Flagged vitamin B & folate issue on latest test - Thyroid UK

Thyroid UK

137,151 members160,830 posts

Flagged vitamin B & folate issue on latest test

MossPiglet21 profile image
12 Replies

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

Written by
MossPiglet21 profile image
MossPiglet21
To view profiles and participate in discussions please or .
Read more about...
12 Replies
SlowDragon profile image
SlowDragonAdministrator

So B12 is in red as too high as taking too much B12

Folate is in red as too low

Instead of taking just B12 ……supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance.

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

What are your vitamin D and ferritin results

And thyroid levels

MossPiglet21 profile image
MossPiglet21 in reply to SlowDragon

Hi SlowDragon, thank you for responding so quickly.

I haven’t had vit D levels tested, but I do take vitamin D3 tablets daily.

My ferritin was 45 ug/L 13.00-150.00 ug/L

T4 level 16 pmol/L 11.10-22.00 pmol/L

TSH level 3.26 mu/L 0.27-4.20 mu/L

It says these figures are all ‘normal’

I will start taking a B Complex as you’ve recommended.

Thanks again for your help.

SlowDragon profile image
SlowDragonAdministrator in reply to MossPiglet21

My ferritin was 45 ug/L 13.00-150.00 ug/L

T4 level 16 pmol/L 11.10-22.00 pmol/L

TSH level 3.26 mu/L 0.27-4.20 mu/L

As you’re on levothyroxine …the TSH is too high and Ft4 too low

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

On levothyroxine TSH should ALWAYS be under 2

FT4: 16 pmol/l (Range 11.1 - 22) 44.95%

Most people when adequately treated on just levothyroxine will have Ft4 at least 60-70% through range and Ft3 at least 50% through range

See GP for 25mcg dose increase in levothyroxine

You could initially increase by 12.5mcg (cut 25mcg tablets in half)

Retest FULL Thyroid TSH, Ft4 and Ft3 6-8 weeks after any dose change or brand change in levothyroxine

Monitor My Health Is cheapest for just TSH, Ft4 and Ft3 at £26.10

go on thyroid uk for money off code

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

monitormyhealth.org.uk/

How much vitamin D are you currently taking

ESSENTIAL to test vitamin D at least annually…..ideally twice year when supplementing ….you may need higher dose in winter than summer

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

SlowDragon profile image
SlowDragonAdministrator in reply to MossPiglet21

My ferritin was 45 ug/L 13.00-150.00 ug/L

Ferritin is still far too low

Look at increasing iron rich foods in diet

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

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

Aiming to increase ferritin to at least around 70

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

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

Medichecks iron panel test

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator in reply to MossPiglet21

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

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

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Persevere - have all guidelines printed and be ready to quote them

healthunlocked.com/thyroidu...

Approx how much do you weigh in kilo

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

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

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).

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

SeasideSusie profile image
SeasideSusieRemembering

What was the reason you were taking the B12?

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.

MossPiglet21 profile image
MossPiglet21 in reply to SeasideSusie

Thank you for responding so quickly SeasideSusie, I really appreciate your guidance.

I was taking B12 as I understood it helped fatigue and anaemia (I was borderline anaemic when diagnosed as hypo)

I will start taking a B complex instead as you and SlowDragon have recommended.

Thank you for your advice!

shaws profile image
shawsAdministrator

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..

MossPiglet21 profile image
MossPiglet21 in reply to shaws

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.

shaws profile image
shawsAdministrator in reply to MossPiglet21

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.

theconversation.com/vitamin...

"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.

Marz profile image
Marz

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.

MossPiglet21 profile image
MossPiglet21 in reply to Marz

Thank you for your reply Marz, really appreciate it. I will keep an eye on symptoms now you’ve mentioned it. Thank you

You may also like...

Folate and Vitamin B results

evening, these are my latest vitamin B and Folate results (both normal). As my Folate is still low...

Thyroid & Vitamin B 12 / Folate blood testing!

monitor the effectiveness of treatment for vitamin B12 or folate deficiency When to Get Tested?...

My latest thyroid test results

ref Range 50 nmol/L - 140 nmol/L Vitamin B12 level, serum: 720 ng/L

Vitamin D, B12, ferritin, folate blood test results

day Serum vitamin B12 - 197 (180 - 900 pg/L) Total OH vitamin D - 50.8 (50 - 75 nmol/L -...

New blood test results - B12 & Folate! Please help!!

September and my results were: Serum B12 level: 119 ng/L (150-900) Serum Folate level: 2.3 ug/L...