Hi, to give the full picture I posted this on the b12 site but looking for your thoughts on the thyroid part of it please ...
Prior to having covid in Dec 2020, I was physically fit and healthy. Started Sertraline in Nov 2017 for severe pmt.
Gave birth in Oct 2018, was induced with hormones and given gas and air.
Had covid Dec 2020, and by March 2021, I was ill with many symptoms fatigue, brain fog, Constipation, neuropathy in feet, poor balance, Blurred vision.
Had bloods done, found b12 deficiency at 118.
Fought for loading doses, had 6 over 2 weeks, felt no better
Started researching and self injecting EOD for 3 mths, improved slowly but still fatigued and in boom bust. GPs were busy with covid so I told them what I was doing but got no support. I'm left with fatigue and brain fog which affects my work. I only work 2 days a week but have a 3 Yr old, single mum, little support.
Did some private bloods and found:
TSH is top end of normal (may be causing fatigue?) Referred on, but endocrinology suggested not high enough to cause severe symptoms so suggested it was long covid so currently diagnosed post covid syndrome and under the clinic, advised pacing.
Have antibodies for Hashimotos
Antibodies for PA are negative
I'm having wild mood swings, emotional, crying a lot, irritability and night sweats, did more bloods .. I'm perimenopausal so starting HRT soon at start of my next cycle.
In the HRT apt with nurse... told her about b12 injections and she scoffed and said "psychological"... I was fuming. Nevertheless I agreed to reduce the injections over time.
I didn't have one for a week, was flawed with fatigue and headache, rang in sick from work, so took b12 injection 2 days ago.
HOWEVER, how do I figure out what is causing what, how much of this is the thyroid.. how much is the perimenopause how do I figure out how much b12 to take.
The nurse is saying to test b12 in 3 mths to decide on treatment. Well we all know there's no point in that but by the end of the apt I was just glad she was prescribing HRT and had no fight left in me to challenge her on b12 issue.
I also noticed my potassium was low end.. and want to run my other bloods by you all?
Thank you for your kind reply.. I did have coeliac check last year and thankfully negative. Ive posted other recent bloods from medichecks under one of the other replies from human bean...
Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but at least a further 80% find gluten free diet helps, sometimes significantly.
It’s always worth trying
Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Fought for loading doses, had 6 over 2 weeks, felt no better
Serum folate level > 24.0 ng/mL [3.3 - 99999.0]
I notice your folate level is surprisingly good. This usually suggests that people have been taking supplements with folic acid in. Before the body can make use of folic acid it must be converted via two steps into methylfolate. Some people can't do that conversion (or can't do it very well or quickly enough) so they end up having lots of unconverted folic acid in the blood (making their folate levels look good) but the body can't make much use of it.
The way to get round this is to take methylfolate itself, which can be used by the body immediately. Methylfolate can be bought as a supplement from sites selling supplements e.g. Amazon.
Note that for the body to make use of vitamin B12 it requires folate too.
I also noticed my potassium was low end
When someone who is low in B12 starts supplementing they start making lots of red blood cells. Being low in B12 would have made it very difficult for your body to make red blood cells because B12 is one of the essential ingredients for making them. So, when you supply that missing ingredient your body goes into catch-up mode.
But there are far more ingredients necessary for making red blood cells than just B12. One of the ingredients that tends to run low is potassium. No doubt there are lots of other required ingredients too, but B12 and potassium are the two I'm most aware of.
So, it is a good idea to eat foods high in potassium while you are going through the early stages of boosting your B12. You can also buy supplements containing potassium :
Since you have given birth in recent years, if there is a chance that you were low in B12 and/or folate during pregnancy then you should keep tabs on your offspring's levels over the coming years.
Anything I don't mention most likely means it is fine, although I don't know anything about sex hormones.
Serum ferritin level 47.0 ug/L [13.0 - 300.0]
Your ferritin (iron stores) result is only about 12% of the way through the range. This is far too low for most people - particularly with thyroid disease - to feel well, and low ferritin and iron will reduce your conversion from T4 to T3. Since T3 levels are the ones that determine how well we feel it is important that our T3 levels are right for us. Too high and people feel hyperthyroid. Too low and they feel hypothyroid.
However, raising ferritin and iron is not straightforward. People can have one of them high, the other low, or both too low or both too high. Basically, any combination tells you something about your health. Iron/ferritin are toxic in overdose or if levels are too high.
Before suggesting that you take iron supplements it is important to find out what the rest of your iron-related results are. See this link for more info on why this is necessary and read the whole thread - the replies are helpful :
High urea levels suggest poor kidney function. This may be due to acute or chronic kidney disease. However, there are many things besides kidney disease that can affect urea levels such as decreased blood flow to the kidneys as in congestive heart failure, shock, stress, recent heart attack or severe burns, bleeding from the gastrointestinal tract, conditions that cause obstruction of urine flow or dehydration.
The above explanation of your high result contradicts the following two results that suggest your kidney function is very good :
Serum creatinine level 63 umol/L [50.0 - 110.0]
GFR calculated abbreviated MDRD > 90 mL/min
What I don't know is what affects urea level - time of day? when you last ate? what you last ate? So, your high urea result is a mystery to me.
Serum TSH level 4.04 mu/L [0.35 - 5.5]
This result suggests your thyroid is struggling - the higher it is the more likely you are to be hypothyroid (have an underactive thyroid). A person with a healthy thyroid would most likely have a TSH between 1 and 2. See this link :
Knowing just a TSH isn't sufficient to give an informed opinion on how well your thyroid is doing (although doctors do this all the time). You really ought to know your Free T4 and Free T3 as well.
See "Monitor My Health" for the cheapest available test of TSH, Free T4, and Free T3, which all need to be done from the same blood sample.
Mean cell volume 99.8 fL [80.0 - 100.0]
This is only a smidgen below the top of the range. It tells you the average volume of your red blood cells. In B12 and folate deficiency it is very high, in iron deficiency it is very low. If someone has low B12 and/or low folate PLUS low iron and/or low ferritin the result of an MCV test is unpredictable. But I would say your very high result is telling you that one or both of your B12 and folate are very low. Whether iron/ferritin is also low, I can't tell from the MCV.
Mean cell haemoglobin concentration 315 g/L [320.0 - 360.0]
Thorne Basic B or Jarrow B Right are recommended 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
Elevated TgAb levels are associated with symptom burden in HT patients, suggesting a role of thyroid autoimmunity in clinical manifestations of HT. Based on these results, we recommend screening for TgAb antibodies in HT patients with symptom burden
Thanks again, I've emailed for list.Regarding the treatment for T4 result, are these written somewhere in nice guidelines so I can go with the info to GP..
I've got so much going on and due to start HRT in next 2 weeks... but just read that thyroid can be mistaken for menopause..
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Standard starter dose of levothyroxine is 50mcg
Bloods should be retested 6-8 weeks after each dose increase
Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test
HRT frequently results in needing increase in levothyroxine
My brain is overloaded.. does it look like I've been taking too much folic acid?
As for Urea levels, I've had this result twice and it looks like I'm not drinking enough, and dehydrated which I'm making efforts to change my intake of water..
As you have a B12 deficiency, request your doctor to test for Pernicious Anaemia. If we have P.A. we need frequent B12 injections as stomach cannot absorb B12. I have monthly injections.
When you had low B12, did GP do a test to exclude that you didn't have Pernicious Anaemia. If we have Pernicious Anaemia we need regular injections of B12.
I have P.A. as did my mother. Unfortunately she died of stomach cancer due to the GP stopping her injections as he said her 'blood tests' were fine.
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Proof it were needed
I have a goitre but GP says I don't... Please help with understanding my blood test results...
Hashimotos - Stopped Levothyroxine + Prescribed Chinese Herbs + Sleeping Earlier
Advice on supplements after blood tests.
