"Not diabetic at this stage"

[Sick-and-Tired]

I recently got myself referred to an endocrinologist by having some blue horizon tests which showed that, while my tsh etc is technically in range, my antibodies are out of control.

The endo was a total let down, and I've finally got a copy of the letter she sent to my GP discharging me. She says I look OK and that all my results are fine etc. She also stated that I am "not diabetic at this stage".

Is that a standard term that would always be used in this sort of letter, or does it suggest there might be signs that I'm on my way there?

One of my symptoms is constant thirst and needing to go to the toilet, as well as holding all my weight on my stomach so diabetes is been something I was previously concerned about but had blood tests done which came back fine.

I'm guessing it's a standard thing but just want to check...? Thanks!

EDIT

Here are the blood test results I have - endo did run some more blood tests but I can't get hold of the results (not for lack of trying).

April 2016

Serum sodium - 140 mmol/L (133-146mmol/L)

Serum potassium - 4.2 mmol/L (3.5-5.3mmol)

Serum creatinine - 51 umol/L (49-90umol/L)

Serum urea level - 3.2 mmol/L (2.5 -7.8mmol/L)

GFR calculated abbreviated MDRD - 60mL/min> (60-99mL/min)

Serum foster - 10.5 ug/L (2-17ug/L)

Plasma vitamin b12 level - 507ng/L (200-900ng/L)

Serum total 25 OH vit D level - 40nmol/L (75-200nmol/L)

Serum calcium - 2.28mmol/L (2.1-2.6mmol/L)

Calcium adjusted level - 2.1mmol/L (2.1-2.6mmol/L)

Serum inorganic phosphate - 0.99 mmol (0.8-1.5mmol)

Serum albumin - 49 g/L (35-50g/L)

Total alkaline phosphata - 70 iu/L (30-130iu/L)

Serum cholesterol - 4.2 mmol/L (N/A)

Serum HDL cholesterol - 1.73mmol/L (1.2-99999mmol/L)

Serum cholesterol/HDL ratio - 2.4 (N/A)

Se Non HDL cholesterol level - 2.5 mmol/L (N/A)

Serum TSH level - 3.5mu/L (0.35-5mu/L)

Blood glucose level - 4.8mmol/L (4.1-6mmol/L)

Serum ferritin - 36 ug/L (15-250 ug/L)

Neutrophil count- 4 10*9/L (2-7.510*9/L)

Lymphocyte count- 2 10*9/L (1-410*9/L)

Monocyte count -0.4 10*9/L (0.2-.810*9/L)

Eosinophil count - 0.1 10*9/L (0-.410*9/L)

Basophil count - 0.1 10*9/L (0-.110*9/L)

Total white blood cell count - 6.710*9//L (4-1110*9/L)

Red blood cell count - 4.74 10*12/L (3.5-5.510*12/L)

Haemoglobin estimation - 155g/L (115-165g/L)

Haematocrit- 0.43 ratio (0.37-.47 ratio)

Mean corpuscular volume - 91.4fl (75-105fl)

Red blood cell distribution width - 12.4 (11-15)

Mean corpusc. Haemoglobin - 32.7pg (26-35pg)

MCHC - 358 g/L (290-350g/L)

Platelet count - 133 10*9/L (150-45010*9/L)

Hypochromia % - 0.7% (N/A)

Erythrocyte sedimentation rate - 5mm/h (0-10mm/h)

Plasma c reactive protein - 4mg/L < (0-10mg/L)

Serum ALT level - 14iu/L 0-50iu/L)

Total alkaline phosphatase - 67iu (30-130iu/L)

Serum total bilirubin - 28umol/L (0-21umol/L)

Serum albumin - 47g/L (35-50 g/L)

August 2016 (blue horizon results)

CRP - 0.1 (<5.0 mg/L)

Ferritin - 86.8 (20-150 ug/L)

TSH - 4.10 (0.27-4.20 iu/L)

T4 total - 116.0 (64.5 - 142 mmol/L)

Free t4 - 20.5 (13-22pmol/L)

Free t3 - 5.61 (3.1-6.8 pmol/L)

Anti thyroid peroxidase - H 319 (<34kiu/L)

Anti thyroglobulin Abs - H 890.8 (<115 Ku/L)

Vitamin B12 - 327 pmol/L (Deficient <140, insufficient 140-250)

Serum folate - 13.87 (10.4 - 42.4 mmol/L)

Active B12 97 (25.1 - 165 pmol/L)

I'm taking a high vitamin D dose daily because of the deficiency now.

Also, one last thing. When the endo ordered the blood tests that she used to discharge me she told me to go straight for the test then. I asked if I have fasted and she said no, fasting isn't necessary for these tests and I should do them immediately, so I had them done at about 11.30am when I'd had breakfast that morning. I've since read that you probably should fast. Is this something I should mention to my GP in looking for further help?

Again, thanks for your help!

[marram]

Most Endos are really diabetes specialists, so they will always check for diabetes because it is their comfort zone! 😂🤣

Untreated or under treated hypothyroidism can lead to type 2 diabetes, so it is important to keep an eye on those antibodies, and consider taking preventive action, some people manage to reduce antibodies by going gluten free, hopefully someone who has done so might pick up on this post and give you some positive idea along those lines.

[radd]

Sick-and-Tired,

Elevated thyroid antibodies denote Hashimotos Autoimmune Disease and the standard care is to simply wait until the immune system has destroyed enough thyroid tissue to classify them as hypothyroid, and then give them thyroid hormone replacement ! ! ! ....

Supplementing selenium has been shown to reduce antibody levels as has a gluten free diet and optimal thyroid hormone.

Insufficient thyroid hormone can cause hypoglycemia (or too little sugar in the blood) or insulin resistance (too much sugar in the blood). I would start with looking at your adrenals as low thyroid hormone will compromise, encouraging first high and eventually low cortisol levels. Both levels can have detrimental effects on thyroid hormone synthesis as well and the way your body uses fats, proteins, and carbohydrates (often seen with accumulated fat around the middle) and controls inflammatory reactions..

Because thyroid hormones drive our metabolism, a low level will slow glucose absorption in the gut and the rate our cells uptake glucose. It can also slow the response of insulin secretion and the clearance of too much in the blood.

Continually elevated cortisol levels can impair the HPT axis by suppressing pituitary function (so not signalling the release of enough thyroid hormone) as too much cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3. This can lead to low T3 levels (active hormone)..

It also impairs our adrenals’ ability to produce and balance other hormones which are important to our long-term health and well-being ( DHEA, estrogen, progesterone, and testosterone). Prolonged cortisol elevations decrease the liver’s ability to clear excess oestrogens from the blood which can increase the levels of TBG, the proteins that thyroid hormone is attached to as it’s transported through the body. When thyroid hormone is bound to TBG, it is inactive as must be cleaved from TBG to become “free-fraction” before it can activate cellular receptors.

People with thyroid issues often have vitamin deficiencies which can impair the workings of thyroid meds and it is important to have optimal levels of Vit B12, vit D, folate and ferritin. Ask your GP to test these & all sex hormones, and post results complete with ranges (numbers in brackets) for members to comment.

Cortisol levels are best evaluated by a saliva test that measures 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.

You would benefit from reading "The Root Cause" by Isabella Wentz.

.

Selenium Reduces TPOAb

press.endocrine.org/doi/ful...

.

Gluten and Thyroid Connection

chriskresser.com/the-gluten...

.

Saliva Stress Test (test ref END01)

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

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

gdx.net/uk/product/27

.

Thyroid & Blood Sugar Issues.

chriskresser.com/thyroid-bl...

[bluebug]

To help everyone here you should edit your initial post and put your lab tests results with their ranges. That way other posters can tell you whether you actually have issues or not.

In addition while endos are diabetes specialists unfortunately it seems that the NHS doctors cannot be bothered to tell patients they are pre-diabetic. Or to put it in plain English they need to say - If you don't do something about these blood glucose levels then within 12- 18 months you will have type 2 diabetes.

The reasons why they are refusing to do this in my opinion is political as the NHS apparently doesn't now do preventative medicine it is now local councils jobs. As if they bothered to tell you, you were pre-diabetic they would then have to tell you what to do to prevent it and then re-test you in 6 months. However it's easier for them to ignore you and then just give you out a prescription for medication your diabetes even though type 2 diabetes is consuming around 10-11% of the NHS budget.

Oh and many type 2 diabetics have vitamin B12 issues.

[humanbean in reply to bluebug]

I agree with Bluebug - we need to see your blood test results.

To edit your original post, click on the v in a square at the bottom of the post. A list of options comes up, one of which is Edit. Click on Edit, make the additions to your post, then click on the green Post button again.

[Sick-and-Tired in reply to bluebug]

Hi, I've put my results up now! Gosh, what a backwards way to go about things! I really hope I'm not on my way to diabetes (or if I am that I can stop it!)

[Hidden]

Yes I too would be interested to see your blood results - especially for your HbA1c (diabetic blood test) as that may give you an idea for the diabetes level.

If you antibodies are out of control then that does sound like Hashimoto's

Hope you do decide to post your results then the forum can help you further.

[Sick-and-Tired in reply to Hidden]

I've put up all the results I have... Not sure whether the one you mentioned is there though...?

It's so frustrating. The endo said I don't have hashimoto's and these my antibodies are normal!

[Treepie in reply to Sick-and-Tired]

That test checks for a longer term position of three months rather than the instant glucose.I was told the same December 2014!, a year later I was most definitely diabetic by last March I was back where I was in December 2014 after cutting carbs .No cakes,scones ,biscuits ,deserts.Added cumin oilto morning porrige.

[Hidden]

Morning sick and tired - go to GP ask them to have the following done:-

TPOab and TgAb - and vitamins B12-D-Seleniun-Ferratin and Folate. These should give a better picture of what is going on.

Take Care and wish you the best 🎅🏻🎄

[Sick-and-Tired in reply to Hidden]

Hi! I've put some results up that I already have.

[Hidden in reply to Sick-and-Tired]

This one is the one that they look for diabetes:

Blood glucose level - 4.8mmol/L (4.1-6mmol/L)

Which looks fine to me so no your not diabetic big relief (you dont want that) I have had it since a child

[Ruthi]

Well, without measuring Hba1c she can't really tell whether you are diabetic, or pre-diabetic. That being said, your blood glucose level two hours post eating looks pretty good. One can't help wondering if she was just using a standard set of words and forgot that you weren't there for diabetes!

Going gluten free frequently helps to reduce antibodies, so is well worth doing.

But other than that, there is little to do other than medicate. Its odd that your free T3 looks pretty good, but you have an elevated TSH. Your pituitary obviously thinks you need more.

Holding weight on your stomach might be due to raised cortisol levels. Doctors are useless until you are overtly suffering from Cushing's but take a look at 'Adrenal Fatigue' and consider doing the 24 hour saliva test privately. The Adrenal Quiz is quite a good starting point adreanlquiz.com. My adrenal problems were kick started by the withdrawal of thyroid meds. The adrenals then try to compensate for inadequate thyroid hormone by pumping out more stress hormone cortisol.

As for your thirst, that could possibly be due to electrolyte imbalance. Try taking the adrenal cocktail, (I make mine with lemon juice or a tsp of wholefood vitamin C to avoid the sugar in the orange juice) two or three times a day. Oh, and recently I have found difficulty drinking the cocktail with salt in. So I throw all the salt in my mouth and quickly drink down the cocktail, or even just water. If it works it will be pretty quick. Also take a magnesium supplement. Most people are fine with the cheap tablets, but they stop me sleeping so I buy chelated magnesium (bisglycinate).

[humanbean]

Serum foster - 10.5 ug/L (2-17ug/L)

Plasma vitamin b12 level - 507ng/L (200-900ng/L)

Serum total 25 OH vit D level - 40nmol/L (75-200nmol/L)

Serum TSH level - 3.5mu/L (0.35-5mu/L)

Blood glucose level - 4.8mmol/L (4.1-6mmol/L)

Serum ferritin - 36 ug/L (15-250 ug/L)

Red blood cell count - 4.74 10*12/L (3.5-5.510*12/L)

Haemoglobin estimation - 155g/L (115-165g/L)

Haematocrit- 0.43 ratio (0.37-.47 ratio)

Ferritin - 86.8 (20-150 ug/L)

TSH - 4.10 (0.27-4.20 iu/L)

T4 total - 116.0 (64.5 - 142 mmol/L)

Free t4 - 20.5 (13-22pmol/L)

Free t3 - 5.61 (3.1-6.8 pmol/L)

Anti thyroid peroxidase - H 319 (<34kiu/L)

Anti thyroglobulin Abs - H 890.8 (<115 Ku/L)

Vitamin B12 - 327 pmol/L (Deficient <140, insufficient 140-250)

Serum folate - 13.87 (10.4 - 42.4 mmol/L)

Active B12 97 (25.1 - 165 pmol/L)

Looking at the result you've typed as "serum foster", I'm assuming that is a typo for "folate".

The two results you have for folate show the first as mid-range and the second as low in range. Folate is optimal in the upper half of the range, so this should be supplemented. Methylfolate works best for most people, although some people prefer folic acid for reasons I don't understand.

chriskresser.com/folate-vs-...

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Vitamin B12 - you've got two serum results and an active result. Having B12 high in the range helps a lot of people feel better. The Japanese consider a serum level below 500 is deficient. You would get more reliable information on B12 and folate if you joined the Pernicious Anaemia Society (PAS) forum on this site and pasted in your B12 and folate results :

healthunlocked.com/pasoc

Be aware that supplementing one or two of the B vitamins (folate is also called Vitamin B9) and ignoring the others is not a good idea. Personally I supplement a good quality B Complex which contains methylfolate and methylcobalamin, and I also take an additional methylcobalamin supplement separately.

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Vitamin D - this was much too low in April but you say you are supplementing it now. Just remember that vitamin D can rise to toxic levels. Don't forget to test occasionally.

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Ferritin - this has risen well and is now optimal or very close to optimal. With the reference range you give, opinions vary as to what is optimal, from mid-range up to about 120 or so. Please do test regularly because supplementing until levels get too high is dangerous with iron, and getting rid of excess iron could take a long time and may only be possible by giving blood in some people. (On the other hand there are some people who can't hang on to iron at all, and stopping supplementing makes it plummet. I have no idea which group you belong to.) It is a good idea to discontinue supplementing iron and vitamin C for 5 days before testing. Iron-related testing should be done in the same way as thyroid testing - first thing in the morning while fasting except for water.

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Your positive thyroid antibodies show that you have autoimmune hypothyroidism or Hashimoto's Thyroiditis. You should search for Izabella Wentz. She has a website (Thyroid Pharmacist) and a Facebook page. She has also written a book. She is a sufferer of Hashi's herself and managed to put it into remission or lower her antibodies immensely with diet and supplements. She gets lots of good reviews on Amazon. Going on a 100% gluten-free diet, if you haven't already done so, seems to help lots of people.

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Your TSH is remarkably high for someone with surprisingly good Free T4 and Free T3. Your Free T4 is 83% of the way through the reference range. Your Free T3 is 68% of the way through the reference range.

I can only speculate why your TSH is so high with such good Free T4 and Free T3 levels. The things that come to mind are

a) TSH takes a while to respond to changes in hormone levels. Perhaps you heading for a flare up of antibody activity after a period of low antibody activity. If antibody activity is low then Free T4 and Free T3 will tend to be low and TSH will be high. Once a flare up of activity starts the Free T4 and Free T3 will rise and it may take a while for TSH to respond to the higher levels and reduce.

b) Perhaps you have high Reverse T3. I'm not sure how TSH reacts to high levels of Reverse T3. Having such a problem will make you feel very hypo, but I'm not clear if it is reflected in the TSH. Big question mark over this suggestion!

c) You may have thyroid resistance. I don't know much about this. Sorry!

c) For a long list of all the things that cause low thyroid function - see this post from another forum :

forums.phoenixrising.me/ind...

But you're on your own with this one because I wouldn't classify your thyroid function as low, I would classify your TSH production as high.

[humanbean]

Doctors tell patients that it doesn't matter when thyroid blood testing is done. This is not true. Look at the first graph on page 2 of this paper :

press.endocrine.org/doi/pdf...

It shows how TSH varies throughout a 24 hour period, with the highest levels in the middle of the night and the lowest levels in the middle of the afternoon. In order to get the highest TSH on a blood test we should get tested as early in the morning as possible.

There are also claims that doing the test after eating will lower TSH, so we should do the test fasting. The evidence I've read for this hasn't convinced me of this one, but I fast anyway because it makes it easier to be consistent from test to test.

There are several common tests which have to be carried out while fasting e.g. cholesterol, blood sugar and iron. So if I get my cholesterol measured one day and thyroid tests are included in the testing, then I will have fasted. If I do thyroid tests on their own but haven't fasted how can I reliably compare the tests? I can't. So I always fast for all blood tests if I can possibly wangle an early morning test. If I can't get tested early I won't fast.