Questions about fatigue

[WiscGuy]

I initially posted this to the B12 deficiency forum, and it was suggested that I post it here.

I am in the USA.

In the spring of 2021 I had been having periods of fatigue that would put me in bed for two or three days at a time, and then suddenly things would be better again. This was a repeating pattern. I took this complaint to the doctor and was diagnosed with B12 deficiency. I was initially put on the treatment regimen for hematologic symptoms: the plan was daily injections for a week, then weekly for a month, them every other week for a month, then monthly. Things went well for the daily injections, ok for the weekly injections, and poorly for the every other week injections. I requested a return to daily injections, and the doctor went along with that. Several symptoms improved (eg, sensation in feet), some didn't change much (eg, proprioception balance). One that improved, but didn't resolve, was the periods of fatigue. Since then, brain fog that limits functioning occurred most days, so that traveling is nearly impossible, and fatigue most days makes even simple things like going to hear music in the park out of the question. Last summer I got a pacemaker.

Recently, for the first time since I began injecting B12, the multi-day fatigue returned and I was in bed sleeping for most of three days; then, as back when I first went to the doctor with this complaint, the fatigue lifted and yesterday morning I was pretty much back to my current normal. On the evening of the second bed-ridden day I called the clinic and was allowed a rare "same day" appointment for the next (third of being sick) day, which appointment I wanted so that blood for testing might be drawn while the period of illness was occurring. One of the tests was TSH, May 17, 2023.

I have had the following TSH test results (normal 0.3 - 4.2 mlU/L)

May 2021 3.1 mlU/L

Feb 2022 3.4 mlU/L

May 2023 2.3 mlU/L

These test results have apparently been interpreted to mean that I have no thyroid problems. Is the TSH test the last word in assessment of endocrine problems, especially thyroid?

Other selected test results from May 17, 2023:

Vit D (20-80) 54

Ferritin (31-409) 274

Chloride, P (98-107) 107

Bicarbonate (22-29) 23

Alanine Aminotransferase (7-55) 13

RBC Distrib Width (11.8-14.5) 11.1

Neutrophils (1.56-6.45 x10(9) ) 6.44

Any comments on any of these test results are appreciated. Also, any suggestions of what I might want to do next would be very helpful. I am planning to request a referral to the Endocrinologist.

[SlowDragon Administrator]

No

You need TSH, Ft4 and Ft3 tested and BOTH TPO and TG thyroid antibodies tested for autoimmune thyroid disease also called Hashimoto’s

ALWAYS Test thyroid levels early morning for highest TSH

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Are you male or female

Approx age

No folate result

What vitamin supplements are you taking apart from B12

[WiscGuy in reply to SlowDragon]

Thank you for your suggestions. I am male, 73. Lots of autoimmune among my brothers and sisters. I am now taking vitamin d, and several of the supplements that Technoid has mentioned. I forgot to ask for the folate test. It's in my multiple vitamin and also in my B Complex supplement.

[SlowDragon Administrator in reply to WiscGuy]

remember to stop any supplements that contain biotin 5-7 days before any blood test as biotin can falsely affect test results (eg vitamin B complex

Lots of thyroid patients take vitamin B complex, vitamin D and magnesium

But Multivitamins never recommended on here

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

[WiscGuy in reply to SlowDragon]

Thank you for the information on biotin. My supplements contain a daily total of 330 mcg of biotin. I found an article on this topic and am posting the link, in case anyone might be interested:

sciencedirect.com/science/a...

[CernCrystal]

Hi, not sure if this can help but I take B12 every day under the tongue as have problems with gut absorption (gets worse with age too). My symptoms brain fog, balance, shakiness, pins/needles and numbness (legs/arms/face) were greatly reduced if I also take folate (NOT folic acid) under the tongue too or in homemade chicken liver pate. Folate is needed for effective use of B12.

[WiscGuy]

I am unable to find confirmation in a recognized medical source, but now and then I hear rumblings regarding sublingual B12, to the effect of B12 molecules being too large to be absorbed through mouth tissues, which means the "sublingual" B12 is likely swallowed and any absorbing is through the digestive tract. If anyone has a good source on whether B12 can be absorbed through the tissues of the mouth, I would appreciate receiving it.

[SlowDragon Administrator in reply to WiscGuy]

Many members use sublingual B12

Very effective B12 drops 

natureprovides.com/products...

Or

B12 sublingual lozenges 

uk.iherb.com/pr/jarrow-form...

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

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

[WiscGuy in reply to SlowDragon]

I noticed that my B Complex supplement contains folic acid, and the Jarrow product is methyl folate. I read that there is some concern about folic acid taking a long time to be converted to methyl folate after consumption. Do you have an outlook on methyl folate vs folic acid?

[SlowDragon Administrator in reply to WiscGuy]

we generally advise a B complex that contains methyl folate

Which brand of B complex are you taking

[WiscGuy in reply to SlowDragon]

I am in the US, where there is a chain of stores called Costco. Costco has a house brand, "Kirkland". That is the kind I use. Kirkland products are generally of high quality.

[SlowDragon Administrator in reply to WiscGuy]

This one….

costco.co.uk/Grocery-Househ...

Yes next time suggest you consider getting Thorne

iherb.com/pr/thorne-basic-b...

Thorne are large capsules. (You can tip powder out if can’t swallow capsule) 

Or Other good quality options 

healthunlocked.com/thyroidu....

[WiscGuy in reply to SlowDragon]

Thanks for the tips. I will check these out.