MCV and supplement question

[EchoWS]

Hi all,

I'm hypothyroid and frequently have MCV and MCH outside of range. In general I feel better supplementing with methyl Bs and have added folate. I want to ask though if there is anything concerning and how to address these results. Is my ferritin ok or are there additional tests to run?

Thank you!

B Vit levels etc.

Medichecks July 2023

CRP hs 2.9mg/mL (<3)

Ferritin 60.7 mcg/mL (30-150)

Folate - Serum 34.2 nmol/L (8.83 - 60.8) 48.8%

Vitamin B12 active 127.0 pmol/L (37.5-188) 59.5%

Vitamin D 75.8 nmol/L (50 - 280)

21 Jun 2023

Serum vitamin B12 level 751 pg/mL [197.0 -

771.01

Serum folate level 12.4 ng/mL [2.9 - 26.8]

21 April 2023

*Haematocrit (I/L) 0.456 L/L (Range: 0.35 - 0.45 L/L)

*MCV (Mean Cell Volume) 102 fL (Range: 83.5-99.5 fL)

*MCH (Mean Cell Hemoglobin) 33.4 pg (Range: 27.5 - 33.1 pg)

*Urate 407 umol/L (Range: 140 - 360 umol/L)

Vitamin D 95.8 nmol/L (Range: 50 - 150 nmol/L)

18 Jan 2023 (10:30am after Thyroid

Red blood cell count 4.32 ×10^12/L [3.95 - 5.15]

Haemoglobin concentration 146 g/L [115.0 - 155.0]

Haematocrit 0.447 L/L [0.33 - 0.45]

*Mean cell volume 103.5 fL [80.0 - 99.0]; Above high reference limit

*Mean cell haemoglobin level 33.8 pg [27.0 - 33.5]; Above high reference limit

Mean cell haemoglobin concentration 327 g/L [320.0 - 360.0]

[FlipperTD]

Scientist, not medic.

You've posted lots of data on here, and there is little doubt your MCV & MCH are on the high side. It's certainly not going to be anything to do with iron, because a lack would cause the MCV and MCH to be lower. Your B12 and folate appear to be OK too. Your haemoglobin concentration couldn't be more normal if it tried!

Some patients who are hypothyroid can show a mild macrocytosis [like yours] and I really don't know why that should be, but it is documented. Does your blood work include an RDW measurement? That can be helpful. Another useful test [but not necessarily included in a standard CBC] is a reticulocyte count. That can be helpful too.

I'm sorry I've not been much help here.

Good luck!

[EchoWS in reply to FlipperTD]

Hi FlipperTD,

Thank you for responding and insight. I like my data too. I had only heard recently about hypothyroidism and MCV and MCH observation. They have been in range in the past so curiosity is whether it has to do with amount or type of thyroid medication. When I don't take B vitamins I feel it but looks like I absorb them well when I take them.

Thanks again, EchoWs

[FlipperTD in reply to EchoWS]

It's a pleasure. I think you may be right about the thyroid medication, although the TSH is a good indicator to tell you if it's under-replaced. Some folks seem better with their TSH totally suppressed, but that's way out of my area.

As long as your Hb maintains the usual level then it's unlikely that much is going wrong but a slightly raised MCV can be a bit of a worry. Remember that the MCV reference range is a [Mean +/- 2 Standard Deviations] range, which is a 95% range. So, 95% of the 'normal' population will lie within it. However, a further 5% will lie outside it. If you take a +/- 3SD range, that captures 99.7% of 'normals' and that's a range of 77-102, which leaves you sitting on the upper limit, but still potentially 'normal'. Keep an eye on it but don't panic!

A good doctor treats the patient, not the numbers.

[jade_s]

Do you have low B12 symptoms? It's possible to be functionally deficient even on supplements. Or have reduced absorption as PA develops, which is perhaps why you feel better on the B complex.

[EchoWS in reply to jade_s]

Hypothyroidism means I’m tired but there is a lot of overlap of symptoms. What would I test to see if functionally deficient? I can do a Medichecks or other test but don’t know which one. I’ll be doing Thyroid again in 6 weeks.

[Ashweb901]

My MCV is always high no matter how I supplement so please let me know if you figure it out!

[egosabadell1974]

Be careful with b12 supplements, sometimes they cause high urates. I see that you have high uric acid.

[EchoWS in reply to egosabadell1974]

Thank you - I'll see what previous results are like and keep an eye on it. Drink more water always advised!

[egosabadell1974 in reply to EchoWS]

Yes, it is true, especially if you drink little, the hematocrit increases and more so in summer, with the heat, but I don't understand what about my mcv.I'm also hypothyroid and I'm an expert in having a high MCV and MCH!! It makes me very angry because I don't know why it is. I have never had a B12 deficiency but since I was a little low, I tried a supplement. Indeed, it increased my b12 but also urates!! Conclusion, I no longer use b12 supplement.

It's curious because I have a twin sister who has NOT developed Hashimoto but who also has many times high MCV and MCH without a B12 deficiency. Could it be something genetic? Now I'm 49 years old, when I was younger I didn't have it high, this is something that has been happening to us for about 10 years.

Sorry for my English, I'm Spanish. I hope you understand me correctly.

[EchoWS in reply to egosabadell1974]

Understand completely - it's really nutty to have these things with mcv, mch going on and as well as hypothyroidism. I met someone who was having similar problems with anemia, and said that ultimately what was working for her was to eat red meat every day. So I'm thinking of trying it - I eat protein everyday but maybe meat once a day would help. Interesting that your sister has the same problem, maybe part genetic, my sister is a year younger than me 😊