recommendation as to the best way to fight for either more testing or injections. If you are a member of the Pernicious Anaemia Society, they can give you very sound guidance. If all else fails, you still have the option to self inject. Your health is worth fighting for!

[Nackapan]

The results I do understand are ferritin is low (although in normal limits) I raised my vit D recently to 73 and my headaches I still have but less of them . I'm also taking iron prescribed by G P. As so many symptoms you seem to need B12 too!! Get a trail of injections as soon as you can. Go by symptoms. The B12 serum test only shows what's on your blood and not what's active. Your high dose of folic acid should raise your leveks quiclay. I only took 400mcg and it went from 9 ng/l to over range 26 in 3 Months. I hope you get the b12 soon to see if it helps you

[Gambit62 Administrator]

serum B12 isn't a very accurate test - run it several times on the same sample will give results that vary by 20% - so its quite possible that you could be below the normal range.

Your blood work isn't showing any clear signs of either macrocytic anaemia (larger rounder red blood cells associated with B12 and folate deficiency) or microcytic anaemia (smaller red blood cells associated with iron anaemia). It is possible to have both going on at the same time so one masks the other - which would be consistent with the low ferritin and nlow B12. If both were going on then RDW (red cell distribution width) would be high - yours is coming out about the top of the normal range.

active B12 has less variation in the results and is usually around 20% of serum B12.

There are a number of ways in which thyroid problems can lead to problems absorbing micronutrients. Studies show crossovers to developing PA (another auto-immune disorder that affects the gut and leads to B12 deficiency) varying between 10-40%.

This is a link to an article on thyro-gastric syndrome that discusses the link between hypothyroidism and PA

ncbi.nlm.nih.gov/pmc/articl...

This is a link to the BCSH standards on cobalamin and folate disorders.

onlinelibrary.wiley.com/doi...

it discusses the limitations of the various tests - like serum B12 in relation to identifying a B12 deficiency. I believe your GP should be able to access the standards through the BNF.

I don't have a magic wand that will ensure your GP listens but you could try sharing the information/links above with your GP to draw their attention to a) the problems of just going by the numbers in relation to serum B12 b) the likelihood of micronutrient deficiencies and particuarly PA in relation to hashimotos c) the importance of going by clinical symptoms in the case of neurological symptoms of B12 to avoid the risk of permanent nerve damage as you have already listed a number of neurological symptoms.

On the other hand there is also a high cross over between symptoms of B12 deficiency and hypothyroidism so going by symptoms alone can be difficult. Tests that may help to clarify - MMA and homocysteine - if there is an underlying B12 deficiency will probably require a hospital referral. The tests are available privately from St Thomas Hospital but GPs can be a bit suspicious of private tests as there isn't necessarily any control over the circumstances in which the sample is taken and stored which can interfere with results.

Although the numbers can be very difficult on TSH your results do imply that you could be over-medicated. thyroid hormones and B12 are used together in some of the processes that go on in your cells - eg the Krebs cycle which is the one that releases energy from food - so it could be that getting treated for B12 deficiency would make this process run more efficiently.