Help with daughter's test results

[MrsQ20]

Here are my 19 year old daughter's results. She is a vegetarian and doesn't eat much dairy. She has cold hands and feet all the time, swings between confidence and being quite agitated, has restless legs and jittery legs frequently and is prone to constipation. We tested her a couple of years ago and tried with the doctors who weren't interested but then we had covid so because she generally is getting on okay (not severely tired) we just kept an eye on these things (lots of life changes too so difficult always to work out what were symptoms) so would be interested in any thoughts. Her vitamin levels are lower than last time and thyroid hormones similar. Thanks in advance

[SlowDragon Administrator]

Well her vitamin levels are terrible

Ferritin is deficient as below 30

GP should do full iron panel test for anaemia

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Also See page 7 on here

rcn.org.uk/-/media/royal-co...

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

B12 is extremely low, likely deficient.

Anything below 70 is too low

Request GP do serum B12 test and test for Pernicious Anaemia

It’s likely her low B12 is entirely diet related

But with such low active B12 PA should be ruled out

May need B12 injections

If not injections will definitely need daily B12 supplement and separate vitamin B complex…..but not until GP has done testing

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s.

Low vitamin levels will probably be lowering TSH, obscuring how hypothyroid she may be

Get coeliac blood test done via GP before considering cutting gluten out

Retest thyroid and vitamin levels in 2 Months

[MrsQ20 in reply to SlowDragon]

Thank you

[MrsQ20 in reply to SlowDragon]

She had high antibodies before too. We will work on getting her vitamin levels sorted and I know we can’t fully understand things til that’s sorted but presume they antibodies means she will need to manage thyroid condition for life? Will it always develop further…? That’s how I understand it.

[SlowDragon Administrator in reply to MrsQ20]

In almost all cases of autoimmune thyroid disease, yes, replacement thyroid hormones are for life

In order for thyroid hormones to work work well (our own or replacement tablets) we MUST have optimal vitamin levels

Being vegetarian and Hashimoto’s is extremely difficult to maintain good vitamin levels

[MrsQ20 in reply to SlowDragon]

So doctors response was try and improve your diet and vitamins and we do another blood test in a month and if it’s similar we can send results to a specialist because of your mums history. The dr literally said - what are you expecting from me?

[SlowDragon Administrator in reply to MrsQ20]

Low B12 highly likely diet related as vegetarian but really GP should do B12 and folate and testing for Pernicious Anaemia now BEFORE Starting on B12 supplements

See different GP

Or if near London get this test

nutris.viapath.co.uk/pages/...

Similarly she needs full iron panel test for anaemia now

[MrsQ20 in reply to SlowDragon]

I know - that is what I was thinking. I don't think she can afford to do that testing at the moment. I know what our doctors are like and they back each other up so don't think we would get another one to test. I think she will have to start supplements - presumably this would be the Thorne Basic as recommended on here many times.

[SlowDragon Administrator in reply to MrsQ20]

Superdrug test includes intrinsic antibodies test for PA

onlinedoctor.superdrug.com/...

The extended test kit checks your vitamin B12 and folate levels, and for antibodies against intrinsic-factor proteins in your blood. If these antibodies are present this may prevent your body from absorbing vitamin B12, causing a condition known as pernicious anaemia.

If you take the extended test kit, and your B12 levels are low, you may be able to start injectable vitamin B12 treatment with Superdrug Health Clinic. One of our doctors will contact you for more information and advise you about the next steps.

If doesn’t qualify for B12 injections

She will need separate B12 supplement first, then after 48 hours add Thorne Basic vitamin B complex

Separate B12

healthunlocked.com/thyroidu...

[MrsQ20 in reply to SlowDragon]

If she starts supplements and things improve does that mask if she has pa then? I’ve ordered Thorne basic b complex and bio active b12 from nature provides. It’s just with the original testing and supplements for both her and me I’m not sure we can afford to pay for another test fir a couple of weeks but want to start improving things. She can try again with the dr first but assuming it’s a no….?

[SlowDragon Administrator in reply to MrsQ20]

If you’re going to retest you can’t start supplementing

As a vegetarian it’s likely diet related…..so you choose if going to retest….or just start supplements

[SlowDragon Administrator]

Low folate and low B12

Once tested by GP and PA ruled out ….

If getting B12 injections, recommended to also supplement daily Vitamin B complex

If no B12 injections via GP….will need vitamin B complex and daily separate B12 as well

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid). This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they 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...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement (eg Jarrow) and continue separate B12

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

As vegetarian, likely to need to continue daily B12 as well as vitamin B complex

B12 liquid drops

healthunlocked.com/thyroidu...

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Vegetarians frequently deficient in B12

academic.oup.com/nutritionr...

The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency. Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3

[MrsQ20 in reply to SlowDragon]

Thank you will pick up with dr

[SlowDragon Administrator in reply to MrsQ20]

Presumably she supplements vitamin D?

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

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...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Good explanations of iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

[MrsQ20 in reply to SlowDragon]

She was supplementing Vit d before summer but has also been travelling for three weeks in sunshine. Thanks for all the links- I will read and share with her and we will book dr appointment