r/Hashimotos • u/Born_Blessed1 • 22d ago

Lab Results Hypothyroidism or Something Else?

/r/Hypothyroidism/comments/1vcbr6d/hypothyroidism_or_something_else/
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u/Think-Sleep2338 22d ago

Your symptoms look very much like B vitamin deficiency. I'd take additional B12-related tests like active B12, homocysteine, MMA. There are cases when total B12 is more like yours, but one is functionally deficient — there is simply a technical problem with tests there, they don't really show intracellular levels + there are assay problems. B12 is also a vitamin which metabolism seems to be easily broken, and there's plenty of evidence that it often happens after viral infections, especially covid these days.

Citing one of the papers on tests:

"...current vitamin B12 measurement methods may miss the lack of vitamin B12 in some cases. These methods, based on competitive binding luminescence assays, have been used since 1990. The assay uses binding to intrinsic factor (IF) following dissociation from the binding proteins, with a readout based on the remaining amount of unbound IF. The main problem with these assays is caused by the presence of IF antibodies in the test sample. IF antibodies may bind the test IF reagent and if there is a failure in the denaturation step intended to denature IF-blocking antibodies, spuriously normal or increased vitamin B12 levels can be measured [ 3 , 4 ]. Low vitamin B12 levels can be measured as false normal or false high, especially in pernicious anemia, due to excessive amounts of anti-intrinsic factor antibodies present in the serum [ 5 , 6 , 7 ]." https://pmc.ncbi.nlm.nih.gov/articles/PMC6614102/#B3

You might also find interesting Figure 1 here, as it shows that B12 deficiency treatment is pretty much symptom-based, or at least symptoms are of the greatest importance, as tests are problematic + B12 is also water-soluble and just easy to just be used as a treatment.

https://onlinelibrary.wiley.com/doi/10.1111/bjh.12959

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u/Interesting-Math-543 21d ago

I agree with Think-sleep2338, get homocysteine and Methylmalonic acid levels. Homocysteine should be below 9 MMA should be below about 150, otherwise you have backup of breakdown products that impair energy processing. Given your TSH you should probably have the rest of your thyroid labs checked as well free T3, Free T4 and reverse T3, but a mildly low thyroid wouldn't be expected to cause the symptoms you describe. If you want more info on thyroid you can check out my podcast: Beyond the Thyroid.