so feed up ,help with blood results

[jayuk]

Hi Everyone

From being diagnoised 6 weeks ago with underactive thyroid and i still feel rubbish, energy zero, aches,

and random pains,the only way i can describe it is like when you first start to feel unwell and u get that

unwell feeling. Feeling so frustrated as i thought i would be feeling better by know. Im still off work and

there expecting me back when sick note runs out but if i feel like this i would'nt be able to cope ,

I have a full copy of my blood results that was done on 13 may, could you please have a look at them and

i would appreciate some advice would be good as i just feel like im losing a battle with doctor as i havent a clue what im talking about.. i will post my results in sections as theres alot

Values and Investigations (Latest Value)

HbAlc levi - IFCC standardised - 34 mmol/mol

(CMR3988) - Normal-No action

09-May-201 3

NON-DIABETIC 25 - 36 rnmol/rnol IFCC (equivalent to 4 5 — 5.5% DCCT)

GOOD Control: <49 mmol/mol IFCC (equivalent to 6.5% or less DCCT)

BORDERLINE: 49 - 64 rnrnol/mol IFCC (equivalent to 6. 6 — 8.0% DCCT)

POOR control: >64 rnrnol/mol IFCC (equivalent to 8.1%. or above DCCT) /2012

NB: only IFCC values (rnmol/mol) reported from 20/01/12

! Thyroid function test - (CMR3988) -

Keep appointment already made

Results consistent with hypothyroidism.

Treatment with Thyroxine is recommended.

! Serum TSH level 21.59 mu/L 0.35 - 5.OOmu/L

Serum free T4 10 pmol/L 9.00 – 19.00 pmol/L

! Bl2/folate level - (CMR3988) - Keep appointment already made

Serum Folate is reduced.

Exclude reduced folate intake, increased demand or malabsorption

Serum vitamin B12 218 ng/L 187.00 – 883.00ng/L

! Serum folate 3.0ng/L 3.10 – 20.50ng/L

[jayuk]

! Serum lipids - (CMB3988) - Keep appointment already made

Lipids & HDL

-Primary prevention treatment decisions should be based on overall cardiovascular risk . Secondary prevention optimal treatment target is total. Cholesterol <4 mmol/L and LDL-Cholesterol <2 rnmol/L.

Audit treatment target is TC <5 mmol/L & LDL-C <3 mmol/L.

! Serum cholesterol 5.4 mmollL <5.OOmmoIIL

! Serum triglycerides 2.1 mmoIIL <1 .7OmmolIL

Serum HDL cholesterol level 1.3 mmol/L >1 .2Ommol/L

! Serum LOL cholesterol level 3.1 mmollL <3.OOmmolIL

Total cholesterol:HDL ratio 4.2

! GFR calculated abbreviatd MDRD

79 mLlmin/1 73sq.m >90.00mL/minhl .73sq.m

(CMB3988) - Keep appointment already made

The eGFRmay be used as a guide for dosage adjustment of medicines BNF) . (see appendix 3 current BNF ). However for renally toxic drugs,

patients at extremes of weight or in acutely unstable renal dysfunction,specialist advice should be sought from pharmacy or renal physician

GFR estimates between 60 and 89 do not indicate CKD unless there is other laboratory/clinical evidence of disease.

GFR estimate only valid for white Caucasians:-

--multiply GFR value by 1.212 for African-Caribbean patients.

eGFR not validated in children or pregnancy (see CKD guidelines)

Liver function test - (CMB3988) - Normal-No action

N.B. Albumin method change from 27/02/13. Ref.range unaffected.

Serum total protein 69g/L 60.00 - 80.00 g/L

Serum albumin 37 gL 35.00 – 50.00g/L

Serum globulin 32 g/L 21.00 – 38.00g/L

Serum total bilirubin level 9 umol/L <20.00 – 130.00iu/L

Serum alkaline phosphatise 68 iu/L 30.00 – 130.00iu/L

Serum ALT level 11 iu/L <55.00iu/L

Urea and elestrolytes - - (CMB3988) Normal-No action

Serum sodium 141mmol/L 132.00 – 144.00mmol/L

Serum potassium 4.4 mmol/L 3.50 – 5.30mmol/L

Serum urea level 4.2mmol/L 2.50 – 7.80mmol/L

Serum creatinine 71umol/L 40.00 – 90.00umol/

Plasma fasting glucose level - (CMB3988)- 5.4 mmol/L 3.00 – 6.00mmol/L

Normal-No action

FOR THE DIAGNOSIS OF MELLITUS:

Random Glucose >11.0 mmol/L diagnostic of DM,if confirmed by repeat

FastingGlucose >6.9 mmol/L diagnostic of DM,if confirmed by repeat

Fastingglucose >6.9mmol/L diagnostic of DM,if confirmed by repeat

Fasting or Random Glucose <6.0 mmol/L considered to exclude DM

Full Blood Count – FBC – (CMB3988)-

Normal-No action

Total white cell count 7.8 10*9/L 4.00 – 11.0010*9/L

Red blood cell (RBC) count 4.72 10*12/L 3.80 – 5.8010*12/L

Haemoglobin estimation 131 g/L 115.00 – 165.00g/L

Haematocrit 0.412 1/1 0.37 – 0.471/1

Mean corpuscular volume (MCV) 87 fL 80.00 – 97.00fL

Mean corpusc haemoglobin (MCH) 28pg 27.00 – 32.00pg

Red blood cell distribute width 14% 11.00 – 15.00%

Platelet count 221 10*9/L 150.00 – 400.0010*9/L

Neutrophil count 4.64 10*9/L 2.00 – 7.5010*9/L

Lymphocyte count 2.41 10*9/L 1.50 – 0.4010*9/L

Monocyte count 0.41 10*9/L 0.20 – 0.8010*9/L

Eosinophil count 0.25 10*9/L 0.00 – 0.4010*9/L

Basophil count 0.07 10*9/L 0.00 – 0.1010*9/L

Nucleated red blood cell count 0.0 10*9/L

[Hidden]

Hi there,

Although there are a few mild abnormalities, the most abnormal result by far is your TSH level of 21. When combined with your symptoms and free T4 level of 10, this allows your doctor to diagnose an underactive thyroid gland (hypothyroidism). Your doctor will probably already have started levothyroxine tablets.

Your serum folate is low, suggesting possible deficiency of this vitamin (or recent lack of folic acid in your diet). Your doctor may give you a supplement, but this is not urgent since your full blood count results are normal. Your B12 level is also rather low.

May I ask your age, and what sort of diet you eat?

It often takes quite a few dosage adjustments of levothyroxine before you feel well again.

Bob.

[jayuk]

hi Bob thanks for replying im currently on 50 mg of levo and also 5mg daily of folic acid, im 41 and my diet could be better but have 3 meals a day,main meals are chicken with maybe stir fry and oven chips but not every day. I must admit i dont have a lot of fruit, and my bad side is i love crisps but havent had a pack in a week :(. I did have a banana today so thats a start and did enjoy it . I had another lot of bloods done morning and this evening missed a phone call from doctor,she has my results and wants me to ring her in the morning,cant believe they are back that quick.

[Hidden]

Hi Jayuk,

As Bob has said your hypothyroidism is the main issue identified by the above blood tests. Do you know if your doctor has checked for thyroid antibodies? If these are present that would indicate Hashimoto's, which is the autoimmune version of the condition.

Also as Bob has said, your B12 and folate are very very low - enough for you to be symptomatic. It is possible to be symptomatic of B12 deficiency in the absence of anaemia, I will put a link to symptoms here but be aware that there is a lot of crossover between hypo symptoms:

pernicious-anaemia-society....

Pernicious anaemia (B12 deficiency) often comes hand in hand with hypothyroidism, so it is worth asking your doctor to screen for this given your levels. The tests your doctor could do are:

- antibodies against parietal cells

- antibodies against intrinsic factor

The active B12 test is also a better measure of B12 status than the serum B12 test, but this is not available from the NHS. You can have this test done at St Thomas' in London, all you need is a referral letter from your GP. Some info below:

thyroiduk.org.uk/tuk/testin...

The best way of increasing B12 levels is through B12 injections - the standard treatment is a loading dose of 6 injections over 2 weeks, followed by a maintenance jab every 2 to 3 months for life (depending on the underlying cause of the deficiency). You should also be prescribed 5mg folic acid by your doctor to get your folate levels up, this strength is not available over the counter.

One more thing, your doctor really needs to check your ferritin/iron levels. If you have a co-existing iron anaemia this could "normalise" your full blood count results, masking both the B12/folate deficiency and the iron anaemia.

If you want any more links on this let me know, I don't want to bombard you with too much info!

Hampster

[Hidden]

Apologies - I've just noticed you have been given the folic acid already. I would urge you to try and get further B12 testing as discussed above, given your current low serum B12 levels. And of course check the iron/ferritin.

H

[jayuk]

Hi hamster

thankyou for your reply , i spoke to doctor this morning as i had blood tests yesterday and she said i have a B12 deficiency my levels are at 149 my TSH levels have gone down to 7.49 and T4 is 13, when talking she said my folate levels are back up now, she has booked me in with nurse tomorrow to retest my blood as she wants to see if the B12 levels are different,to be honest i think she is puzzled too as to whats going on, she said on phone she is referring me to hospital as she feel i my get more help. I think that she doesnt know whats going on and feel as i respect her as a doctor i dont want to challange her and the way my mind is at the moment i could'nt argue my point as dont feel confident. I will write still down and try and arm myself and see what she says..

Im going to read the links you have put in as this seems interesting ,i feel like a frustrated jigsaw and wnat to be feeling better. I really appreciate your support. a big thankyou

[Hidden in reply to jayuk]

Well you are officially B12 deficient, I don't know why she isn't starting you on treatment? Frankly a retest is just a waste of time. B12 and folate work closely together in the body so what's probably happened is because your folate level went up with the folic acid supplementation, your B12 level went down as it was utilised by the folate. I'm not really explaining this very well! Please bear in mind that you will probably need to keep taking some folic acid when you start on B12 jabs for this reason.

Make sure whomever you see at the hospital does run those antibody tests for both Pernicious Anaemia (parietal cells/intrinsic factor) and thyroid antibodies. And don't forget to ask for iron/ferritin tests and vitamin D as well if you can.

I'm going to give you some additional B12 links.

This is the Patient UK professional reference article:

patient.co.uk/doctor/Pernic...

I've already mentioned the Pernicious Anaemia Society, you can read around their website for free, although you need to be a member for some of it:

pernicious-anaemia-society....

This is a charity also campaigning for better diagnosis and treatment of PA:

b12d.org/

And there are 2 books on this subject:

1) Pernicious Anaemia: The Forgotten Disease

2) Could It Be B12?

With regard to getting a proper thyroid diagnosis and treatment, the Thyroid UK links are very good:

thyroiduk.org.uk/tuk/diagno...

thyroiduk.org.uk/tuk/diagno...

Do you know how soon before you see someone at the hospital? I know you don't want to question your GP, but she should really have started you on that B12 treatment...

Take care, H x

[jayuk]

forgot to mention no anitbodies test have been done.

[jayuk]

Thanks for rely hamster, to be honest i dont know why she questioning my B12 levels and i might try and see if i can ring her before going for blood tests and seeing if i can have these test done. Im not sure how long its going to be for a hospital appointment, theres a few other things that are going on,i seem to have slight fuild in legs and ankle more on right than left leg if im not on feet all the time they seem to be slightly swollen but when i was working my ankles more right leg would also swell up, i also have small blood spot dotted around and on arms they look more like a rash, both symptoms ive had for over 12mths. I never went doctors with them as with working didnt get time but as i have been more unwell the doctor has had everything pushed at her at once. I know she is concerned as 2 weeks ago see rang me a 8.30pm and said i need to go into hospital straight away she even came to my house to past me some notes for hospital as she thought i might have brain tumor all results came back fine and headaches are not as bad now. I seem to find im worrying about work as occy health have said they expect me to be back in work when my next sicknote runs out as they said my levels shoud be back to normal. I work for ppl with adult learning disablites and the way i feel at the moment i wouldnt be able to support anyone as i think they would be supporting me lol.

[Hidden in reply to jayuk]

Sounds like you've had a really tough time, I'm not hypo (I have Graves - hyper), but I'm guessing the fluid retention and rash could be a hypo symptom or a linked condition (things like psoriasis, ezcema, and maybe lupus come to mind)? It's going to be a case of unravelling the puzzle one step at a time, and it could be a slow process. You need to hang in there, and make sure you get copies of every test you have done.