Could you help me understand and interpret these results please.

[sharonjarvis]

Hello all you lovely, knowledgeable helpful people on here.

I've just had my blood results back from Genova and I need some help interpreting them please.

I had the Thyroid-Plus blood test done as I wasn't receiving any help from my endoknob and was categorically told I would not get a FT3 or RT3 test on the NHS. I've got an appointment with another Endo (hopefully another endo as the last one told me all my symptoms were due to the grief of losing my brother 2 years ago!) so i'm hoping to be able to go in armed with some information.

My results are as follows:

T4 82.4 (58-154)

TSH 0.354 (0.4-4.0) Low

FT4 14.9 (10-22)

FT3 3.3 (2.8-6.5) Low

FT4:FT3 ratio 4.5 (2.0-4.5) High

RT3 0.34 (0.14-0.54)

TG 54.9 (0-40) High

TPO 240 (0-35) High

On the commentary it's stated probable Graves disease. I know I've got Hashimoto's and I have absolutely no Hyper symptoms and loads of Hypo symptoms so I'm a bit confused. Have they said Graves because my TSH is suppressed? I'm also wondering If my endo will even read it with the graves rather than the hashi's information. It's also said to consider selenium deficiency and/ or Wilson's syndrome. Anyone had any experience with either of these?

I'm supplementing with 5000mcg Methyl Vit B12, Vit B complete complex, Vit D3 400iu and just started supplementing selenium 200 mcg as all came back as very low but in normal range.

I really appreciate all the help, support and advice I've received on here. I wouldn't be able to do this without you all.xx

[sharonjarvis]

Apologies I should have stated that I'm taking 125mcg Levo and have done since April. I take it first thing in the morning and wait 2 hours before I eat and drink.

[HarryE]

I think the comments are automatically generated so will be based on the TSH I would think. But mine came on 2 sheets, so maybe just only show the doc the first sheet??

I'm not really sure how to advise you, but your ft3 & ft4 are pretty low. What's your ferritin,b12, folate etc like?

[HarryE in reply to HarryE]

Sorry, just realised you commented on most of these! Except ferritin, how's that?

[sharonjarvis in reply to HarryE]

Thanks for your feedback Harry. As with all my bloods Ferritin came back low at 47. I haven't started supplementing this yet as I'm thinking if I take any more pills I'll start rattling! I thought the same as you, to just take the 1st page with me. I'm not expecting much from the endoknob I think the blood tests were for myself more. If nothing comes of this next appointment I'll look at dosing myself with the T3.

[jimh111]

"On the commentary it's stated probable Graves disease". This is nonsense, I'd ask for your money back. It's unacceptable to give seriously wrong advice.

"consider selenium deficiency and/ or Wilson's syndrome". They shouldn't speculate on the results without taking note of medication. "Wilson's syndrome" is not a recognised disorder.

[sharonjarvis in reply to jimh111]

Thanks jimh for your feedback. I've left a message with Genova just asking for clarification but somehow I don't think I'll get a reply! I've never heard of wilsons syndrome so I was a bit confused. I just wanted the blood tests for myself and my peace of mind. Next test will be adrenals. Not sure if I'll go back to geneva though. I'll see if I get any replies from them.

[humanbean in reply to sharonjarvis]

I wouldn't rely on the comments of any lab about anything related to thyroid, and I'd be dubious about comments on any other results too. After all, many of their customers will be sick people that the NHS has let down. But the private lab doctors and biochemists haven't been trained differently from NHS doctors and biochemists, so the same rubbish is likely to get spouted about the results.

I trust Genova to give me valid results. But I wouldn't trust them or any other lab to do any interpretation of those results for me. I'll interpret them myself and also ask for feedback on forums like this one. Ultimately, the decision about what to believe about my own results (from private tests) is up to me and nobody else.

[sharonjarvis in reply to humanbean]

Thanks for the advice humanbean. I'm not paying to much attention to genova's comments. Although as I said on my original post I was confused as to why Graves rather than Hashi's. As I said I assume it's because of my suppressed TSH. The blood tests were really for me so I can see where I need to go to feel better (with or without my endoknob!) I didn't enjoy that appointment with the endoknob at all but it was positive in that it made me realise I'm the only person who's going to make myself feel better! (Everyone on this fantastic site will help, support and advise me as well)

[jimh111]

Wilson's syndrome is a theory that cellular conversion from T4 to T3 has become downregulated and that high doses of T3 can reset the mechanism. There is no evidence such a syndrome exists. This is a gross oversimplification as it can get very deep.

On reflection I've been a little harsh on Genova. They shouldn't speculate on disorders but to be honest they are no worse than all labs the NHS use, they also makes diagnoses without any knowledge or ever seeing the patient. The biochemists shouldn't be diagnosing the patient, that's the doctor's job after a full examination of the patient.

[sharonjarvis in reply to jimh111]

Totally agree with you about Genova diagnosing jimh. My doctors wonderful but she has no idea why I'm not feeling better and the endoknob told me all my symptoms were due to grief at losing my brother. How he could tell that less than 3 minutes into my first appointment I'll never know! When I did the blood tests I knew that Genova couldn't advise me afterwards and I was fine with that, upto the point where they said Graves.

[jimh111]

These numbers:

TSH 0.354 (0.4-4.0) Low

FT4 14.9 (10-22)

FT3 3.3 (2.8-6.5) Low

indicate a low output (TSH) from the pituitary. TSH tends to promote conversion from T4 to T3, so the low TSH explains why your fT3 is lowish. Your overall thyroid hormone level is low, usually with an fT4 of 14.9 you would get an fT3 of about say 4.7. As fT3 is about 4 or 5 times as potent as fT4 (as measured in the blood, not in tablet form) you are fairly low on hormone.

Sometimes severe stress or depression can lead to a lower TSH (via lower output from the hypothalamus) so your endocrinologist could have been right when he referred to the loss of your brother, EXCEPT this happened two years ago and you would have seen the same pattern in previous blood tests. Another possiblity, more likely, is that as you have high antibody levels your thyroid can swing from low to high output, gradually declining with occasional 'thyroid storms'. This can be treated by a regime called 'block and replace' but often things settle down naturally after 6 months or so. So, I'd see how it goes for a while.

As your TSH seems to be unnaturally low at the moment the best way to monitor your blood tests while taking levothyroxine is to just look at the fT4 figure. Most people on levothyroxine would do well with an fT4 around 20 on the 10-22 reference interval from this blood test. I wouldn't bother with too many private blood tests, just let the NHS do TSH and fT4 for now (you can try for fT3 but your doctor may be overruled). If you are having the occasional 'thyroid storm' your TSH will jump around unexpectedly.

I've found no problem having my porridge / cereals immediately after taking levothyroxine, as long as you're consistent it doesn't matter if absorption isn't perfect, it will be reflected in the blood test results. The most important thing is not to have coffee an hour either side of taking thyroid hormones. Coffee has a major effect on absorption. If you're at all worried just take the tablets at night.

Jim.