Advice on B12 and ferritin

[MarsBar12]

Can anyone advise me whether my levels of B12 and Ferritin are optimal for thyroid support.

I am hypothyroid - here are my latest blood test results. Of course, the GP insists they’re all normal, but I’ve been struggling with extreme fatigue, palpitations and feeling cold all the time. GP is reluctant to increase my thyroxine because of the palpitations.

TSH = 1.62mu/L (0.35 - 4.94)

Serum free T4 = 14.7 (9.0 - 19.0)

Active B12 >128 pool/L (>24)

Ferritin = 66ug/L (10 x204)

Serum folate = 14.7 ug/L (3.1 - 20.5)

Thanks in advance

[Tina_Maria]

Your TSH seems perhaps a bit high for someone on replacement therapy, most people feel better when their TSH is around 1 or even less. Your T4 is 57% through the range, again most people feel better when T4 is between 60-70%. Are you still supplementing with T3 and have you got a test for T3 as well? It is difficult to say where the problem could be without a T3 value; as if that is still quite low, then this could be the reason for your fatigue.

The B12 active range is usually between 38 and 188 pmol/l, so 128 pmol/l looks good, but some people might feel better near the top of the range. Similarly, your folate is decent, but could do perhaps with being a bit higher. Do you supplement with a Vitamin B complex? If not might be a good idea to add one (Igennus Super B complex or Thorne B-complex).

Ferritin looks a bit low (which can also contribute to fatigue), but before thinking of raising it, have you considered doing an iron panel? You could have high iron and low ferritin, so it is good to know your iron status before changing your diet or supplementing, as too much iron can be harmful for the liver.

[MarsBar12 in reply to Tina_Maria]

Hi

Thanks for your reply.

Yes, I agree my TSH is high and my T4 is low, but GP just says everything is in range and - like I said- won’t consider increasing my thyroxine because of the palpitations.

No, I don’t take T3 and my GP practice won’t test for it.

I take the Igennus B complex.

These are my iron levels:

Full blood count

Haemoglobin concentration 131 g/L [115.0 - 160.0]

Total white blood count 7.2 10*9/L [4.0 - 12.0]

Red blood cell count 4.61 10*12/L [4.2 - 5.4]

Haematocrit 0.404 [0.37 - 0.47]

Mean cell volume 87.6 fL [78.0 - 100.0]

Mean cell haemoglobin level 28.4 pg [27.0 - 32.0]

Mean cell haemoglobin concentration 324.0 g/L [310.0 - 350.0]

Platelet count - observation 353 10*9/L [140.0 - 450.0]

Red blood cell distribution width 14.3 % [11.0 - 16.0]

[Tina_Maria in reply to MarsBar12]

I think your T3 might be quite low and this is probably the reason you feel so tired. Most GP practices sadly do not test T3, could you do a private test to check your T3 level?

How much levothyroxine are you taking? The prescribing guidelines state that levothyroxine should be given at 1.6 mcg per kg of body weight:

cks.nice.org.uk/topics/hypo...

If your GP is reluctant to increase, you could use this guidance to ask for an increase? You could say that you are very symptomatic and would like an increase on a trial basis, some GPs are a bit more receptive to that.

However, if you are not converting T4 to T3, then an increase might help somewhat, but not completely. Did you not try T3 some years ago (I looked at your profile)? Was there a reason why you gave it up?

[greygoose]

Palpitations are often a symptom of under-replacement, so suggest to your doctor that it would be a good idea to trial an increase in dose to see if they go away.

[Jingley in reply to greygoose]

I was just about to say the same as greygoose I had been on the same dosage for years with no palpitations whatsoever once I was stable but as soon as my gp messed with my dose of Levo and reduced it, they started. I'm back on my previous dose now and no more weird heart skips.

(I'm not the best person to give advice about B12 and ferritin so I won't comment on those. I'm still struggling with my atrocious levels.)