I have hyperthyroidism (only taking propranolol) but have not been diagnosed as to the cause yet (not Graves or adenoma, possibly Resistance to Thyroid Hormone). I have an appointment later this month. I’d like advice regarding my results please:
TSH 3.7 (0.27-4.2)
fT4 32.6 (12-22)
fT3 6.4 (3.1-6.8)
Vit b12 293 ng/L (197-771)
Serum folate 4 ng/ml (3-20)
Serum ferritin 165 (30-400)
Serum total 25-hydroxy vitD level 90.1 (50-150).
I’m concerned that my b12 and folate are low/borderline. Just taking multivitamins at present. I’m noticing a decline in terms of memory, brain fog, and feel that these low numbers might be contributing.
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Vit b12 293 ng/L (197-771) ng/L is the same as pg/ml
This is low.
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Many people with B12 in the 300s have been found to have B12 deficiency.
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
Serum folate 4 ng/ml (3-20)
This is low. Folate deficiency is diagnosed when level is below 3, your result is in the "indeterminate zone" of 3-4.5 - see
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
Maybe discuss with your GP.
You shouldn't start folic acid or a folate supplement before further testing of B12 and B12 injections or supplements started.
Serum ferritin 165 (30-400)
This seems to be fine, it's often recommended that ferritin is half way through range although I have seen it said that for males 150 is a good level.
Serum total 25-hydroxy vitD level 90.1 (50-150).
This is pretty good. The Vit D Society and Grassroots Health both recommend a level of 100-150nmol/L so you could, if you wish, aim for that range.
Just taking multivitamins at present.
Multivitamins aren't recommended here. They tend to contain the cheapest and least absorbable forms of active ingredients, often the wrong form. They usually contain too little of anything to help improve low levels or deficiencies.
Some combinations shouldn't be taken together, eg
Vit C can keep the body from using B12.
Calcium should not be taken at the same time as iron, zinc or magnesium.
Zinc affects copper absorption.
They also often contain things we should test first and only supplement if found to be deficiency, eg calcium, iodine, iron.
If it contains iron then it affects the absorption of everything else as iron needs to be taken 2 hours away from other supplements.
Many thanks for your comprehensive and speedy reply. I do have many symptoms of b12 deficiency, which I had put down to the hyperthyroidism. I will be speaking to my GP on Monday with a number of questions this raises. Thanks again.
Hi, yes I’ve had an ultrasound, two MRIs and a Methionine PET/CT. I’ve also undergone genetic testing with no joy (yet). I’ve an appointment at Pituitary Clinic in two weeks, so I hope that my two and a half year wait for a diagnosis doesn’t go on much longer.
Many say FT3 being the active hormone causes the symptoms & if this is optimal can still manage well even if FT4 is not in range, but some find abnormal FT4 causes issues too & your FT4 is far higher at 206% of range. Whereas your FT3 is 89% within range.
Being hyper may have depleted your nutrients. Improving your B12 & folate may help your symptoms but your FT3 could also rise as conversion would also improve. This might balance out but if the FT3 did creep over range you might want to consider carbimazole.
Has your Doctor not offered you carbimazole? Or do you not wish to try it?
Are you still taking a low dose of 30mg propranolol daily? This has a mild anti thyroid affect, so helpful when hyper (not for hypos).
Did you have the TRH test? Did this show anything?
I did have the TRH test, which showed a flat response. Doctors felt this was suggestive of a TSH-secreting adenoma, but a Methionine PET/CT and volumetric MRI showed no evidence. So, after some genetic tests for thyroid hormone resistance proved negative, there is likely to be some further testing to come.
My fT3 has dropped slightly, having been static at 6.7 for at least 15 months. My TSH is also at its lowest, having been between the current level and as high as 4.6 early last year. My most recent diagnosis is “Elevated T4 with non-suppressed TSH (possibly disorder of thyroid hormone transport/metabolism)”.
I have not been offered Carbimazole throughout the now nearly two and a half years since this was identified. It took me a while to even get the low dose (30mg) of propranolol, which I still take. It has helped with symptoms.
I’m also taking metformin (for LADA diabetes) and Lansoprazole for Barrett’s Oesophagus, and these can impact negatively on b12 and folate, so that is something I need to speak to my GP about- I’ve got a telephone appointment on Monday. Much for me to think about- many thanks for your helpful comments.
I am surprised as doctors usually encourage treatment at first sign of hyper. Even when is turns out to have transient high levels and patients end up very hypothyroid. If just goes to show how much focus is placed on the TSH.
An option would be to increase propranolol. The maximum being 240mg (split 3 or 4 times per day). If it helps further with symptoms. But you do need to be cautious. I was given 120mg initially then instructed to stop abruptly. Which shouldn’t be done. It gave me dreadful migraines & GP resumed it as a preventer. I lowered it very slowly but now seem stuck on low dose.
I’ve heard of LADA but don’t know much about it. How was It diagnosed & differentiated from type 2?
Thyroid levels do impact blood sugar & cholesterol. Within a year of starting carbimazole my thyroid levels were too low (doctor wanted TSH in range & it never has been) & this is when my HbA1c increased to type 2 level. I improved it by diet alone and allowing thyroid levels to rise.
My LADA was diagnosed initially as T2, but when I went on a programme for new T2 diabetics one of the nurses said I might be T1. I was tested for GAD autoantibodies, which was positive, and the diagnosis was changed to LADA.
I’ve been having a bit of a debate with my endocrinologists because, although my hyper diagnosis came after my diabetes one, I feel that the thyroid problem was there first and possibly unmasked the latent diabetes. I think my thyroid levels definitely impact my blood sugars. However, for me when my hyper symptoms are at their worst, my blood sugars are higher than other times. My endos are sceptical about my theories, and they hopefully know a bit more than me!
I do increase my propranolol dose when I can feel hyper symptoms increasing, as my consultant was fine with this.
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