BH Test results

[Vwyrien]

Hi All,

I got my test results back from BH. Could someone please help me decipher them/give me some advice? Thanks

Biochemistry

CRPH 17.80<5.0mg/L

Ferritin72.020 - 150ug/L

Thyroid Function

TSH2.140.27 - 4.20mIU/L

T4 Total93.064.5 - 142.0nmol/L

Free T4L11.8612 - 22pmol/L

Free T34.123.1 - 6.8pmol/L

Immunology

Anti-Thyroidperoxidase abs16.7<34kIU/L

Anti-Thyroglobulin Abs<10<115kU/L

Vitamins

Vitamin B12L 79Deficient <140pmol/L

Insufficient 140 - 250

Consider reducing dose >725

Serum FolateL 4.948.83 - 60.8nmol/L

These are the doctors comments:

The vitamin B12 level is low. Some experts believe levels of 400-500 are desirable and that levels below this may lead to symptoms. Low Vitamin B12 levels can lead to Pernicious Anaemia (PA), a state of deficiency of the red blood cells in which there is reduced quality and number. Characteristically, the red blood cells are enlarged in this state (if the deficiency is severe and longstanding). A Full Blood Count is needed to check for this state, which is known as megaloblastic anaemia. Vitamin B12 is commonly found in many foods, particularly meats. Deficiency can develop if intake of the vitamin is reduced or if absorption from the gut is impaired. Poor absorption owing to a deficiency of Intrinsic Factor (IF) is the underlying reason for PA. Vitamin B12 deficiency in the longer run can lead to nervous system disorders - with sensation changes, loss of power or co-ordination, gut disorders and (rarely) dementia or mental illness. Lower level deficiency has been associated with a range of symptoms such as fatigue, memory impairment, irritability, depression and personality changes. Please discuss this finding with your usual doctor, supplementation would be advisable.

The Folate level is low. Folate (Folic acid or Vitamin B9) is one of the B group of vitamins, found in green vegetables in particular. The body's reserves of Folate, unlike Vitamin B12, are low and only sufficient for about four months. Causes of deficiency include reduced intake from the diet or from poor absorption through the gut; increased demand for folate (for example, pregnancy) and side effects of some medication (for example, methotrexate). Symptoms of deficiency include fatigue, mild sensation changes and depression. Prolonged lack of Folate results in megaloblastic anaemia (a red blood cell deficiency in which the cells are characteristically large). Supplementation would be advisable - I advise you to discuss this result with your usual doctor.

The free T4 level is low. In the presence of a normal thyroid stimulating hormone level (TSH), and normal free T3 level it would not surprise me to learn you are taking liothyronine (T3) instead of levothyroxine - is this the case? If you are taking a form of thyroxine medication already, you may need to adjust your dose – a discussion with your usual doctor would be sensible. If not, I also suggest you make an appointment to see your doctor – at least surveillance of thyroid function would be wise, as it would seem in this scenario that an underactive thyroid gland might be developing.

The CRP is raised. A high CRP (C reactive protein) is associated with inflammation from some cause (as seen for example with arthritis or infection). It is not an exact test, and is nonspecific. An elevated CRP is not a normal finding and its presence should lead to further investigation to establish the cause. If you have any symptoms suggesting either infection (cough, fever, urinary symptoms etc) or inflammation (swollen painful joints or generalised aching, for example) is present, I advise you to speak to your doctor soon. In any event a discussion with your doctor in due course would be sensible.

[SeasideSusie Remembering]

Vwyrien

CRP H 17.80 <5.0mg/L - high CRP can be caused by infection or inflammation.

*****

Ferritin 72.0 (20 - 150ug/L) - this is just about OK. It needs to be at least 70 for thyroid hormone to work properly, our own or replacemen. Best for females is 100-150. Eating liver regularly will help raise ferritin and much less faff than using iron tablets.

*****

Anti-Thyroidperoxidase abs16.7<34kIU/L

Anti-Thyroglobulin Abs<10<115kU/L

Antibodies are nice and low, no sign of autoimmune thyroid disease with those results

*****

TSH 2.14 (0.27 - 4.20mIU/L)

T4 Total 93.0 (64.5 - 142.0nmol/L)

Free T4 L 11.86 (12 - 22pmol/L)

Free T3 4.12 (3.1 - 6.8pmol/L)

Your FT4 is under range which is unusual, especially considering your FT3 is within range, albeit low. Ask your doctor to consider investigating for secondary/central hypothyroidism where the problem lies with the pituitary or hypothalamus rather than the thyroid and is can be present when TSH is normal or low and FT4 and FT3 low.

progressivehealth.com/secon...

medscape.com/viewarticle/43... (If you have to log in to read that, then go from this Google search page and it should be the third link down with the title "A Rare form of Hypothyroidism - Medscape"

google.co.uk/#q=secondary+h...

*****

B12 L 79 Deficient <140pmol/L

Folate L 4.94 (8.83 - 60.8nmol/L)

B12 and folate work together and yours are absolutely dire. Please take these results over to the Pernicious Anaemia Society forum here on Health Unlocked for their advice. You will probably be advised to ask for investigations into Pernicious Anaemia, be tested for intrinsic factor, may need B12 injections and folic acid supplements. Take their advice and discuss it with your GP. Do not start any supplements for either until investigations have been carried out.

healthunlocked.com/pasoc

*****

Didn't you have Vit D tested?

[humanbean]

For someone whose B12 and folate are so desperately bad I'm quite suspicious of the surprisingly good ferritin level.

With high CRP this suggests you have a problem with inflammation or infection. In that situation the body stores iron in ferritin rather than risk bacteria or other pathogens from getting access to your iron. Pathogens can't access iron in ferritin but they can access the iron in your red blood cell, in haemoglobin etc, so the body keeps those levels as low as is consistent with keeping you alive and pushes as much iron as it can into ferritin and so ferritin can look artificially good.

The condition I've described above is called Anaemia of Chronic Disease or Anaemia of Inflammatory Response.

irondisorders.org/anemia-of...

The only way of being sure about the above is to get a full iron panel and get a Full Blood Count done. Your doctor should do these tests for you if you ask, but if he won't, then an iron panel can be done with finger-prick testing.

medichecks.com/iron-tests/i...

And so can a full blood count :

medichecks.com/haematology-...

But I really think your doctor should cough up for these tests. You've clearly been ill for a long time and just been left to rot.