2nd appointment at doctors to review blood results - don't know what to think?

[Piplysmelie]

I went to see my GP today it was supposedly to review some blood tests for things like Vit D after he diagnosed me Hypo nearly 4 weeks ago after i gave him these private blood results.

ENDOCRINOLOGY

THYROID STIMULATING HORMONE * 4.45 mIU/L 0.27 - 4.2

FREE THYROXINE 17.3 pmol/l 12.0 - 22.0

FREE T3. 3.7 pmol/L 3.1 - 6.8

D.H.E.A. Sulphate 2.8 umol/L 0.26 - 11.0

25 OH Vitamin D * 26 nmol/L 50 - 200

Interpretation of results:

Deficient <25 nmol/L

Insufficient 25 - 49 nmol/L

Normal Range 50 - 200 nmol/L ENDOCRINOLOGY

IMMUNOLOGY

THYROID ANTIBODIES .

Thyroglobulin Antibody 52.7 IU/mL 0-115(Negative)

Method used for Anti-Tg: Roche Modular

Thyroid Peroxidase Antibodies 11.5 IU/mL 0 - 34

Method used for Anti-TPO: Roche Modular .

He asked how I was, I said i had been feeling bit better, he seemed surprised and asked me why i felt better. I said i have put it down to the thyroxin. He said it was a very small dose so he was surprised I felt better. I said I did not say i was better but that I had felt a bit better i.e felt better in the mornings but tired in the afternoons still. He lead the conversation into a discussion about my depression!!! I said i was not depressed and had said so at our last appointment. He asked me how my concentration was I said yes I still found it difficult to concentrate. He nodded and proceeded to tell me why anti depressants would help me!!! i repeated i was not depressed and closed the conversation by asking about my blood results.

He went through them and said they were "normal" my husband who was with me said what about the red flag. Oh that that is normal.

Red Blood Cell (RBC) Count 4.89 (3.80 4.8010 *12/L)

He persisted on my behalf bless him, he said he noticed some of the levels are at the bottom of the ranges.

Plasma Feritin Level 21 (11 - 307.00 ug/l)

For this effrontery we were treated to a dialogue on it being normal for me so is normal and therefore is just normal, blar, blar, blar!

Full blood results

Plasma glucose level 4.7 (impaired fating 4.0 - 6.0)

Plasma Folate Level 14.2 (3.20 - 25.90ug/L

Serum Vitamin B12 408 ng/L (B12 > 160ng/L B12 deficiency excluded)

Plasma Feritin Level 21 (11 - 307.00 ug/l)

Liver Function test

Plasma total protein 73 (60.00 - 80.00g/L)

Plasma total biirubin Level 17 (0.00 - 20.00 umol/L)

Plasma ALT Level 9 (7.00 35.00 iu/L(37C))

Bone Proile

Plasma Calcium Level 2.51 mmol/L

Plasma corrected Calcium Level 2.46mmol/L (2.20 2.60mmol/L

Plasma albumin Level 43 g/L (35.00 - 50.00 ug/L)

Plasma alk phosphatse level 57 U/L (30.00 - 130.00 U/L)

Renal Profile

Plasma sodium level 137 (133.00 - 146.00 mmol/L)

Plasma urea Level 6.2 mmol/L (2.50 -7.80 mmol/L

Plasma creatinine Level 91 (53 -97 umol/L)

GFR calculated abbreviatd MDRD 58 mL/min/1.73m2

Full blood count

Hemoglobin estimation 145 g/L (120 -150)

Total white cell count 5.8 10*9/L (4.00 - 11.0010*9/L)

Platelet count 227 (150 - 400.00)

Neutrophil count 3.1 (2.00 7.5010*9/L)

Lymphocyte count 2.0 (1.50 - 4.0010*9/L)

Monocyte count 0.4 10*9/L (0.20 - 1.0010*9/L)

Eosinophil count 0.3 10*9/L (0.00 - 5.0010*9/L)

Basophil count 0.00 10*9/L (0.00 - 0.1010*9/L)

Red Blood Cell (RBC) Count 4.89 (3.80 4.8010 *12/L)

Packed Cell Volume 0.412 L/t (0.36 - 0.46L/t

Mean corpuscular volume (MCV) 84.3ft (80.00 - 100.00 fL)

Mean corpuscular haeolobin(MCH) 29.7pg (27.00 - 32.00pg)

Mean corpuscular Hb/ conc (MCHC) 3553 g/t (320.00 - 360.00 g/L)

Vitamin D was not back yet!!

I asked about a repeat prescription and blood test for thyroid function he said I needed to wait 6 weeks but he would give me a form. He lead the discussion into my sex hormone levels. I said I was waiting for them to settle down as the thyroixin and progesterone cream seemed to have affected them. He nodded sagely and said I definitely needed them done so would add them to the thyroid blood test. I said last time you wanted it done on day 21 he said on lets do it anyway to get a base line. My husband chipped in and insisted T3 was tested to check conversion he was given an irritated look but the doctor did add it to the form.

He closed by saying I needed to come back after the blood test as I may be on too much thyroxin so he would wait to give me the free perscription form!!!!!!!

I left with the distinct impression he wants to label me a depressed menopausal women and take me off thyroxin.

I feel totally let down and am now inclined to used hard won savings and go private or self treat.

May be he's right.... however I am freezing with it being 20 ouutside and sleep with two duvets. Is that from depression?

[greygoose]

Well, depression doesn't give you low T3, and yours is right at the bottom of the range! And that isn't 'normal' for anyone. No wonder you don't feel so good. What a load of claptrap they do sometimes talk. Whatever you do, don't start believing he's right. Continue to fight your corner and don't let him get away with it, because if he gets away with it with you, he'll try it on others! We have to stop them in their tracks!!!

Hugs, Grey

[greygoose in reply to greygoose]

Oh, meant to say, your feritin and DHEA are also too low!

[Piplysmelie in reply to greygoose]

Thanks for you reply Grey. I am just so glad for the support this web site provides, without it I am sure I would have been packed off with HRT and anti depressants by now.

I am going to get some help with my Feritin and DHEA thanks for spotting them.

Also thanks for the hugs much needed and appreciated :0)

[greygoose in reply to Piplysmelie]

Your more than welcome. I do hope you manage to get your GP sorted out soon!

[Jackie]

Hi Your FT3 is too low, T4 probably Ok. You need some T3 with the T4 if on it, on its own if not.The T3 helps all the symptoms and reduces the tSH. you need to start on 20mcg T3. split the dose, 12 hours apart. Retest, TSH, T 4 and FT3 in 6 weeks.You need a test for correted calcium ( usually called a bone test) it must always be in range, if very low, treatment with D and calcium, NICE favourite! If in range well, then just D as D makes the corrected calcium go up, the other Ca does not matter.does not matter.Any way re test 3 moths, it takes that long. D normally for life, occasional checks on both as can alter.Glucose fine, but worth also trying to have Hb1Ac test for diabetes, more accurate, can have similar symptoms to thyroid, autoimmune and hormonal.Iron ,as said, Spatone from Amazon preferred Endo option. You may even do better with slightly less T4 but definitely need T3, it is often needed to be near the top of range. Tests always essential to make sure it does not go over range, not good!You also need the other autoimmune test which is B12 + foliates, it needs to be high in range. If you see an Endo they will advise, If tell them self funding, you just pay for consultations, drugs anyway from GP on instruction ( safety) and tests NHS if asked. Make sure it is a good Endo though.

I hope this helps.

Jackie

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[Piplysmelie in reply to Jackie]

Hi Jackie

Thank you so much for your reply. I have decided to find an endo as I just don't feel confident enough to self treat. I just don't have the energy to keep fighting the GP and would rather concentrate on getting well. I thought I might need some T3 as well so thanks for that info.

In the meantime please can I just check:

Plasma corrected Calcium Level 2.46mmol/L (2.20 2.60mmol/L). - In range so treat with Vit D?

Plasma Folate Level 14.2 (3.20 - 25.90ug/L). Is this the folate test you mentioned?

Serum Vitamin B12 408 ng/L (B12 > 160ng/L B12 deficiency excluded). Needs to be high in range 800?

So I am supplementing Vit D, B12, Feritin/iron with spa tone.

Thanks

Pippa

[Jackie in reply to Piplysmelie]

Hi Yes ,you will need a referral but although common very complicated.Corrected calcium yes. if D at bottom or below range treat with D ,ideally under Endo ( hormonal0 on a script ( GP) because of repeat bloods. Foliates fine, B12 not bad but Endo may think you need it a little higher in range, autoimmune and hormonal I personally would leave the B12 at that until under a good Endo, D and iron/feritin definitely treat. iron especially needs to be well in range, GP will only treat if very low for a year!Endo will advise on all this and much more.

Best wishes,

Jackie

[Hidden]

Good evening,

You blood tests do reveal a few issues - but fortunately most are normal.

1. You are clearly in need of a vitamin D supplement. Vitamin D3 (colecalciferol) is the recommended preparation. You GP can prescribe this for you, common brands include Sunvit D3, Fultium D3 and Pro-D3. You results are on the borderline between insufficient and deficient. You will probably require between 150 000 and 300 000 units of vitamin D3 to normalise your levels, A low maintenance dose is then given to prevent recurrence.

The initial 'loading dose' to correct the deficiency can be given as daily or weekly doses. For example, if your doctor decided to prescribe a loading dose of 200 000 units, he might prescribe 1 x 20 000 unit capsule once weekly for 10 weeks, or 1 x 10 000 unit capsule once daily for 20 days. There is not enough evidence to say which is best. Anyway, after the deficiency has been corrected, a daily dose of around 800 units is usually adequate to prevent recurrence. Individual requirements may vary but this is a guide.

2. Feeling cold is a common symptom of hypothyroidism, but your blood results are not conclusive. Given that your TSH is elevated, a trial of levothyroxine is a good idea. Once your dose has been gradually increased to a level which produces a TSH of less than 2 and a free T4 of about 19 to 24, you should start to notice some benefit. T3 is almost never prescribed initially, but can be initiated by a specialist if your symptoms are not relieved by levothyroxine. It is uncommon for GPs to start treatment with T3, but they will continue to prescribe what your consultant has recommended. It makes sense to give levothyroxine a chance to work first because you might do very well on it. Your GP should retest your thyroid function after about six weeks of treatment and adjust the dose as appropriate. If you respond well to treatment and your TSH normalises, testing T3 will not provide much additional information. If you don't respond well, further tests may be needed. In most patients, levothyroxine increases T3 levels because T4 is converted to T3 in the body. It is thought that some patients have reduced conversion of T4 to T3... but this is presumably the exception, not the rule. If you continue to feel unwell even after your dose of levothyroxine has been optimised, ask your GP to refer you to a specialist for further assessment.

3. >Red Blood Cell (RBC) Count 4.89 (3.80 4.80 10 *12/L)

I am inclined to agree with your GP that this result is not significant. If it was, I would expect your other RBC indices to be abnormal - but they are not. If you decide to take an iron supplement, it might be worth repeating your full blood count and ferritin in a few months time.

4. >Plasma Ferritin Level 21 (11 - 307.00 ug/l)

Although your ferritin level is a bit on the low side, iron-deficiency anaemia is not present. Your haemoglobin, PCV (haemotocrit), MCH and MCHC are all within range. There is no need for your GP to prescribe a high dose iron supplement but you could buy a low dose iron supplement over the counter, or take a multivitamin with iron. High doses of iron frequently cause gastro-intestinal distress, but most people are able to tolerate low doses. Women tend to have lower ferritin levels than men due to menstrual blood loss. Once you have gone through the menopause, iron supplements are less likely to be needed.

I think someone mentioned Spa Tone. Spa Tone is a rather expensive way of taking iron! It is well tolerated due to the low dose of iron, but then again, other products containing such low doses also cause few adverse effects. Supermarket brands of iron tablets usually contain about 15 mg of elemental iron. A dose of 1-2 per day should be sufficient.

5. >Serum Vitamin B12 408 ng/L.

With a level of 408 ng/L there is little reason to think you are deficient in vitamin B12. Although your lab's normal range may be too low (160 or above), levels of above 350-400 should generally be fine.

Apparently, Japanese doctors believe that levels above 500 are optimal for neurological health. You can buy 50mcg cyanocobalamin tablets from a pharmacy (Cytacon brand or generic). These are often recommended for vegetarians/vegans because B12 comes from animal products. Excessive alcohol consumption and Coeliac disease are other cause of deficiency.

Pernicious anaemia is an autoimmune disease which prevents B12 from being absorbed from the gastro-intestinal tract. It can lead to severe deficiency. Replacement therapy is given by injection. Pernicious anaemia causes neurological symptoms, anaemia (low haemoglobin) and macrocytosis (mean red cell volume over 100 fL).

6. >GFR calculated abbreviated MDRD 58 mL/min/1.73m2,

An eGFR of 58 is suggestive of mild chronic renal (kidney) impairment. If you post your age, weight and height I can calculate your estimated creatinine clearance for you. This provides a measure of renal function. Your sex is also important, but you mentioned HRT so I assume you are female! To interpret this calculation, it would be helpful to know whether you have a large amount of muscle - this can affect the results.

Mild renal impairment doesn't usually cause any symptoms, but does mean that you need to be careful with certain medications. Do you have high blood pressure by any chance?

7. >He lead the discussion into my sex hormone levels...

This could be useful. Do let us know what the results are if you have the tests.

8. >He nodded and proceeded to tell me why anti depressants would help me!!! I repeated I was not depressed.

Did your doctor ask whether you had very low moods and/or loss of interest in your favourite activities? These are the core symptoms of depressive illness. Other symptoms such as fatigue and poor concentration are extremely common but your doctor should not attempt to diagnose depression in the absence of core symptoms.

Take care,

Bob

[Piplysmelie in reply to Hidden]

Hi Bob and thank you for post. I found it very helpful and informative.

In answer to some questions you asked

Thank you for saying you would work out my creatinine clearance I am 44, 5ft 3inches, 8st 5ibs. I am not very muscular, I have low blood pressure.

I have had some other bloods done, I am low on progesterone so am, supplementing.

PROGESTERONE 2.1 nmol/L

Ref Range:(Follicular 0.6 - 4.7)

Ref Range:(Periovulatory 2.4 - 9.4)

Ref Range:(Luteal 5.3 - 86.0)

TESTOSTERONE <0.4 nmol/L 0 - 1.8

Reference Ranges apply to adults

17-Beta OESTRADIOL 73 pmol/L

Ref Range Follicular 46 - 607 )

Ref Range Mid-cycle 315 - 1828)

Ref Range Luteal 161 - 774 )

D.H.E.A. Sulphate 2.8 umol/L 0.26 - 11.0

The doctor did ask me about my moods. I said I felt fine just tired. He asked about my interests I said what I like to do but found it difficult because I am so tired.

I found your comment about mild renal impairment a bit worrying so googled it. I read that it should be checked again as it may just be a one off. Do you think I should ask the doctor to retest it just to be certain.

Thanks again

[Hidden]

Hello, I just calculated your creatinine clearance using the Cockcroft and gault method. It was 58. I'll need to check it later because I'm using my mobile phone calculator! Anyway, it agrees with your lab's estimation of 58, using the mdrd formula. There's no urgency whatsoever, but I'd suggest a repeat u&es plus urinalysis at your gps using a 'dipstick' for protein etc. bob

[Hidden]

Hi Pippa,

Creatinine clearance is a measure of the kidney's ability to filter the blood. Creatinine is a waste product produced continuously by the body; it is removed from the blood by the kidneys. The estimated creatinine clearance is one of the most reliable measures of kidney function.

You have provided the following information to allow the calculation of creatinine clearance...

Plasma creatinine Level - 91 umol/L.

Female, age 44.

Weight 8 stones, 5 lb = 53 kg.

Height 5 ft 3 in = 1.6 metres.

BMI is therefore 20.7, which is fine.

Estimated BSA 1.54 m2.

Musculature: normal.

Your plasma creatinine is at the upper end of the normal range. Plasma creatinine on its own is a poor measure of renal function however - this is why creatinine clearance has to be calculated. Since your BMI is normal, we can use your actual body weight in the Cockcroft-Gault formula (ideal body weight for height is used in obese patients). It is helpful that your musculature is normal. Patients who are very muscular have elevated plasma creatinine, which can invalidate the calculation.

Creatinine clearance = [(140 – Age) × Weight in kg × Constant] / [serum creatinine in umol/L].

Constant = 1.23 for men; 1.04 for women.

So for you,

Creatinine clearance = [(140 – 44) × 53 × 1.04] / 91 = *58 ml/minute*. This is suggestive of mild renal impairment but it's not conclusive since it's based on a single measurement of plasma creatinine. So, ask your GP about possibly repeating your U&Es, 'dip' the urine for protein/blood/etc. A renal ultrasound is sometimes appropriate.

If you do turn out to have mild renal impairment, do not worry. It is extremely common. Most elderly people have some degree of impairment. It's less common at 44 but not rare by any means. It would not be expected to cause any symptoms. Recommendations are to monitor bloods, urine and BP every year. If you smoke, stop!

>I have had some other bloods done, I am low on progesterone so am, supplementing.

Which product are you using?

Take care,

Bob