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Suggest Treatment For Low Vitamin B12 Levels

Posted on Mon, 16 Feb 2015

Question: Hi, My B12 level is 216 ( range 187 -883 pg/ml) . My doc has suggested Renerve plus injections, one injection after every 4 days for 8 injections. What b12 level should I expect after my course is completed. Also having this level (216) of b12 does it impact the Thyroid level...mine has inreased recently to 4.69 (range 0.40 to 4.00 miu/ml). I am having hypothyroid. I have been taking Thyroup 100 mg now on daily basis recently. My vitamin d is 33.80. Details are attached in the pdf. Also I am taking Vit D tablets of 60000IU on a 6 months course out of which I have completed 3 months.

Answered by Dr. Ajish TP (4 hours later)

Brief Answer:
B12 will be on the upper half of normal.

Detailed Answer:
Hi XXXXXX,

Welcome to HCM. I have gone through the question and understand your concerns.

The answers to your questions are

1. Your B12 is on lower side. Once started on injections the B12 will initially be above normal and then return to the higher half of normal.

2. B12 has no direct effect on hypothyroidism. One explanation of worsening TSH with low B12 is that if B12 deficiency is due to gastritis or malabsorption, this will also result in decreased absorption of thyroid hormone (Thyroup)

3. Vitamin D is on the lower side. Monthly replacement of 60,000 iu will be enough

Hope I have answered your questions. If you have any further queries I will be happy to help you.

Regards,

Dr Ajish TP [MD,DM]
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (18 hours later)

Dear sir, Many thanks for your reply. Can you pls let me know as I am a veggie what should I daily have to add Vit b12 in my diet as I have heard vegans generally face this problem of b12 deficiency.

Also does jogging/running help in reducing Thyroid TSH levels.

Can you pls advise me what diet ( and what should I avoid in my diet) I should follow as I am a Thyroid patient. I eat non-veg (chicken/fish) once or twice in a week. And I am a occasional drinker ( drink alcohol once or twice in a month)

Answered by Dr. Ajish TP (16 minutes later)

Brief Answer:
See detailed answer

Detailed Answer:
Hi XXXXXX,

Welcome back.
Good day. The answers to your questions are

1. Vegetarian diet for B12

Milk and milk products (cheese), fortified cereals & soya and eggs are good source of vitamin B12 (Though good sources are non vegetarian like shellfish, liver, fish, crab, red meat etc)

2. Diet in hypothyroidism. It depends on the cause of hypothyroidism

a, Hashimoto's or auto immune hypothyroidism : No diet modifications needed

b, Iodine deficiency hypothyroidism :

Have - iodised salt, milk (for vegetarians) and sea foods (for non vegetarians)
Avoid - goitrogens like cabbage, cauliflower, tapioca and millet

These two causes can be detected by presence or absence of anti thyroid peroxidase antibody.

Hope this will clear your queries

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (6 minutes later)

Thanks for your reply. This was very helpful. How can I detect the cause of my hypothyroidism?. Is there any blood test that I can conduct to detect the presence or absence of anti thyroid peroxidase antibody. Thank You again.

Answered by Dr. Ajish TP (7 hours later)

Brief Answer:
You can do antibody titres in blood

Detailed Answer:
Hi XXXXXXX,

Welcome back.

Hashimoto's disease is diagnosed by the presence of anti thyroid antibodies in blood. This is simple blood test. You can get a lab prescription for :

1. Anti thyroid peroxidase (TPO) or anti microsomal antibody
2. Anti thyroglobulin antibodies

If the blood levels of any of these two antibodies are high, the hypothyroidism is due to Hashimoto's.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (11 hours later)

Hi, Many thanks for your reply. Just a last query, should I do this test as I am having Hypothyroid from last 3 years now however my level has increased lately. Earlier I was having 75mg tablets and it was under control. However due to increase in hypothyroidism I am taking 100 mg daily. Pls advise. Thx

Answered by Dr. Ajish TP (1 hour later)

Brief Answer:
This test is not mandatory

Detailed Answer:
Hi XXXXXXX,

Welcome back.

For the treatment of hypothyroidism we just need thyroid function tests. The dose of thyroxine needed for replacement is adjusted based on thyroid function done every 3-6 months. Presence or absence of anti thyroid antibodies won't alter the treatment.

Anti thyroid antibodies are usually done:

1. When hypothyroidism is of short duration- to predict the prognosis.

For example in a newly detected hypothyroidism we do antibodies. If antibodies are positive hypothyroidism is probably permanent and progressive. So he need to be on continuous thyroid hormone replacement.

2. To advice dietary modifications

If antibodies are positive no diet modifications needed.

3. To predict the risk in family members

Auto immune (Hashimoto's) hypothyroidism runs in families. So other family members are at risk if antibodies are positive.

In your case you are having hypothyroidism of more than 2 years and you are on a good dose of thyroxine. So you are likely to have permanent hypothyroidism. You have to be on thyroxine replacement (probably life long) and no dietary modifications will affect the thyroid.

So doing an antibody won't really change the management.

Regards
Dr Ajish TP

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Above answer was peer-reviewed by : Dr. Vaishalee Punj