Newbie - needs advice on blood test results

[MamaRidge]

Hello I am a newbie. Two years on from being diagnosed with bilateral Breast Cancer followed by Mastectomy, Chemotherapy, Radiotherapy, 12-month 3-weekly injections, and tablet for 5 years my on-going bone aching chronic fatigue was always, attributed to these treatments.

However, on one of the Doctor In the House programmes earlier in the year a 35 year old man who had chronic fatigue was finally diagnosed by Dr Chatterjee as being B12 deficient.

At a Doctors appointment in May of this year I asked for blood tests to check my B12 level. My doctor agreed and requested a range of tests, including B12. On recall I was told I was Hypothyroid and that my iron levels were low. I was given no other information, other than I would be on life long thyroid medication, and that I would have my bloods taken every 6-8 weeks until this medication is deemed to be at the right level.

I have found this site absolutely invaluable in learning about this condition, how little the medical professional actually know about it, and importantly in managing it. I have had to inform my GP on my second visit, from the knowledge acquired from this site, that fasting blood tests should be done as early as possible, with a gap of 24 hours since last thyroid medication. She was unaware and promised to look into this further so she could update other GPs in the practice.

In May I was started on 50 Levothyroxine and this was increased in August to 75. I did feel marginally better at first but this last couple of weeks or so I have had some very bad days due to fatigue, and some headaches which I am not normally prone to. I have also quickly gained half a stone recently.

As I am due to see my GP later on this week I would welcome any comment about the blood results I have had so far, which I must admit most of which I don't understand too well!

I asked that my recent bloods included a check test for Hashimoto antibodies, which I have learned from this site is the most common form of Hypothyroidism. Do I have this? Also I have learned that I need to get my TSH to 1.0 or below, again this was not something my GP was aware of.

My blood test results so far are as follows:

24 May 2017

Bone profile

Serum calcium level 2.38 mmol/L [2.2 - 2.6]

Serum adjusted calcium concentration 2.47 mmol/L [2.2 - 2.6]

Serum lipid levels

Serum cholesterol levels 6.1 mmol/L

Serum HDL cholesterol level 1.48 mmol/L [1.17 - 1.81]

Serum cholesterol/HDL ration 4.1

Serum triglyceride levels above range 3.1 mmol/L [0.5 - 2.0]

Serum non high density lipoprotein cholesterol level 4.6 mmol/L

Blood haematinic levels

Serum ferritin level below range 26 ug/L [30.0 - 400.0]

Serum vitamin B12 level 376 ng/L [197.0 - 771.0]

Serum folate level 4.9 ug/L [3.89 - 26.8]

Liver function tests

Serum total bilirubin level 7 umol/L [< 21.0]

Serum alkaline phosphatase level 98 iul/L [35.0 - 104.0]

Serum alanine aminotransferase level 15 iu/L [< 40.0]

Serum gamma-glutamyl transferase level 19 iu/L [7.0 - 33.0]

Serum total protein level 71 g/L [60.0 - 80.0]

Serum albumin level 37 g/L [35.0 - 50.0]

Serum globulin level 34 g/L [25.0 - 41.0]

Urea and electrolytes

Serum sodium level above range 147 mmol/L [133.0 - 146.0]

Serum potassium level 4.3 moll [3.5 - 5.3]

Serum urea level 5.9 mmol/L [2.5 - 7.8]

Serum creatinine level 78 umol/L [45.0 - 84.0]

GFR calculated abbreviated MDRD > 60 mL/min/1.73m2

Thyroid function test

Serum TSH level above range 24.2 miu/L [0.3 - 5.5]

Serum free T4 level below range 7.9 pmol/L [12.0 - 22.0]

4 August 2017

Serum ferritin level below range 23 ug/L [30.0 - 400.0]

Serum TSH level 3.43 miu/L [0.3 - 5.5] If on T4 the TSH suggests adequate treatment. If the patient is on antithyroid drugs or there is a suspicion of pituitary disease further tests may be required.

28 September 2017

Serum ferritin level below range 24 ug/L [30.0 - 400.0]

Serum total 25-hydroxy vitamin D level 69 nmol/L [50.0 - 144.0]

Serum TSH level 3.01 miu/L [0.3 - 5.5] If on T4 the TSH suggests adequate treatment. If the patient is on antithyroid drugs or there is a suspicion of pituitary disease further tests may be required.

Serum thyroid peroxidase antibody concentration 10 ku/L [< 34.0]

[Nanaedake]

Most people don't feel well until their TSH level is around 1.0 or a little lower. This means you could do with an increase in your thyroid medication. You could increase by 25 mcg and test again in 6 weeks and adjust until you feel better and TSH is around 1.0. Your ferritin level is still too low, it needs to be mid-range. What are you supplementing for it? Did you get a full iron panel this time? What supplements are you taking for vitamin D? It could still do with a bit of help to get it up to around 100 especially if in the UK as we are going into winter when your body will use your stored vitamin D.

B12 and folate were both low. B12 is best top of range and folate could then do with a boost. You could eat lots of leafy green vegetables to help folate and if you supplement then methylfolate is the most absorbable form of folate.

[MamaRidge]

Hi Nanaedake thank you for replying. I've not been advised to take any supplements so I will discuss this with GP tomorrow, or take matters into my own hands as most seem to have to do. It's been a bit overwhelming & GP doesn't say to much in the 5 to 10 minute appointment. My diet is generally very good especially with regards to vegetables, leafy greens etc so it looks like I will have to supplement & try & get improvements.

[MamaRidge]

No GP didn't order a full iron panel this time. I will ask for this at the next TSH blood test.