Help with my husband's results he is really struggling

[Susanmcg]

I am so grateful to everyone on this forum as I have now been officially diagnosed with Hashimotos after going privately and opted for Armour NDT so next bloods will be first on meds and supplements. I wonder if I could get some wisdom on my husband's results. He has been ill for years now which was precipitated by covid infection in 2020 but I suspect he had stuff going on before that. Basically fatigue, weight gain, muscle weakness brain fog, dizziness. The problem is his TSH is always in range so the nhs will not look at T4 or T3. Anyway after a medichecks blood test the results are below? Taken early morning. He has been taking Vit D and B12 so in some ways those numbers are better than in December. To me his T4 and T3 are really low? His Cholesterol, lipids and triglycerides are all elevated in every blood test on his records going back to 2019. Too numerous to include.

Inflammation

CRP HS 1.330 mg/L (Range: < 3)

Iron Status

Ferritin 417.00 ug/L (Range: 30 - 518)

Vitamins

Folate - Serum ! Sample error

Vitamin B12 - Active 123.0 pmol/L

Please note change of reference range 23 Oct 2022

(Range: 37.5 - 188)

Vitamin D 83.8 nmol/L

Total 25(OH) vitamin D < 25 nmol/L is deficient.

Total 25(OH)D of 25-50 nmol/L may be inadequate in some people.

Total 25(OH)D > 50 nmol/L is sufficient in most individuals.

Total Vitamin D level >250 nmol/L - indicates potential for toxicity.

Please note change of reference range 23 Oct 2022

(Range: 50 - 250)

Thyroid Hormones

TSH 2.710 mIU/L (Range: 0.27 - 4.2)

Free T3 3.6 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 15.5 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies 14.70 kIU/L (Range: 0 - 115)

Thyroid Peroxidase Antibodies <9 kIU/L (Range: 0 - 34)

Below are some other results from his NHS records over the last few years:

22/12/23

TSH 3.78 mlU/L (.35-4.95)

B12 196 ng/L (200-900)

Folate 2.2ug/L (3-20.5)

15/11/22

TSH1.59 mlU/L (.35-4.95)

Vit D 32 nmol/L (50-200)

B12 208 ng/l (200-900)

22/5/20

TSH 2.22 mlU/L (.3-3.13)

T4 13.6 pmol/l (13.1-21.3)

Vit D 47 nmol/l (50-200)

I would really appreciate any help.

Thanks

Susan

[helvella]

The B12 is odd. Two very low results - then an OK one? (Yes - I did notice two serum and one Active.)

Has he taken any B12 supplements?

I think I'd suggest a post on the Pernicious Anaemia Society forum.

healthunlocked.com/pasoc

Postal folate tests often fail - they really need very fresh blood. Definitely needs to be done.

But the previous folate test was very low. Has he supplemented that at all?

Has he had any iron tests at all? Whether ferritin or any others?

The FT4 and FT3 are certainly lower than most of us would like. And TSH is higher. Unfortunately the TSH obsession does mean he is unlikely to be diagnosed with a thyroid issues - yet.

[helvella in reply to helvella]

Sorry - I was so busy reading back and forth, I missed the fact he has been supplementing B12.

It looks like he should also be taking folic acid/folate. A dose of up to 400 micrograms is readily available and might be enough. There is much discussion about whether to use methyl-folate or folic acid but, at low doses, I think many are OK on folic acid.

[Susanmcg in reply to helvella]

Thanks for you comments. His Ferritin has always been in range on the upper quarter so that looks ok. He is not Vegan or Vegetarian so low B12 and Folate not a good sign. He is on methyl folate now so next blood results will be interesting. The doctor has diagnosed pernicious anemia and he is getting injections now but is there a link to the thyroid?

[helvella in reply to Susanmcg]

Yes - a larger proportion of those with thyroid disease have pernicious anaemia - or B12 deficiency.

Poorer digestion in hypothyroidism appears to impair absorption of nutrients. That can improve as thyroid hormone levels rise.

But Pernicious Anaemia also sees impaired absorption or nutrients. Some on the Pernicious Anaemia Society forum find they need to do things like consume some lime juice at meals in order to increase stomach acidity.

[gabkad in reply to Susanmcg]

What I've read is ferritin over 400 in males = iron overload. He needs to have his transferrin saturation tested. There is a possibility of hemochromatosis. His symptoms are very much in line with this disorder.

nhs.uk/conditions/haemochro...

[GlowCoach Administrator]

In December his B12 and folate were deficient so has he had tests for pernicious anaemia or have you just gone straight to supplementing? What is his GPs opinion about his deficient B12?

Is he vegan or vegetarian?

What time of day has he been testing for thyroid? 9am or earlier is recommended for highest TSH, do the test fasting that day, only drinking water and no biotin containing supplements for 4-7 days before the test.

It might take longer and ensuring all key vitamins (including folate) are optimal before TSH responds better.

[Susanmcg in reply to GlowCoach]

Thanks for replying. Yes the doctor has diagnosed pernicious anemia and prescribed injections but will that impact thyroid? Not vegan or vegetarian. Yes tests always first thing. I hope the supplements help the Thyroid numbers but I am not sure it will and wonder if it is Central Hypothyroidism at the core of the problem?

[GlowCoach Administrator in reply to Susanmcg]

Pernicious anaemia will in itself cause fatigue and a range of other symptoms.

theb12society.com/signs-and...

It will take some months for the B12 injections to take effect. I assume he is having loading doses?

Posting on the PA group here on HealthUnlocked might be helpful to get an idea on what to expect next from PA and treatment. Some people need injections more frequently than GPs offer as standard.

Perhaps retest thyroid after a good 3-4 months of B12 injections and see what results look like then. Members in this group have found that low B12 can lower TSH and resolving B12 levels has an effect on TSH.

[Susanmcg in reply to GlowCoach]

He is getting loaded doses 3 times a week for two weeks. I think you are right maybe test again in 3 months. Thanks.

[Cornwaller in reply to Susanmcg]

Don't retest b12 once diagnosed and treated. The result may be high and tempt an incorrect cessation of treatment. All protocols such as NICE and BMJ say not to retest for this reason and also it is a waste of time.

The metric for treatment frequency should be when no further improvement in symptoms is obtained and then a maintenance schedule should be put in place such that symptoms don't reappear.

Most GPS don't know the above for some reason!

[Rosills1 in reply to Cornwaller]

See B12d.orgThis is really important

Look up the Nice guidelines so that you are prepared.

What is written above is correct

It's great his GP has him on B12 injections.

Nurture his gut microbiome, consider low carb?

[Litatamon in reply to Susanmcg]

If the doctor continues to test his b12 levels over time, he or she does not understand Pernicious Anemia. Testing during supplementation means nothing when this is not a diet issue but an absorption issue. Just be careful, the majority of doctors simply do not have a proper grasp of it. I know that sounds absurd, but it is unfortunately true.

Also note it is normal to feel worse and sometimes even acquire more symptoms when one starts the b12 shots.

[Litatamon in reply to Litatamon]

Some good concise reads about b12 deficiency with medical footnotes -stichtingb12tekort.nl/engli...

Testing during treatment -

stichtingb12tekort.nl/engli...

Safety (as doctors often confuse causation with a study that shows high b12 levels can exist - without supplementation - when there is an underlying health issue at hand - not that high supplementation/readings/b12 shots caused it)

So make sure you are armed with knowledge -

stichtingb12tekort.nl/engli...

All the best to you both. Hope the NDT works out wonderfully for you.

[Susanmcg in reply to Litatamon]

Thank you for all the info it really helps to know all the details. Yes I hope NDT helps. It is still early days but I feel at last I am getting to the bottom of health issues that have been going on for years. Thank God for this forum.

[WaystarRoyco]

One suggestion: get him to do a thyroid scan. I don’t know where you live but I recently did one in London and it was very easy. Also very helpful as it showed I had an atrophied thyroid despite never having tested positive for the usual hashimoto’s antibodies.

londonsono.com/product/thyr...

[Susanmcg in reply to WaystarRoyco]

Great idea. We are in Surrey so London near fo you ha e the details of the clinic. I need a scan too!

[Susanmcg in reply to Susanmcg]

Sorry I see you included the link. L

[SmallBlueThing]

His symptoms could indicate "male menopause" (low testosterone) which is treatable, and worth treating.

nature.com/articles/s41443-...

[Susanmcg in reply to SmallBlueThing]

Thanks I never thought of that sounds important.

[Sandalsforever]

I agree with the others here, that Pernicious Anemia may be an issue, if he have it, then b12 supplements often will not help and he may need injections. It could make the world of difference in his livelihood. I have a mild case of PA - initially thought my symptoms were thyroid since I have goiters. But my thyroid blood work was normal with low b12, I started taking lots of b12 and feeling better, but I also found I have venous thrombosis which many people get when they have PA. My doctor checked circulation in my toes and hand and my toes were 28%. I started wearing compression socks 20-30% compression and I feel like a new person, did not know that would make such a difference- better blood flow to the brain and heart! My legs do not get swollen and never have, I am not over weight, I do exercise, don’t have neuropathy in my feet, just not enough blood flow in my legs… This was an easy solution to my issues. I feel like a new person- and it was almost immediately. Worth a try. Good luck, hope you find what ever works for him.