Pathology Test results for thyroid, biochemistry, immunology and Vitamins - Advice about results.

[kevan65]

Hi,

I am a 52 year old male with symptoms that include tiredness/fatigue and various food intolerances, brittle nails, muscle aches, occasional constipation and some depression in the past. My hair has thinned dramatically in the last year too but that could just be age although no-one in my family has suffered with major hair loss well into old age. I am a fit 52 year old who runs and cycles regularly but have had these symptoms for a long time so I had a full range of tests carried out that seem to say I am fine (good news I guess) but I wondered if anyone here might see anything within these results that regular gp's may miss. My thanks in advance to. Thought I would add a photo so you know who you are replying to. Hopefully my mug shot won't offend too many. Blood test carried out by Blue Horizon. I have added their normal ranges (in brackets)but was told the ranges can change from company to company.

Biochemistry

CRP 0.90 mg/L (<3.0)

Ferritin 144.1ug/L (30-400)

Thyroid Function

Free T4 18.62 pmol/L (12-22)

Free T3 5.04 pmol/L (3.1-6.8)

TSH 1.82 IU/L (0.27-4.20)

T4 Total 113.7 nmol/L (64.5-142.0)

Immunology

Anti-Thyroidperoxidase abs 24.3 kIU/L (<34)

Anti-Thyroglobulin Abs 34.2 kIU/L (<115)

Vitamins

Vitamin B12 423 pmol/L (Deficient <140, Insufficient 140-250, Consider reducing dose >725)

Serum Folate 30.57 nmol/L (10.4 - 42.4)

[SeasideSusie Remembering]

Hi kevan65 Is that a Blue Horizon test? It looks familiar but you've put no reference ranges and for anyone who doesn't know BH ranges they won't be able to comment other than from guesswork.

As I think it is a BH test, your thyroid results don't flag up anything, in fact they seem to be pretty good.

The only one that is obviously not good is B12. The Pernicious Anaemia Society recommends a level of 1000 so you might want to supplement with Solgar or Jarrows sublingual methylcobalamin lozenges. Whilst using B12 you should also take a B Complex to balance all the B vits.

Everything else seems OK (if I'm right about the ranges). The TPO antibodies are tending towards the higher end of the range, so that doesn't completely rule out autoimmune thyroiditis aka Hashimoto's disease, but they would need to be above range to confirm that. Another test at some time to see what your antibodies are doing might be useful.

You might want to do a Vit D test as that's the only other one we recommend that isn't covered. You can do that through City Assays for £28, it's a fingerprick blood spot test and the results are usually back within a week.

[kevan65 in reply to SeasideSusie]

Hi Susie

Thanks very much for the reply. Yes, it was a Blue Horizon test. They do give ranges on that report and your quite right, my results fall within their normal ranges. I can add the ranges if you think they would help. I only omitted them because I had seen other posts without ranges where people have commented that the ranges may be fine when looking individually at results but some made comments from their experience if something may have seemed a bit off looking at them all. I am very glad the results all came back as within their normal range. I was told that each company could have differing ranges so in a way I was clutching at straws.

It's funny that you mentioned the B12. I have just started to take that supplement today with Jarrows Methyl B12. The dose is quite high. Each tab has 5000 mcg. It wasn't because my gp recommended it. It was my own research that bought me to that decision.

Thanks for all the advice on the Vit D and other leads.

Kevin

[SeasideSusie Remembering in reply to kevan65]

kevan65 The reason we ask for ranges is because they vary from lab to lab, not always by much but it can make a difference when someone's result is very close to the top or bottom. Also, not everyone is familiar with BH ranges but for those of us who have used BH we tend to recognise them.

It's not so much that results are in range, doctors like that phrase just as much as 'normal', but it's where in the range the results fall. A high in range TSH indicates the thyroid could be starting to struggle, combine it with low in range FT4 and it points to hypothyroidism. High FT4 and low FT3 indicates poor conversion. As mentioned, your TPO antibodies are quite high and doesn't completely rule out Hashimoto's.

With vits and mins optimal levels are needed so again ranges help us to see whether the result is anywhere near that level of, of low, how deficient they actually are.

Ferritin and folate need to be at least half way through their ranges and your folate is good but your ferritin maybe could do with coming up a bit. That could be one reason for hair loss, also tiredness. You could consider an iron supplement and as you have occasional constipation it's best taken with 1000mg Vit C as that helps avoid constipation and also aids absorption. Iron Bisglycinate is supposed to be more gentle on the tummy and non-constipating, Solgar Gentle Iron is one such brand.

[kevan65 in reply to SeasideSusie]

Hi Susie

Makes perfect sense, thank you. I have updated my post now to show the ranges and once again I am very grateful for your advice and views.

[bluebug]

Apart from your vitamin B12 being too low, I would suggest you have a vitamin D test if you haven't had one in the past 18 months. You need to make sure your level is around 100nmol/L to be optimal. If you go to thyroiduk.org.uk website and look under testing you will find the link to City Assays.

[kevan65 in reply to bluebug]

Hi Blubug

Both you and Susie have mentioned the vit D test so I will send for that test as I haven't had that test before. Grateful for the advice,

Regards

[greygoose]

No, you don't want folic acid, you want a B complex with methylfolate, which is natural. Folic acid is synthetic, and is less well absorbed. And, you need all the Bs, to keep them balanced.

[greygoose]

Maybe they did. But methylfolate is still better.

[Marz in reply to greygoose]

On the PAS forum they have discussed Folate v Folic Acid and one of the members is an ex Chemist and posted that Folic Acid performs in the body the same as Methylfolate. Cannot remember the exact facts - but I think this is where Annonymous has picked up her information. I now tell people to do their own research and come their own conclusions. I know it is confusing.

[Gambit62 in reply to Marz]

some people have problems converting folate in food and folic acid to the methylated forms that are used at the cell level - MTHFR genes. Depending on the combinations it will reduce the efficiency of converstion by something like 20%-60%. Which means that more would be needed to get the same amount of methylated forms. One indication that you have this problem can be high levels of folate in blood as the body isn't able to use it so it stays in the blood.

Some people are supermethylaters and can actually experience problems with methylated forms of folate.

[Marz in reply to Gambit62]

Thank you Gambit62 ...

[kevan65 in reply to Marz]

Thanks everyone. Lots of information for me to consider. I appreciate everyones input.

[Angel_of_the_North]

It looks more like a B12 deficiency than a thyroid problem. Levels under 500 can cause neurological damage and around 1000 is recommended. Methylcobalamin sublingual 5000iu a day until you get to around 900, then 1000iu a day.

[Gambit62]

Can only really comment on the B12 and folate results.

Serum B12 isn't a particularly good guide as what is important is what is happening at the cell level not the levels in blood. Ranges are also based on averages of people and the reality with B12 is that people vary so much that just going by ranges can be misleading. What really matters is symptoms and you can find checklist of symptoms of B12 deficiency here

pernicious-anaemia-society....

However, it is also true that the symptoms of a B12 deficiency overlap with a lot of other conditions and it is more than possible for 2 or more conditions to be involved, which makes things difficult. Unfortunately most GPs aren't aware of B12 deficiency beyond macrocytosis so if that isn't present then they won't consider it as a potential factor.

There are other tests that look at waste products that build up if the body doesn't have enough B12 - namely MMA and homocysteine - though these tests generally aren't available through GPs - and elevation can be caused by other factors which is why they aren't first line tests ... and many GPs are totally unaware of them.

Your folate levels look very good. High folate can actually mask macrocytosis - type of anaemia in which red blood cells are enlarged and deformed so they don't carry oxygen so efficiently. If you haven't been supplementing then it could be an indication that there may be an underlying methylation problem so folate is staying in your blood because it isn't in a form that cells can use. However, its still within the normal range so a good diet could be the explanation.

Folate and B12 are done together as the body needs folate in order to process B12 so there is some overlap between folate and B12 deficiencies and symptoms can overlap.

The body can use a lot of B12 if you are very active - sports coaches tend to be more aware of B12 than most GPs.

50s is the age range where B12 absorption problems start to increase because stomach acidity reduces as you get older. The symptoms of low stomach acidity overlap a lot with high stomach acidity meaning that it frequently gets (mis)treated with PPIs which lower stomach acidity even more making the problem worse. Would be interesting to try and get the tests redone in 6 months to see what the trend is on B12 and if it is dropping. Normally the body stores large amounts of B12 in the liver and releases it back into the ileum for reabsorption. If there are absorption problems then these affect the ileum so the mechanism becomes less efficient and B12 leaks out of your system. It can take years and even decades for a full blown deficiency to manifest.

No real answers I'm afraid, but hope it points you at something that helps or rules out a possibility.

[kevan65 in reply to Gambit62]

Interesting post Gambit62,

There are so many symptoms that overlap and are the same. Take gluten intolerance. It can cause among other things bloating, fatigue, effect the chemical balance in our bodies causing mild depression. I do have an issue with gluten but its not immediate. If I eat bread, the kind that is processed rather than freshly made, I could sleep within 30 mins of eating it such is the tiredness. I altered my diet a long time ago to avoid gluten and try to avoid it as much as I can but its a tricky thing to cut out. People with food allergies, particularly those with celiac disease (the gluten allergy), frequently suffer from hypothyroidism from my understanding. The blood test was me clutching at straws to see if anything appeared obvious. I'm not convinced I have any thyroid problems from the results and it may well just be this gluten sensitivity (I had a stool test some years ago that signalled a had a gluten sensitivity). The B12 one is something that may need some help.I have just started to take that supplement today with Jarrows Methyl B12 with a B complex supplement to see how that goes. I don't eat a lot of meat so that could contribute to a lower B12 result. Again I agree with you that it is not easy to know. I guess we just have to try things out, try not to get too engrained in worrying about it and carry on regardless. Everyone is different and whats good for someone may not be good for another. Trail and error, thats the way and hopefully having some positive results that can be shared to others. Thanks for taking the time to write. Regards

[Gambit62 in reply to kevan65]

Did mean to add that there are links between B12 deficiency and glutten intolerance.

The body needs two forms of B12 at the cell level - methyl and adenosyl. Most people seem to be able to convert one to the other quite happily but the literature does include some cases where people were unable to convert methyl to adenosyl so it may be worth trying different types of B12 as well as the methyl - people do respond very differently to different types of B12 - I have absorption problems and actually take 3 different types to cover all bases - doesn't deal with all the problems - and some may not be down to B12 though I don't have any other specific conditions.

There is a forum on health unlocked that deals specifically with things B12 - and I'm pretty sure there are fora for gluten and other food intolerances so you might find it informative to look at those as well as the thyroid forum.

The only downside of supplementing is that it could make it more difficult to diagnose a B12 absorption problem but the important thing is your health and being in control of that so really hope you manage to get to the bottom of things.

Although meat - and in particular liver - has reputation for being high in B12 I believe the most readily processed B12 is from fish and dairy. Personally I think that absorption is more likely to be cause than not having much meat in your diet - the body is sooo efficient normally with B12 that RDA is really small.

[kevan65]

Hi Sandy

I am not too bad but I tend to take a dip every now and again and experience fatigue in the afternoons that occasionally are bad enough to force me to bail out of work and go home to rest. I'm self employed so have the luxury of being able to do that sometimes. My hair has thinned rapidly over the last year and can be quite coarse (again sometimes). There is some history of depression in my family. I've had my own issues in the past but managed to get through that ok. Memory can be a bit patchy. There is a history of heart disease too and thats why I maintain a healthy diet and exercise. I do not consider myself to have any severe symptoms apart from fatigue which is the thing that causes the most problems for me. I am active, fit and otherwise healthy but sometimes I am overcome with tiredness. I also do not eat much gluten as that makes me very tired. The fatigue is my worry hence taking the tests to see if anything leaps out and grabs me by the lapels of my jacket and shakes me vigerously to alert me to a possible reason.