Help with where to go next

[Scottishsally]

Hi all, I posted this originally on the thyroid UK board and received some great advice but was advised to post here too so I hope you can help

Hi all, I’m so glad I’ve found this forum and I’m really hopeful that you’ll be able to help me. For info I’m a 32 year old female, 8 months postpartum with my second baby and have generally always been fit and healthy. Since having baby number 2 I’ve struggled with being really tired and shaky, feeling weak, losing lots of hair, dry skin, some stomach aches and variable bowel movements and just generally been quite anxious and struggling to sleep. On the recommendation of a friend I contacted the doctor to ask about a thyroid check. I had bloods taken with the following results:

Ferritin: 22 (15-200)

B12: 175 (200-883)

Folate: 4.4 (3.1-20)

TSH:0.87 (0.35-5)

Free T4: 12.1 (9.0 - 21.0)

From these a receptionist from the doctors called me to tell me I’m low on b12 and prescribed ferrous fumarate 3 times a day. I then had further bloods taken the following week which I don’t have results for as still to collect them but when I called they told me the doctor said no further action.

I’m still feeling pretty awful, I have a kind of electric feeling in my hands and feet particularly at night time, I’m still feeling weak and almost like I’m struggling to string words together, particularly as the day goes on. I’ve called back to request further bloods as my grandfather had pernicious anaemia and chrones and I have 2 cousins with coeliac disease all on the same side of the family. They can’t book me in for another 2 weeks so it’s still a waiting game.

From reading on here I’m not sure if my thyroid results suggest anything else going on so I hope someone with expertise can advise although I think I’ll need further tests done first, is that right? Is it right that I should be feeling like this with these levels or is this just new parent life catching up on me?

Thanks so much for any help you’re able to give.

[wedgewood]

The treatment for low B12 - which you certainly have, would be initially. Injections of B12 , not doses of g ferrous fumerate , which would be prescribed for iron deficiency . I must tell you straight away that Pernicious Anaemia/ B12 deficiency are subjects that doctors generally are ignorant about .

I assume that you are not vegan or strict vegetarian , This can lead to low B12 which are only found in animal products . As P.A. is in your family , you perhaps know that it can be genetic . Does your doctor know about this ?

Pernicious Anaemia means that one is unable to absorb B12 because of of autoimmune antibodies that attack the parietal cells in ones stomach , which means one lacks intrinsic Factor and stomach acid both of which are required to process and absorb B12 , the most difficult vitamin to absorb . The lack of stomach acid causes gut problems which you write about .

I had this also . I treated it with probiotics when I got the correct treatment with B12 injections ( I have to self inject because I can’t get more than 1injection in 3 months . )

Sorry I have to dash . You will get some good advice from excellent members on this forum . .

[Scottishsally in reply to wedgewood]

Thanks so much for your reply. No, not vegetarian or vegan, eat a pretty balanced diet so I don’t think that’s where the problem lies unfortunately. My doctor doesn’t know about PA being in the family only because I haven’t actually communicated directly with him, only a locum doctor and then the receptionist. I’m going to give the surgery a call on Monday morning and cross my fingers I can get an app for a phone consultation ASAP, I’m feeling pretty awful and want to try and get sorted out before I need to go back to work.

[wedgewood in reply to Scottishsally]

You should be able to get a face -to face appointment now .

[Nackapan]

It's quite common for b12 to drop after having a baby. Have you been taking the recommended vitamin supplements advised by midwife? They include b12. .

No further action from Gp...

Unbelievable.

Was your intrinsic factor antibody test done? . 50% of those with PA are picked up if negative could still have PA.

Shoukd be done before start of b12.

If not on supplements

Then why not try b12

Tablets?

Will do you no harm . If no improvement insist on a trial of b12 injections.

B12 needs to be treated before folate

The ferrous fumerste will raises your ferritin levels which are probably causing some of your symptoms

Vit d snd I assume a full blood count done.

It's ruling things out.

I'm not medical .

[Scottishsally in reply to Nackapan]

No, not PA test at all, just a blood count, thyroid and iron count. I haven’t had vitamin d tested either so I’ll need to ask about this. I think I’ll see what the doctor says when I can get an appointment - I’m thinking now that since there is a family history of PA then he should be open to testing for it but if he won’t then I would definitely look towards supplementing myself. Thanks so much for your reply!

[Nackapan in reply to Scottishsally]

Yrs if you haven't been on supplements during pregnansy or after it may be s matter of depletion after childbirth. I hope that is the case as much easier to fix with the right supplements over time.

[Scottishsally in reply to Nackapan]

I was on pregnacare type supplements during pregnancy (just the ones given by the midwife) but I was also anaemic during pregnancy and was on ferrous sulphate for most of the pregnancy. When they tested my blood after having my little one they gave me another months supply of the iron tablets but I was never checked again until recently so I’m unsure if my iron levels have been low since then or if they’ve dropped again recently.

[Nackapan in reply to Scottishsally]

Oh okay. So no supplements after giving birth apart from iron. You shoukd really have had bloods done 3 monthsc after delivery if put on iron.

I'm really hoping it's that rather than PA.

Depletion from pregnancy and birth.

Make sure bloods are done st 3 monthly intervals as on iron

Most need a maintenance dosage quite a while .

You may just need oral supplements. I'm surprised you wernt advised.

Your b12 needs addressing

Low b12 after delivery can be one of the causes of post natal depression .The medics are aware of this as well as depletion of iron at times pp they know that much.

Hope you can absorb snd just Need a boost

Get a print off of your bloods gor your own records.

I hope you get it sorted soon .

[Showgem]

As Nackapan has said hopefully it's just that your levels have dropped as you haven't been told to supplement following having your baby. You do have neurological symptoms of b12 deficiency though and I would definitely see your GP for further testing. In any case try to get your GP to agree to a course of B12 injections to boost your levels.

You know the dangers of b12 deficiency so don't let them palm you off with only iron pills or you will continue to get worse. If they won't agree to injections even on a trial basis take b12 supplements, hopefully you will be able to absorb it but with 2 young babies to look after you need b12 injections if at all possible.

[Scottishsally in reply to Showgem]

I’ll definitely be asking the doctor on Monday for further treatment as I’m really struggling and my little boys need me on top form! Thanks so much

[Parlay]

I am only a lowly ex nurse and there are way more knowledgeable people about b12 but what I would ask you is if you used gas and air during your Labour as all your other levels look good. Definitely no need for any of the ferrous salts. B12 injections definitely needed to replenish levels and then if no absorption issues that may be enough.

[Scottishsally in reply to Parlay]

Hey, thanks for your reply! I can only have dreamed of using gas and air, I arrived at hospital and gave birth in triage within minutes of being allowed in 🥴 COVID times etc, they had me in a waiting room alone for 20 mins without my husband! Mental really....I had a couple of puffs of gas and air after while they dealt with a small tear so I don’t know if that would have been enough to cause me problems? Any input is helpful!

[Bonjourtristesse]

If you had gas and air for the birth, this can also deplete b12.

[Gen89]

I agree with all of the above. You are definitely low in b12 so the doctor should give you either b12 injections or b12 tablets. I am assuming those are ok if you are breast feeding-the Dr should be able to tell you that. Your Dr would need to monitor to see if your levels go up on tablets in case you can’t absorb them. Also get an intrinsic factor antibody test done. If it’s positive you have PA and won’t be able to absorb b12 properly. If it’s negative it doesn’t mean you don’t have PA. Your thyroid results look normal (my t4 is always the lower end of normal and my Dr says that’s fine) and your ferritin is the lower end of normal. Iron tablets three times a day can be quite harsh on your stomach. My Dr advised one ferrous fumarate 210 mg every other day but it’s taking a very long time to make any difference to my ferritin level but at least I haven’t had to stop them due to stomach problems. You definitely need to speak to your doctor to ask what is going to be done about your low b12. Good luck.

[xRABBITx]

I recognize this post is old now, I do hope you got everything sorted.

Just based on some of your symptoms however, have you had a blood test to check your HbA1c?

Just a thought.

Good luck with everything x