High TPO 461.7 U/ml yet normal TSH/T4. Abnormal B12 + folate. Not getting anywhere, please advise.

[1966sll]

Hi, just looking for some advice regarding my recent blood tests...

Thyroid Antibody TPO 461.7U/ml - Normal 0.0 - 9.0 (ABNORMAL)

Free T4 8.4pmol/L - Normal 7.9 - 14.0 (IN-RANGE)

TSH 2.194 mU/L - Normal 0.570 - 3.600 (IN-RANGE)

Serum B12 88ng/L - Normal > 203 (ABNORMAL)

Serum Folate 3.0 ug/L - Normal > 4.0 (ABNORMAL)

Vitamin D: 55.1nmol/L Normal > 50.0

Ferritin: 31 ug/L Normal 11-307

Background:

Symptoms starting roughly 2 years ago experienced increasing weakness/lack of energy and motivation to do anything, occasional muscle weakness and putting zoning out of conversations and the inability to focus to be a factor of my B12 reading. Was not previously aware of any thyroid problem and have no family history of this. I'm a full-time university student and 22yr old so put my exhaustion down to this, however, decided to get my bloods done to make sure.

Initially was only aware of B12 and folate result as Thyroid antibody blood test was taken after this, therefore put my tiredness down to low B12 levels. After discovering I also have high antibody levels in my thyroid GP stated there's to be no treatment at the moment just annual blood tests to check my TSH Level as TSH Level is currently in range.

My questions are:

1. I asked GP whether my symptoms at the moment (extreme fatigue, difficulty in focusing, fluctuating emotions) could be related to this high antibody TPO finding - the answer was there's no correlation and it's due to my low B12 however evidence online seems to contradict this? is this true? After a week of taking oral B12 supplements and folic acid, I feel no better whatsoever and am considering the way I'm feeling to be thyroid related. I've not been diagnosed medically with anything thyroid related I assume I have Hashimoto's disease from the research I've conducted online but not been told this, is this something I need to be "diagnosed" with? In the meantime to reduce antibodies should I be adopting a gluten-free diet, taking Selenium supplements etc? I've seen this may be helpful.

2. I'm aware the Free T3 level is an important factor to know as it is the active form and reflects thyroid levels in the tissues. I have not had this blood test done, is this something I should be asking for? Would it even make a difference e.g. would an abnormal reading mean treatment would be prescribed or would it still remain a "wait and watch" approach?

Any advice would be greatly appreciated.. Thank you.

[Cooper27]

You have auto-immune thyroid disease (Hashimotos), which is where antibodies attack the thyroid gland, eventually causing you to become hypothyroid. Your thyroid numbers are not great, so your thyroid gland is struggling, unfortunately you're not sick enough for a doctor to act.

I'm in a similar boat - high TPO, everything else within range. You can improve your symptoms through diet, and I recommend reading the Hashimotos Protocol by Izabella Wentz - it's helped me quite a bit. It explains the link between food intolerances and Hashimotos, and suggests vitamins as well.

I would take your results to your GP and ask that they retest your throid levels every few months to check whether you're getting any worse. Hopefully they will act on the low vitamin levels. Ask if they will also test ferritin and vitamin D, they are often low with Hashimotos and contribute to tiredness.

[1966sll in reply to Cooper27]

Thank you for your reply really appreciate it, will definitely look into the book if anything added knowledge is only going to help isn't it! I believe Ferritin and Vitamin D came back within range if i remember rightly, but will definitely ask for more regular blood tests. A lot can happen in a year!

[Cooper27 in reply to 1966sll]

Sorry, I forgot to mention your vitamin levels too, I edited the last paragraph of my post, but thought I'd better let you know!

I hope your GP can help

[Cooper27 in reply to 1966sll]

With vitamins, it's not always enough to be in range - you want to be optimal. If you share those results too, someone will be able to advise.

I think with vit D you want to be around 100 and with ferritin you want to be in the upper 1/3 of the range.

[1966sll in reply to Cooper27]

I didn't even pay much attention to Vitamin D and Ferritin with everything else however now I've had a closer look both seem not high above what's classed as the normal range.

Vitamin D: 55.1nmol/L Normal > 50.0

Ferritin: 31 ug/L Normal 11-307

Thank you!

[Marz in reply to 1966sll]

healthunlocked.com/api/redi...

I posted the above link earlier today - so read and read so you can discuss with more knowledge than your GP. Cobalamin is B12

[Cooper27 in reply to 1966sll]

I would take some vitamin D and iron supplements as well

Vitamin D is better in liquid form - I use this spray: betteryou.com/dlux3000 (you can buy it in Holland and Barratts) you don't want to take high doses for a long time, so maybe take 1 spray a day for a month, then twice a week until it runs out and get your vitamin D retested in 3 months. Take vitamin D in the morning - we normally get it from the sun, so if we take it at night, it confuses the body.

B12 wise, a sub-lingual (under the tongue) tablet is the best form if you wish to supplement after your prescription ends

Ferritin and folate are not my strong points - I saw an advert for something called the "lucky iron fish" if you want something more natural than supplements.

[SlowDragon Administrator]

Your B12 and folate are extremely low. gP should be testing for Pernicious Anaemia before starting B12 injections and folic acid supplements.

Make an appointment to GP and request this

Folic acid supplements should not be started until 48 hours after first B12 injection

Also request vitamin D and ferritin are tested

Your Vitamins re likely low because of having Hashimoto's. GP will more likely call it autoimmune thyroid disease and often they dismiss antibodies as irrelevant

Getting all four vitamins tested and treated to bring to optimal levels is first step. This often then increases TSH so that medics recognise that you need Levothyroxine

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels. Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten.

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)

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

Ideally ask GP for coeliac blood test first

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

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[1966sll in reply to SlowDragon]

Thank you for your reply!

I am currently waiting on Intrinsic Factor Antibody test and Celiac blood test results to come back. GP would not start me on B12 injections and commenced oral supplements and folic acid first. I am not vegetarian/vegan therefore stated I don't see how it could be a dietary issue and more an absorbancy problem therefore i'd need injections.. however after taking 2 tablets my B12 went from 88 to 120. However, still abnormal.. Normal classed as > 203. Unsure of where my B12 levels are at now after having taken tablets for a week.

Thank you for the information will definitely look into a Gluten free diet!

[Jazzw in reply to 1966sll]

Thing is, it doesn’t really matter where your B12 results are after a couple of days of taking tablets - blood test results are of little use once you start B12 treatment and definitely shouldn’t be used as a guide to whether you should continue treatment. I’m appalled your doctor didn’t recognise you need loading doses of Vitamin B12 by injection. A week of taking oral supplements will not fix the problem!

I’ll post a link to the Pernicious Anaemia (PA) Society forum here on Healthunlocked.

healthunlocked.com/pasoc

I think your thyroid results really are of secondary importance at the moment - your major problem is that low B12. I’d recommend that you post again on the PA forum as they will advise on how to proceed.

[ShootingStars]

Hi 1966sll. You have Hashimoto’s and you are hypothyroid. Your symptoms outlined in #1 are because of it. The treatment for Hashi’s is thyroid medication and you should be on it to increase your FT4, suppress your TSH, and this will help reduce your TPO and symptoms. This is a lifetime treatment. Your doctor is wrong that your high TPO, low FT4 and high in range TSH are not causing your symptoms because they are.

Your FT4, 8.4, is at bottom and is not even 25% of range, 9.425. It should be at least 50% of range, which is 10.95, but should be closer to 75%, or 12.475. FT3 was not tested, but since FT4 converts to FT3, yours is likely very low.

Yes, your folate and B12 are too low, but the bigger problem is that you have an autoimmune disease and you are hypo. This needs to be addressed because it will not get better without medication: it will only get worse. You need to start medication now, before your TPO gets even higher and your thyroid hormones get even lower, and you have increased hypo symptoms.

Fixing your low vitamin levels will not effect your low FT4, high TSH, or high TPO, only thyroid medication can do that. Fixing low vitamins will help in your over all health and might help you feel a tiny bit better, though.

Yes gluten free is recommended. Soy and dairy free is too. 200 mcg selenium is good but it is no miracle cure. The only thing that you’ll notice significant improvement from is thyroid medication. It’s possible you only need T4, but in absence of your FT3 results, it’s unknown if you’re converting or not, and if you might need T3, too.

[Angel_of_the_North]

Fatigue is more likely to be your low B12, folate and ferritin. You need to be tested for pernicious anaemia. However your free t4 is much too low in range - you'd expect a TSH way over range with a free T4 that low, so I'd also suspect a pituitary problem preventing TSH from rising.