Tips on getting GP to test

[HypoFrog]

Hi everyone

I’m new to the forum after someone recommended I ask on here about getting further testing after a low B12 result and I am hypothyroid following radioiodine for hyperthyroidism.

My most recent B12 result was 263 (200-900)

I want to start taking B12 but have been told I should get tested for PA first. The only thing is, my GP and Endo just see my result as in range and therefore normal so won’t investigate further. I also believe the PA test is only around 50% reliable so are there other tests I would need?

Any tips as to how to get them to look into it further? I need to start supplementing ASAP as I’m on a journey this year to get my thyroid levels optimal and hopefully improve my health. Ideally don’t want to spend money on another private test at the moment after purchasing vitamins D3 and the co-factors.

Thank you

[Gambit62 Administrator]

Have you had B12 done in the past and the result was significantly higher ie more than 20% higher? That would suggest an absorption problem.Whilst the test for IFAB can give false positives if done too close to supplementation the time scale is a maximum of 10-14 days of not supplementing and can be as little as 24 hours - it depends on the exact test method.

The phrase 'optimal level' is one that makes me uncomfortable as it implies everyone is the same. What is best point for one person can be very different for another - particularly with B12. differentiating symptoms from other conditions can also be very difficult.

If you want to look at other tests around B12 deficiency - MMA or homocysteine - then now would be time to do so before supplementing.

If you have neurological symptoms then you could try pushing for a trial of injections in line with this guidance produced by the BCSH

onlinelibrary.wiley.com/doi...

Personally I wouldn't push for IFAB because it is so prone to false negatives and is only about one possible absorption problem.

Also sharing an article on thyro-gastric symdrome

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

[HypoFrog in reply to Gambit62]

I’ve just had 2 tests. I had a private one done and the result actually said insufficient and was 218. So the NHS would test then and got the 236 in Range result.

Thanks for the advice. 😊

[Gambit62 Administrator in reply to HypoFrog]

Different labs may be either using different rages or have different cut off points - assuming the same units the two tests are within the margin of error for the serum B12 test. You could delay supplementing and redo testing in another month or so and see if levels have fallen significantly in that time (20% or more) which would point to an absorption problem.If you have strong neurological symptoms then push for a trial of B12 in line with the guidance shared above

[HypoFrog in reply to Gambit62]

Thank you 😊