Help with Blood test results

May I request help with GENOA LAB Thyroid Function blood test results as below:

#Central Thyroid Regulation & Activity Peripheral

Total Thyroxine (T4)............. 70 (58-161 nmol/L)

Thyroid Stimulating

Hormone (TSH) 4.22 (0.40-4.00 mIU/L)

Free Thyroxine (FT4) 10.8 (11.5-22.7 pmol/L)

# Peripheral Thyroid Function

Free T3 (FT3) 5.7 (2.8-6.5 pmol/L)

FT4 : FT3 Ratio 1.9 (2.0-4.5 Ratio)

Reverse T3 (rT3) * 0.21 (0.14-0.54 nmol/L)

#Thyroid Auto Immunity

Thyroglobulin (TG) <20 (<= 40 IU/mL)

Peroxidase (TPO) 21 (<= 35 IU/mL)

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#Commentary

hypothyroidism. If such a condition exists, future repeat testing may be warranted.

Free T4 (FT4) is measured below the reference range, indicating a hypothyroid state, although multiple causes for

decreased FT4 are possible. FT4 measures the biologically active fraction of total T4, the majority of which is bound

by protein carriers in the serum and is therefore inactive.

In primary hypothyroidism, TSH values will be high, indicating a lack of responsiveness of the thyroid gland to TSH

stimulation. Generally in such cases, free T3 (FT3) and reverse T3 will also be low or low normal. The ratio of FT4 to

FT3 may be depressed since the body will preferentially make relatively more T3 in an attempt to compensate

partially for low total thyroid hormone production.

Thyroiditis can also present a laboratory picture of primary hypothyroidism. In addition to low FT4, low FT3, and

elevated TSH, anti-thyroglobulin, anti-thyroid peroxidase, or anti-TSH antibodies may be elevated, blocking the

production and release of thyroid hormone.

If TSH is also below the reference range, pituitary involvement must be suspected. In classic secondary

hypothyroidism, TSH production from the pituitary is low and thus T4 production is low. In extremely rare cases, thyrotropin-stimulating hormone production is low indicating tertiary hypothyroidism.

Prescription drugs like corticosteroids (e.g., prednisone) and dopamine can suppress TSH production, leading to

reduced T4 production. Phenytoin (dilantin) therapy can lower T4 and T3 levels, but TSH levels are usually unaffected.

Cushing's syndrome can also lead to low TSH and FT4 levels.

Free T3 (FT3) is measured to be within the reference range. FT3 measures the biologically active fraction of total T3,

the majority of which is bound by protein carriers in the serum and is therefore inactive. T3 is 3-5 times as

physiologically active as T4, and 80% of the circulating T3 is from the peripheral conversion of T4 predominately in

liver and kidney.

Reverse T3 is measured to be within the reference range.

Levels of anti-thyroglobulin antibodies are within the reference range. Thyroglobulin (Tg) is a large glycoprotein

synthesized in response to TSH stimulation. T4 and, to a limited extent, T3 are produced when tyrosine residues in Tg

are iodinated and coupled together under the action of thyroid peroxidase (TPO). Subsequent proteolysis of Tg in

cellular lysosomes allows for the release of T4 and T3 from the thyroid gland into the systemic circulation.

Levels of anti-thyroid peroxidase antibodies are within the reference range. Thyroid peroxidase is a heme-containing

enzyme that is necessary for the oxidation of iodide ions and for using hydrogen peroxide for the incorporation of these iodide ions into the tyrosine residues of thyroglobulin.

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THESE ARE THE BLOOD TEST DONE BY MY GP - (BY NHS )

Serum total bilirubin level 7 (0.00 - 21.00umol/L)

Serum ALT level 25 (10.00 - 50.00 IU/L)

SERIUM FOLATE - NORMAL - NO ACTION

Serum Folate-(SSS) 17.7 (3.9 - 20ug/L)

Serum Ferritin-(SSS) 163 (30.00 -400.00ug/L)

FULL BLOOD COUNT - FBC - ABNORMAL - CONTACT PATIENT

Haemoglobin estimation 124 (130-170g/L)

Red Blood Cell (RBC) count 4.26 (4.40 - 5.8x10^12/L)

Haematocrit 0.4 (0.37 - 0.5L/L)

Mean Corpuscular volume(MCV) 93 (80 - 99 fL)

Mean corpusc. haemoglobin(MCH) 29.1 (26 - 33.5pg)

Mean Corpusc. Hb. conc.(MCHC) 313 (300 - 350g/L)

Red blood cell distribut width 13.8 ( 11.5 - 15 %)

Platelet count 255 (150 -400x10^9/L)

Mean platelet volume 9.7 (7 - 13 fL)

Total White Cell count 5.5 ( 3 - 10x10^9/L)

Neutrophil count 2.3 ( 2 - 7.50x10^9/L)

Lymphocyte count 2.3 (1.5 - 4x10^9/L)

Monocyte count 0.5 ( 0.2 - 1x10^9/L)

Eosinophil count 0.3 ( 0 - 0.4x10^9/L)

Basophil count 0.0 ( 0 - 0.10x10^9/L)

Percentage neutrophils 42.3 %

Percentage lymphocytes 41.8 %

Percentage monocytes 9.9 %

Percentage eosinophils 5.8 %

Percentage basophils 0.2 %

BONE PROFILE - ABNORMAL - CONTACT PATIENT

Serum alkaline phosphatase 50 ( 30 - 130 IU/L)

Serum Albumin 44 (35 - 50 g/L)

Serum calcium 2.33 (2.15 - 2.55mmol/L)

Serum adjusted calcium conc 2.37 ( 2.20 - 2.6mmol/L)

Serum inorganic phosphate 0.76 ( 0.8 - 1.5mmol/L)

SERUM VITAMIN B-12 - ABNORMAL - CONTACT PATIENT

Serum Vitamin B12 850 ( 197 - 771ng/L)

SERUM 25-HO VITAMIN D3 LEVEL - NORMAL - NO ACTION

Serum total 25-OH vit D level

interpretation 61 ( 50 - 140nmol/L)

25-Hydroxyvitamin D2 level 15 nmol/L

25-Hydroxyvitamin D3 level 46 nmol/L

HbA1C LEVEL - NORMAL - NO ACTION

HbA1c levl - IFCC standardised 38 (27 - 47mmol/molHb)

SE PROSTATE SPECIFIC Ag LEVEL - NORMAL - NO ACTION

Se Prostate specific Ag level 3.12 ( 0 - 4.1ug/L)

RENAL PROFILE - NORMAL - NO ACTION

Serum sodium 141 (133 - 146 mmol/L)

Serum potassium 3.8 (3.5 - 5.3mmol/L)

Serum urea level 3.6 (2.5 - 7.8mm0l/L)

Serum creatinine 79 (62 - 106mol/L)

GFR calculated abbreviated MDRD >90

THYROID FUNCTION TEST - NORMAL - NO ACTION

Serum TSH level 3.98 ( 0.27 - 4.20mlU/L)

SERUM LIPIDS TEST - ABNORMAL - Contact Patient

Serum triglycerides 1.3 ( 0 - 2.3mmol/L)

Serum Cholesterol 6 (2.3 - 4.9mmol/L)

Serum HDL cholesterol level 1.4 ( 0.9 - 1.5mmol/L)

Serum cholesterol/HDL ratio 4.3 ( 0 - 4 )

LIVER FUNCTION TEST - NORMAL - NO ACTION

I am feeling better compared to last year by supplementing t3 only 6.25mg dose once early morning. I tried to increase the dose but makes feel more drowsy, almost keep me a sleep all day & night. At present I can keep awake for at least 12 - 16 hours per day and do light work but my digestion of food is taking longer & longer & I am down to one light breakfast & medium meal during 24 hours. I am supplementing with HCL with pepsin & other for protien digestion for each meal.

I saw my GP last week and he says all my test are normal and nothing to worry, except he is concerned on Cholesterol level and want me start on Statin Tablets although it is coming down compared to last year & year before results. Please advise as much as you can which will really appreciated.

6 Replies

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  • KadirVankalwala,

    I'm surprised your TSH is so high when FT3 is good. There is scope to increase T3 slightly, say 6.25mcg (quarter tablet) to raise FT3 higher and bring down TSH. FT4 is below range because you are taking T3 only. Do you take 62.5mcg in one dose or split into 2 or 3 doses?

    This link will explain the evaluations in the full blood count labtestsonline.org/understa...

    Ferritin and folate levels are fine.

    Vitamin D 61 is sub optimal. Around 100 is optimal. I would supplement 5,000iu D3 for 6-8 weeks then reduce to 5,000iu alternate days. Take vitamin D 4 hours away from T3.

    If you Google Hypothyroidism+Statins you'll see that statins are contraindicated in hypothyroid patients and Dr. Malcolm Kendrick's blogs on why we shouldn't take statins are very informative.

  • KadirVankalwala,

    Apologies, it has been pointed out to me that you are taking 6.25mcg T3, not 62.5mcg.

    If you can't tolerate more T3 perhaps you could add 25mcg Levothyroxine?

  • KW,

    Why are you only medicating T3 ? ? ...

    Your high TSH is indicative of a struggling thyroid gland, when the pituitary gland secretes more TSH to encourage it to function better. Medicating T3 can lower the TSH and although your T3 dose is small, could mean your TSH is realistically a lot higher. Also your T4 level is too low, and again I don't think 6.25mcg T3 would have much impact.

    Gut issues and high cholesterol are common in people with low thyroid hormone as this slows the whole digestive process down and impairs liver function in metabolising hormones and filtering toxins. Adequate bile is (indirectly) required for good thyroid hormone synthesis as are stomach acid and digestive enzymes.

    Inadequate amounts can inhibit digestion of essential fatty acids and the absorption of improperly digested fat globules, raising cholesterol levels and leading to deficiencies in fat-soluble vitamins (Vit A, E, K and D. Supplementing Betaine HCL with pepsin will help and I also used Ox Bile taken in a cycle of 1 before each meal on day 1, 2 before each meal on day 2, 3 before each meal on day 3 and then repeating.

    I also supplemented Taurine that is a major constituent of bile and Curcumin which has an anti-inflammatory effect in gastric conditions as reducing gut inflammation will calm immune responses and histamine levels. Histamine helps control stomach acid and too much will further disrupt gut issues.

    Everything is a vicious circle. I supplement digestive enzymes and milk thistle which helps keep the liver clear. .Also address any gut issues such as candida, parasites and dysbiosis, and supplement probiotics to help balance the microbiome.

    You can not medicate further T3 because it might take you over range. Have you tried adding T4 (Levothyroxine) ? ? ...

    Are you supporting your adrenal glands ? ? .. Adequate supplies of cortisol are required for good thyroid hormone synthesis, to modulate the immune system and especially in the gut where it lines the GI tract. You may find adrenal glandulars or adaptogens to be beneficial but would need to test saliva to ensure appropriate supplementation.

    .

    Saliva Stress Test (test ref END01)

    thyroiduk.org.uk/tuk/testin...

    Four saliva tests that measure the available "active" cortisol (& DHEA) secreted at set times over a 24 hours period. The results will allow you to see any imbalances in the daily circadian pattern so enabling use of correcting supplements to aid your adrenal health. Unfortunately this test is not generally used or recognised by GP's.

    The cost is £77.00 which is a discounted price for THyroidUK when code A42AQ is used.

    gdx.net/uk/product/27

    .

  • T3 is the active thyroid hormone which controls the metabolism and therefore the symptoms. Your Free T3 is in the top part of the normal range, which is good, so you should not have hypothyroid symptoms.

    With this good Free T3 it is unusual to have such high TSH and hypothyroid symptoms. One possible cause is a genetic condition commonly known as Thyroid Hormone Resistance. It causes hypothyroid symptoms and requires very high T3 levels (often above the top of the normal range) in the body to overcome the resistance.

    It would explain your unusual thyroid blood test results - you have good Free T3 but your body wants it higher making TSH to stimulate the thyroid and also converting as much as possible of the Free T4 to T3.

    6.25 mcg is a very small amount - equivalent to 25 mcg of T4, much less than the normal starting dose. Some people find that small amounts of thyroid hormone medication makes them feel worse and it takes larger amounts to help.

    As it is genetic if there are other family members with thyroid problems, fibromyalgia, CFS, ME, Coeliac Disease, MS, Heart Disease or depression this would further support this possibility.

  • Many thanks Sandy, really appreciated.

    I have brother & sister who suffers from Thyroid problems. So it may be genetic. I have sent of DIO2 test to see if thst is the case. Would you advise higher dose of T4 with same 6.25mcg t3 or higher t3 as well ?

    Many thanks

    Kadir

  • The DIO2 gene is about the conversion of T4 to T3 but as your Free T3 is so good your are unlikely to have a problem with it.

    With your thyroid blood test results and this family thyroid history it is very likely that you have thyroid hormone resistance.

    If so a single daily dose of T3 works best.

    I will send you a personal message with more information.

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