B12 260 ng/l - "Normal?"

[Tomwoj]

Hi,

I'm sure you get a lot of "please have a look at my blood test" type posts on here but I would really appreciate any help given. I have felt fatigue/tiredness for a while and did get B12/bloods done a couple of years ago and they came back normal.

Had some tests done in may this year, again "normal". Decided to go back this week to discuss as I still feel tired, oversleep, and have also recently started to develop aches/tendon pain in my hands (I am working bass player so I'm not sure if that is related in any way to a possible B12 issue).

I'm a 25 year old male and I just don't believe I should feel this fatigued.

BLOOD WORK:

Serum Vitamin B12: 260 ng/l (187 -883 ng/l)

Serum Folate: 3.1 ug/1 (2.40 - 14.60 ug/l)

Serum TSH (SMK): 4.29 mu/l (0.00 - 5.00 mu/l)

Serum Albumin: 51 g/l (35.00 - 50.00 g/l)

Serum total bilirubin level: 6 umol/l (0.00 - 20.00 umol/l)

Serum ALT level: 9 u/l (0.00 - 41.00 u/l)

Serum alkaline phosphatase: 93 u/l (0.00 -125.00 u/l)

HbA1c level (DCCT aligned): 5.7 % (0.00 - 7.50 %)

HbA1c level (IFCC standardised): 39 mmol/mol (0.00 - 59.00)

Typical target for HbA1c: 6.5 - 7.5% (DCCT aligned), 48 - 59 mmol/mol (IFCC)

From full blood count:

Platelet count: 140 10*9/L (150 - 400 10*9/L)

Lymphocyte count: 1.36 10*9/L (1.50 - 4.00 10*9/L)

My mother has hypothyroidism/pernicous anemia. Bother her and my sister get B12 injections, my mother also takes thyroxine tablets (or levothyroxine it's called I think).

Many thanks,

Tom

[Clutter]

Tom, I suspect the major reason for your fatigue is low thyroid hormones as your TSH is close to top of the range. Ask your GP to start you on a trial of Levothyroxine. If GP won't diagnose subclinical hypothyroidism until your TSH is >5.0 ask for a follow up test and make sure to have it as early in the morning as possible when TSH is highest.

thyroiduk.org.uk/tuk/diagno...

Ferritin, vitamin D, B12 and folate are often deficient/low in hypothyroid patients and you should request blood tests to rule out deficiencies. All can present fatigue and pain similiar to hypothyroid symptoms.

B12 under <500 can cause neuropathy and fatigue. Your folate is low too. Supplementing 1,000-2,000mcg methylcobalamin sublingual lozenges, sprays or patches will build levels. Methylfolate is better absorbed than folic acid for low folate. Please use the TUK affiliate link if you buy on Amazon thyroiduk.org.uk/tuk/go_sho...

[Tomwoj in reply to Clutter]

Many thanks for the advice, Clutter!

I will make sure to use the affiliate link when buying any supplements.

I will do my best to convince the GP to start a trial of Levothyroxine; however, if my GP refuses to do this/any follow up blood tests, would taking b12/folate/vitD supplements have a similar effect to Levothyroxine?

Or will my TSH level still be high no matter what supplements I take?

Many thanks,

Tom

[Clutter in reply to Tomwoj]

Tom, supplements won't alter your TSH, only thyroid meds will do that. If this is the first thyroid test you've had your GP might want to wait and retest in 3 months. Hopefully, your family history may make him/her think otherwise.

Good vitamin and mineral levels will help with absorption of Levothyroxine and conversion of T4 to T3 which is the active hormone you will be low in.

Levothyroxine should be taken with water one hour before, or 90mins (for men) after food and drink, two hours away from other meds and supplements and 4 hours away from iron and calcium.

[Marz]

I think with your family history you should be tested for PA - by having the anti-bodies tested in addition to the other tests suggested by Clutter....

[shaws]

Has your doctor taken into account a family history of P.A. They can do a special blood test

and this is an excerpt:-

A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have pernicious anemia have low reticulocyte counts.

Serum folate, iron, and iron-binding capacity tests also can help show whether you have pernicious anemia or another type of anemia.

Maybe before supplementing get checked for P.A. as taking supplements may mask problems.

nhlbi.nih.gov/health/health...

[waveylines]

I agree with Martz you would be wise to get tested for PA -if so you really should not take B12 supplements -this is the advice that PA give -please nosey at their support forum on healthunlock. You need to not only have your irons checked but be tested for aniti factor and hoemystiene ( spelling!). If you take supplements you will then have to stop taking them for several months to get tested. Please ask on the PA Forum they will tell you precisely what blood tests you need to get checked -or am guessing your Mum and sister will know?

Your TSH is also suspicious for developing hypothyroidism -pity the labs didn't decide to do your Ft4 as well -it sounds like you may be following in your family's footsteps for an underactive thyroid and PA -your GP should be keeping a careful eye on you -however am afraid these days it is likely that it will be you keeping an eye on things!!-the 15mins appointments that GP's are allowed to give these days are so so very short!

[Tomwoj]

Thank you all for your help,

Indeed Waveylines, I can sense I'm going to have to keep chasing this and keep an eye on this myself.

The annoying thing is when I've spoken to my GP docs they have said everything is normal, as well as stating that they tested for pernicious anaemia - but as far as I can see they only did B12 and folate tests for it, and because they're in range they didn't test further. Oh and one doc who I had a phone call with said something along the lines of ..."I wouldn't look too much in to it/worry about it. Tiredness is a very common complaint ..." oO Seriously!?

As you say it's so hard to get things sorted in 10 - 15min appointments.