Recently discovered I have an underactive thyroid with antibodies. TSH 17.33, Free T4 8.7 TPO 1919.7.
I asked for a copy of my blood results and noted that my MCH level was raised at 33.4 (range 27-32).
Upon doing a lot of reading into the thyroid following diagnosis I have found that thyroid conditions often result in vitamin deficiences mainly b12 and folic acid.
I was reading that raised MCH could indicate deficiencies in the above mentioned vitamins so I contacted my GP to enquire about getting a blood test to check my levels.
My request has been refused as GP says my MCV level was fine (99.8 - range is 83-101). He wasn’t interested when I said about these deficiencies being common with those with thyroid problems.
I am happy to pay for the tests to be done as I would really like to find out these values so I have a baseline.
I guess my question is - should my request have been taken more seriously with the levels that I have posted? Or is the response from GP fair enough. I feel a bit deflated as I just want to feel better as quickly as possible.
Thank you!
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Newtohashimotos2025
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Could you tell us what thyroid medications your taking, any other medications and also any other vitamins. This will give us a better understanding of what’s going on before we answer.
Yes your correct vitamins, especially B12, folate, ferritin and Vit D play a big part in getting our thyroid hormones to work properly.
I do not take any other medications or vitamins. GP did advise starting Vitamin D but would not carry out bloodwork for a baseline for this either.
I felt very fobbed off and frankly that I was a nuisance to him especially as I had told him that I had been doing a lot of reading about the thyroid since being diagnosed.
How long have you been taking 50mcg Levo? GP should retest 6-8 Weeks after commencing treatment. Likely you will need significantly more to get TSH under 2 (with most members here reporting they feel best with this closer to/ under 1). Ask GP again to test key thyroid vitamins (folate, ferritin, B12 in addition to Vit D) and if you get no joy, I would investigate doing this privately (as many members here do).
GP says my MCV level was fine (99.8 - range is 83-101)
MCV = Mean Cell (or Corpuscular) Volume
This test gives you the average volume of your red blood cells.
If people have a low level of MCV their blood cells are smaller than average. This is usually caused by having low iron and/or low ferritin (iron stores).
If MCV is high their blood cells are larger than average. This is usually caused by having a low level of Vitamin B12 and/or folate.
And of course, there is no way of knowing what the effects will be if the patient has severely low iron and low ferritin AND severely low B12 and low folate. It is quite common for low iron/ferritin to occur in the same person who has low B12/folate, and all of them need to be treated if you want to have any hope of feeling well.
Your MCV is almost right at the top of the range at 93.3% through the range suggesting that you need, most urgently, to test your B12 and your folate. If both are low in range or under range then you must start treating your B12 first (for a short while anyway) then add in treatment for low folate. Treating the folate first will shrink the red blood cells making it look as though your red blood cells are fine and your B12 is also fine. This is misleading.
Your GP telling you that your MCV is fine is horrifying. If B12/folate are low enough for long enough there are possible severe consequences.
Depending on the levels of your iron/ferritin/B12/folate there is a possibility that you might have Pernicious Anaemia. And left untreated this might lead to this condition :
I came off the phone I had another look at the MCV level and noticed it was very close to the top of the range. I have also seen other countries consider the top of the range to be 100.
The GP basically said he MCH doesn’t give a full picture and it would be the MCV level that would indicate deficiencies. I don’t know enough about it to argue but I just felt so let down and not listened too.
Are b12 and folate blood tests expensive for the NHS? As I cannot understand why he wouldn’t want to just test them to be sure unless it is an expensive test.
Will definitely got through Medichecks as really want my levels checked and will then treat myself to get to optimum levels.
If my test comes back from Medichecks as having low levels of b12/folate do GPs accept these results?
Sorry, I don't know the costs of B12 and folate testing to the NHS. jimh111 and/or helvella might know.
There are various test bundles that can be done privately (no doctor required and you don't need your GP's permission) with a finger-prick test that are worth doing. Several private test companies get mentioned on this forum quite often. See this link - there may be discount codes available :
I don't know who the favourites are at the moment, nor who is the cheapest. And I don't think the list is complete. There's no mention of Randox, for example, and there may well be others.
If you want to do private testing make sure to check the offerings from each company, learn about timing of getting blood samples, taking thyroid hormones and supplements before testing, and how to get the test samples to the lab at an appropriate time. Ask for advice in a new thread when you've had a chance to look at your options so people can suggest a cheaper/better test if necessary. Don''t spend a single penny until you've checked with people on the forum. Many of us will have wasted money on unsuitable tests before, and it is very frustrating - and expensive!
One thing to be aware of is that if you go down the private route most GPs won't accept the results. They assume if it isn't done by the NHS then it isn't reliable. And they even apply this to MMH which is a private company run by the NHS! So, you might be able to use private testing for additional ammunition in your quest for testing from the NHS. But if it turns out that you are short of a vitamin or a mineral you've had tested privately you will probably have to pay out of your own pocket to fix it with over-the-counter supplements.
Another thing to bear in mind is that some supplements are very poor quality, so you need to ask about that too when you've decided what you want to buy.
Reference intervals, ranges, vary from lab to lab.
An MCV at the top of the range does very likely indicate inadequate B12 and/or folate - as has already been said. Though there are other possibilities.
This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.
The normal range: it is not normal and it is not a range
This blog has the abstract of this paper plus link to the original full paper. Also includes some extra links to a video and some other related information.
I have only been taking the levothyroxine for about a week and a half.
My Ferritin level is 113 so within range.
I asked the GP twice on the telephone call and even got him to confirm that he was unwilling to check my b12, folate and vitamin D levels despite having a thyroid condition that can result in these deficiencies.
My queries were very much dismissed I felt. He said MCH levels didn’t really mean anything and weren’t really that abnormal!
If MCH levels don't really mean anything, why did he test them? They do all these tests that they really know nothing about, and can't interpret the results, but refuse to test the most important ones! It's sheer lunacy!
But, if has to be said that doctors just don't learn about the importance of nutrition in med school. My B12 was low once and I had so many symptoms, but the the doctor said 'it's only a vitamin' and dismissed it! And if they do give any nutritional advice it's usually totally wrong - never take nutritional advice from a doctor! And, if they do prescribe anything, it's usually the wrong thing, or not enough of it. So, I'm afraid we're really pretty much on our own where nutrients are concerned.
Unfortunately your doc is feeling threatened by your knowledge and your justified challenges. It’s not uncommon I’m afraid and many members here can tell similar stories.
Ideally do Medichecks test 6-8 weeks after being on starter dose Levo
No point testing Thyroid levels until minimum of 6-8 weeks on constant unchanging dose and brand of levothyroxine
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
A) many/most Hashimoto’s patients have low vitamin levels, especially initially
B) it’s very common to need to test and supplement privately
GP’s are often completely disinterested or unaware of the link between poor gut function and low vitamin levels as a result of being hypothyroid
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test folate, ferritin and B12 at least once year minimum
Test vitamin D ideally twice year
Test more frequently when initially starting on vitamin supplements
GP should have tested vitamin D, folate, ferritin and B12 and coeliac test at diagnosis of Hashimoto’s
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels
Recommended that 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
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Testing options and includes money off codes for private testing
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
If serum B12 result is 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
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
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
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 if last test result serum B12 was below 500 or active B12 (private test) under 70
Can I just say thank you to everyone who has responded to my query - it is very much appreciated as I felt completely deflated by my GPs frankly unsympathetic and unhelpful answers today.
I have ordered a kit from Medichecks and I luckily have a nurse friend who will draw bloods from me.
I will take all information on board regarding supplements, when to take, how to take etc.
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