Thoughts please

[staruk]

B12/folate level

Serum vitamin B12 level 332 ng/L [197.0 - 771.0]

Serum folate level 1.8 ug/L [> 3.9]

Please note, new method in use as of 15/11/2016. Below Recommended Range

Bone profile

Serum calcium level 2.46 mmol/L [2.15 - 2.5]

Serum adjusted calcium concentration 2.32 mmol/L [2.15 - 2.5]

Serum inorganic phosphate level 1.18 mmol/L [0.81 - 1.45]

Serum alkaline phosphatase level 119 iu/L [35.0 - 104.0]

Above high reference limit

Serum total protein level 74 g/L [66.0 - 87.0]

Serum albumin level 47 g/L [35.0 - 52.0]

Serum globulin level 27 g/L [18.0 - 36.0]

Serum urea level 4.8 mmol/L [2.8 - 8.1]

Urea and electrolytes

Serum sodium level 141 mmol/L [136.0 - 145.0]

Serum potassium level 4.1 mmol/L [3.5 - 5.1]

Serum creatinine level 146 umol/L [44.0 - 80.0]

Above high reference limit

GFR calculated abbreviated MDRD 33 mL/min [60.0 - 90.0]

Below low reference limit

EGFR COMMENT 1 eGFR should not be used in patients with acute

renal impairment.

EGFR COMMENT 2 If patient is of African-Caribbean origin the eGFR

result should be multiplied by a factor of 1.21

EGFR COMMENT 3 eGFR is not validated in pregnant women.

Liver function tests

Serum total bilirubin level 12 umol/L [0.0 - 21.0]

Serum alanine aminotransferase level 18 iu/L [0.0 - 33.0]

Serum lipid levels

Serum total cholesterol level 5.3 mmol/L [< 5.0]

Above high reference limit

Serum HDL cholesterol level 3.0 mmol/L [> 1.0]

Serum cholesterol/HDL ratio 1.8

Triglyceride level 1.0 mmol/L [< 2.0]

Serum non high density lipoprotein cholesterol level 2.3 mmol/L [0.0 - 3.9]

A treatment goal of 2.5mmol/L approximates to an

LDL of 2.0mmol/L

Thyroid function test

Serum free T4 level 17.7 pmol/L [12.0 - 22.0]

Serum TSH level 1.30 mu/L [0.27 - 4.2]

VIT D, 25OH, TOTAL, SERUM

Serum total 25-hydroxy vitamin D level 39 nmol/L [50.0 - 120.0]

Below low reference limit

[startagaingirl]

Hi - I note you say you have graves, but you now look to be slightly hypo, would that be the case? Though thyroid numbers don't look too bad, but you would need to have a free t3 result to confirm that. Your kidney function looks a bit low, but so was mine when hypo and GP said this was probably due to hypo and would correct itself when optimal - have you been checked for any other reason for this?

Other main issue I see is low nutrients. Your b12, folate and vit d are all way too low and need supplemented. B12 is optimal at 1000ish, you need 5000 per day sublingual metylcobalamin. Your folate is so low that GP should address. You also need a general b complex to balance. Vit d - supplement 5000 in/ day d3 - spray or soft gel - for a few months then re-test, optimal 100-120. I don't see a ferritin result, that is also important. It is also important to take vit k2-mk7 and magnesium when taking vit d.

Lots of other posts on nutrients with more details and links for info. Search in group to find.

Good luck

Gillian xx

[staruk in reply to startagaingirl]

i feel hypo Gillian and my kidneys are struggling function is poor i am seeing a specialist about them next week i also have MGUS and family history of Myeloma i was reading that kidney issues are a feature of myeloma... i also have a stoma so i don't tolerate tablets and vitamins well i am sure thats complicating things at this point i am thinking if i was a horse someone would shoot me! I will be more disciplined about my vitamins just ordered some K2 and magnesium too currently on folate 5mg too so hope things will improve Thank you for your reply

[Gambit62]

you are certainly folate deficient and could be B12 deficient - the serum B12 test is not a good guide on its own and requires evaluation of symptoms though the strong overlap with thyroid and and folate deficiency will make that difficult.

Please don't supplement with B12 until you have explored all the possible avenues for ruling out a deficiency as any supplementation (particularly with high dose B12 - ie 100mcg+) makes it at best difficult and at worst impossible to get a diagnosis.

If you can then ask your GP to do an MMA test to see if levels are raised (something that will happen if your cells don't have enough B12) - homocysteine will also be raised but as you are folate deficient and that also raises levels of homocysteine it isn't going to provide any information about what is happening with your B12 levels.

Not sure a full blood count is going to help with diagnosis as folate deficiency also causes macrocytosis ... and at least 30% of B12 deficient people present with other symptoms long before macrocytosis develops - particularly if there are iron absorption problems as well

Next steps would also include looking at our diet in relation to folate and B12 to rule out a dietary deficiency and then looking into possible absorption problems in the gut - which include PA, coeliacs and crohn's as well as a raft of drug interactions.

Lots of support on getting B12 deficiency diagnosed on the PAS forum

healthunlocked.com/pasoc

[staruk in reply to Gambit62]

Thank you