Can someone explain my blood test results?

[elementofsurprise]

Google isn't helping - very difficult to find what the ranges are supposed to be. Plus what they will agree to treat in the UK .

I have symptoms, tiredness, confusion etc - not sure if just (longterm) MH issues and/or endometriosis issues though. Also bowel issues they are going to look into...

Anyway:

Serum TSH level (miu/L) - 2.64
Vit B12 (ng/L) - 412
Serum folate level (ng/ml) - 16.6
Serum ferritin level (ng/ml) - 39

These test results are 3 months old, only just got round to checking (tiredness, memory, confusion...!). Have been taking ferrous sulphate since the test as GP pointed that one out. I also take vit D over winter.

There's a whole load of other things they tested for but wasn't sure if others were relevant.

Can anyone tell me if these are normal?

In our area the ranges are:

TSH 0.5-5.5
B12 180-1000
Folate >4
Ferritin 25-300

Ideal results however would be TSH under about 2.5-3, B12 over 500, Ferritin over 70. Your folate looks great.

If it was my data I would personally start taking B12 supplements (I take these sublingual ones - the sublingual means you dissolve them under your tongue so they go straight into the bloodstream which bypasses any gut absorption issues), and keep on with the iron pills as your ferritin (iron stores) are fairly depleted.

What else did they test?

As a PP has already said, it’s helpful to have the reference ranges as these vary across the country. Where I live the range for TSH is 0.27-4.2 for example.

Anyway, here goes:

I think your TSH is too high – you’d expect it to be around 1 in a healthy person and about the same in a properly medicated person taking thyroxine. That suggests that your thyroid is starting to struggle, which might be because:

Vitamin B12 needs to be over 500 to avoid neurological issues and the PA Society would have it a lot higher. I endorse the use of sublingual supplements as a PP said.

Ferritin needs to be at least 70 and preferably mid-range to be optimal. I can’t tell you how much better I feel now mine is 257 instead of 16!

However, I would keep an eye on the thyroid and get it tested at least annually. It may be pretty much static, but if it’s going up year on year, you may have to take action.

Folate looks to be about mid-range so that should be OK.

Vitamin D is very important. Good levels will ease bone pain and protect against illness.

Also, the NICE guidelines recommend a TSH under 2 to conceive or maintain a pregnancy. I don’t know if this is relevant to you, but it’s worth bearing in mind.

Finally, I’m a historian, not a doctor, but I’ve been here.

If the nice guidelines suggest a TSH under 2, will the gp give meds if i was ttc? Im not, just seems weird.

how do I get my GP to give a shit? Why didnt he mention b12?

With a TSH of 2.64 I don't think you stand a cat in hell's chance of getting prescribed thyroxine to be perfectly frank, even if you may benefit from it! here are the NICE guidelines on hypothyroidism which state the criteria for diagnosis/prescription. My TSH had to rise above 10 before my GP was prepared to do anything about it, I was on my knees.

I'm not surprised they didn't mention B12. It is well into the range used in this country and wouldn't raise concern for a GP. For your own health however you will probably do better to improve it to optimal rather than just ok. The sublingual lozenges really do work. I bought them when my B12 was 162 (and GP still said probably wouldn't do injections as it was only "borderline"!). My B12 is about 900 these days, I take 1 pill a day, but do notice my levels start to decline if I stop taking them.

What else did they look into/test?

Sadly,mint may not be possible to get your GP to give a shit, but if you can sort out your vitamins and minerals yourself, you are likely to feel appreciably better, but you do need to keep an eye on your thyroid and yes, if you were TTC, there would be an argument for printing off the NICE guidelines, asking for another TSH test and pushing for treatment if it were over 2.

Your B12 would be generally accepted as satisfactory. It is well above the average (~300), hence why your doctor said it was satisfactory. The figure quoted above that a B12 of 500 is needed to avoid neurological issues is not widely accepted and I am unsure which study this has come from. A study of almost 1000 healthy subjects showed that approximately 87% of people have a B12 reading under 470 (Study referenced below).

Your ferritin is borderline low and replacement would seem sensible though if other iron studies were normal might not be required.

Your Folate is satisfactory.

Your symptoms do not seem consistent with vitamin D deficiency (it would not explain confusion). Your TSH levels are broadly satisfactory, however if the clinical picture was consistent with hypothyroidism it could be worth a trial of levothyroxine.

As you can see from the varied responses on this thread these tests do not give simple yes/no answers and diagnosis can not be made without assessment by a healthcare professional trained in history and examination - ie a doctor.

You would be best off returning to your GP and iif you disagree with them ask them to explain their rationale. Failing that, seek a second opinion.

If you choose to buy replacement vitamins, please let your doctor know whenever blood tests are taken in future as it will affect the results.

1. journals.cambridge.org/download.php?file=%2FPHN%2FPHN5_03%2FS1368980002000708a.pdf&code=04180e89a760a1199a01ec5fab104dcd

Btw MrsTweedie what were you doing/taking to manage to raise your ferritin so far and how long did it take? Mine is 27, which is apparently "fine" , but was 45 a year ago so going the wrong way! Am now 9 weeks pregnant so could do with boosting that before I get to birth etc...

Menopause meant the end of fourteen day periods. I raised it over four years with iron tablets from 16 to just over 100 Abd then my periods stopped.

Sorry, that's not going to help you.

thanks everyone. A lot to take in there but will re-read when mentally with it... thanks for explaining.

congrats spilttea

Ah fair enough, I'm only 30 so have probably got some years to go before I get permanent period relief! But it looks like it's reasonable to think that you can up ferritin by about 20 points a year on tablets at any rate. I've got some Solgar gentle iron that has no constipating side effects which is marvellous. Don't extra constipation & piles just at the moment thank you!

Good luck getting to the bottom of it all OP, it can take a while to pinpoint your problems, but do keep going back to your GP with a list of your symptoms and how it's affecting/restricting you and keep pushing for more checks until you get there and feel well again. I know how frustrating and miserable it is to feel permanently shit