Would really appreciate some feedback on my most recent bloods before Endo app on Wed. Thanks in advance. *All input welcome*

[Bacatti]

I was diagnosed with 'florid' or 'rampant' Graves Disease in January 2012. I had a T4 of 47 and high antibodies for both TRAB and TPO. The private Endo that I saw said "hmm, I'm diagnosing Graves but we'll have to keep an eye on those TPO antibodies". I had no idea what he meant at the time.

I was treated with large doses of beta blockers and 60mg of Carbimazole for about a six months, then it was reduced to 20 and from there I gradually weaned it down and off it in Nov just gone. I did this in despair myself as my GP kept telling me my bloods were perfect despite debilitating fatigue and cognitive symptoms. Other than the first few months of treatment I have always had wildly mixed symptoms, basically hyper and hypo.

I have been med free since Nov 2013. I was unable to get out of bed for most of 2013 I was so unwell and oddly, when I discontinued the Carbimazole in Nov 2013 (a dose of 2.5mg) my TPO antibodies began to climb and seem to be continuing to do so. The TRAB seems fine. The GP finally conceded that I probably have Hashimotos now.

I left the practice as I had spent over a year pleading with her to please help me as she repeatedly told me my bloods were 'perfect' and suggested I was stressed and depressed. She was also incredibly difficult to get blood results from and said I was focusing on the bloods to try and find a reason for my symptoms. She had also advised that I just relax and let the Endos or the 'experts' as they are termed, do their job. (This is very worrying as my experience had been once you're within range you're treated regardless of how sick you are.) I have really found that the most stressful part of these conditions has been dealing with GPs and consultants. It is extraordinary stressful and if you try to advocate for yourself and push for treatment, like an American would demand, you get stonewalled and referred to 'psychological medicine'.

My symptoms are very swollen face and eyes, weakness in the voice, tingling in hands and feet, complete inability to concentrate or read, weight gain, chronic constipation, constant bladder irritation, fatigue, depression and feeling of general overwhelm, enlarging goitre and swelling in the neck, deafness in left ear upon waking, worsening asthma, worsening rhinitis/sinusitis and most depressingly worsening rosacea/rhinophyma on a very cold nose (Raynauds?)

...Cheery stuff eh!

Bloods Dec 13th 2013

T.S.H. 1.690 mU/L (0.2 - 4.0)

Anti Thyroid Peroxidase 13.5 IU/ml (<5.6 )

TSH Receptor Ab (TRAB) 1.1 IU/l (0.0 - 1.5)

Free T4 13.0 pmol/l ( 9 - 19 )

Free T3 4.5 pmol/l (2.6 - 5.7)

Glucose 5.2 mmol/l (2.5 - 5.5) Fasting

Investigation; Haematinics

VITAMIN B12 358 pg/ml (187 - 883)

Folic Acid *2.6 ng/ml (3.1- 20.5)

Ferritin 8 ng/ml (5 - 204)

FBC

RBC 4.41 x10^12/l ( 4.0 - 5.2 )

Haemoglobin 12.9 g/dl ( 11.5 - 16.5 )

Hct. 0.376 L/L ( 0.37 - 0.47 )

MCV 85.3 fl ( 80 - 100 )

MCH 29.2 pg ( 27 - 32 )

MCHC 34.2 g/dl ( 32 - 37 )

Platelet Count 342 X10^9/l ( 140 - 400 )

White Cell Count 4.8 x10^9/l ( 4.0 - 10.0 )

Neutrophils 2.69 x10^9/l ( 2.0 - 7.5 )

Lymphocytes 1.58 x10^9/l ( 1.0 - 3.0 )

Monocytes 0.34 x10^9/l ( 0.2 - 1.0 )

Eosinophils 0.14 x10^9/l ( 0.04 - 0.4 )

Basophils 0.05 x10^9/l ( < 0.2 )

Nucleated RBCs 0 /100 WBC

RDW 12.8 % CV ( 11.0 - 15 )

Investigation; Serum U/E

Sodium 137 mmol/l (136 - 145)

Potassium 4.4 mmol/l (3.5 - 5.1)

Chloride 105 mmol/l (98 - 107)

Urea 3.2 mmol/l (2.5 - 6.7) Age related

Creatinine 61 umol/l (50.4 - 98.1) Age related

Investigation; LFT

Protein 69 g/l (60 -82 )

Albumin 37 g/l (35 - 50)

Globulin 32 g/l

Bilirubin total 7 umol/l ( 3.4 - 20.5 )

Alk. Phos 90 IU/l (40 - 150) Age related

ALT (SGPT) 32 IU/l ( < 55 )

Gamma GT 17 IU/l (9 - 36 )

[Jackie]

Hi Make sure you take the ranges to the Endo, these are unusually low ranges As for results T4 and FT3 look slightly low, depends on how long you have been on treatment and if this test was 6 weeks after the last alteration in meds.With slightly more levo T4) your fT3 may come up a little. otherwise you will then need to look at if you need T3 too, now everyone does. It is essential that FT3 is never over range.

Glucose is in range but need watching, safer to go on the diabetic diet, best for thyroid anyway. The better diabetic test ( it is autoimmune and hormonal too) is Hb1Ac. i would try and have that done any way.

B123 and iron/ferritin an Endo would consider should both be treated, ask.this would help your FBC

U` and E`s kidney good There is another test that should have been done, the most important renal one is eGFR, not a range, over 60 OK.

LFT`s liver good.

You also need a vit D test, hormonal. If low a calcium test, corrected calcium. If that is in range treatment with D on a script, retest 4 months of both. This is also Endo.

I hope that helps,

Jackie

[Bacatti in reply to Jackie]

Thanks Jackie, I have amended the post above to include more info as it wasn't clear what I had been treated for. Thanks.

[Jackie in reply to Bacatti]

Hi That explains a lot. Graves you go between hypo and hyper, sometimes with Hashi too. Therefore vital to have thyroid tests and treat at that time,ie alters..You should certainly be under an Endo.Like all docs some good, some not. be sure you are seeing a good one or ask for a new referral at a different hospital.You will, obviously develop other autoimmune diseases too, just watch out for them, some treatable some not.

I hope that helps.

Jackie

[Bacatti]

Thanks RFU123, have amended the post above to include the missing info.

[nobodysdriving]

you vitamin B12 results are 'suspicious', it would be useful to do a homocysteine blood test and methylmalonic acid, if these are raised they will point to a b12 deficiency. Yes as pointed by someone else you need folate and iron.

you can find loads of info on pernicious anaemia society forum (often autoimmune conditions go hand in hand)

[LouiseRoberts]

VERY helpful and informative answers... Can't really add anything..

Good luck with your appointment, please let us know how it goes..

L

x

[karinad]

Feel for you I know how it feels to be ignored my every gp. I recently found out my ferritin was too low and have been taking ferrous fumarate for a month and havnt noticed any difference don't know if it will take longer. Difficult to take 3 x daily along with thyroid meds 2x daily 2-3 hours apart, making sure not with milk ect.

I would reccomended you make sure any vit b12 you take is methyclobalamin, as often this is not the form of b12 you will get from gp. You can buy it online. Really hope you start getting somewhere. X