I take B12 injections for functional B12 deficiency. So far as I know due to active monitoring since 2017 my level of B12 is fine but lately I have been developing problems relating to mental health which are worrying and bothering me. Though I will probably be passed off as some nut on here with everything fine with me, medically speaking.
I take vitamin D and folic acid too.
For some reason when people talk to me about something fairly straightforward, I lose my patience and don't want to speak to them. Normally I have the patience of a saint but this has now suddenly worn thin.
Tearfulness. Even the mention of something and I burst into tears at the drop of a hat.
Memory. I am unable to retain information, even passwords. I am in training for a new job and the number of times I have had password resets just beggars belief.
Concentration. So, so distracted, mixed up and intrusive thoughts. Again, this is causing major impact on me because I meant to be learning new things. Having disturbed concentration should not be happening right now.
Tiredness, fatigue. Sleeping a lot during the day. Oversleeping in the morning. Insomnia at night.
Bruising on legs. Don't know how, just always happens on my lower legs, on my calves and shins. Tender in some spots too.
Heartbeat. Goes fast, slow, fast, slow, fast, slow. Chest and jaw sometimes hurts but not at the same time, it isn't radiating.
Nails. Breaking easily, going a little spoon-shaped the more they grow. Splitting in the corners.
Periods. Heavy. Painful. Irregular, Early. Late. I am in my 30's, this shouldn't be happening to me.
I am fast approaching the time to just go to my GP and request some antidepressants.
Any advice on my bloods below would be appreciated. Thank you.
December 2019
Vitamin B12 1108 pg/L (190 - 900)
Folate 4.3 ug/L (2.5 - 19.5)
TSH 5.86 mIU/L (0.27 - 4.2)
Free T4 15.6 pmol/L (12.0 - 22.0)
Ferritin 22 ug/L (15 - 150)
February 2020
TSH 2.2 mIU/L (0.27 - 4.2)
Vitamin D 30.5 nmol/L
(<25 severe vitamin D deficiency.
25 - 50 vitamin D deficiency
50 - 75 vitamin D may be suboptimal
> 75 adequate vitamin D)
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Slowmo19
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For full Thyroid evaluation you need 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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels
You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Your folate is too low. It needs to be in the upper half of the range, roughly 11 - 20. The best form of folate supplement is methylfolate rather than folic acid :
In order to make use of the B12 you have you need adequate levels of folate.
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Your vitamin D is diabolical. It needs to be around 100 - 150nmol/L or 125nmol/L depending on the source you read.
To raise your level you need to supplement, I would suggest at around 5000 iU per day. It is important that you take the necessary co-factors with vitamin D, and these are vitamin K2 and magnesium. To read info on these you should read SeasideSusie 's replies to others on the subject :
Your ferritin of 22 is also diabolical. With the reference range you've provided you would need to raise your ferritin to roughly mid-range i.e. about 80 - 90 or 80 - 100.
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Your current TSH of 2.2 is still too high for most hypothyroid people to have a hope of feeling well. Most people who are hypothyroid and struggling need their TSH to be 1 or under. (The higher the TSH the more hypothyroid you are, as a general rule.)
Are you being treated for hypothyroidism?
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I'm aware how awful people feel when they are untreated for hypothyroidism and their nutrient levels are diabolical. Your depression, heavy bleeding, fears about your mental health are almost certainly completely explained by your appalling levels of nutrients and being hypothyroid. You can be better and you will be better if you learn how to treat yourself for your nutrient issues.
Hopefully you can get help from a doctor about your hypothyroidism, but that could be problematic. Your results are in range and are therefore "normal" according to doctors.
You shouldn't start supplementing everything all at the same time.
I would suggest that you should start with supplementing methylfolate at 1000mcg per day for a couple of months, then you would need to re-test. It can be bought online on sites like Amazon or other supplement sites. Depending on how well you absorb it you may be able to cut down on your dose then to taking it three or four times a week.
A couple of weeks after you start methylfolate add in a 5000 iU vitamin D3 supplement, vitamin K2 and magnesium.
To improve your ferritin (iron stores) is more complicated. And you probably have enough to be going on with for now with the other suggestions. You can try improving the amount of iron you get from your food.
I think you should start with treating your low nutrients yourself. You may need to fight with a doctor for hypothyroid treatment, and you simply aren't well enough to take them on right now.
I'm not denying that. I'm just suggesting that you should walk before you can run.
Doctors (and many patients) often think that minerals and vitamins are not important - but they make a massive difference to how well people feel. Give the folate, vitamin D, vitamin K2 and magnesium a chance then in about a month, come back and ask for suggestions on your iron.
Of course you can ask your doctor to investigate! Make sure you get copies of any results including reference ranges.
Were your results from tests you paid for or are they from your doctor?
If they were from your doctor, and they've done tests in December and February then your second result being in range probably means they assume you are not hypothyroid and will dismiss your problems as being anything to do with your thyroid.
But the fact that your first result was nearly 6 means that you would already be treated as hypothyroid if the system had any compassion. Sadly, until TSH is 10 or over doctors are unlikely to treat you.
Sorting out the nutrients is part of sorting out your thyroid. Thyroid hormones - your own or ones you take - do not work well in the body when nutrients are as low as yours. We see it here all the time ...
GP"s rarely have a clue about vitamins and minerals so follow the advice here if you can.
A perfect example is your dose of VitD of 800 iu's which I am guessing is prescribed by your GP. Well has it worked ? Your level needs to be 100 ++ Dosing of VitD is based on the blood test result ...
Your reply is a bit harsh, don't you think? The fact that the OP had a TSH of nearly 6 in December means that her thyroid is in trouble.
The rules for the diagnosis of hypothyroidism are sadistic and inadequate and leave people suffering for a long time. It is likely that eventually the OP will be declared hypothyroid but is being forced to wait for her thyroid to become much worse because the medical profession doesn't really care how patients feel in some situations. And having a dodgy thyroid is one of them.
I'm sure there are a probably quite a few medical professionals who are secretly members of this forum. Some of them may be patients as well as doctors, but there will be others who hate patients and want to just keep tabs on the rude things we say about doctors. I'd love to be a fly on the wall in an endocrinology department listening to the conversation if this forum ever came up during lunch.
Second .....once on levothyroxine TSH is frequently extremely unreliable especially with Hashimoto’s,gluten intolerance, vitamin deficiencies and lactose intolerance....some or all of these are extremely common
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor
And did you stop taking your B vitamins a week before?
Those actions may help ensure consistent results so that you get a diagnosis (and treatment).
You could also ask Dr to test for Hashimotos antibodies. If positive, that alone might explain the difference in the thyroid blood test results. (if negative, it doesnt mean you dont have it, just that it hasnt been found.
I agree about about sorting the very low vitamins and minerals (in stages) cos those results wont help you.
I really sympathise, especially when you want to be at your best in your new job.
TSH 5.86 mIU/L (0.27 - 4.2)
Vitamin D 30.5 nmol/L
There's your answer, or part of it.
Ferritin and folate a bit low too. Need supplementing.
Ask for a trial of thyroxine
I am not an expert and haven't read others' answers yet but we see this all the time. Almost all your symptoms, including anxiety and/or depression, could be those of hypothyroidism
EDIT: Missed this
TSH 2.2 mIU/L (0.27 - 4.2)
Still probably too high for you. Most of us need a TSH under 1
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Dipping my toe into the possibility of thyroid issues
Endo has given me T3.. What do I need to know?
Results in from medichecks. I'd love some input on them please.
Am I going the wrong way? ⬇️
what is the desired T4:T3 ratio? (because I don’t think this is it)
