Proof it were needed

That my GP surgery is rubbish. They received my results on 13th May. I phoned for them today and they have an action note - Make appointment to see doctor. Have I received a call? Have I heck. Anyway, I had the blood test at 8.30am after not taking my 125 mcg levo for 2 nights. Results as follows:-

Full Blood Count

Total white blood count 8.1 10*9/L (4.0-13.0)

Haemoglobin Concentration 135 g/L (114-165.0)

Red Blood Cell 4.37 10*12/L (3.9-5.6)

Haematocrit 0.385 (0.35-0.47)

Mean cell volume 88.1 fL (73-100.0)

Mean cell haemoglobin level 30.9 pg (26.0-32.0)

Mean cell haemoglobin concentration ABOVE RANGE 351 g/L (300.0-350.0) - above high reference limit

Red blood cell distribution width 13.2 % (11.8-14.8)

Platelet count - observation 232 10*9/L (150-500)

Differential White Blood Count

Neutrophil count 4.7 10*9/L (1.5-8.5)

Lymphocyte count 2.6 10*9/L (1.5-4.5)

Monocyte count observation 0.6 10*9/L (0.2-0.8)

Eosinophil count - observation 0.2 10*9/L (0.0-0.5)

Basophil count 0.0 10*9/L (0.0-0.1)

Serum Vit D Level

Serum Calcium Level 2.37 mmol/L (2.2-2.6)

Corrected Serum Calcium level 2.27 mmol/L (2.2-2.6)

Serum inorganic phosphate level 0.92 mmol/L (0.8-1.5)

Vitamin D comment - Normal corrected serum calcium. Vitamin D Assay not indicated

Serum alkaline phosphatase level 87 iu/L (30.0-120.0)

Serum Albumin Level 45 g/L (35.0-50.0)

Liver function tests

Serum total Bilirubin level 6 umo/L (3.0-20.0)

Serum alanine aminotransferase level 16iu/L (0.0-40.0)

Thyroid function test

Serum TSH level below range 0.03 miu/L (0.25-4.0) - below reference limit.

Blood haematinic levels

Serum iron levels 18 umol/L (9.0-27.0)

Serum transferritin level 35 umol/L (23.0-43.0)

Serum ferritin level 48 ug/L (15.0-150.0)

Serum Vitamin B12 level 317 ng/L (150.0-99,999.0)

Serum folate level 13.8 ug/L (4.6-18.7)

Serum free T4 level 18 pmol/L 12.0-22.0 (Note - in primary hypothyroidism, the aim of thyroxine replacement should be to restore and maintain the TSH level within the reference range.)

Finally, (sorry, it's long!), I asked for thyroid antibodies. And T3. Neither have been done, with the comment from the haematology unit as follows ...

Error comment - Thyroid Abs no sample received.

Any comments you would have on the above please, as I am seeing the Endo tomorrow and I'm at a bit of a loss. This was on 125 mcg of Levo, and my symptoms were awful. Back pain, brain fog, muscle pain, hair loss, dry skin, weight gain, lack of energy, poor sleep, you name it, I've probably got it.

13 Replies

  • I'm surprised your lab didn't test FT3 as your TSH is suppressed. Your FT4 is up in the top 75% of range, which is good. You certainly don't look to be undermedicated. I don't understand the vitD result. Did they do it or not?

    Low iron, vitD and B12 can cause joint & muscle pain, fatigue and low mood and your B12 is low. I suspect Levothyroxine just isn't doing it for you. Ask your endo for T3 in addition to T4. I've found it very beneficial.

  • I agree, B12 probably needs to be supplemented, I've known this for a while, since the last test, but I didn't want to skew these results. I don't understand the Vit D result either. I'll see, but I have no confidence in the Endo as yet. Dr Rajeev Kumar at Bedford.

  • It seems that they won't do Vit D if the Calcium and Phosphate levels are "normal". Therefore I can't know if my Vit D is low or not. Neither can I know if I am converting to T3 because they won't test T3 if TSH/T4 are within range/suppressed. Grrrr!!!

    And he wasn't interested in my B12 at all even though I pointed out that it was low. Obviously just toeing the NHS/NICE line. He kept saying these are the guidelines we have to work within ...

  • it would be helpful if he'd advised whether or not to self supplement when results don't warrant prescription. Did he agree to prescribe T3?

    Have you asked your GP to test vitD? You may safely assume that your vitD is low, but how low will determine how much to supplement and for how long. Most of the population will be low as insufficient sun is available Oct-April and it will take well into the summer to convert sufficient VitD. If you supplement under 8,000iu daily it's unlikely you'll get vitD toxicity, but 4-5,000iu should boost you. B12 is a toughie. If you supplement you risk masking PA and will have to come off for several weeks before retesting. On the other hand, sublinguals can improve symptoms although they are unlikely to repair nerve damage. Hampster1 is the person to ask advice on B12.

  • No, he didn't advise that. He more or less suggested that using only T3 was dangerous for the heart and wouldn't countenance it.

    He said that results MUST be normal if the calcium and phosphate were normal. He also said that the labs won't test Vit D even if it is requested if the above is true. I don't think I have PA looking at the other bloods, although my husband says that my eyes do look somewhat pale.

    I think I may try the 4,000 iu Vit D and see if things improve. At least I'm allowed to continue on the levo that I was happy on at the beginning of all this palaver.

  • He could have considered T3+T4 combination, if he wasn't such an arrogant twat. Pm if you want a source for T3. You probably need 4/6 weeks on vitD to feel improvement.

  • Yes, he could, but if they won't test it then he wouldn't prescribe it because it couldn't be monitored! Ridiculous! I'll see how the vits go first, but thanks, I'll keep the T3 in mind.

  • Ferritin is way way below minimum halfway in its range which it needs to be in order to convert the t4 in levothyroxine into the T3 your cells are screaming for

    so thats the most likely cause along with major mineral and vitamin deficiencies that always seem to occur long before patients get diagnosed hypothyroid

    If you have Central/2ndary hypothyroid the lab should not go by tsh since it will always be almost zero and should do t3 to see if you are converting thyroxine ok

    sadly NHS cutbacks mean they choose to ignore possibility of central/2ndary hypothyroid

  • I think you're right - I'm interested to know what the Endo says tomorrow - suspect he will go along with the standard NHS "normal" line. Still not sure what the MCHC indicates.

  • the high MCHC does need proper investigation

    i think it might be connected with ?wilsons Disease need to refresh my memory

  • Thanks reallyfedup123. Once I've seen the endo I'll update.

  • Had a look at Wilson's disease, but I don't think it's that. I'll keep it in mind though, in case things don't improve. Had to laugh at the psychological symptoms though - think I have all of them!

  • Just looked it up a bit ...

    Test Results: What does a high MCHC test result mean?

    If your levels are too high (above the 33% average) then there’s a chance you’re suffering from macrocytic anemia.

    A deficiency in folic acid could lead to this. Also, liver disease, hereditary spherocytes and vitamin B12 deficiency are responsible for this type of result. Also burn victims show elevated MCHC.

    So .... there we have it. And my B12 results were more or less identical last time. So why hasn't the GP called me in yet?! Monkeys, the lot of them!

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