Test printout

[MrsRaven]

Hi all. I have just got hold of my test printout for the last bloods I had done. I did ask for the last two lots, but that was all I got. I had sn appointmeng with the endo, for the rnd of Octobet, but that has been brought forward to Thursday next. I am having a short Syacthen test to check my cortisol reserves.

Some of the test results go over my head, some I understand. I will put them up as they appear, with ranges where appropriate. Some are printed in bold, with an exclamation mark. I cant do bold, but the exclamation mark should be clear enough. Here goes.

! Full blood count -FBC - (ALD238) mild anaemia

Total white cell count 7.03 10*9/L 4.20 - 10.8010*9/L

Red blood cell count. 4.01 10*12/L 3.90 - 5.6010*12/L

! Haemoglobin est. 117 g/L 120.00 - 160.00 g/L

Haematocrit 0.365. 0.36 - 0.46

Platelet count. 261 10*9/L 150.00- 400.00 10*9/L

MCV 91.0 fL 82.00 - 104.00 fL

MCH. 29.2 pg. 27.00 - 32.00 pg

MCH 321 gL. 320 - 360.00 gL

Red blood cell distribution width

13.4 11.50 - 16.00

Neutrophil count 4.48 10*9/L 2.00 - 7.5010*9/L

Lymphocyte count. 1.81 10*9/L. 1.50 - 3.5010*9/L

Monocyte count. 0.42 10*9/L. 0.20 - 0910*9/L

Eosinophil count. 0.15 10*9/L. 0.02 - 0.5010*9/L

! Basophil count 0.01 10*9/L. 0.02 - 0.1010*9L

Large stained cells 0.16 10*9L. 0.00 - 0.1610*9/L

Serum free T4 - (ALD238) - satisfactory, 13.8 pmol/L

No action

(Note change to provisional range as of 19/01/12

New provisional range 7.2 - 20.0 pmol/l

Serum Vit B 12 - (ALD238) - task note sent

250 ng/L 120 - 625.00 ng/L

Serum prolactin level -(ALD238) - 181 miu/l

Satisfsctory. No action

Female 50y 71-566 mui/l

Serum folate satisfsctory, no action 9.5 ug/L

Serum ferritin

satisfactory, no action 78 ug/L 11.00 - 307.00 ug/L

Serum free T3 satusfactory, no action 4.3 pmol/L 3.80 - 6.00 pmol

Serum cortisol normal, no action 234 nmol/L

Provisional ranges

0.700hr - 1000hr 185 - 632 nmol

1600hr - 2000hr 276 nmol/l

! Serum TSH level overreplaced as before

0.06 mu/l. 0.34 - 5.60 mu/l

Please analyse fot - (ALD238) - await paper report.

ANCA

Please return report to Immunology, Musgrove Park Hospital.

Se thyroid petoxidase Ab conc

Satusfactory, no action 1.0 IU/ml - 0.00 - 8.00IU/ ml

Serum magnesium no action

0.8 mmol/L 0.70 - 1.00 mmol

! Serum Urea abd electrolytes no action

Serum sodium. 142 mmol/L 136.00 - 145.00mmol/L

Serum potassium 4.2 mmol/L. 3.50 - 5.00 mmol/L

! Serum urea level. 8.8 mmol/L 2.50 - 6.60 mmol/L

Serum creatinine. 73 umol/L. 50.00 - 100.00 umol/L

Liver function satisfactory, no action

! Serum bilirubin level 4 umol/L. 5.00 - 17.00 umol/L

Serun alkaline phosphatase. 77 u/L. 25.00 - 110.00 u/L

Serum albumen 4- g/L. 35.00 - 50.00 g/L

There you have it. If anybody can make any sense of it zi'd live to know. I sm absolutely hanging this evening, and was struggling towards the end. If there's anything that doesnt make sense, I'll recheck.

Thanks everybody x

[MrsRaven]

Spotted a mistake already. The second MCH result should be MCHC

[Clutter]

MrsRaven,

Thyroid peroxidase antibody 1 is negative for autoimmune thyroid disease (Hashimoto's).

TSH 0.06 is below the ref range so the lab has commented you are over replaced. FT4 13.8 is just over halfway through range and FT3 4.3 is low within range. If you were over replaced FT4 and FT3 would be high.

The lab's indicated you have mild anaemia which may be B12, folate or iron anaemia. Folate looks good so I think that can be ruled out.

B12 250 is very low, optimal is 1,000. Supplement 5,000mcg methylcobalamin sublingual lozenges, spray or patches for 6-8 weeks to raise levels then reduce to 1,000mcg maintenance dose. Take a B Complex vitamin to keep the other B vits balanced.

Ferritin 78 is adequate but halfway through range is optimal. You might want to supplement Ferrous Fumarate iron taken with 500-1,000mcg vitamin C to aid absorption. Take iron 4 hours away from Levothyroxine and retest 4-6 months after supplementing.

This link explains what the ANCA antibody test awaiting report is for labtestsonline.org.uk/under...

! flags up results below or over the range. One off flagged results aren't usually significant unless other results within the group are also abnormal.

This link will indicate what the causes of high/low full blood count may be. labtestsonline.org/understa...

If you Google "serum urea high", "serum bilirubin low" etc. for flagged results you'll get hits for relevant links. The other results are within range (normal).

[MrsRaven in reply to Clutter]

Hi,

Thanks for the assessment Clutter.

I could see that my TSH was out of range, and that free T3 is low. I did ask for the results of the original blood test she was looking at but didnt get them.

She only commented that I have got T3 in my blood. She wanted to lower my Levothyroxine, but I have read before on this forum what you have said, that it is a Pituitary hormone and if it was overreplaced my T3 and T4 would be high. Does this mean my thyroid hormones are at reasonsble levels, or that I am hypo? I have never officially been diagnosed as hypo. Only subclinical.

She ordered a blood ESR test too, I am not sure how that wouldi be written down. I sm supposed to have them regularly as the rheumatologist is 85% sure I have rheumatoid, but if I get one a year Ive been doing well.

I spotted the Vit B12 is at the low end, and that I do have all the symptoms of deficiency. I have been supplementing with B12, plus B6, folic acid, magnesium, zinc gluconate in roughly the doses my original GP used to prescribe for me, many years ago. I forgot to print the magnesium and zinc results. I am supplemented with VitD3 by the rheumatologist at 800 iu a day. I will order some sublingual lozenges of methylcobalamin asap, 5000 to begin with.

I might have a problem taking iron pills, as they cause me severe constipstion and I am already there with constipation. They often bring me out in a rash and i get bad stomach pains. I have gut problems due to years of anti-inflammatory drugs.

I was looking at various B Vits to supplement with. I used to do this many years ago, but I cant swallow big tablets now and the ones I was taking were like horse pills. Unfortunately nobody shows how big they are, and as I am on pension credit with (till IDS decides otherwise) a bit of DLA, i cant afford to spent a fortune on pills that I cant take or end up not working.

there are several things bothering me. One, in the light of the diagnosis of subcinical hyperparathyroid, is whether my blood calcium is high or low.

Another is why do I suddenly have fluid retention to the degree which I have it. I have gained weight over this last year or two anyway, for no apparent reason as I am not a big eater and rarely feel hungry, just desperately thirsty all the time, but not diabetic, and have apparently some old pyramidal kidney damage, but this fluid retention has been sudden. When I drink my stomach swells up so that I look and feel 6 months pregnant by evening. without diuretics I dont use the toilet more than once in the morning and at night.

The weight gain, around a stone, is having a bad effect on my joints, and depressing me as its all round my midriff, I have few clothes that fit me and little spare cash to buy anything else. The charity shops around here are poor on the whole too. I would love to get the sewing machine out and try to make myself a few things, but as with my other hobbies, the mental and physical effort required wears me out inside 20 minutes. And my enthusiasm for everything has gone. half the time I cant even think straight, cant remember conversations of ten minutes before, and cant use my hands because theyre stiff and got no feeling in my fingers. Its taken me nearly two hours to type this. The crazy thing is that 5 months ago I was feeling mentally and physicslly so much better.

Sorry, you must have heard all this before. Any advise re: actions I can take, supplementation, managing this thing whatever is the matter with me, even if its something small, will be valuable beyond rubies. i have gone from being a lively, extrovert, happy go lucky, alert, fit as a butchers dog, a successful visual artist who loved life, to a zombie.

And thank you for this forum. Its given me the courage and motivation to not accept what I'm being fobbed off with. Sorry for mistskes, the keyboard is dyslexic.

[Clutter in reply to MrsRaven]

MrsR, I don't think your FT4 and FT3 are low enough to make you hypo. You might feel better with them higher but that will make your TSH lower.

Subclinical just means your TSH was >5 and <10 when you were first diagnosed. The term is meaningless once you are medicated. You are now euthyroid ie have normal thyroid levels.

B12 sublingual lozenges are large but they aren't supposed to be swallowed. They should dissolve slowly under your lip, tongue or in your cheek. Spray and patches are also available.

Skip the iron. Ferritin 78 is sufficient. Iron requirements aren't so high post menopause.

I think your kidney function needs to be checked, creatinine is good but urea is high. I don't see eGFR. You should be urinating more frequently than twice a day and that is why the fluid is retained and may be contributing to the weight gain.

Some signs and symptoms of kidney dysfunction include:

Fatigue, lack of concentration, poor appetite or trouble sleeping

Swelling or puffiness, particularly around the eyes or in the face, wrists, abdomen, thighs or ankles

Urine that is foamy, bloody, or coffee-coloured

A decrease in the amount of urine

Problems urinating, such as a burning feeling or abnormal discharge during urination, or a change in the frequency of urination, especially at night

Mid-back pain (flank), below the ribs, near where the kidneys are located

High blood pressure

[MrsRaven in reply to Clutter]

I just spotted at the top of the test results page

GFR calaclated abbreviated MDRD - satisfactory - no action

69 ml/min

[Clutter in reply to MrsRaven]

MrsRaven, the blood tests, other than slightly elevated urea, aren't showing kidney dysfunction but you aren't urinating enough. Perhaps you could keep a note of your fluid intake and times of urination to show your GP in September.

I've just seen your other post, I really don't think you need to worry about the ferritin/iron.

Good luck with the endo tomorrow.

[MrsRaven in reply to Clutter]

Thanks Clutter. My GP has put me on co-amilofruse because without that I can end up 6 lbs heavier at the day than when I started, all depending on how much I drink. I would need to not take any that day in order to get a true picture. I do drink a lot, and always have done even when I was younger, but am definitely not diabetic. Ive been tested more for diabetes than rheumatoid factor or thyroid.

I'm sorry to be such a nuisance, I am having trouble dealing with all this specially when feeling so ill and low.

I re-read one of your posts and you said that my TSH is low, and my FT3 is low but increasing it would make my TSH go even lower although I might feel better. Is that a bad thing? I feel as though I'm going to die right now, and would sell my soul to feel better. Maybe the some of the levothyroxine could be replaced with T3? Is this something I should ask about when I see the endo?

Thanks again and sorry to be a pain. I just want to be my old self again.

[Clutter in reply to MrsRaven]

MrsRaven, Levothyroxine dose increase would increase your FT4 and FT3 but will lower your TSH. Liothyronine (T3) will raise your FT3 and lower your TSH. Either may help so discuss with your Endo.

[MrsRaven in reply to Clutter]

Hi Clutter, just a quickie to say that the meeting with the endo's registrar was very positive. I hit it off with her straight away. She took it all very seriously and was enthusiastic about leaving no stone unturned to sort things out. She made some suggestions regarding my thyroid meds, and has proposed a whole raft of tests in about 5 weeks time, including an ECG as apparently I have a heart murmur I didnt know about.

I am off to get some sleep noe as I am bone tired.

[Clutter in reply to MrsRaven]

MrsRaven, I'm glad the endo consult went well. I hope the testing will help drill down what's making you unwell.

[MrsRaven in reply to Clutter]

Thanks. I have got to leave it for 4-5 weeks to allow my D3 levels to rebuild as they were very low, then she's going to do PTH, pituitary function, short Synacthen, Kidney function and an ECG because we have discovered that I have a heart murmur. She says that I should leave my levo dose as it is, or reduce because with a low TSH I am at risk of osteoporosis. For that reason she doesnt recommend raising it or taking T3, which she says she cant prescribe anyway and its efficacy hasnt be proven conclusively. i dont want to lower my dose because I feel as bad, or worse, than when I originally started taking levo all those years ago. i asked if I was to take additional T3, plus my levo, or replace some of the levo with T3 would it be likely to help. In her opinion it probably wouldnt and if would force my TSH even lower.

she isnt convinced that Vit B12 will help as my result, at 250, is within range, though she did concede that as I have digestive problems my absorption could be impaired and it wouldn't hurt to try.

So, not wanting to do everything at once, I have to decide whether to soldier on until the tests, try Vit B12 first, or lower my thyroid/try T3.

[Clutter in reply to MrsRaven]

Mrs.Raven, typical endo clap trap about low TSH and osteoporosis and lack of evidence re the benefits of T4+T3.

Your B12 is low, there is no reason to delay improving it by supplementing and it won't impact on the tests you are having. Good levels of B12 can help prevent dementia so I supplement daily to keep mine high.

I had the same lack of evidence debate with my endo but he couldn't deny the improvement in my health after 6 months self medicating and he agreed to prescribe T3. The only way you'll know whether T3 raising your FT3 is helpful is to try it. Your FT4 is low in range so there's no need to reduce T4 dose. You can add a quarter of a 25mcg T3 tablet (6.25mcg) to your existing T4 dose. Taking T3 won't impact on your other tests either but it will lower your TSH.

The mild osteopenia I have is unlikely to have been caused by 2 years suppressed TSH and is likely due to menopause <42, severe vitamin D deficiency corrected in 2014, and a tall thin frame and low bmi. Nevertheless my TSH is to remain suppressed <0.1 although it is always <0.01.

[MrsRaven in reply to Clutter]

Thanks, thats pretty much how I feel about it having referred to the website, read the other posts and given it a great deal of thought. I was hoping, and almost expecting, you'd say that. I have already ordered the VitB12 abd multi b vitamins, and it only remains for me to ask you what T3 you recommend and where I can get it from.

[MrsRaven]

Re: kidney dysfunction, i will ask for a test, its not normal to produce as little as I do without pills. This has been a problem for a while, but over the counter diuretics dont help any more. I have many of the problems typical of kidney dysfunction, but the trouble is they are typical of so many other things too, including fibromyalgia and depression, which is what my old GP surgery came back with time after time. I still dont know where I am re: blood calcium leveld.

So, I am seeing the endo tomorrow and having a short Synacthen test to check cortisol reserves. Then I see my GP in September. I will get the methylcobalamin supplement as advised, and will see if I can source some refined iron. My old GP years ago used to give me pregaday sustsined release capsules. If not I'll have to rely on an iron rich diet.

I'm not holding my breath for a good result tomorrow. This has been going on for so long now that I have almost given up hope of getting it sorted out. its depressing me so much that if I hadnt got my family, I think I would probably have topped myself years ago out of sheer desperation.