Could it be Thyroid issues? High MCV and MCH for 3 years, very low ferritin. All with no anemia. Normal B12, Folate and Iron levels.

[looking_for_answers]

Hi all,

I'm new here.

This my third year of consistently high and increasing MCV and MCH levels, coupled with extremely low and unresponsive ferritin levels.

More on blood results:

* MCV (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

95.1/95.7/96.2/101/100/104/105 normal range [83.5-99.5]

* MCH (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

31.4/32.1/31.4/33.9/33.6/34.3/34.7 normal range [27.5 - 33.1]

No anemia:

* Haemoglobin concentration (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

128/128/116/124/126/128/136 Normal range [114.0 - 150.0]

* B12 (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

-/496/700/-/-/-/728 normal range [160.0 - 800.0]

* Folate (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

-/-/13.4/-/-/-/16.8 normal range [> 2.7]

* Serum ferritin (April 2016/August 2017/March 2018/July2018/June 2019/July 2020)

12/-/8/21/8/10 normal range [10.0 - 120.0]

-->Supplemented after March 2018 with 100mg ferrous fumarate for 3 months

-->Supplemented after June 2019 with Ferrous fumarate 210mg for 6 months

Another very strange learning from these blood results is that I continue having low ferritin but very normal iron levels:

* Serum iron level (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

10/-/-/-/-/-/20 normal range [7.0 - 27.0]

* Serum transferrin level (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

2.9/-/-/-/-/-/2.9 normal range [1.7 - 3.4]

* Transferrin saturation index (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

14%/-/-/-/-/-/27% normal range [16.0 - 55.0]

My thyroid tests have not been consistently checked (haven't been tested for T4 since 2017), but these are the results:

* Serum TSH level (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

0.82/-/0.85/-/-/1.13/- normal range [0.3 - 4.2]

* Serum free T4 level (April 2016/August 2017/March 2018/July2018/June 2019/July 2020/July2020 one week later)

14.6/-/13.2/-/-/-/- normal range [9.0 - 23.0]

More about me:

* Vegan since June 2017 (mainly whole-food plant-based. Junk food on very, very rare exceptions)

* Mostly gluten-free since March 2019, strictly gluten-free since February 2020

* I take 400iu D3 every day since January 2018 for maintenance (I was deficient in March still and was supplemented back then with 2000iu 2x day for 2months)

* I take 1000mcg sublingual vitamin B12 Methylcobalamin 2 times a week since September 2017

* Never drank (to get drunk) and since 2017 do not drink at all

Chronic/Auto-immune diseases and strange things about my health:

* I have psoriasis (discovered 10-11 years ago), now mild symptoms following UV therapy and becoming vegan

* I have rosacea (discovered 8 years ago), now on remission following going gluten-free. It flares up in 0.5 day after eating gluten cross-contaminated food.

* Since 1-2 years I have strong need of clearing my throat many times for 30min after eating a normal sized meal, like something is stuck in my throat (nothing happens with small meals).

* I nearly always have undigested food in stools

* I have glossitis and scalloped tongue

* I have hyperpigmentation in my mouth's inner lips

* I have hyperpigmentation ( staining) around my ankles since a year ago

* Eyesight worsens progressively (worsening myopia) in on eye in a matter of few months (having to change lenses too often)

* I'm having a dull stomach pain more often since 1-2 years with a couple of cases of severe pain

* I'm 39 years old and since maybe a decade my hair is over 95% gray I dye my hair but I know it is all grey. I've started graying at 17-18 years old

* My nails are creating vertical ridges since about one year ago and are now splitting in the middle

* I have Terry's nails

* I have endometriosis but no symptoms (discovered in appendicitis surgery nearly 20 years ago)

* I have heavy periods since forever

* I had uterine fibroids continuously and had several small surgeries to remove them. Fibroids stopped giving me trouble (middle of cycle bleeding) after becoming vegan and had no more surgeries.

* Normal Weight. Light exercise every day.

* Never smoked

What could be the reasons for my crazy blood results?

Any diagnoses for similar cases?

[SlowDragon Administrator]

Welcome to the forum

Recommend you get FULL Thyroid and vitamin testing including Both thyroid antibodies

But as vegetarian/vegan B12 supplement is likely inadequate

Vitamin D - dose you are taking likely far too small

Ferritin obviously terrible and hard to improve on vegan diet

The fact you find gluten free helps suggests autoimmune thyroid

Psoriasis is Autoimmune and Other autoimmune disease is more likely

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

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)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin (doesn’t include folate)

medichecks.com/products/thy...

Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

Heavy periods are classic sign of being hypothyroid

Obviously makes extremely difficult to maintain Ferritin

Read humanbean many replies re iron and ferritin

[looking_for_answers in reply to SlowDragon]

Thanks a million for this very thorough message.

I've now adjusted my post to reflect I took 2000iu 2x day for 2months when I was deficient. 400iu per day now is for maintenance.

I'll be exploring testing for thyroid and vitamins.

Would you have any input on the dynamic of ever increasing MCV/MCH in a thyroid disease?

[Hillwoman]

I agree, get all the tests SlowDragon suggests and consider timing of blood draws, current diet, etc.

A quick look through the results you provided appears to suggest macrocytic anaemia - the over-range MCV and MCH - which is usually caused by B12 deficiency. Your B12 levels are pretty respectable, but your folate is low in range, and that could well be the problem here.

There is also the possibility of 'functional' B12 deficiency, where serum cobalamin levels can be quite high, or even very high, but either there is a problem leading to insufficient transport protein - transcobalamin II - and/or poor cellular metabolism. These problems are due to relatively common genetic faults. One indirect way to test for poor cellular metabolism of B12 is to check levels of homocysteine and methylmalonic acid (MMA). In your case, I would suggest adding the latter two tests to your list.

Your FT4 doesn't look too good, but SlowDragon has advised what to do about thyroid testing.

[looking_for_answers in reply to Hillwoman]

Once again, thanks a ton. So, I understand the increased MCH/MCV does not directly connect to thyroid issues. Correct?

My testing of 'functional' B12 deficiency is a tricky one given it may be skewed by my B12 supplementation (given I'm vegan). I've understood homocysteine and MMA would be skewed if I'm under supplementation (and that individuals suspecting 'functional deficiency' should stop all supplementation for 4 months). But again, being vegan and stopping all supplementation would lead me to no B12 intake whatsoever (given nothing comes from my diet). Am I correct in my interpretation?

[Hillwoman in reply to looking_for_answers]

Yes, you are. A conundrum!

[Marymary7 in reply to looking_for_answers]

You could check out sister site called Pernicious Anemia to see if there is any more info to help although you are so thorough I suspect you have already.

Excellent advice by everyone on here, definitely pay for your own extensive tests to gain complete insight, you will get there! 😀

[Heloise]

Just a suggestion that you might try a different type of B12. Some do better with hydroxy or adeno or even injections for a while. You have some gut issues going on and digesting minerals and B12 is considered a mineral I believe, you need to have loads of stomach acid to metabolize although you may be taking a sublingual type. Why not try taking HCL with meals and get your digestion more active. Some people think they have too much acid but often it is the opposite.

You need folate to work with B12 and sometimes folinic acid is more effective than folate.

I think Chris Shade's website may explain more about it.

[looking_for_answers in reply to Heloise]

Thank you Heloise, notes taken on trying different B12s and increasing acid (but yes, I take a sublingual B12 indeed).

Thank you so much.