Over range B12 and serum folate: Hi everyone... - Thyroid UK

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Over range B12 and serum folate

Caroline888 profile image
29 Replies

Hi everyone,

After months of feeling so much better and so much more relaxed, now I am again starting to suffer periods of anxiety. This time I'm pinning all my anxious thoughts on my vitamin B12 and folate results from last November😕.

B12 856 ng/L [190 - 800] - Above high reference limit

Serum folate 22.4 ug/L [3.0 - 17.0] - Above high reference limit

I do supplement with a multivitamin containing 25 ug vitamin B12 and 200 ug folic acid. Should I stop taking this?

I have read that over-range levels, particularly of B12, might indicate a blood or

liver disorder.

I would be grateful for any advice.

Best wishes

Caroline

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29 Replies
Nanaedake profile image
Nanaedake

If your b vitamin results are high due to supplementing then it's not due to a disorder. People who have B12 injections can have results as high as 2000 I believe.

Folic acid is not the best form of folate supplementation. Methyfolate would be better.

It's unlikely your multivitamin is the cause of anxiety. What was your vitamin D level?

You could stop taking supplements that include the B's and retest in 3 months to see if levels have dropped if concerned.

Caroline888 profile image
Caroline888 in reply toNanaedake

Thank you so much Nanaedake for getting back to me so quickly. I feel better already😊

My vitamin D is good as I supplement 2000 i.U a day with K2 and magnesium. Last result was 108 nmol/L [24.0 - 167.0].

I think my anxiety might be a symptom of being hypo in my case. I noticed a significant difference a few months after starting levothyroxine. I started to sleep better instead of waking at intervals and worrying!

The multi has always seemed to be a good idea as, being vegetarian, I felt it was insurance against lacking some vital nutrient. Some of its ingredients though, as you say, are not in the best form. I will certainly look into finding a better one, if such exists!!

Again many thanks for taking the time to help me. I am very grateful.

Best wishes

Caroline

Nanaedake profile image
Nanaedake in reply toCaroline888

Find a multivitamin without iron and take iron supplements separately if needed (according to blood tests) as the iron in a multivitamin may stop you absorbing the other vitamins effectively.

Caroline888 profile image
Caroline888 in reply toNanaedake

Thanks Nanaedake. My current multi is for seniors so doesn't contain iron but I'm glad you reminded me. Can you recommend a good multi?

SlowDragon profile image
SlowDragonAdministrator in reply toCaroline888

We generally don't recommend multivitamins on here as most contain iodine- not a good idea as you have Hashimoto's

drknews.com/iodine-and-hash...

A good quality daily vitamin B complex likely more benefit

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

How long since your last dose increase and can you add latest test results for TSH, FT3 and FT4

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Have you tried gluten free diet?

Nanaedake profile image
Nanaedake in reply toSlowDragon

OK, didn't know they contained iodine too!!

Caroline888 profile image
Caroline888 in reply toSlowDragon

You are right SlowDragon. My multi does contain 150 mcg iodine, said to be 100% RDA. I did know that supplementing with iodine was controversial but have carried on taking this multi which I have been taking for several years because I am a vegetarian and don't eat any fish or products from the sea, nor do I add salt to anything. I am also aware of so-called Derbyshire neck (goitre) which was supposedly the result of iodine deficiency. Being confused about the whole issue I've just stayed with the multi. Do you still think, in view of the above, I should stop taking it? I live close to the Derbyshire border.

I am gluten free and follow the rules re fasting, no biotin for five days and no levo for 24 hours before blood tests.

Blood test results on 58.3 mcg levo (May 2018)

TSH 0.29 mu/L (0.5 - 4.4)

FT4 18.5 pmol/L (10.0 - 20.0)

FT3 5.0 pmol/L (3.5 - 6.5)

I was happy with those results. My GP was not! He wanted me to reduce levo but finally agreed to a repeat blood test.

So as to be forearmed, I did a Medichecks test (22nd June)

TSH 1.7 (0.27 - 4.20)

FT4 16.700 (12 - 22)

FT3 4.05 (3.10 - 6.80)

NHS blood test (29th June)

TSH 0.83 (0.5 - 4.4) - no frees since in range!

As you might expect the GP was happy with that.

I have increased my levo by a tiny amount. I am now taking 62.5 mcg per day (50 mcg one day, 75 mcg the next). It's more convenient and I felt there was room for improvement anyway. What do you think? I will do another Medichecks test mid September.

Any advice and guidance would be much appreciated.

Best wishes

Caroline

Nanaedake profile image
Nanaedake in reply toCaroline888

If you are taking Levothyroxine. It contains iodine I believe so you should get some iodine with each dose.

Caroline888 profile image
Caroline888 in reply toNanaedake

Thanks Nanaedake. Is that all we need do you think? I’ve found it difficult to find anything definitive as to the amount in the tablet and the amount we need daily. Do we only need iodine for the thyroid to work properly or does it have other functions elsewhere in the body?

If we only need it for the thyroid, maybe the dose in the tablet is sufficient. You’d think that the manufacturers obviously include it for that purpose wouldn’t you.

Thank you so much for taking the time to reply and especially for your earlier comments which calmed me down when I was in panic mode!!

Thank you. Best wishes

Caroline

helvella profile image
helvellaAdministrator in reply toCaroline888

Looks like a misunderstanding here.

Each molecule of levothyroxine has four iodine atoms.

That represents approximately 66% of the levothyroxine by weight. So a 100 microgram levothyroxine tablet contains about 66 micrograms of iodine.

Iodine is NOT added to levothyroxine tablets. (At least, not in any UK tablets.)

When the levothyroxine (T4) is converted into T3, one iodine atom is released. Again, when T3 is converted into T2, one iodine atom is released.

In general, the body is good at scavenging iodine and recycling via the thyroid.

Typically an adult is thought to require about 150 micrograms of iodine a day.

Caroline888 profile image
Caroline888 in reply tohelvella

Thank you so much, helvella, for that detailed explanation.

So, since I am only taking a small dose of levothyroxine (62.5 mcg daily) and am a vegetarian, that would leave me with quite a bit less than the required 150 mcg of iodine. I am currently taking 150 mcg iodine in a multivitamin. I am completely at a loss as to whether that is a good idea or not. I do know that since they stopped the mandatory iodisation of table salt many years ago, there has been a resurgence of iodine deficiency and "Derbyshire neck".

I don't add salt to my food anyway so sea salt is not an answer and I suppose it would be difficult to assess the amount of iodine added anyway.

Any advice would be appreciated.

Best wishes

Caroline

helvella profile image
helvellaAdministrator in reply toCaroline888

Sea salt wouldn't be an answer anyway! Most sea salt is not iodised and contains less iodine than many would expect. There are a few iodised sea salts but I don't think I have ever seen one for sale in a shop.

I don't believe we have ever had mandatory iodisation of salt in the UK.

I wouldn't get too obsessed about Derbyshire neck - after all, most of us consume products from many counties and countries these days.

A major source of iodine in the UK is dairy produce.

Review your diet and consider how much you are taking in. Then decide.

Caroline888 profile image
Caroline888 in reply tohelvella

Thank you helvella. I don't drink milk at all per se but do love all kinds of cheese and eat natural yogurt every day. Will follow your advice and research how much iodine is in the foods I eat. For the time being I will carry on taking my multivitamin as I can't help feeling concerned at the number of people, particularly in the uk, who are now suffering from iodine deficiency.

I do have Hashimoto's though, so am really grateful for your advice and will do as you say. I will try to ascertain how much iodine I get in my diet and supplement only if I think it's deficient.

Thanks again for taking the trouble to advise me.

Best wishes

Caroline

helvella profile image
helvellaAdministrator in reply toCaroline888

Testing might be an idea, too! :-)

Mirandarr profile image
Mirandarr in reply toSlowDragon

Hi SlowDragon

Can Biotin affect the B12 result?

Thanks

M

SlowDragon profile image
SlowDragonAdministrator in reply toMirandarr

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect various test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

SlowDragon profile image
SlowDragonAdministrator

As you have Hashimoto's it's important to get this right

SeasideSusie has info on which is best iodine test to do. Would certainly want to test iodine before continuing with any iodine supplements

Personally I choose organic milk specifically because it tended to have lower iodine levels than standard milk. Was dismayed to see this is now longer the case.

soilassociation.org/blogs/2...

You are likely ready for next dose increase in Levothyroxine. Anxiety is common hypo symptom. Medics tend to think it's only a hyperthyroid symptom

Most people eventually need somewhere between 100mcg and 200mcg Levothyroxine

NHS guidelines saying standard starter dose is 50mcgs

beta.nhs.uk/medicines/levot...

Caroline888 profile image
Caroline888 in reply toSlowDragon

Thanks SlowDragon.

I think you are right about anxiety being a symptom of hypothyroidism. Before being diagnosed I was waking up in the night with unfounded feelings of dread, and in the day I frequently felt really anxious and jittery without any real cause. A few months after starting levothyroxine, I noticed i was sleeping better and generally feeling more positive about things. Perhaps as you say I might just need more levo though I didn't think my recent results were too bad. I will do more blood tests with Medichecks next month and see what they indicate.

Thanks again for taking the time to help and advise me. I am really grateful.

Best wishes

Caroline

helvella profile image
helvellaAdministrator in reply toCaroline888

I think you are right about anxiety being a symptom of hypothyroidism.

Yes, most certainly can be. Some suffer far more from that than do others.

SeasideSusie profile image
SeasideSusieRemembering

Caroline888

This is apparently the best test for iodine

Genova Diagnostics

Urine Iodine Test:

Specimen requirements: Urine

Cost: £71.00

Order Code: END25

Turnaround time: 5 - 10 days

Iodine is an essential trace element, vital for healthy thyroid function. Adequate levels are required to enable the production of T3 and T4 thyroid hormones, whilst also being required in other areas of health. Deficiencies can lead to impaired heat and energy production, mental function and slow metabolism. Urine iodine is one of the best measures of iodine status. This test is not performed as a loading test, but can be used to establish existing levels or to monitor iodine supplementation.

You need ThyroidUK as your "practioner" - details of how to order and receive your resutls are here thyroiduk.org/tuk/testing/g...

Iodine isn't that hard to get from diet, without making an effort.

I tested mine with that test linked to and my level was exactly in the middle - 150 (100-199). I consulted with a practioner and sent all the private tests I had done. She put me on a Multivitamin/mineral and when I mentioned that it had 150mcg iodine she said it wasn't a problem as that was a very small amount (it's 100% of the RDA as you are aware). I retested after a while and my new level came back at 250 so I stopped immediately and I eventually ditched the practioner as she was dud in other ways too!

Here's a list of some iodine rich foods from the British Dietetic Association

bda.uk.com/foodfacts/Iodine...

A little out of date though because it now appears that organic milk is no longer lower in iodine than non-organic milk.

Caroline888 profile image
Caroline888 in reply toSeasideSusie

Thank you so much SeasideSusie for all that information. If I can stay awake I will be reading it all next! The sheet specifying iodine-rich foods looks particularly useful.

Best wishes

Caroline

PS Just read the above-cited article and the list of iodine-rich foods. Very useful. As you say, I think I should be able to get the necessary amount of iodine from foods. Cheese, yogurt and nuts are favourites of mine😊. I think I will be giving the multi a miss from now on!! Thanks again.

Nanaedake profile image
Nanaedake in reply toCaroline888

Tonight's BBC 1 programme on nutrition stated that a glass of milk contains all the iodine we need. helvella la gave a good explanation of Levothyroxine and iodine that I didn't know.

Caroline888 profile image
Caroline888 in reply toNanaedake

I will try and watch the programme. Thanks for telling me about it.

I can’t stand milk, don’t even have it in coffee or tea, but I do like cheese and yogurt.

My main concern in relying on dairy for iodine is the original source of the iodine. Is it from cleansing the cows’ teats with iodine disinfectant? Or from the soil via the grass they eat? I guess it could vary considerably. I am going to look into this later today and will post if I find anything useful😊

SlowDragon profile image
SlowDragonAdministrator in reply toCaroline888

Apparently the reason organic use to have lower iodine was that they don't wipe organic cows teats with iodine, use something else instead

Increased iodine content of organic milk is due to iodine rich diet (including seaweed I believe)

Caroline888 profile image
Caroline888 in reply toSlowDragon

That’s interesting! Especially about the seaweed-rich feed. I’ve been researching iodine-rich foods this morning and dairy does appear to be very variable in its iodine content, depending on region, season, and the milking procedures you mentioned. There are lots of very iodine-rich foods for meat and fish eaters but as a vegetarian I am again beginning to think I need a small supplement to be sure of getting enough. As the body apparently needs iodine every day as it is not stored, perhaps the multivitamin is not such a bad thing to take after all. I am still undecided.... and still researching!

SlowDragon profile image
SlowDragonAdministrator in reply toCaroline888

Your getting iodine everyday in your Levothyroxine

Iodine use to be used to treat hyperthyroid patients

Hence advice by Hashimoto's experts Isabella Wentz and Dr K to steer clear of extra iodine

Caroline888 profile image
Caroline888 in reply toSlowDragon

Thanks SlowDragon,

I understand (now, thanks helvella😊) about the iodine in levothyroxine, but I'm on only 62.5 mcg a day so getting only approximately 40 mcg iodine from the levo. I have to find another 110 mcg in food to make up the deficit. I'm not a big eater. I think I might finish up being iodine deficient which is apparently at least as bad as having too much iodine. Thank you though for all your advice. Despite appearances, I am taking it on board and am still researching how to get all the iodine I need from food. I do have a pot of natural yoghurt every day so I guess that is a good start!

Best wishes

Caroline

Nanaedake profile image
Nanaedake in reply toCaroline888

The BBC programme also advised against multivitamins. It said multiple research studies had shown lack of efficacy and some harmful effects, including some increase in cancer risks. You'll have to watch the programme for details as I can't quote accurately.

Caroline888 profile image
Caroline888 in reply toNanaedake

Thanks Nanaedake,

I will watch the programme - it sounds really interesting!

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