Thyroid UK
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Results of vitamins and minerals not correlating with symptoms of deficiency

Hi here are all my blood test results for folate/ferritin/B12/vitamin D.

Despite having seemingly optimal results I am sure the symptoms I have listed below with each result suggest low or deficient results. Is there anything I should be continuing, stopping or starting?


I started taking the tablets in December last year and another GP has rechecked my folate and it has come back much improved within a month. But I don’t understand why I have these symptoms of folate deficiency still:

Loss of appetite, some weight loss, weakness, sore tongue, headaches, palpitations, irritability, megaloblastic anaemia findings on full blood count report.


Serum folate 3.28 ng/L (4.60 – 18.70)


Serum folate 16.41 ng/L (4.60 – 18.70)


I was given iron tablets in January 2014 for deficient ferritin and haematologist will not start me back on any iron tablets until my ferritin is 20. I get heavy and irregular periods and I have these symptoms of low ferritin:

Feeling tired, weakness, shortness of breath, poor ability to exercise, confusion, faintness, pale skin. MCV I have been told is not doing very much on full blood count reports.


Serum ferritin 107 ng/L (15 – 150)


Serum ferritin 77 ng/L (15-150)

Vitamin B12

I took vitamin B12 very briefly and I felt more energised on the supplement but when I had a blood draw after coming off the iron tablets to see what my body was holding onto, the complete blood count suggested I had pernicious anaemia.

I have these symptoms of pernicious anaemia:

Tingling, sore tongue, fatigue, weakness, depressive mood, diarrhoea, dyspepsia, some weight loss, neuropathy, sores at corners of mouth, look of exhaustion, dark circles around eyes, brittle nails, thinning hair, clumsiness, memory loss, difficulty concentrating, brain fog, clumsiness, high blood pressure, yellow waxy colour to skin, shortness of breath (the sighs)


Serum vitamin B12 562 (180 – 900)


Serum vitamin B12 301 (180 – 900)

Vitamin D

I currently take 20mcg vitamin D tablets for vitamin D deficiency. GP does not check me for vitamin D very often.

My haematologist asked my GP in June 2016 to monitor my vitamin D and told me my vitamin D level in 2015 is not life threateningly low.

I have these symptoms of vitamin D deficiency:

Depression, light-headedness, muscle aches and weakness, muscle twitching.


Total 25 OH vitamin D 54.4 nmol/L (50 – 75 vitamin D suboptimal)


Total 25 OH vitamin D 63.1 nmol/L (50 – 75 vitamin D suboptimal)

Any feedback on the above would be appreciated.

Thanks in advance.

12 Replies

HI Moomin,

First off - a basic thing - I see from your previous post that you are hypothyroid, Hashis and well under-medicated. A lot of the symptoms you list here and attribute to a deficiency will actually be due to those. Symptoms of many of these things overlap and can be caused by several different things, it is not as clear-cut as you assume.

So looking at individual levels

Your folate is optimal.

Your ferritin is still optimal but declining - possibly due to heavy bleeding. Some of the symptoms you list are disturbing eg faintness and need to be checked out - have you had a FBC done to check haemaglobin etc?

Vit B12 - this is not clear - are you supplementing or not? Your levels are decreasing so that would suggest not, yet you say you felt a benefit from supplementing - so why would you stop? Your current level is definitely too low, optimum is considered to be around 1000 (in thyroid patient circles!) You need to raise this.

Vit D - you don't give a recent number, but this should be around 100. When taking D3 you should also take vit K2-MK7, as D increases uptake of calcium and the K2 sends this to bones and teeth rather than arteries. Also Magnesium is a co-factor (used in conjunction with) it and should also be supplemented.

Deficiencies in all of these can be caused by the low stomach acid and malabsorption issues that a typical Hashi (including myself) will have, but as you obviously realise already, need to be kept to optimum to help healing.

This is all in conjunction with the dietary, thyroxine replacement and supplement advice you have already been given in your earlier post.

Good luck

Gillian xx


Sorry - I forgot to say, if you're taking B12 you should take a good B-vit supplement as well (Solgar and Jarrows brands are commonly recommended), to keep all the Bs in balance.

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Thanks I have 2 complete blood counts with abnormalities in them. GP is not investigating any further. I was told to stop my B12 on advice of the GP because I was taking a toxic amount (1200mg) My total vitamin D is 63.1


Oh dear, for the medical profession again, null points! (in French accent of course).

B12 - I think you must have your units wrong on the b12, but anyway. You need to supplement this - I use Solgar sublingual methylcobalamin 5000mcg. B12 is water soluble so it doesn't become toxic as your body simply passes any excess out in the urine.

Vit D - your levels have not really changed despite supplementation and 20mcg is a low dose anyway, so that suggests to me that you need a higher dose. If you have those tablets how about doubling up on them or more for a while? Vit D is fat soluble so needs to be taken with a fatty meal for proper absorption. As an alternative I use a 3000iu (75mcg) BetterYou mouth spray from Holland & Barrett which bypasses any absorption problems.

I would suggest you get a copy of your FBC results from GP's receptionist to look at your iron levels. If you post here, people can help.

Are you aware of the timing issues with supplements and thyroid replacement? I think I have them right but please double-check with earlier posts by any of the administrators. All B's by lunch-time, but at least 2 hours after thyroid meds, no Vit D or iron within 4 hrs of thyroid meds and in general keep vitamins and minerals apart. If you are taking iron (to raise ferritin or haemaglobin) then that needs to be taken with vit C and 4 hours away from any other meds or supplements. Oh and HRT and PPIs have their own issues - if you are on any of those, put up another post and ask for advice on combinations and timing.

Good luck xx


B12 isn't toxic as it is water soluable and you just pee out any excess. GPs aren't taught about nutrition, so best not to believe them when they pontificate. Get back on the B12.


I think you are looking at this rather too simplistically. All these symptoms could be attributed to all sorts of things.

And no amount of optimal nutrition will make up for under-medication. In fact proper thyroid replacement will improve your stomach acid production. And that leads to improved nutrient absorption from food, so your figures would then improve without supplementation, which is, after all, only second best.

You cannot even hope to be well while under-medicated.


Have you investigated food sensitivities, gluten being the most common:

Testing is unreliable, better to find out by a process of elimination. The PAI cuts out most problem foods which you then try reintroducing as symptoms improve:

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Thanks I think I am sensitive to gluten but I was thinking about getting tested for Coeliac disease because of how low my vitamins and minerals have gotten in the past. Definitely sensitive to dairy, it makes me bloated and crampy.

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Gluten can cause a lot of the symptoms you describe, so it would be well worth going gluten free after you've been tested for celiac, regardless of the result. Best to wean off gradually over a week or two so it's not a shock to the system.

Hopefully as your gut function improves, so will your digestion and absorption of nutrients. Having Apple cider vinegar (organic with "mother") in water before food can also help with digestion. Probiotics eg Biokult taken on an empty stomach should also help. Magnesium eg Natural Calm can help with constipation.

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Full blood count 1 (NOV 2016)

Total white cell count 5.2 (4 - 11)

Haemoglobin estimation 138 (115 - 160)

Red blood cell count 4.93 (3.8 - 5.3)

Haematocrit 0.390 (0.37 - 0.47)

Mean corpuscular volume 78.2 (80 - 98)

Mean corpuscular Hb. conc 376 (310 - 360)

Mean corpuscular haemoglobin 28 (27 - 32)

Platelet count 245 (150 - 400)

Neutrophil count 3.0 (2 - 7.5)

Lymphocyte count 1.5 (1 - 4.5)

Monocyte count 0.5 (0.2 - 0.8)

Eosinophil count 0.1 (0.0 - 0.4)

Basophil count 0.0 (0.0 - 0.2)

Full blood count 2 (JAN 2017)

Total white cell count 6.54 (4 - 11)

Haemoglobin estimation 159 (120 - 150)

Red blood cell count 5.56 (3.8 - 5.3)

Haematocrit 0.51 (0.37 - 0.45)

Mean corpuscular volume 80.1 (80 - 98)

Mean corpuscular Hb. conc 334 (310 - 350)

Mean corpuscular haemoglobin 28.7 (27 - 32)

Platelet count 289 (150 - 350)

Neutrophil count 3.99 (1.5 - 8.0)

Lymphocyte count 1.95 (1.0 - 4.0)

Monocyte count 0.52 (0.0 - 1.0)

Eosinophil count 0.29 (0.0 - 0.5)

Basophil count 0.01 (0.0 - 0.2)


Hi - so there is nothing wrong with your haemoglobin levels. I am borrowing from SeasideSusie here with this link

to help understand the rest.

So in the absence of major iron issues, I would suggest that your faintness could be caused by your adrenals. When you are hypothyroid these try to compensate by working harder, but they can't do this forever and start to become fatigued. Then when you, for instance, stand up from sitting, they simply haven't got the energy to produce cortisol necessary to raise blood pressure to that now required. Hence we can get something called orthostatic hypotension - I used to get it quite frequently, a weird spaced out, distant from body type of faintness. Does that sound familiar in any way?

In all likelihood, if you manage to sort out your thyroid levels, this will ease off and the adrenals will recover gradually on their own. Some need help, but cross that bridge if you come to it. For now I would concentrate on your thyroid.

Good luck and best wishes

Gillian xx


symptoms of folate deficiency and B12 deficiency overlap because the two are used together for a lot of processes in the body - which is the most likely explanation for contrinuing to experinece symptoms of folate deficiency although levels are good- you are B12 deficient.

Serum B12 test not a good guide to B12 deficiency. PA is just one potential cause of a B12 deficiency and it is B12 deficiency that causes the symptoms. The anaemia caused by B12 deficiency is macrocytosis - larger rounder blood cells than normal - iron deficient anaemias tend to lead to microcytosis - smaller blood cells.

the drop in B12 levels does suggest an absorption problem.

Serum B12 test needs at least 3 months free of supplementation to have any chance of being a guide to what is going on.

Suggest you take a look at the PAS forum and pinned posts there


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