Hello! I’m currently on 100mg Levo and have just had latest blood results back from GP. Flagged in red is my Serum Vitamin B12 (1515 ng/L 197.00-771.00 ng/L) and Serum Folate (4.3 uh/L 1.90-25.00 ug/L). I take Solgar B12 1000ug every evening.
Can anyone advise on my results please and how I might improve my levels?
Thank you for your help
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MossPiglet21
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Thorne Basic B or Jarrow B Right are recommended brand options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
If guidelines on dose by weight help to get dose increase in levothyroxine use them
guidelines on dose levothyroxine by weight
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
As SlowDragon says, the reason your B12 level is high is because you're taking the B12 supplement. You're just wasting your money, when supplementing any excess is excreted.
I would look for a B Complex with a low amount of B12 (methylcobalamin), you certainly don't need one with a high amount of B12 but you do need a decent amount of methylfolate to improve your folate level, look for no less than 400mcg and keep B6 to no nore than 10mg for regular daily use.
Before you started to take B12 tablets did you have a blood test for B12 ?.
If B12 was low you should first have been tested to exclude Pernicious Anaemia as the person cannot absorb B12 they have this condition so have to have regular B12 injections..
Thank you Shaws for responding, it’s really appreciated as I haven’t got a handle on this condition at all yet. I didn’t have any tests for B12, no - I was taking B12 tablets as part of my general vitamin supplement routine which I’d been following before I was diagnosed as hypo. Didn’t really think it would have an impact on my hypo. I was thought to be borderline anaemic (I don’t think Pernicious was mentioned) when I was first diagnosed - GP suggested I take an iron supplement tonic, which seemed to have worked as it hasn’t been flagged since.
I am not medically qualified but I do have pernicious anaemia as did my mother. Her GP stopped her injections telling her that her bloods were now 'fine' and she didn't need any more injections.
I get a monthly B12 injection now when the norm is once every three months.
Excerpt from following link:
While some B12 deficiencies are caused by diet, the most common reason for low B12 levels worldwide is an autoimmune disorder called pernicious anaemia. This is a chronic form of low B12 that can have serious consequences on health if left untreated long-term. However, because symptoms of the condition typically look like other common conditions, it’s often misdiagnosed as depression or anxiety. Not only does the condition cause physical distress, the stigma of living with this chronic condition can also cause serious psychological harm, as I’ve shown in my research.
"Both my syster and I myself thought that was 'good'. that our mother needed no more injections. We later found out that the decision was bad as mother died due to stomach cancer due to not getting B12 injections.
Once supplementing B12 further testing will show results that will be skewed upwards ! The result is the amount of B12 circulating in the blood but only around 20% can be transferred to the red blood cells - where it is needed. Taking a GOOD B Complex could be good - as suggested - but do keep an eye on your B12 Symptoms - should you have them.
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