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underactive thyroid and b12 deficency

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littlegem38:
HI Dawn thanks for advice will make sure he does the tests to investigate why i keep dropping down and not absorbing b12 in my diet or subligual will take a look at the website you suggested and when its time for bloods tests i will phone and talk  to him first as they print the same blood tests of every time i go for them.

Thanks again  sun21

littlegem38:
Hi Everyone sp014

Ive had my bloods done and results are in any advice or help very gratefull xxxx
 bloods taken on 07/08/09.

Serum vitamin b12 331 ng/1 range(180-800 u) 2 injections and started taking 5000mg of sublingual b12 only took 2 tabs a week before bloods.
Serum ferritin 40.3  ng/ml range (12.0-310.0 u)

Thyroid Homone tests.

Serum Free T4 is 14 pmol/L range (11-25 u)
Serum TSH level 3.9 mu/L range (0.270-4.200 u)

Liver Function Test.

Serum bilirubin level 7 umol/L (<17u)
Serum alkalinen level 77 IU/L range (30-135 u)
AST serum level 19 IU/L (<45 u)
ALT/SGPT serum level 15 IU/L (<65u)
Serum total protein 76 g/l (64-82 u )
Serum albumin 47 g/l (35-50 u)
Serum globulin 29 g/l no range given

Serum Lipids: Just out of normal range.A big diffrence from last tests done.- fasting blood test.Taking simvastin 40mg daily for 6 weeks now

Serum Cholesterol 4.0 mmo1/L (<5.0 u)
Serum triglycerides 1.9 mmo1/L (0.3-2.0 u)
Serum HDL cholesterol level  low  0.92 mmo1/L (<1.00 u)
serum LDL cholesterol level 2.2 mmo1/L (<3.0 u)
Total cholesterol:HDL Ratio 4.3

When i spoke to the doc last night he said would i like to stop the statins now as ive made changes to my diet i said i made changes to my diet 12 months ago and it went highter so iam staying on statins for now cause i know if i stop them it will shoot up again.

Urea and electrolytes.

Serum sodium 141 mmo1/L (133-146u)
Serum potassium 3.9 mmo1/L (3.5-5.3u)
Serum urea level 3.7 mmo1/L (2.5-7.8u)
Serum creatinine 75 umo1/L (44-80u)

 Fasting blood glucose 5.1 mmo1/L (2.8-6.0 u)

Full Blood Count

Haemoglobin estimation 14.5 g/d1 (11.5-16.5 u)
Total white cell count 8.7 (4.0-11.0)
platelet count 255 (150-450 u)
mean corpuscular volume (MCV) 90 (76-99 u )
red blood cell count 4.79 (3.80-5.80)
haematocrit 0.43 (0.37-0.47u )
mean corpusc haemoglobin (MCH) 30.3 pg (27.0-34.5 u)
mean corpusc.hb. conc.(MCHC) 33.7 g/d1 (32.0-36.0 u)
RBC,S - hypochromic 0.6  %
neutrophil count 5.24 (2.00-7.50 u)
Lymphocyte count 2.94 (1.30-3.50 u)
Monocyte count 0.37 (0.20-0.80 u)
Eosinophil count 0.08 (0.04-0.40 u)
Basophil count 0.03 (0.00-0.20 u)

waiting two more tests to come back friday are

 serum b12 intrinsic factor.pernicious anemia test.
Endomysial antibody level test- celiac disease

I asked the gp to raise my levo he said no so i said will wait for these test results then i will come and see him he also asked me how my tiredness was and i said the same if not sleeping more he must think because my b12 is over 300 that i will suddenly be bouncing around with energy i dont think so i wish flow2




floss:
Hi Gem, How I wish I had caught up with your posts before you had these tests done as there is one
glaring omission - the test for red blood cell folate, This is very important to be done along with the
B12 and ferritin, the three always go hand in hand as they work together to give you good blood.
Never mind, get it done as soon as you can.

Your B12 has improved with the injections and sublinguals, but would be better when it balances out
above 500. Optimal is between 500-1000. Your ferritin is too low and optimal needs to be around 90,
perhaps you could try Spatone or spirulina or something like that, but if you take any tablets for iron
its a good idea to take Vitamin C with it to prevent constipation.  Iron must be taken at least four
hours away from thyroid and other meds as it will bind them.

thyroid hormones, well the TSH is still rising so you are clearly undermedicated and you should push for
another rise - ask your doctor for a trial rise to see if it makes you feel any better, which of course it should do.

The rest of the blood tests seem to be good to me, nothing stands out as being amiss. and the cholesterol
is well improved.  The antibody tests always take a lot longer than the others, I dont know if they have to
grow cultures or things, but they are usually a couple of weeks behind the others.  A negative for intrinsic
factor antibodies does not rule out Pernicious Anaemia, it is merely "not proven" and some people have
two negative tests and then a positive third or fourth.  Let us know the result when you can.

The blood test for Coeliac antibodies is only 80% accurate.  Do you have absorption problems, do you
think?  This could explain why you are not absorbing your B12 from food, and is a positive for getting
injections.

littlegem38:
Hi Floss
Thankyou for you reply my prievious blood tests had serum folate on it was 2.9 ug/1 (2.5-18.0) as from 1/05/09 it is no longer avalible it says on my print out from 21/04/09 i dont know why the labs are not doing this test anymore.

Ive just phoned the docs and had my other test back for intrinsic factor it was normal she said, Iam phoning back tommorow to see if the endomysial antibody test is back and what that says as soon as its back and i know the result.

 Iam then going to book a appoinment to see my doc and too discuss what gonna happen next with my body no absorbing b12 and to see if he is going to carry on with injections each month or not in the meantime i will continue too take my b12 5000mg every 3 days.

If the other test comes back negitive the next test is too see if i have got parisites in my small intestine. i might ask him too refere me to a gastroligist to find out what going on in my small intestine for its not  absorbing my intrinsic factor b12 and a endo for my thyroid.

I will ook into buying Spatone or spirulina or something like it for my ferritin to increase it too over 90.

I did ask again on tuesday when i spoke too him on the phone he got quite shirty with me and said its in normal range i wish he would treat the symtoms and not the results i think he has not got a clue when it comes too thyroid, i really do iam very tempted to increase it myself.

But i will go down the right road first and request a referal and see what happens.

Gem xxxx

floss:
Gem, your folate reading is also too low and you would be wise to take a supplement for that too.
folic acid.  When your doc says things are normal you need to know whether they are low normal
or high normal or in the middle - you wouldnt expect to squeeze a size 6 foot into a size 3 shoe,
but they are both equally normal.

Theres good advice here:  http://www.pernicious-anaemia-society.org/phpbb/viewtopic.php?t=10704&sid=c5ce396f4584bfa3d98b45121519b2d4

also:[Which investigations are useful in the diagnosis of vitamin B12 deficiency and folate deficiency anaemia?
Full blood count:
Low haemoglobin (Hb) and increased mean cell volume (MCV) although macrocytosis can precede the development of anaemia.
Pancytopenia in severe cases.
Reticulocyte count low for the degree of anaemia (13% only).
MCV may be normal if there is associated iron deficiency. There is the possibility that coexistent pathology could be missed. There will be a dimorphic blood film. The ferritin level should be checked.
Blood film: macrocytic red cells, neutrophils with hypersegmented nuclei, and Howell-Jolly bodies
Biochemistry: increased plasma unconjugated bilirubin (increased destruction of red-cell precursors in the marrow)

Vitamin B12 deficiency will result in reduced serum vitamin B12 levels. It may also result in increased serum folate and reduced red-cell folate levels, because of the effect on intracellular folate metabolism. Combined deficiency usually results in both reduced serum vitamin B12 and serum folate levels.
False-positive vitamin B12 levels (low levels in the absence of deficiency) may occur in folate deficiency, pregnancy, multiple myeloma, and excessive vitamin C intake.

False-negative vitamin B12 levels (normal levels in the presence of deficiency) may occur in true deficiency, liver disease, lymphoma, autoimmune disease, and myeloproliferative disorders.
Autoantibody screen:
Intrinsic factor (IF) antibodies are virtually diagnostic of pernicious anaemia (PA). However, absence of IF antibodies does not exclude the diagnosis, as they are present in only 50% of people with PA (i.e. it has high specificity but low sensitivity).
Gastric parietal-cell antibodies are present in 85% of people with PA, but are also found in 310% of people who do not have PA (i.e. it has high sensitivity but low specificity).
Schilling test (radioactive vitamin B12 absorption study): to determine if malabsorption of vitamin B12 is occurring and whether it is due to PA or due to an intestinal lesion. People with PA show impaired absorption of vitamin B12, which can be corrected by giving IF. People with malabsorption because of an intestinal lesion do not respond to IF.
The Schilling test has many limitations, and the result often does not alter clinical management. /color]    

  This was taken direct from the PA forum, written by Marre.  The schilling Test is no longer done in this country

Do read as much as you can about all this, knowledge is power and you will be better able to persuade your doc along
the right route.  After all B12 is only a vitamin not a drug, it is cheap at about 2.75 per shot, it is in most cases effective,
and we dont ask for it just for the "high" as some docs think - sometimes it b***dy hurts.

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