Lab results - help please

[Spanglysplash]

Here are my lab results that i've managed to get the doctors to print off.

Nov 2014:

TSH: 5.9 (0.35-6)

FT4: 11.3 (9-26)

FSH: 7

LH: 3 (follic 2-3, ovulat 5-21, luteal 2-8)

Oestradiol: 192

Testosterone: 0.5 (<1.8)

TPO: 39 (<35)

Which I was then prescribed 50mg of levothyroxine which progressively has made me feel more hypo. I started taking iron, selenium, magneasium, vit d3, methyl folate, vit c, multi Vit, b12, b complex, zinc, fish oil, ginseng (Korean and Panay) rhodelea rosea, licorice.

Feb 2015

TSH: 1.59 (0.35-6)

T4: 13.5 (9-26)

T3: 3.5 (2.8-7.1)

Prolactin: 274 (<501)

B12: 460 (191-663)

Folate: >20 (4.6-18.7)

Cortisol: 329 (150-720)

Gastric parietal cells: negative

TPO: 44

Tissue transglutaminase: 1 (<5)

I had stopped all medication and supplements for 7 days before having the blood tests taken below. 2 weeks prior to this I had changed from levothyroxine to Erfa (60mg) for 5 days which made me feel worse. By this point I was bedridden for 2 weeks.

March 2015

Urea and electrolytes -

Sodium: 141 (133-146)

Potassium: 4.2 (3.5-5.3)

Urea: 2.5 (2.5-7.8)

Creatinine: 71 (50-90)

Liver function test -

Total protein: 72 (60-80)

Albumin: 46 (35-50)

Bilirubin: 7 (4-20)

Akaline phosphatase: 36 (35-105)

ALT: 12 (5-38)

Bone-

Calcium: 2.28

Adjusted calcium: 2.16 (2.10-2.58)

Full blood count-

WBC: 5.12 x 10^9/l (4-11)

Rbc: 4.52 x 10^12/l (4.1-5.10)

Hb: 138 (120-150)

Hct: 0.417 l/l (0.36-0.46)

MCV: 92.3 (80-100)

MCHC: 331 (315-345)

Plt: 247 x 10^9/l (140-400)

Neut: 2.72 x 10^9/l (2-7)

Lymp: 1.76 x 10^9/l (1-3)

Mono: 0.35 x 10^9/l (0.2-1)

Eos: 0.27 x 10^9/l (0.02-0.5)

Baso: 0.02 x 10^9/l (0.01-0.1)

Lipids (fasting) -

Total cholesterol: 5.3

HDL: 1.4

Triglycerides: 0.6 (0.4-1.9)

Total chol:HDL ratio: 3.8

LDL Cholesterol: 3.6

TSH: 5.5 (0.35-6) the lab in their infinite wisdom decided not to test for T4 and T3 even though requested by my GP! Which means the money I've paid out on getting the reverse T3 done at the same time is now wasted which I'm so very mad about.

FSH: 2

LH: 1

B12: 401 (191-663)

Folate > 20 (4.6-18.7)

Iron: 32 (7-26)

Ferritin: 67 (10-150)

eGFR >60ml/min/1.73m2

Glucose 4.7 (3-5.6)

Selenium: 1.06 (0.9-1.7)

Transferrin: 2 (2-3.6)

Transferrin saturation: 64%

Zinc: 12.4 (11-24)

I also had a 24hr adrenal saliva test at this time (whilst bedridden)

Sample 1 post awakening: 9.6 (5.56-22.2)

Sample 2 (+4-5 hrs): 2.3 (2.45-8.12)

Sample 3 (+4-5hrs): 1.6 (1.54-5.56)

Sample 4 (prior to sleeping): 1.3 (1.17-3.18)

Sum of cortisol: 14.8

DHEA am sample: 0.11 (0.25-2.22)

DHEA pm sample: 0.17 (0.25-2.22)

DHEA mean: 0.14

DHEA:cortisol ratio: 0.95

I'm now getting a bit better, but still can't do much and will have bad days like today where I can't manage anything. I 'crash' a lot where I become very slow, total exhaustion and find it difficult to hold my head up let alone keep my eyes open these can last from hours to just 30 mins. I'm currently taking Erfa at 15mg a day for a week will be increasing it to 30mg in a few days according to the TPUK dosage advice for those sensitive to NDT.

If anybody could shed any light on these results it would be greatly appreciated, I need to get back on my feet as I'm currently off work.

Many thanks

[Clutter]

Spanglysplash, Without the TPO range it isn't possible to see whether your antibodies are positive or negative.

Your thyroid levels were improving on 50mcg Levothyroxine. TSH was a tad high for some people but a dose increase would have improved FT4 and FT3 and lowered TSH.

60mg Erfa is 1 grain which is bioactively equivalent to 75-100mcg Levothyroxine so you were possibly overmedicated or needed to acclimate to the T3. Usual advice is to start NDT at half a grain to see how you tolerate the T3 and to increase every two weeks by half a grain until symptoms resolve but to hold at 2 grains for 4 weeks and have FT4 and FT3 blood tests to check levels before increasing further. If you haven't had adverse effects on 1/4 grain you can increase dose now.

It's not necessary to leave more than 24 hours between last thyroid dose and blood draw. The point of testing is to see the normal circulating level of hormone in your serum. Leaving it a week means that most of the hormone will have washed out and your FT4 and FT3 will have dropped which is why your TSH rose to 5.5. Labs often don't test FT3 unless TSH is suppressed <0.04. I think you need to have FT3 and rT3 tested at the same time by the same lab to get an accurate rT3 ratio. I'd wait until you have been on a stable dose of Erfa for 3 months if you intend to check FT3/rT3 ratio again.

B12 <500 can cause neurological symptoms so most supplement until it is high in range. Supplement 1,000mcg sublingual lozenges, spray or patches and take a B complex vitamin to keep the other B vitamins balanced. Slightly elevated folate isn't a problem as excess is excreted in urine.

Iron is slightly elevated and ferritin is just below the optimal half way through range so no need to supplement. Retest iron in 6 months because high levels are not good.

[Spanglysplash in reply to Clutter]

Thank you for that info, very useful.