Low B12, ferritin and folate

After my post last week. I asked for all the blood tests you suggested on here. Got a call from gp surgery today.

T4 17.1

TSH 4.52

Said they weren’t concerned about tSh being raised slightly as t4 is good.

But then said concerned about very low b12, ferritin and folate.

Got to go for more blood tests tomorrow.

She was asking about coeliac disease, but no family history of. Really don’t want an endoscopy! (I work there!)

Not sure what the blood tests are tomorrow. (Will ask tomorrow) but after them I presume I’ll be told if definitely to take iron or folic acid.

Anything else it could be other than coeliac?

(Btw I had partial thyroidectomy 1998 for Hashimoto goitre.)

15 Replies

Hashimoto's very often affects the gut, leading to low stomach acid, low vitamin levels and leaky gut.

Low vitamins that affect thyroid are vitamin D, folate, ferritin and B12. When they are too low they stop Thyroid hormones working.

Gluten intolerance is common

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, lower antibodies and help heal gut






Your TSH needs to be much lower

Post vitamin results and ranges when you get them

Essential to get vitamin D checked

Just checked online and results are all there.

Vit D 76.5 (>75 optimal)

B12 157 (range 197-771)

Ferritin 10 (range 13-150)

Folate 2.7 (range 3.9-26.8)

So if they find the reason why three of those are low and give me supplements. My absorption of my levothyroxine should increase, in turn lowering my TSH??

Your B12 - they have to test the intrinsic factor to make sure you do not have pernicious anaemia. This is a link and read the response SeasideSusie has made re B12, ferritin etc etc.


When you post results of tests you must also give the ranges. The reason being that ranges vary from lab to lab and it is necessary to also give ranges so that members can comment. I hope they test Free T4 and Free T3 as well as B12, Vit D, iron, ferritin and folate. Also any others they think fit.

Your TSH is more than 'slightly' raised. The aim is a TSH of 1 or lower. They say nothing about T3, which is the only active thyroid hormone so you need Free T4 and Free T3 to see if your conversion is good. (these will rarely be taken).

You must also get your results of your vitamins/minerals with the ranges as everything has to be optimum.

Meheg3 She was asking about coeliac disease, but no family history of. Really don’t want an endoscopy! (I work there!)

So don't have one. You are Hashi's, it doesn't matter whether you are coeliac or not, gluten free is most likely going to help, so just do it. Also, to help reduce the antibodies, supplement with selenium l-selenomethionine 200mcg daily.


T4 17.1

TSH 4.52

Said they weren’t concerned about tSh being raised slightly as t4 is good.

Utter tosh! Ask what reference ranges are for if they're going to ignore them. And show your GP this information from thyroiduk.org.uk/tuk/about_... > Treatment Options:

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.

So if you still have symptoms, don't fee optimally dosed, then ask for an increase in line with Dr Toft's suggestion.


Vit D 76.5 (>75 optimal)

Vit D is recommended to be 100-150nmol/L according to the Vit D Council. Your result will satisfy your GP but you really need to improve it, especially now it's winter and we can't make natural Vit D from the sun for the next few months, your body will use the Vit D stored during the summer so your level might drop. I would get yourself a maintenace dose of D3 and be aware of the important cofactors also


D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds


Check out the other cofactors too.

You can get combined D3/K2-MK7 supplements, capsules or oral spray. Magnesium can be taken in powder form or tablets, magnesium oil or cream, epsom salt baths, etc.


Ferritin 10 (range 13-150)

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.

You need an iron supplement and as your level is so low you should ask for an iron infusion which will raise your level within 24-48 hours, tablets will take many months.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

But most important also, you need an iron panel and full blood count because there's a very real possibility of anaemia.


B12 157 (range 197-771)

Folate 2.7 (range 3.9-26.8)

This is serious. Go and post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc Quote these results, your ferritin result, any iron information you may already have, also list any signs of B12 deficiency you are experiencing - check here b12deficiency.info/signs-an...

You will need testing for pernicious anaemia and most likely will need B12 injections. If you are prescribed folic acid don't start taking it until further investigations have been carried out.

Omg you’re amazing. Thank you so much for all of this information.

My Hb is actually ok at 118 (range 115-160)

I’ll go for this other blood test in the morning and find out what it is. I’ll report back results and a plan.

Btw I have a very large majority of the symptoms of b12 deficiency.

I’ll have a look on the pernicious anaemia forum too thank you again.

Oooh, I'm blushing here :D

Forgot to say, the Vit D dose to go for would be probably 2000-3000iu daily throughout the winter. Retest in the Spring and reduce/stop if necessary, keep within the 100-150nmol/L range. I need 2000iu all year round to keep my level in range.

Just to add, Vit B12/folate deficiency and Iron deficiency has apposing effects on your blood cells - one makes them larger and the other makes them smaller for example which can normalise the blood count and hide anaemia but you are clearly deficient in all three regardless of blood count results as all under range so need treatment for all three and asap :-)

Thank you

Also the blood test for coeliac is unreliable (as stated on NHS website) and doesn't rule out non-coeliac gluten sensitivity either so a negative result doesn't mean much and should still send you for endoscopy to rule it out. As SeasideSusie mentions, even if you test negative, definitely still worth just going GF anyway :-)

No it isn't. WHO and NICE guidelines say the lower boundary should be 12. Many UK labs use a lower level for a mixture of reasons including if they used 12 many more females would be classed as having iron deficiency anaemia in the UK. Once you start taking iron to improve ferritin levels your haemoglobin level should increase. You don't need to take more iron than what has already been recommended.

Can I ask why not take the folic acid?

I’ve just been prescribed ferrous fumerate, folic acid and 1 b12 injection. This is after me nearly fainting at work.

As SeasideSusie mentioned upthread: "You will need testing for pernicious anaemia and most likely will need B12 injections. If you are prescribed folic acid don't start taking it until further investigations have been carried out".

Supplementing with folic acid might confound the results of any additional tests that you need to find out why you have a B12 absorption issue. So, tests are done first and then the folic acid can be supplemented.

Ok. Unfortunately I think I’ll just have to take it as gp not in agreement to do instrinic factor until 2 months after I’ve had the b12 injection.

Taking the B12 is fine - it's just the folic acid. But do take further advice on this from the recommended HU PASoc forum. :)

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