VITAMIN B12 LOADING DOSE INJECTIONS

[debandmum]

Hi I am new to this site so please bear with me whilst I get used to it. We have just found out that mum who is a laryngectomy and who has taken levothyroxine for underactive thyroid due to a partial removal 12 years ago has a low vitamin b12. this is due to levothyroxine stopping the absorption of normal b12 via food. She has started on 2 weeks loading doses of vitamin b12 but is feeling far far more tired than she did prior to the starting of the injections. Does anyone know if this is the norm?

[greygoose]

Hi debandmum, welcome to the forum.

Why do you think it's the levo stopping your mum absorbing B12? It far more likely to be her hypothyroidism, with the attendant low stomach acid, stopping her absorbing it. But, has she been tested for Pernicious Anemia?

I really can't say if it's normal for B12 injections to make her more tired, because I've never had them. But, if her B12 is low, her ferritin could be low, too, and that would make her tired. What about her vit D? Has that been tested?

Is she taking a daily B complex to keep her Bs balanced? Has she had her folate tested, too? Is she now optimally medicated for her hypothyroidism?

More questions than answers, I'm afraid, but things are never simple, and all the details are important for people to be able to advise you.

[debandmum in reply to greygoose]

Thyroid uk site states that people who take levothyroxine due to an underactive thyroid cannot absorb vitamin b12 normally. see extract below taken from this website which I have copied and pasted in.

B12

People with an underactive thyroid or people with no thyroid cannot absorb this vitamin. A serious lack of B12 can cause mental illness, various neurological disorders, neuralgia, neuritis and bursitis. Some doctors believe the "normal range" of B12 is too low and that the normal range should be at least 500 - 1,300pg/ml (rather than 200 - 1,100).

[greygoose in reply to debandmum]

It says that they cannot absorb vit B12 because they are hypo, not because they are taking levo. Not the same thing at all. Sorry, but it's got nothing to do with the levo.

[debandmum in reply to greygoose]

Yes that is what I meant as she has an underactive thyroid she obviously has to take levothyroxine and due to having an underactive thyroid she cannot absorb vitamin b12 in line with the details on the thyroid uk website.

[greygoose in reply to debandmum]

Well, sorry, but that's not what you said. That's what I said. Being hypos causes low stomach acid, which means difficulty digesting and absorbing nutrients. Which is why we should get them all tested and supplement as necessary. But, as doctors know nothing about hormones or nutrition, we should never just take their word for it that everything is 'fine', but get print-outs of our results and ranges.

[debandmum in reply to greygoose]

As i said i am new to this site and I was only looking for some advice. I am aware of what I said, things are stressful enough at present so I really do not need to receive a curt reply. I will leave it thanks and speak to our specialist head and neck and thyroid Professor however, I was just trying to avoid bothering such a busy amazing man with this.

[greygoose in reply to debandmum]

Sorry if my reply was curt, I was just trying to understand. But, you don't have to take an notice of me, other people have given you perfectly good replies. There's no reason why you should ignore them just because of me.

I hope you find some answers.

[debandmum in reply to greygoose]

Yes I was fully aware of the issues I only wanted to know if anyone had experienced this extreme tiredness after starting loading dose injections.

[greygoose in reply to debandmum]

It's impossible to know what someone else knows if they don't tell you. We have a lot of new people come on here who know nothing about any of it. The questions are to find out what they do know and what they don't. It's not a personal insult, it's just a procedure to help people who often don't know how to help themselves.

[debandmum in reply to greygoose]

Fully appreciate that and I didn’t think it was a personal insult. No one knows everthing and I was just curious regarding the tiredness at the commencement of loading injections. I now know regarding this thanks to our professor

[debandmum in reply to greygoose]

Hi Mum had all the blood tests that you mentioned and they all came back as fine however, the vitamin b12 was low therefore, she is now on a loading dose injection regime over the next 2 weeks.

[greygoose in reply to debandmum]

'Fine' is an opinion, not a diagnosis. To be able to advise, we need the numbers: results and ranges.

[humanbean]

You could join/follow the Pernicious Anaemia Society forum on this website :

healthunlocked.com/pasoc

They can help you with issues of low B12 and whether your mother's experience of injections is normal or common.

[debandmum in reply to humanbean]

thank you for the information

[SlowDragon Administrator]

If her B12 is low this suggests she may not be adequately treated for her hypothyroidism

Do you have her recent results for TSH, FT4 and FT3

She likely has low folate too

Essential to test vitamin D and ferritin as well

What dose of Levothyroxine is she currently taking?

Does she always get the same brand of Levothyroxine?

For full Thyroid evaluation she needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised or if under medicated

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Ask her GP to test other vitamins if not been done, plus thyroid antibodies

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.

So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

[debandmum]

Hi her thyroid tests are stable and fine as she was being undermedicated at 75mcg which she has been on for years so now she is taking 75mcg one day and 100mcg the next as at 100mcg per day she was being slightly overmedicated

[Marz in reply to debandmum]

You inadvertently replied to yourself so I have tagged SlowDragon so she will be alerted and read your reply 😊

[SlowDragon Administrator in reply to debandmum]

So once she's stable and finished loading doses of B12, best to get FULL Thyroid testing 6-8 weeks later. TSH, FT3 and FT4 and BOTH TPO and TG thyroid antibodies tested

Getting folate levels tested if not been done is next step. BEFORE starting any vitamin B complex

Always get actual results and ranges on vitamins. As greygoose says......"fine" is only an opinion....often results are only just within range & bumping along bottom of range

Recommended on here, especially if folate is low, to also supplement a good quality daily vitamin B complex, when on B12 injections. One with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two). Or Jarrow B-right

If taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

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

endocrinenews.endocrine.org...

You may find she needs dose increase in Levothyroxine once her vitamin levels are improved

[debandmum in reply to SlowDragon]

Thank you for the information much appreciated