My dad has just received his private blood test results from bluehorizon, he took this private test as his GP refuses to acknowledge his long term complaints of feeling tired, depressed (so they give prozac) overweight, terrible memory, achy, swollen from head to toe, the list goes on! Can anyone advise what they mean and what he can say to the GP, if anything?
HbA1c-(IFCC) 38 (20-42)
hs-CRP 1.30 (<5)
Ferritin 84.2 (30-400)
Magnesium
0.93 (0.6-1.0)
Insulin 44.6 (0.88)
TSH
0.67 (0.27-4.20)
T4 Total
89.8 (64.5-142.0)
Free T4
15.70 (12.0-22.0)
Free T3 4.33 (3.1-6.8)
Reverse T3* 20 (10-24)
Reverse T3 ratio L 14.10 )Normal>15 Boarderline 12-15 Low <12)
Were any of the results flagged and discussed by the Medicheck's doctor? Can you check the insulin report as I'm wondering if there's a typo as the HbA1c is in range?
"Insulin 44.6 (0.88)"
"Anti-Thyroglobulin Abs H 1025 (<115)" - the antibodies are very high but the other thyroid results look in range so I'll leave others to comment.
SeasideSusie has very helpful guidance on how to increase vitamin D levels as your father's is a whole 1 point into the 'adequate' category and it's likely it would fall over winter.
Did he have an iron panel and full blood count (FBC) run? His ferritin is in range but sometimes it's helpful to have a fuller picture.
The insulin still looks wrong - if it were "44.6 (0-0.88)" your father would be very out of range and I'd expect Medichecks to comment on it. Pinky3
And I agree with SlowDragon that by themselves those antibodies are not strongly indicative of anything obvious.
ETA: Now that I've seen he's officially diagnosed with hypothyroidism and is taking levo. then that's a very different set of circumstances and I agree, again, with SlowDragon and with SeasideSusie.
Sorry I should also mention he has hypothyroidism and takes 200mcg levothyroxin daily. I have asked on PAS for further advice on testing. Are there any ways to up vitamin d levels? He isn’t adverse to some liver, so he’ll be happy to do this lol!
Did he do this test as early as possible in morning and fasting and no Levo in 24 hours prior to test?
This gives highest TSH and lowest FT4.
Option to add more Levo (25mcgs). Obviously easier than T3. High dose Levo might increase reverse T3 (which you don't want)
Or consider adding some T3. (Once vitamin levels are better)
His FT3 is low in range
Has he tried strictly gluten free diet? Very many of us find it helps
Personally I would push for slight dose increase, try gluten free and improve vitamins.
Then retest, if FT3 still low, look at adding T3
This below might help persuade GP to increase Levo dose by 25mcg
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.
Thank you so much for this advise, I will email Louise and also pass this onto my dad, he at last has some evidence to show the GP why he's been feeling like rubbish for years. I'm not aware on the things he had the test but next time I will advise these rules so he can get the most accurate results. Thanks again
This is good, the aim of a treated hypo patient is for TSH to be 1 or below with free Ts in the upper part of their ranges.
T4 Total
89.8 (64.5-142.0)
Considering his dose of Levo, his total T4 is low.
Free T4 15.70 (12.0-22.0)
37% through range - too low.
Free T3 4.33 (3.1-6.8)
33% through range, too low but virtually in balance with FT4.
Reverse T3* 20 (10-24)
I can't understand why this has been flagged, it is within range and wouldn't normally be commented on. What did they say?
Reverse T3 ratio L 14.10 Normal>15 Boarderline 12-15 Low <12
I would have expected this to be flagged if anything as it is borderline.
Was anything commented on?
Anti-Thyroidperoxidase abs 10.4. (<34)
Anti-Thyroglobulin Abs H 1025 (<115)
Now we know that he is hypothyroid, the high TG antibodies are possibly indicating autoimmune thyroid disease aka Hashimoto's which is where antibodies attack and gradually destroy the thyroid. Adopting a strict gluten free diet and supplementing with selenium l-selenomethionine 200mcg daily can help reduce the antibodies, as can keeping TSH suppressed.
I'm not sure an increase in Levo is the best idea, he is already on quite a high dose with a good TSH, increasing Levo might push the rT3 up over range and that isn't a good thing, but the free Ts need to be higher. As Hashi's can cause gut/absorption problems that needs looking at, and optimising vitamins and minerals, then see if there is any improvement in the free T results.
The Vit D Council recommends a level of 100-150nmol/L. I would suggest supplementing with 5000iu daily for 3 months then retest (Vit D only, if no other tests need repeating, can be done with a fingerprick bloodspot test with City Assays vitamindtest.org.uk/
)
BetterYou oral spray (best for absorption where there's Hashi's) comes in 3000iu and 1000iu doses, so maybe do 6000iu daily.
There are important cofactors needed when taking D3
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
So it's important to check for signs of B12 deficiency as mentioned in your other thread, and maybe get GP to test intrinsic factor antibodies. See what the PA forum says.
And an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Ferritin 84.2 (30-400)
Good enough for T4 to T3 conversion to take place (and that seems good from his FT4/FT3 results) but really should be half way through range. Liver once a week (max 200g) is the way to go to raise ferritin.
Thank you so much for such a detailed response I will study this and relay it to my dad, it all makes sense with his current health issues with what you have said. A gluten free diet is a great idea, he is very overweight so he needs some sort of guidance and this will be a good rating point. I know he takes Hey Smithy meds at night so taking bit in the am I assume will be ok? the betterYou spray I use but I will send him a link on the one containing k2.
The comments he received:
The low reverse T3 ratio is unlikely to be of clinical significance. There is much controversy about the role of reverse T3 in thyroid illness. Conventional endocrinologists (hormone specialists) generally believe that knowing of the level of this substance does not influence thyroid treatment decisions. The alternative view however is that reverse T3 is effectively 'antithyroid' - T3 is the active thyroid hormone that stimulates the body's energy system (metabolism). Reverse T3 is a mirror image - it goes into cells, and instead of controlling metabolic processes it blocks the effect of T3. In this model, reverse T3 is effectively a hibernation hormone - in times of stress and chronic illness it lowers energy release from the cells - so normal thyroid levels with high reverse T3 may still result in hypothyroidism.
The positive thyroid antibody result, however, increases the possibility of your having or ultimately developing autoimmune thyroid disease, such as Hashimoto's thyroiditis or Grave's disease.
The Vitamin B12 level is insufficient. 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). 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. Supplementation with Vitamin B12 is likely to be of benefit - please discuss this finding with your usual doctor.
I know he takes Hey Smithy meds at night so taking bit in the am I assume will be ok?
??? Any predictive text/typos here? I'll try and help with timing of everything if I know what he's taking.
Personally, I wouldn't worry about the rT3 ratio. His rT3 is currently in range. I would concentrate on getting vitamins and minerals optimal, addressing the Hashi's and any gut/absorption problems then see how things are.
ops yes thats odd? I meant he take his meds at night and assume taking vit D in the morning will be ok, I'm typo oblivious lol! He takes cholesterol statins and prozac. He also loves to drink and eat so always struggled with weight, its a circle he goes round but with optimum vitamins I'm sure things will get easier.
What meds is he taking at night? All of them - Levo, statins and prozac?
As a general rule - Levo should be taken on an empty stomach, one hour before or two hours after food, with a glass of water only (no tea, coffee, milk, etc, for an hour either side as it affects absorption).
Levo should be taken 2 hours away from other medication and supplements, sometimes 4 hours. I would just make it a rule to take Levo as far as possible away from any other medication.
Vit D/K2 needs to be taken with the fattiest meal of the day, or some dietary fat (cracker and butter/full fat yogurt/etc. D3 should be taken 4 hours away from Levo.
Vit D's other cofactor - magnesium - should be taken 4 hours away from Levo.
B vitamins are best no later than lunchtime as they can be stimulating and may disturb sleep.
You could google each of his medications eg 'prozac + levothyroxine' to see if there are any interactions and recommendations.
Ah, statins wil reduce his B12 and his CoQ10 so he needs to supplement both (or get off statins if he hasn't had a heart attack). They also cause calcification of the arteries so it is vital that he starts vitamin K2 ASAP. Probably a good idea to find out about gradually getting of prozac too. It's highly addictive so you can't just stop. A ketogenic diet might suit him.
Take supplemental vitamin D3 (at least 2000iu) plus vitamin K2 (as MK-7) and magnesium with a fatty meal at the other end of the day from levo. The liver would be good to increase B12, but I think he'll need a sublingual methylcobalamin supplement at least to start with, plus a probiotic to help with absorbtion.
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Results with T3 and 50mg T4
I have seen my GP today
New Bloods
Trying to understand test results, please can anyone advise how to read them? 
