B12 & ferritin results

[Girlslovescifi]

My B12 is 179 (110-900) and ferritin is 33 (30-339). GP thinks b12 is normal but she wants to discuss ferritin. What can cause this? I usually supplement. I have medical anxiety so worried there may be something nasty going on.

[Buddy195 Administrator]

As your ferritin is at the low end of the scale, I would ask for a full iron panel to be completed, as iron supplements are not recommended without having this.

Ive had low ferritin in the past- as a first step, try introducing more iron rich foods into your diet (dailyiron.net is useful for highlighting iron rich foods).

[helvella Administrator]

110 is a very low bottom of range for a serum B12 test.

There has been discussion about why some UK labs have such low lower ends - and it is not complimentary to those who decided on them.

More typical is around 180 to 220.

Are you in a position to get an Active B12 test done?

And, yes, your ferritin is too low (it is only marginally in range - as you know).

In my view, you need a Full Blood Count, and an iron panel.

In an awful lot of people, low B12 is due to inadequate dietary B12 and not taking any (or not sufficient) B12 supplements to compensate. And can be addressed simply by taking a B12 supplement regularly. (E.g. at least 50 micrograms of B12 in any form every day.) Some need a higher dose (e.g. 1000 micrograms) and do better on methylcobalamin or hydroxocobalamin or even adenosylcobalamin.

But I see that your B12 has dropped in the past six months.

If you are regularly supplementing B12 and it is still falling, I think you need to review your dosing and have Pernicious Anaemia considered.

Regarding ferritin, again, it is likely you are not getting enough iron in forms you can absorb. That is more likely than any other reason. Again, review your iron intake and consider whether you need to increase your intake. But definitely more comprehensive testing is required. Which would also tend to help understand whether your low B12 is having an impact (e.g. on mean cell volume).

And ,while you are at it, get at least folate tested.

helvella - Iron Panel

A short article about explaining what is meant by "iron panel" in relation to blood tests including some reference interval (range) information.

Last updated 18/07/2024

helvella.blogspot.com/p/hel...

[Girlslovescifi in reply to helvella]

Thank you. I eat chicken and fish. I had a hip replacement 3 months ago. Not sure if that’s related.

[helvella Administrator in reply to Girlslovescifi]

It might have contributed. But the issues exist now and need action now.

Few of us see B12 or iron (ferritin) improve without taking specific action. Even if both were improving now you have had your hip replacement, a helping hand in the form of appropriate supplementation would likely help you reach repletion sooner rather than later.

Eating chicken and fish could well have kept you from being even worse, but it appears not to be enough.

Ironically, if someone suddenly switched to a diet low in iron and low in B12 (for the sake of an example, a poorly considered plant-only diet), their ferritin and B12 might well drop quote quickly. And when discovered, they might have been low in ferritin and B12 for a limited time. And, if obviously severe, they might get urgent and strong action. Whereas if someone is getting just a bit less than they need, it can take years to be identified. And any action is also likely to be low level, gentle, mild. Yet it is this second case which is likely to accumulate more damage through being low in ferritin and B12 for a much longer time.

[Girlslovescifi in reply to helvella]

I had these done too.

Test

[Girlslovescifi in reply to helvella]

and this one

Tests

[helvella Administrator in reply to Girlslovescifi]

Afraid that there is nothing there that I can really comment on.

When results are very obviously "wrong" it is easy to point at them and identify possible causes. But with less obvious results, someone who really understands is needed for interpretation.

[Marz]

Low B12 could well be contributing to your anxiety....

[Buddy195 Administrator]

Increased anxiety has been the worst symptom of having a thyroid condition for me and it is always worse if thyroid medication or key vitamins (ferritin, folate, vitamins B12 and D) are not optimal.

[Girlslovescifi in reply to Buddy195]

Thank you

[SlowDragon Administrator]

Anaesthetic can significantly lower B12

b12-vitamin.com/anesthesia/

NHS only tests for and treats vitamin deficiencies…..as your B12 is (just) within range…..GP unlikely to treat

But many, many people on replacement thyroid hormones need to supplement vitamin B complex daily to maintain good B vitamins

Some need separate B12 as well, especially initially

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

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

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

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Great reply by @humanbean on B12 here

healthunlocked.com/thyroidu...

Low folate

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

healthline.com/nutrition/fo...

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

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week

Post discussing different B complex

healthunlocked.com/thyroidu...

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) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Girlslovescifi in reply to SlowDragon]

Thank you so much. My anxiety is sky high worrying why my ferritin and b12 have decreased over 6 months. I did have a hip replacement 3 months ago with a general anaesthetic. I eat fish & chicken and supplement but only when I remember - which isn’t consistent.

[SlowDragon Administrator in reply to Girlslovescifi]

So you need to improve levels by supplementing

Look at increasing iron rich foods in your diet too

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

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week. ideally other red meat daily , 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

Links about iron and ferritin

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.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Ferrodyn supplement

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

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...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[SlowDragon Administrator]

looking at previous post…..

healthunlocked.com/thyroidu...

dose T3 was reduced on Sept 10th

You need to retest…..likely reduced thyroid hormones is contributing to vitamin levels decline

Important to test vitamin D and folate too

[Girlslovescifi in reply to SlowDragon]

I was mistaken about when I reduced t3. It was July. This week’s t3 result is 4.68 (3.5-6.8)

Blood iron

[SlowDragon Administrator in reply to Girlslovescifi]

All thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

is this how you did this test?

what was Ft4 result and ranges

Free T3 (fT3) 4.68 pmol/L (3.5 - 6.8) 

Ft3 only 35.8% through range

anxiety is hypo symptom

Did you get vitamin D and folate results

[Girlslovescifi in reply to SlowDragon]

I took my last dose of t3 too early I think. Took it at 4pm day before and test was at 8.30am. No food and only water before.

[SlowDragon Administrator in reply to Girlslovescifi]

What was Ft4 result

Which brand Levo are you taking

Which brand T3

Suggest you work on low B12 by taking separate B12 and vitamin B complex daily

Plus working on low ferritin…..this will take weeks/months to improve

Retest thyroid levels correctly in 8 weeks

[Girlslovescifi in reply to SlowDragon]

They only did t3. I take Mercury Pharma Levo and Morningside t3.

[Girlslovescifi in reply to SlowDragon]

Folate 13.6 (5-19); FT4 13.8 (7.8-18); tsh suppressed. Think I do better when t4 is in upper quarter.

[SlowDragon Administrator in reply to Girlslovescifi]

Free T4 (fT4) 13.8 pmol/L (7.8 - 18) 

Ft4 only 58.8% through range

So yes on low side

[Girlslovescifi in reply to SlowDragon]

Thank you! I ordered the liquid b12 you suggested. I appreciate all your advice and info.

[Girlslovescifi in reply to SlowDragon]

d3 was 101 and the lab said >50. Not sure about folate

[Girlslovescifi in reply to Girlslovescifi]

Folate 13.6 (5-19); FT4 13.8 (7.8-18); tsh suppressed. Think I do better when t4 is in upper quarter.

[Girlslovescifi in reply to SlowDragon]

Obviously my result should’ve been higher if I’d taken it within 12 hours. Just hope the ferritin and b12 isn’t anything scary.