Inside: Underactive thyroid and vit B12 deficiency. What are low B12 and thyroid symptoms? Also how much and what form of vit B12 to take to support the thyroid gland.

Vitamin B12 deficiency is very commonly associated with Thyroid disorders. Especially in autoimmune thyroid diseases like Hashimoto’s; the prevalence of vitamin B12 deficiency is very high. 

The worst part is that the symptoms of vitamin B12 deficiency can sometimes be easily missed, especially if you have low thyroid.

So as a functional medicine doctor for thyroid, for me it is very important to have a high index of suspicion and check vitamin B12 levels. 

 Consult Functional Medicine Doctor 

Underactive Thyroid and Vitamin B12 Deficiency 

Now the bigger question is why is vit. B12 deficiency so highly prevalent in thyroid patients.

There are various reasons for underactive thyroid and vitamin b12 deficiency can be dietary related. Also, certain people are at higher risk for Vit. B12 deficiency as compared to others.

Like vegetarians, vegans and elderly are all at higher risk for vit B12 deficiency, and if they have thyroid dysfunction, it increases the chances more.

Another big reason for people with thyroid disorders to have low Vitamin B12 levels is — antibodies against the parietal cells (which helps with Vitamin B12 absorption).

This condition is also called pernicious anemia. Where the body develops antibodies against the parietal cells and destroys them. Parietal cells secrete what is called intrinsic factor which is required for the absorption of it. B12 in our gut.

According to this study, the prevalence of Vitamin B12 deficiency in autoimmune thyroid patients was 28%, so it is not a rare phenomenon but very common one.

In another study, the prevalence of low vitamin B12 was 55% in patients with autoimmune thyroid disease.

The second study raised another important question that — a single test to check for Vitamin B12 levels in the blood might miss a lot of patients which might be deficient in vitamin B12 and not picked up by that test!

So to make sure the vitamin B12 deficiency in thyroid patients does not get undetected – as a functional medicine physician I suggest looking at different markers like MMA, homocysteine levels also in conjunction, in addition to B12 deficiency blood tests.

B12 and Thyroid Symptoms 

Upon discussion of B12 and Thyroid relation, most people will have this question — what are the symptoms of B12 deficiency in thyroid patients?

The huge problem is that the symptoms of B12 deficiency and low thyroid overlap, so it make the situation a little tricky to catch in the first place.

The most common symptoms of B12 deficiency are—

• Tiredness and fatigue
• Constipation
• Mood changes 
• Tingling or numbness in hands and feet

Interestingly the majority of these symptoms are also attributed to low thyroid.

So that’s the reason it becomes difficult to differentiate until we check for B12 deficiency.

The most concerning symptoms is the peripheral nerve damage that occurs because of B12 deficiency and that can easily be avoided with supplementation from B12, so again very important in thyroid patients to for deficiency of B12. 

Recommended Thyroid Supplement – Pure Encapsulation Liquid B12

Tests for VItamin B12 deficiency

Unfortunately, the blood tests that are ordered to check for vitamin B12 deficiency don’t give the true picture of functioning B12 in your system and can sometimes miss suboptimal B12 levels.

Vitamin B12 levels in the blood is often an inaccurate reflection of your vitamin B12 status in the body and also there are some concerns about the range that is being used in the labs which are very broad often from 200-900 ng/ml.

The broad range can miss the patients whose levels might be on the lower end of the spectrum and still have symptoms.

For a complete evaluation, functional medicine doctors recommend getting a combination of tests is the best way to check for vitamin B12 status.

The following test can be done by any standard lab and can help to evaluate your vitaminB12 status —

1. Vitamin B12 serum levels 
2. MMA levels 
3. Homocysteine levels. 

The way these tests are interpreted are very different and have to be carefully understood. I feel Vitamin B12 serum levels should be more than 300ng/ml and ideally above 400ng/ml.

MMA levels have to be understood carefully, as the high MMA levels indicate low vitamin B12 status, any MMA level above 300 nmol/l is concerning for me and reflect suboptimal vitamin B12. Homocysteine levels reflect the functioning status of Vit. B12 and we want these levels to be less than 10.

So based on these tests people can evaluate their Vit. B12 status and take supplementation accordingly.

 Consults with Dr. Gupta 

What kind of Vitamin B12 Supplement to Take and How Much

This is the Thyroid Supplement I suggest to my patients.

Now you got your blood work checked and it came back that you are vitamin B12 deficient, so how much and what form and which route to take vitamin B12.

Vitamin B12 comes in oral tablets, Intramuscular injections and also sublingual tablets.

The concern is that in thyroid patients there is a problem with Vitamin B12 absorption because of the antibodies against intrinsic factor as explained above.

So the oral route might not be the best way of supplementation for people with thyroid dysfunction.

For my patients with autoimmune thyroid conditions like Hashimoto’s, I recommend them sublingual or Intramuscular injection.

Both of them are good ways to get your Vitamin B12 levels up, in fact, a study was done which showed equal efficacy of sublingual as compared to injectable Vit. B12. I generally recommend sublingual 1000mcg of Vit. B12 daily.

Here’s the Vitamin B12 Supplement I suggest to my patients for Thyroid.

 Consult Dr. Gupta for Thyroid Dysfunction 

The injectable will have different dosages generally around 1000 mcg once a week initially for 1 month and then 1000mcg once a month. 

The prevalence of Vitamin B12 deficiency is higher in underactive thyroid patient especially Hashimoto’s.

Often low Vitamin B12 and thyroid symptoms are very similar, so clinically it makes it harder for physicians to diagnose B12 deficiency.

Consult a functional medicine physician, if you have a high index of suspicion for vitamin B12 deficiency with thyroid dysfunction. We do a comprehensive panel to check for Vitamin B12 and how to interpret these results is also important.

Suffering from a chronic disease like thyroid, gut problem, weight issues, autoimmune issues, etc... is not easy. Dr. Gupta is a certified Functional Medicine Physician and his personalized plans have helped thousands of people to reclaim their health back.

Now you can get virtual functional medicine consultation from anywhere in the country, especially if you live in Houston, Toledo, Northern Virginia, Los Angeles, NEW YORK & Miami.  Please click below to get started with a 15-minute free evaluation call with Dr. Gupta.

 Book your FREE Functional Medicine Evaluation Call 

Related Read —

Zinc For Thyroid Heath – The Best form of Zinc Supplement and Dosage?

Are these Supplements Hurting your Thyroid?

4 Toxins in Household Things that are Damaging your Thyroid

The 3 Step Program to Improve Brain Fog because of Thyroid Disorder

Can I take Levothyroxine with Coffee in the Morning?

Thyroid Irritable Bowel Syndrome

FAQ

1. Why is Vitamin B12 important for people with hypothyroidism?

Vitamin B12 is important for people suffering from hypothyroidism because it improves metabolism and prevents fatigue. It is also responsible for mitigating deficiency levels of red blood cells, which are highly effective in curing anaemia and alleviating fatigue levels. Hypothyroidism is a kind of condition that has a huge negative impact on the whole body's metabolism, so consuming vitamin B12 supplements will maintain proper functioning of the body and the brain. With comprehensive maintenance of myelin sheath, a protective layer around the nerves, vitamin B12 improves brain function, often disrupted because of malfunctioning of the pituitary thyroid gland. Vitamin B12 is also helpful for people suffering from autoimmune hypothyroid conditions like Hashimoto's. 

2. What is the recommended daily intake of Vitamin B12 for adults with hypothyroidism?

For adults who are suffering from hypothyroidism, the recommended regular intake of vitamin B12 falls in the range of 500-2000 mcg on daily basis for both men and women. For pregnant women,and for breastfeeding women, this number can be higher as they have more need. Among hypothyroid patients who are suffering from autoimmune conditions like Hashimoto's, they have a minimised level of stomach acid, impairing the vitamin B12 functioning capability of food absorption. Approximately 1000 to 2000 mcg per day, either orally or through injection, is prescribed for extreme deficiency of vitamin B12. However, without a doctor's consultation, vitamin B12 consumption is prohibited. For authentic medical advice, consult Dr Anshul Gupta, and under his medical supervision, you will receive the correct dosage. 

3. How does Vitamin B12 supplementation support thyroid medication? 

Vitamin B12 supplements do not have a negative interaction with thyroid medication levothyroxine. The indirect impact of vitamin B12 on the efficiency level of levothyroxine has led to the improvement of metabolism, cellular energy level, and nutrient proportion. Levothyroxine improves metabolic rate, but due to B12 deficiency, people suffer from anemia, leading to tiredness and weakness. Therefore, B12 supplement consumption can help in improving red blood cell count, complementing thyroid levels. Although there is no direct connection of vitamin B12 towards improving thyroid medication, B12 supports cellular function ability which helps in responding better functioning capability of T3 and T4 thyroid hormones. An additional factor is that vitamin B12 supplements do not hurt levothyroxine absorption, so they can be consumed at any time of day.

4. Can hypothyroidism affect the absorption of Vitamin B12? 

Hypothyroidism has an indirect effect on the absorption of vitamin B12. Due to hypothyroidism, digestive processes get slowed down, resulting in minimised nutrient absorption, including vitamin B12. Due to hypothyroidism, a small amount of stomach acid is produced, which is incompatible with vitamin B12 secretion from food. Individuals who are suffering from hypothyroidism, especially those who have an autoimmune condition called Hashimoto's thyroiditis, can develop severe anemia, another autoimmune condition restricting essential vitamin B12 absorption. Hypothyroidism has a strong impact on inadequate digestive systems, affecting gut health, resulting in impaired vitamin B12 absorption. So it should be considered that people who are going through hypothyroidism have a mandatory vitamin B12 deficiency until it is medically taken care of.

5. Is it necessary to combine Vitamin B12 with folic acid or other vitamins for optimal thyroid health?

It is not mandatory to combine vitamin B12 with folic acid (vitamin B9) or any other vitamins for optimal thyroid health unless a notable deficiency is present. But joint consumption of vitamin B12 and folic acid is beneficial for noteworthy thyroid improvement as it mitigates strong thyroid issues involving minimal energy production, slowing down metabolism, and dysfunction of the thyroid gland itself. Individuals who suffer from thyroid disorders frequently face problems while absorbing necessary nutrients. Therefore, taking vitamin B12 and vitamin B9 supplements helps in the fast absorption of the nutrients. It should be taken into consideration after checking vitamin B12 and folic acid levels under authentic medical supervision. 

6. Should people with autoimmune hypothyroidism (Hashimoto’s) take more Vitamin B12?

Additional consumption of vitamin B12 is often recommended for people who are suffering from Hashimoto's autoimmune condition, which occurs because of hypothyroidism. This is because Hashimoto's is often detected with severe B12 deficiency. Due to severe B12 deficiency, the digestive function of the body gets affected because it is unable to produce a sufficient amount of stomach acid, which is important for enzyme formation, leading to improper digestion. Further, the deficiency also leads to inflammatory guts, a severe, unfavorable situation for the individuals. Alongside this, another flaw of Hashimoto's autoimmune condition is that it lacks nutrient absorption, which also includes vitamin B12. However, additional consumption of vitamin B12 should be considered under authentic medical supervision.

Want to know your actual B12 levels? Book a consultation with Dr. Anshul Gupta to get tested and find the right plan for you.