Mixed blood test results - what's the next step?

[PurpleThyroid]

This follows on from a previous post, so apologies for some repetition.

Had a private blood draw on 9th August. Results were:

Inflammation CRP HS 1.33 mg/L (range:<5)

Ferritin 28.1 ug/L (range: 13 - 150)

Folate - Serum 3.66 ug/L (range: > 3.89)

Vitamin B12 - Active 30.100 pmol/L (range: 37.5 - 188)

Vitamin D 51.1 nmol/L (range: 50 - 175)

TSH 0.014 mIU/L (range: 0.27 - 4.2)

Free T3 4.12 pmol/L (range: 3.1 - 6.8)

Free Thyroxine 19.300 pmol/L (range: 12 - 22)

Thyroglobulin Antibodies 18.400 kIU/L (range: < 115)

Thyroid Peroxidase Antibodies 162 kIU/L (Range: < 34)

I'm exhausted, have constant headaches, tinnitus, aching legs, poor balance, amongst other things. Saw the GP who was unimpressed about having private blood tests, but eventually agreed (despite his initial suggestion that "a multivitamin would do the trick") to do further tests, and that if these showed decreased B12 they would consider injections.

Had an NHS blood draw on 16th August. These are the results:

Serum Vitamin 12 201 ng/L (range 197.00-771.00)

Serum Folate 9 ug/L (range 3.80-9999.00)

Serum Ferritin 15 (range 13.00-150.00)

Full Blood Count:

Haemoglobin estimation 136 g/L (range 120.00-150.00)

Total white cell count 4.8 10*9/L (range 4.00-10.00 10*9/L)

Platelet count 257 10*9/L (range 150.00-410.00 10*9/L)

Haematocrit 0.43 L/L (range 0.36-0.46 L/L)

Red Blood Cell Count 5.04 10*12/L (range 3.80-4.80 10*12/L)

Mean corpuscular volume 84.3 fL (range 83.00-101.00 fL)

Mean corpusc. haemoglobin 27 pg (range 25.00-33.00 pg)

Mean corpusc. Hb. conc. 320 g/L (range 315.00-345.00 g/L)

Red blood cell distribut width 14% (range 11.60-14.00%)

Neutrophil count 2.2 10*9/L (range 2.00-7.00 10*9/L)

Lymphocyte count 1.8 10*9/L (range 1.00-3.00 10*9/L)

Monocyte count 0.4 10*9/L (range 0.20-1.00 10*9/L)

Eosinphil count 0.4 10*9/L (range 0.00-0.50 10*9/L)

Basophil count 0.01 10*9/L (range 0.00-0.10 10*9/L)

Immature granulocyte count 0 10*9/L (range 0.00-0.30 10*9/L)

Nucleated red blood cell count 0 10*9/L (range 0.00-0.20 10*9/L)

Spoke to GP today who said my results were ok and so no B12 injections, and again said about taking a multivitamin. I pushed back a bit and he's prescribed:

Ferrous Sulfate 200mg (one twice a day)

Cyanocobalamin 50mcg (one a day)

Folic Acid 5mg (one a day)

To be honest I don't know what a lot of this means, and I don't really understand how my B12 (for instance) can be below range in the first test and fine in the second just a few days later.

Any advice gratefully received!

[SlowDragon Administrator]

Suggest you also post these on PAS healthunlocked

Serum B12 by NHS is EXTREMELY low

Active B12 is more accurate test than serum blood test and is BELOW range

Folate very low or BELOW range depending which test you look at

Folic acid supplements should not be started until B12 supplements/B12 injections started first

Ferritin extremely low.

Eating liver or liver pate once a week, plus other iron rich foods like black pudding, prawns, spinach, pumpkin seeds and dark chocolate, plus daily vitamin C supplements with each ferrous fumerate can help improve iron absorption

Links about iron and ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

drhedberg.com/ferritin-hypo...

restartmed.com/hypothyroidi...

Post about iron supplements

healthunlocked.com/thyroidu...

vitamin D is too low. Are you now supplementing?

GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Retesting twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs.

[PurpleThyroid in reply to SlowDragon]

Thanks SlowDragon! I got so cross with the GP earlier!

I've posted on PAS as you suggest.

I'm a strict veggie so no meat or fish but will try to up the iron rich foods otherwise. I do eat a varied diet and lots of leafy greens like spinach etc. Am concerned about absorption, and did query this with the GP - who now clearly thinks I am a hypochondriac...

[Angel_of_the_North in reply to PurpleThyroid]

Spinach stops you from absorbing iron because of the oxalic acid in it. You'd get more iron from cashew nuts and lentils or cooking food in a iron pan.

[PurpleThyroid in reply to SlowDragon]

One other questions: should these supplements that I've been prescribed be taken with food or on an empty stomach? And how far away from thyroid meds should I take them? I take my levo first thing in the morning, around 6:30am.

Have previously taken via D supplements but not lately. Will start these again.

[SlowDragon Administrator in reply to PurpleThyroid]

Vitamin D mouth spray is absorbed in mouth rather than gut so doesn't need to be so long away from Levo

Works much better for many with Hashimoto's much than ones you swallow

Vitamin D that you swallow needs to be at least four hours away from taking Levothyroxine and with meal high in fat

It can be hard to get iron levels up with Hashimoto's, obviously even more so if vegetarian

Vegetarian based iron is non heme and harder to absorb

thyroidpharmacist.com/artic...

[SlowDragon Administrator in reply to PurpleThyroid]

Your results suggest you likely need B12 injections

Many Hashimoto's patients find we need to supplement some or all four vitamins virtually continuously

Being vegetarian you will likely need ongoing iron supplements, but important to test iron levels regularly if supplementing

[SlowDragon Administrator]

Next step is to get vitamins optimal and getting T3 prescribed

Email Dionne at Thyroid Uk for list of recommended thyroid specialists who will prescribe T3

DIO2 gene test might help get T3 prescribed on NHS .....if you test positive

[PurpleThyroid in reply to SlowDragon]

Wow, this is amazing - will definitely follow this up - thanks!

[SlowDragon Administrator in reply to PurpleThyroid]

Link for DIO2 gene test

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