I am a 73 year old male on 125 mg levo a day ,main symptoms are really bad fatigue ,ibs
Lots of headaches ,tinnitus, and severe dry eye ,be great if someone could look at my last blood tests
Plasma vit b12 275ngl (180-650)
Serum folate 20.0. Ug/l. (2.8-15
Vitamin d. 76 (50.1-220)
Serum free t4 17.5 (12-22)
T3 4.0 (3.1-6.8)
Serum tsh 0.840 (0.27-4.2)
Welcome to the group.
Did you take your Levo after the blood test so your last dose was 24hrs before the test?
What time of day was this blood test? It makes a big difference as TSH vries throughout the day and is highest at 9am or earlier.
Are you taking any supplements?
Free T4 (fT4) 17.5 pmol/L (12 - 22) 55.0%
Free T3 (fT3) 4 pmol/L (3.1 - 6.8) 24.3%
Your free hormone results are on the low side so you would benefit from a dose icnrease. Ask GP for it as a trial.
Your conversion isn't great but before thinking about adding T3 its best to get optimally replaced with Levo alone and get all key vitamins to OPTIMAL levels.
Your B12 level is terribly low and will be causing you many symptoms.
Are you vegan or vegetarian? If not: B12 - do you have symptoms of B12 deficiency? The reference range for B12 is very wide and cut off point too low. theb12society.com/signs-and...
If you do then you should discuss this with your doctor for further tests for Pernicious Anaemia.
If not, then start with a methyl B12 sublingual spray or lozenge for a week, then add a good B complex. Once you run out of the separate B12 just continue with the B complex.
cytoplan.co.uk/vitamin-b12-...
amazon.co.uk/Better-You-Boo...
This B complex has all the right vitamins at a not unreasonable cost for 90 days supply(also contains folate). Once B12 is good you can stop the stand alone B12 and just continue with the B complex.
B complex suggestions: Slightly cheaper options with inactive B6:
amazon.co.uk/Liposomal-Soft...
Contains B6 as P5P an active form:
bigvits.co.uk/thorne-resear...
healf.com/products/basic-b-...
Explanation about the different forms of B6:
helvella.blogspot.com/p/hel...
B complex comparison spreadsheet:
healthunlocked.com/thyroidu...
What supplements are you taking?
Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150.grassrootshealth.net/projec...
Do you have a ferritin result?
took levo at 7 am ,test was 11am
Only take vitamin d ,I am not vegetarian,
No ferretin result ,spoke to my doctor today particularly about b 12 ,he said the results were all fine ,my father and grandfather both had pernicious anemia
Thanks for your reply
So with only 4 hours after last Levo dose your FT4 is lower than 55%.
Try insisting on a trial increase of Levo.
If at all possible always book a 9am or earlier blood test appointment as this is when TSH is highest. Take Levo AFTER blood test that day, otherwise the test ends up measuring what you've just taken as opposed to your stable blood level.
You would benefit from increasing your vit D dose slightly.
You could post on the PA forum for advice regarding dealing with GPs that think a low normal result is OK. healthunlocked.com/pasoc
Try a different GP about low B12 and PA. If not then start supplementing. Absorption of vitamins does get worse as we age also.
I'm not surprised you have no energy.
Thanks again for your reply ,like other people on here it seems to be a problem with doctors who seem obsessed with test results rather than symptoms,I will start supplementing my b12
Thanks once again
Another thought. I'm on low 25g but changed chemist who gave me Levo brand. After a few weeks I felt really ill. Back on mercury now and feeling a lot better.
Hi, please do *not* start supplementing B12 or folate until you have had more tests, even if you have to get them done privately. Your serum folate is high, likely due to the 'folate trap', because of insufficient B12 to metabolise it properly, hence cellular deficiency. Your results are not fine and you have PA in the family, so you are likely to have a B12 metabolism issue even if it has not yet progressed to PA in yourself. There are no tests which can rule out a B12 issue. Tests which may help, as well as a full blood count and serum B12 and serum folate, are active B12 (holotc), anti-gastric parietal cell antibodies, anti-intrinsic factor antibodies, serum gastrin, homocysteine and methylmalonic acid (MMA), but all can be 'normal' and you still have a cellular/functional deficiency. I also found testing for genetic polymorphisms useful - if you have variants in the methylation/one-carbon metabolism areas then you may benefit from methylfolate rather than folic, but in small doses (certainly to begin with). The only way to know for certain that B12 cannot help is to have a therapeutic trial of injections and see if things start to change, or not. Those symptoms could all be B12/folate related/affected. Oral B12 may well still raise serum level but will not be certain to repair damage caused so far, nor stop progression. Best wishes
Thank you
Doctors do not understand the vital importance of B12. They know nothing about nutrition. It really would be good if you could get tested for PA, but if not, it would be a good idea to observe the following protocol:
- buy sublingual methylcobalamin (B12), 1000 mcg and take for a week
- get a good B complex with methylcobalamin and methylfolate (not cyanocobalamin and folic acid) - Thorne Basic B is a good one. Take one a day along with your sublingual B12. The Bs all work together and need to be kept balanced.
- when the sublingual B12 is all gone, retest to see levels. If B12 is still very low, get more sublingual B12. If it's risen well then just continue with the B complex as a maintenance dose and take for life. If you stop your level will drop again.
Are you taking vit K2-MK7 and magnesium with your vit D?
I am a little concerned that this presupposes that raising serum B12 with oral/sublingual supplements necessarily gets the B12 into the cells or improves function in the cells, which it doesn't (not reliably for everyone). As an experiment to see if symptoms improve, it might be ok, but absorption will be on a downward trajectory anyway and given thyroid, age and family history, I don't think it adviseable to risk worsening symptoms and make diagnosis even harder, unless there is absolutely no option. At some point injections will be needed and getting them will be more difficult if signs have been obscured. I agree that some doctors do not have a clue about B12 and that PA should be tested for, but PA is not the only form of B12 issue. And some people react to too many methyl groups. B12 treatment has to be symptom driven, not serum driven.
I don't think it presupposes anything, but seems like worth a try when faced with ignorance and lack of co-operation from doctors.
Perhaps you can suggest where the OP can get all the tests you mention because she's unlikely to get them from her GP.
I'm sorry, I wasn't trying to be awkward. Believe me I know, after 24 overtly symptomatic years of misdiagnosis, how hard it can be to get anyone to look properly at B12, but supplementing first when it is not an obvious dietary issue in a young otherwise healthy person really does skew the results and mess up your chances. Anyone with a family history (or autoimmunity) needs better. The OP is male, and GP should be able to do intrinsic factor and parietal with no difficulty, refer if unwilling to do Hcy and MMA but both can be done by NHS, active B12 is part of Medichecks thyroid testing although they should be able to do that too. Private testing for PA is available if you have the money. The pernicious anaemia society are very helpful, as are B12info b12info.com/what-to-do-next/ . Cheers
But the OP is not young and healthy. He's 75 and hypo, which probably means he has very low stomach acid and great difficulty absorbing nutrients.
You missed my point - which was that the only people who might be ok to risk trying oral are those who have a clear dietary deficiency and are otherwise young and healthy - not me, not you and not the OP.
well, first time I've ever heard that.
All I was trying to suggest was a little caution. If someone came on the PA forum with clear thyroid symptoms I might suggest testing but would refer them here for help with results. If someone comes on here with a family history of PA or other B12 issue, it would be sensible to suggest the PA forum or societies for best practice and advice. Anyone with (any) autoimmunity is likely to have increasing difficulty with absorption and at some point may have to go from oral to injections to maintain health, which will be far more difficult if oral has pushed serum level to anywhere in range (which it will for most). At the very least, people need a paper hard copy of test results, family history, signs and symptoms, doctor(s) seen and actions taken or not, then supplement(s) tried (form, strength, frequency) and diary of changes to symptoms, if any. Then in due course you have some evidence of what you did and why you did it.
I know that oral in multiple forms used to help my symptoms but I still deteriorated. Perhaps slower than I might have done, but perhaps I didn't need to deteriorate at all had I had injections when I should have had them, many years ago, rather than starting recently (thanks to a good GP). And at that point, more of the damage would have been reversible. Cheers
Point taken. In future I shall refer all B12 questions to the PA forum.
There is no harm in suggesting standard testing, we all need that first as some can be picked up from low serum, but you need to investigate why it is low, or why there are symptoms. If we don't keep going back to doctors asking for better investigation and better treatment which at least roughly approximates to the new guidelines, nothing will improve. Best wishes
But I did suggest standard testing: It really would be good if you could get tested for PA. But I know how hard it is to get that test. We see that problem on here all the time, doctors refusing to do further testing.
I have booked a b12 jab at the pharmacy and got some good b complex ,I will see how it goes
Thanks for your very good advice
Well, I'm not sure that's the right thing to do because you need to get the further testing before having any B12, or it will skew the results. If you do have PA you will get B12 jabs on the NHS for life.
I am at a dead end with doctors,two doctors conferred with each other on Monday and said my results are ok
God they're useless! They haven't got a clue. Well, maybe ask advice on the PA forum before doing anything:
healthunlocked.com/pasoc/po...
We don't want you to do the wrong thing. Perhaps you could get a private test?
I need to do something,I have been getting more depressed and anxious the last few weeks ,the doc did ask me if I wanted another test ,I can get tested in a few weeks time ,I can see how it goes
Thanks for you and everyone else being so helpful
Yes, but he just meant another ordinary serum B12 test, and there's not much point in that. I really think you should consult the PA forum. 
I hope the jab goes well. Make sure you record symptoms before and any changes of any sort as a result of the injection. Hopefully it will be enough for the GP to consider a therapeutic trial of loading doses. If not, you could consider self injecting. Even with either a PA diagnosis or a metabolism issue diagnosis you may not get enough frequency of injections to resolve your symptoms effectively. Please try to avoid letting the GP retest your serum B12 once you have had an injection. If they must, it should be high - rarely it doesn't raise and that may give you evidence to support referral for MMA testing.
Thanks ,it’s a lot to take in isn’t it ,pity the doctors aren’t more helpful ,I forgot to say that a lot of my fatigue symptoms are delayed reaction a couple of hours after I have done anything
I do understand where you are coming from. It is an additional problem that the serum test is inaccurate, especially so for those with high IF antibodies, so PA is not an easy diagnosis. Nor is it the only form of B12D, and often is late stage, following years of functional deficiency. Even if the IF test is done it is assumed by too many doctors to be conclusive, either way, which it is not.
Thanks
Hello Astlebridge
So having taken your T4 that morning before the blood draw your T4 is a false high -
and your T4 is actually running too low for you which in turn means your T3 too low for you to be as well as you can be :
Please ensure whatever you use on your eyes to ease this dryness are Preservative Free -
whether prescribed or Over The Counter :
There are heavy duty little tubes of what looks like vaseline for overnight use -
squeeze this in last thing as your vision will be blurred afterwards -
but you will still see your dreams - good or bad !!
Thanks to you all for the advice ,I will start to take the supplements
increasing T4 may not be a healthy option, substantial evidence shows increasing risk of cardiology issues particularly AFib with free T4 at upper levels even below top of lab ranges. maybe think about increasing conversion efficiency by selenium supplements and or reducing levothyroxine and adding Liothyronine T3 with monthly blood tests to closely monitor changes Suppressed TSH is potentially disruptive and associated with other adverse effects. TSH is around 1.0 healthy normal NOT 0.something
Thank you
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