latest labs,please

[irme]

Hi everyone,I hope you're all doing good.

Can you please comment on my labs? Is that anemia that I'm seeing in the results or I'm not interpreting correctly?Also,scan revealed two nodules,sized 0.20 & 0.23 cm, one on each lobe. Should I have a biopsy?Do nodules affect adrenal function,as mine is already low?

Thanks in advance

Serum Urea 26 (10-50mg/dl)

Creatinine 0.8 (0.6-1.4mg/dl)

Serum Ca 9.7 (8.4-10.1mg/dl)

Serum Potassium 4.1 (3.5-5.1mEq/l)

Serum Na 142 (137-150mEq/l)

CK CPK 125 (122-214iu/l)

Lactate Dehydrogenase LDH 159 (122-214U/L)

WBC 5990 (4000-10000)

RBC 4160000 (4200000- 5400000)

HB 13.4 (12-16G/100ML)

HT 39 (36-46)

MCV 93.8 (77-98)

MCH 32.2 (26-32)

MCHC 34.4 (32-36)

PLT 248000 (140000-440000)

RDW-CV 13 (11.5-14.5)

MPV 10.7 (7.4-11.5)

Vit B12 543 (225-1000pg/ml)

Serum Folate 5.8 (>5.4 ng/ml normal)

Serum Ferritin 52 (13-150 ng/ml)

25-OH Vit D 31.3 (sufficiency >30)

Serum cortisol 8am 9.6 (6.2-19.4 μg/dl)

Serum TSH 5.81 (0.27-4.7)

Serum FT4 1.16 (0.7-2ng/dl)

Serum FT3 2.85 (2-4.4pg/ml)

ANTI-TPO 19.9 (<34)

ANTI- TG 16.3 (<115)

Serum insulin 7.3 (2.6-25μIU/ml)

[Clutter]

Irme,

Nodules <1cm are too small to biopsy. It is very rare that a nodule <1cm will be malignant. Nodules don't affect thyroid or adrenal levels.

Thyroid antibodies are negative for autoimmune thyroiditis (Hashimoto's).

If you are prescribed Levothyroxine you are undermedicated. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.4 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

RBC count is mildly low which can indicate anaemia but your ferritin, B12 and folate don't appear to be deficient. labtestsonline.org/understa...

VitD 31.3 is insufficient. My sister's GP prescribed 2 x 20,000iu D3 per week when her vitD was 40. Alternatively you can buy vitamin D3 without prescription. I recommend 10,000iu D3 x 6 weeks and then reduce to 5,000iu D3 and retest in 4 months. If you buy on Amazon please use the affiliate link healthunlocked.com/thyroidu...

Ferritin is optimal halfway through range. You can raise ferritin by supplementing iron with 1,000mg vitamin C to aid absorption and minimise constipation.

Vitamin D and iron should be taken 4 hours away from Levothyroxine.

[irme in reply to Clutter]

Thank you so much for your reply. Actually I am totally un-medicated.I take only 2000IU vitamin D3 and when the tingling in hands gets worse, I add B12 sublingual 1000IU.Scan also confirmed right lobe heterogeneity shown on previous scan.

[Clutter in reply to irme]

Irme,

TSH is over range. Why hasn't your GP prescribed Levothyroxine? As well as improving your thyroid levels Levothyroxine may help shrink nodules.

B12 543 is unlikely to be deficient but your folate is very low and that can impede how B12 works. You might want to supplement folic acid or methylfolate for 2-3 months to raise folate and eat more green leafy veg.

20,000iu D3 is not sufficient.

[irme in reply to Clutter]

Yes,I was put on 25mcg levothyroxine but I got a severe allergic reaction to the drug,not the fillers,and the endocrinologist said it's either levo or nothing. So while I've been going downhill, I've been taking what my dr. suggested,nothing.I have one more question please. I read that high MCH could suggest macrocytic anemia.Mine is slightly over range so should I investigate?

[Clutter in reply to irme]

Irme,

Thyroxine occurs naturally in the body so it's unlikely you are allergic to thyroxine in Levothyroxine but very possible to be allergic to the fillers. There are 4 makes of Leovthyroxine tablets in the UK, Mercury Pharma, Actavis, Wockhardt and Teva. You should try alternative makes to see whether they are more tolerable. If not, your GP can prescribe liquid thyroxine which has no fillers.

Macrocytic cells can be due to B12 or folate deficiency or hypothyroidism.

labtestsonline.org/understa...