Test Results Now In - Next Step?

[gareth83]

Finally managed to get a copy of the lab results which are as follows:

Quote Quote

Serum testosterone = 13.6 nmol/L

Free T4 = 13.6 pmol/L

Free T3 = 4.3 pmol/L

TSH = 0.62 mU/L

Serum folate = 3.8 ug/L (3.1-20)

Serum ferritin = 29microg/L (15-300)

Serum vitamin B12 = 680 ng/L (130-900)

Red blood cell distribution width = 13%

Basophil count = 0.1 10*9/L (0.00 - 0.10)

Haematocrit = 0.505

Lymphocyte count = 2 10*9/L (1.0 - 4.5)

White cell count = 6.1 10*9/L (4.0 - 11.0)

Red blood count = 5.32 10*12/L (4.5 - 6.0)

Platelet count = 252 10*9/L(150 - 400)

Neutrophil count = 3.5 10*9/L (1.7 - 7.5)

Monocyte count = 0.4 10*9/L (0.2 - 0.8)

Mean cell volume = 95 fL (80.0 - 100.0)

Mean cell haemoglobin = 29.3 pg

Haemoglobin estimation = 156 g/L (130 - 180)

Eosinophil count = 0.2 10*9/L (0.0 - 0.4)

All being described as 'normal' with no need for a follow up.

However I have already determined the following based on this table that the results are not 'optimal'.

Quote Quote

Test Lab Low Optimal Range Lab High

TSH 0.5 1.3-1.8 5.0

Free T4 0.8 1.2-1.3 1.8

Free T3 230 320-330 420

Free T3* 2.3 3.2-3.3 4.2

Thyroid Scale Overview

1. TSH is relatively low - indicative of an issue in conjunction with other symptoms

2. Free T3 is high - this would represent hyperthyroidism according to my book 'Stop The Thyroid Madness' although could indicate low cortisol with presence of hypothyroid symptoms but should also request antibody tests to rule out Hashimoto's or Graves Disease

3. Average daily temperature is low, currently ~97.4f which has however increased from ~96.8f. currently taking 2 Nutri Thyroid tablets a day. Clear indication of hypothyroidism

4. Average daily temperature not within 0.3f of each other over a 5 day period, indicative of adrenal issues

5. Vitmain B12 is not optimal. Need to increase to 800+ so will up my intake of B-Vitamins

6. Ferritin: Measures your levels of storage iron, which can be chronically low in hypothyroid patients. If your Ferritin result is less than 50, your levels are too low and can be causing problems…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. If you are in the 50's, you are scooting by. Optimally, females shoot for 70-90 at the minimum (Janie’s is 80 when her iron is good); men tend to be above 100 and optimally close to the 130's. Optimal Lab Values--how to interpret your results | Stop The Thyroid Madness

So therefore appear to be deficient in iron

7. Folate, lower end of scale. Again deficient from what is optimal

So it appears something is up as I've suggested all along.

Any other comments or opinions on the results?

I will be going back with my thoughts and requesting further tests and a referral, if there are no thyroid antibodies present I will request I be treated for hypothyroidism regardless. If they do not I will change doctors until I find one that will.

They are happy to dish out anti-depressants but are not looking at the real clinical presentation.

Requests for my next batch of tests so far will be:

Vitamin D test

Thyroid antibodies

24hr saliva test

Help appreciated as I really want to nail this this year before it drives me insane, I cannot feel like this I'm 29 not 92!

[helvella]

I really don't know what you are trying to do.

The optimal ranges table you quote need to be in the same units as the test you had done. Clearly not the case for FT4. You cannot simply lift figures from dr rind and use them on your results. At least, not meaningfully.

You need the reference ranges of the lab. For example, your FT4 of 13.6 could quite easily be be over-range or low-to-middle in range. FT3 ranges can vary a fair bit as well.

Rod

[Williamsmum]

i'm no expert on this stuff but many of the values are at the lower end of the lab's range. So i think you could feel better if you improve your iron/ b vitamin values for example.

I don't understand how the thyroid results (or other results) can't be compared to another range - isn't the point made by these doctors that the standard lab ranges, or the ranges quoted by the various endocrinologist groups, are wrong?

There is a similar issue with vitamin D levels - scientists/ some 'experts' are now saying that current RDA/ serum levels are much lower than they should be. This is over and above lab ranges - they're saying lab ranges are wrong.

Helvella - can you explain this? I've had trouble understanding my results because of this.

Thanks

Vicky

[helvella in reply to Williamsmum]

If you weigh someone, the scales can be calibrated to extraordinary accuracy. And allowances can be made for local variations in gravity and elevation. The physics is pretty much entirely understand, the engineering is readily available.

Therefore, if you wish, you can compare your weight to the weight of anyone else on the earth to within a tiny fraction of a gram.

But when you are dealing with lab tests for thyroid hormones, the tests simply do not have the required repeatability and accuracy, and have not been properly calibrated one to another. So, the numbers vary.

There have been all sorts of problems in the history of thyroid tests. For example, it was found that antibodies to TSH itself could result in massively higher measurements in TSH tests. So the next generation of test processes/kits tried to eliminate that problem. But, that also meant that the distribution of results changed - with values on average reducing.

For some medical tests, the results can be much more readily compared. These tend to be tests which have a simpler science, are performed more frequently, where effort has been put in to ensure they are calibrated one to another. Typically their ranges vary only very slightly.

When some expert says "TSH should be between x and y" they utterly fail to take into account the variation in lab reference ranges and cause much confusion. Possibly, at least sometimes, they expect their audience to understand the issues.

We really, really need the testing regimes to be tightened up and calibrated properly. But it is not going to happen today or tomorrow, so we need to live with what we have got.

For vitamin D, the issue does not seem to be the science of measurement, but the interpretation.

The RDA issues seem to be a matter of how best to treat - not one of measurement and testing in itself.

Rod

[Williamsmum]

Hi Rod

thanks for the explanation. So is there still a discrpancy between the ranges that the different endos believe to be correct - so if they all used the same lab would they still have different ranges? or don't we know? is there any way of comparing the experts' normal ranges?

is that why some treat on symptoms? or do some take the lab range and then deduct, eg 2, from the hypo cut-off and add a couple of basis points for hyper? (say lab range tsh is 0.5-4, might they decide their range is 0.7-2?)

thanks

Vicky

[helvella in reply to Williamsmum]

If they all used the same lab, then they would all use the same reference ranges.

Let us take a simple FT4 range of 10 to 20 (made up for simplicity).

One endo might be fairly happy at an FT4 value of 15 for one patient, but would be happier to see 18 for another. Or different endos might have different opinions - like anyone at 12 is on the way down - so some would start treatment there, other might wait until the patient hits 10. But these are all the usual issues of knowledge, experience and tailoring the interpretation to the symptoms, the patient, the circumstances.

If TSH, FT4, FT3, symptoms and background all point in the same direction, then whether the FT4 is 10, 11 or 12 is not a big deal - it is at the low end.

As I see it, anything outside the reference ranges is a big red flag that something is wrong, but simply being within the range is not sufficient.

Ironically, severe hypothyroidism seem more likely to be referred to an endo, and mild cases handled by GPs - though mild cases are more likely to have confusing and seemingly contradictory blood test results, whereas severe cases are very often cut and dried in terms of test results.

[gareth83]

It's not difficult to change the units from nmol to pmol etc, very easy to divide by 10 or multiply by 10. It's not like we are comparing metric to imperial, the results are the results and as williamsmum points out we are not interested in the reference ranges as these vary from one surgery to another. It is the values we are interested in and it is the values I have provided, in fact the reference ranges weren't even on the report for those results but lets just assume they are:

9.0 - 19.1 for Free T4

and

0.35 - 5.0 for TSH

These are what the ranges were for my results two years from the same lab. That doesn't however change the absolute values, and even if their is an inaccuracy it's going to be minimal. The issue is clear, my Free T3 is high with a relatively low Free T4

What I don't understand is why B-vitamins and iron is low? I consume lots of meat, fish eggs and take a strong B complex twice a day.

[Clarebear in reply to gareth83]

I'm really sorry but I disagree - they may well have had a new machine in the lab since your test two years ago, and this may have totally different ranges. I used to work in a vet surgery until recently, and they changed machine, and the lab ranges and test results totally changed afterwards.

[gareth83 in reply to Clarebear]

I agree they may be different, but we get a rough idea what the results are give or take a couple percent either way.

[helvella in reply to gareth83]

No - not give or take a couple of percent.

If you had a single sample analysed at two labs, then, at least for FT4, one could return a result of 7, another another of 13. And yet both show you at the bottom of range. Or one could return 12 the other 25 at both show you at top of range.

These reference range issues are absolutely NOT the slight skews seen when the lab looks at local populations. They are fundamental differences.

I have tried to explain.I shall now give up.

[gareth83 in reply to helvella]

I disagree one lab would differ as much as 13 from 7. That's almost 100% different.

Maybe 7 and 7.7 but never by as much as you have used in your example

[helvella in reply to gareth83]

I suggest you wander round a number of pathology handbooks available on the internet.

[gareth83 in reply to helvella]

you genuinely think that labs are that far different/out of calibration from one another?

I fully understand the reference ranges will differ due to the difference in population using the lab, but do not believe the actual values will differ by so much you state.

So could I also weigh 100kg in a Cardiff lab and 200kg in a London lab? Very unlikely so why do you think this would be the case with hormones? The unit of measurement for most is pmol/L or nmol/L. Regardless of lab the actual result will be within a few percent of one another.

Maybe you could provide clear examples where one person has been tested in two different labs on the same day and had widely differing values not just the ranges?

Let's just agree to disagree

[helvella in reply to gareth83]

I can show you a massively more extreme variation than that:

thyroiduk.healthunlocked.co...

[gareth83 in reply to helvella]

What a ridiculous example which you have cherry picked and poorly.

Summary of the full journal is that the patient had 'macro-TSH' and had widely varying TSH levels. It is also worth noting that the blood samples of the 4 tests were not taken at the same time from teh same blood sample. So for that reasoning alone your argument is flawed you are comparing the TSH at differing times and that is exactly what macro-TSH

I stand by my statement that the actual results will be the same regardless of what machine, what lab etc etc. Only the ranges will differ and that is skewed by the size of the sample not the individual.

[gareth83 in reply to gareth83]

^^^^give or take a few percent

[Clarebear in reply to gareth83]

You haven't responded to my earlier comment that the range in my lab for fT3 is 3.1-6,8, making your result of 4.3 low rather than high...

[gareth83 in reply to Clarebear]

ok so that would indicate hypothyroidism for sure?

[Clarebear in reply to gareth83]

It would depend on the range from your lab - please can you get hold of the actual ranges and post them here, then we will be able to tell more...

[gareth83 in reply to Clarebear]

TSH 0.62 (0.35 - 5.5)

FT4 13.6 (10 - 23)

FT3 4.3 (3.5 - 6.5)

So now I've provided the ranges what difference does that have? They are still 'normal' but not optimal such as:

TSH (1.3 - 1.8)

FT4 (12 - 13)

FT3 (3.2 - 3.3)

[gareth83]

Vicky, ignore the ranges as they are irrelevant. The ranges are formed from a bell shaped probability curve medical-dictionary.thefreed... so every lab will be different based on the patients it tests. If one lab tests more people with thyroid issues then the 'average' is going to be skewed.

We need to just look at the results and compare them relatively to one another not look at them compared to 'averages', read this for a good explanation:

drrind.com/therapies/thyroi...

I think Rod is confusing the matter, reference ranges are simply not needed to discuss my results. The reference ranges I would rather use are the 'optimal' ranges compiled by Dr Rind from experience on people he successfully treats as opposed to an 'average' of people getting blood tests.

[helvella in reply to gareth83]

You will also find that the TSH distribution curve is NOT a "normal", "Gaussian", bell-shaped distribution curve but something considerably more complicated.

That many medics treat the TSH distribution is if it were Gaussian may well be the case, but they are wrong to do so.

[lare73]

I'm confused...my ft4 result was 11.6 range 10-20, tsh 1.9 range 0.5-4.5. But your values are different Gareth? did you convert them? Sorry if I sound thick but I'm new to all this and easily confused. I clicked on the page and am totally lost now, I understand the concept of low optimum and high but how do I workout where my results sit in the graph?

[gareth83]

Well ideally you'd need your Free T3, this is pretty much the main hormone, but needs to be looked at relative. You would enter your values here:

drrind.com/forms/ts_diagram...

on the excel spreadsheet...

You would use TSH as 1.9 and Free T4 as 1.16 (I simply divided your reading by 10 so we are using the same scale)

You can see, once you have put this on the scale that your results appear to be pretty much optimal but could be messed up if your Free T3 is out....

So, get your Free T3 tested first then you look at them in relation to one another...

[lare73 in reply to gareth83]

So even though my t4 is lowest end of the labs range (10-20), using this tool I'm optimum? They didn't test my t3 ... I'm symptomatic and undiagnosed, and if this tool is right, my thyroid is not the cause. Back the drawing board

[gareth83 in reply to lare73]

It is meaningless without looking at your Free T3....

Have you been tracking your body's temperature? drrind.com/therapies/metabo... That would be your first port of call, it was only upon stumbling across that site a few weeks back things have started to make sense after almost 9yrs

[Clarebear in reply to lare73]

No - you are right - you need to look at your results in respect o your own lab range, and you look on the very low end of "normal" and certainly not optimal. Xx

[lare73]

My temp is between 35-36.5 never higher.

[CarolineAnne]

Hya

You really do need to be looking at your results in the context of the ranges that your lab provides. Janie from STTM has stated this many times.

For instance when I lived in Somerset the range for ft3 was 3.9-6.8 and ft4 was 11-26 ( my ft3 was 5.9 in this test but i have AI hypothyroidism) but when I moved to West midlands the range they use is ft3 2.1-6 and ft4 11.5-23.

They don't always put the ranges on the printout but you could ring your surgery and enquire perhaps?

Sometimes when Ft3 is higher in the range than ft4 it simply means that hormone is being asked for quickly by the body to keep up demand, as in Hypo it all slows down so in effect the body is trying its best to work in the face of a slowdown. I dont think it would indicate hyper unless it's over the range.

You are correct in that your Ferritin is woefully low. Gps won't take any notice though as you are in range. Supplementing will help especially with aches, depression and restlessness or ADHD symptoms/ brain fog.

You are wise to ask for an antibodies test and vitamin d -insist on one don't let them fob you off! ( my result was 6 and high dose supps for three months helped ) although they probably won't entertain the saliva cortisol test, but you can pay for that one yourself if need be.

Hope this helps

Good luck

Carolineanne x

[CarolineAnne]

Have just read your other post.

The actual value of your blood test is processed in relation to the lab reference range that a particular lab uses. So if you were to take your vial of blood to different labs the ft3 would not give a universal reading of 4.3 pmol/l in each lab you went to. It would be a different value. That is why in needs to be interpreted in context with its reference range.

CA

[Clarebear in reply to CarolineAnne]

Yes this is my understanding too - different machines are calibrated in different ways - so you do really need the reference range from your own lab in order to interpret your results

[gareth83 in reply to CarolineAnne]

It would give a reading of 4.3 or thereabouts in any lab countrywide. Dr Rind suggests one needs to look at the results relative to each other ie, look at Free T3 to Free T4 and TSH not just look at each one in isolation. A good summary is here:

If My Thyroid Labs Are ‘Normal’, Why Do I Feel So Bad?

When’s the last time you went to the doctor and gave a blood sample – that was then sent to a lab? Chances are that lab result came back ‘normal’. Too often, when interpreting lab values, the doctor looks for normal rather than optimal.

A comparison of values relative to each other yields a great deal of information that would be lost if the values were viewed independently of each other. For example, if the normal height for a man is between 5’3” and 6’ and normal weight is between 130 lbs and 200 lbs., scanning the results column of a lab or other report (for flagged abnormal values) would declare a man who is 5’3” tall weighing 200 lbs to be just as normal as a man 6’ tall weighing 135 lbs. Both are in the ‘normal’ range and therefore would be considered normal. In reality, however, simply looking at a short/obese man next to a tall/thin and a possibly undernourished man would suggest that the two are more than likely not in the same state of health.

Normal rather than Optimal. The frequently used term of ‘normal’ refers to a mathematical or statistical situation. Thus, a ‘normal’ state of health probably means you have some medical problems. It may be normal to die at 76 yrs of age, but at 75 years old, you may decide that what you really want is ‘optimal’ health as opposed to ‘normal’. Normal is not the same as optimal, whether it relates to longevity of life, a body temperature or a lab test result.

Thyroid levels are a critical component of determining the cause of low metabolic energy. The Thyroid Scale™ helps us compare thyroid lab values to each other and thus see their implications more clearly. It can be a line diagram or a table of lab values to visually depict how TSH, T4, and T3 relate to each other. It is an approximation. Nonetheless, as a clinical tool, it seems to be more informative than the alternative which is to call a lab value low, normal, or high. After using it several times, you will probably wonder how anyone can use a term like ‘normal’ to describe a relationship as complex as the one that exists between these hormones.

drrind.com/therapies/thyroi...

[AnthonyMs]

You're lucky to have had all these tests done, I've had to pay for everything privately..I don't understand why as the GP is well-aware of my sorry situation. From the looks of things, you're most likely not anemic despite your ferritin and folate being near the lower end of normality, your haemoglobin is good and you have higher haematocrit/red blood cell count than most men, although if you were dehydrated this would have artificially increased the values, every other red blood cell parameters looks normal/optimal and with that in mind I wonder what would be the purpose of raising your ferritin/folate? I don't know what else folate/ferritin levels effects? I don't know why you say your B12 is suboptimal, it looks higher than average.

[CarolineAnne in reply to AnthonyMs]

Hi there

Iron deficiency is not the same as anemia. Anemia is the last stage of iron deficiency which occurs after many functions are already impaired. Hemoglobin and hematocrit are vital tests for anemia but are late indicators for iron deficiency.

Ferritin is your total body iron storage. Low serum ferritin always identifies iron deficiency. But one problem identified is ferritin levels could be increased with inflammation, infection and liver damage. I have read recently on STTM about a more thorough iron test. Iron deficiency is extremely widespread and causes many symptoms before anemia shows up.

Symptoms of iron deficiency are breathlessness, fatigue, low body temp, irritability, depression, body aches, ADHD symptoms, brain fog, sore burning tongue, sores at corner of mouth, sore eyes, ankle swelling, heart palps on exertion, ridges on nails, cold feet and hands, headaches, headaches, poor wound healing, appetite loss, dizziness, constipation, night time leg cramps, asthma, sores on skin, itching, poor memory, cognitive function and impaired learning, listlessness and weakness, brittle or flat or spoon shaped nails, chronic bladder infections, impaired reactivity and co ordination.

But be aware of high iron levels being dangerous so make sure you test your levels before supplementing and get advice from your doctor.

[AnthonyMs in reply to CarolineAnne]

Thankyou. I always thought iron was only needed for haemoglobin purposes, but it apparently serves other functions, such as being stored in the myoglobin cells of the muscles to accept, store, transport and release oxygen and is needed for proper immune function. I thought that his ferritin levels weren't relevant because his haemoglobin estimation was normal/good which is what my own GP told me when I asked him if I was iron deficient, the GP only needed to look at haematology values to provide an affirmative answer on that question.

Yes you're right about the dangers of high iron levels, as well as thickening the blood increasing your risk of heart attack/stroke, higher than normal iron levels produce higher than normal levels of free radicals/cell oxydation, so you're healthy whilst having lower than normal iron levels then all the better.

[gareth83]

I still disagree with the ranges being significant in the fact they are different between labs. If you weigh 100kg on one weighing scale and 100.5kg in another you can still see one would be 100kg or thereabouts on any scale in the world.

The difference between labs is going to be minimal, regardless I have a high free t3

What would cause low iron storage? I eat plenty of meat, liver etc and have never been refused to give blood in the last 13yrs or so

[Clarebear in reply to gareth83]

The range at my lab for fT3 is 3.1-6.8, so your fT3 result of 4.3 (hope I've undrestood that correctly), appears to be quite low. I feel hypo with a fT3 under 5.8.

[CarolineAnne]

Being hypothyroid can result in having a lower production of stomach acid which leads to malabsorption thus resulting in lower iron levels. Hypo also lowers the body temperature which causes less red blood cells to be made. Thirdly, inflammation can lower iron levels. You may have chronic inflammation due to diet, ie: allergy to dairy or gluten in wheat.

Interestingly, Having low iron levels slows down the conversion of t4 to t3.

For the full picture, apparently you need ferritin, serum iron, TIBC and %saturation tests done at the same time.

For your information, Janie of STTM states that if your ft3 is mid range or lower in the presence of hypo symptoms - you may have hypothyroidism, no matter how low the TSH. In my opinion, without knowing the range of course I would say that your free t3 would be low to mid range not high.

Best wishes

Carolineanne x

[gareth83 in reply to CarolineAnne]

thanks for your response. would a gram of ferrous sulphate address the iron deficiency to start with?

what order should I tackle this?

[gareth83]

anyone?

[Hidden in reply to gareth83]

Gareth

'Bumping' does not work on this site as it will not move the question to the top of the question list.

Can I suggest if you have a new question you would like answered, you post it as such.

Louise