New results. Dose adjustment? Reason for macrocytosis?

[blogsy2]

Hi Everyone,

My husband would really appreciate any wisdom on his latest results. He's been on NDT for the last seven months, gradually increasing the dose. Currently on 1.5 Thyrogold a day. I think this makes 75ug of T4 plus 19ug of T3. He was on Naturethroid but problems with supply and then a new bottle which seemed to cause him severe headaches have caused him to switch.

His B12 was in the grey area last year, and he certainly was very foggy and low. He's been self injecting after initial loading doses from the GP, and this has undoubtedly helped his mood and mental faculties - I feel I've got "him" back mentally, but not physically. Results still show macrocytosis, in fact worse than his previous results. He's also supplementing folate, usually 400ug a day, but I've asked him to add in another 1000ug for a month or so to raise this further. Also I've advised him to raise his Vitamin D dose. He takes quite a few supplements currently and I can list these if helpful. He has been taking selenium for several months.

He was previously on an autoimmune diet and his antibodies (which were high in range initially) declined. He's now just gluten free and his antibodies have gone up out of range for the first time. However he's been struggling with weight loss, hence him putting most things back into his diet. He eats three times as much as I do but is struggling to put on weight - very thin. He's had a three-day stool test that's come out fine.

His RT3 has come down dramatically.

His DHEA has shown at bottom of range twice in the last few months. His cortisol looked okay and had a nice curve. He's had a short synacthen test and that was okay.

He's tired, has a slow pulse (low 50s), low blood pressure that sometimes makes him feel faint (finds drinking salt water helpful), very constipated, body temperature tends to dive at the least challenge and he's generally cold.

His HbA1c seems high for someone who doesn't eat sugar or refined carbs.

He very rarely drinks alcohol. He eats a ridiculously healthy diet.

Some questions for the wonderful hive mind please!

Medichecks say he needs to lower his NDT dose. I feel he should raise it, but what do you think?

Can his low thyroid hormones be causing this macrocytosis, or should we be looking for something more sinister? Is the folate low enough to cause it? He's been diagnosed with CFS, so nobody is looking for anything else now. I've read that hypothyroidism can cause macrocytosis, but I don't know what the mechanism is.

Do you think low stomach acid could be literally making him malnourished?

Many thanks for any thoughts, ideas or suggestions!

ENDOCRINOLOGY

Thyroid Function

THYROID STIMULATING HORMONE *0.025 mI/L 0.27 - 4.20

FREE THYROXINE 12.100 pmol/L 12.00 - 22.00

FREE T3 3.87 pmol/L 3.10 - 6.80

REVERSE T3 *9.9 ng/dL 10.00 - 24.00

REVERSE T3 RATIO 25.45 15.01 - 75.00

THYROGLOBULIN ANTIBODY *151.000 IU/mL 0.00 - 115.00

THYROID PEROXIDASE ANTIBODIES <9.0 IU/mL 0.00 - 34.00

HAEMATOLOGY

Vitamins

ACTIVE B12 *>300 pmol/L 25.10 - 165.00

FOLATE (SERUM) 13.16 ug/L 2.91 - 50.00

25 OH VITAMIN D 84.9 nmol/L 50.00 - 200.00

Interpretation of results:

Deficient <25

Insufficient 25 - 49

Normal Range 50 - 200

Consider reducing dose >200

BIOCHEMISTRY

Inflammation Marker

CRP - HIGH SENSITIVITY 0.17 mg/1 0.00 - 5.00

HAEMATOLOGY

Red Blood Cells

HAEMOGLOBIN (G/L) 147 g/L 130.00 - 170.00

HCT 0.433 L/L 0.37 - 0.50

RED CELL COUNT *4.24 s10"12/L 4.40 - 5.80

MCV *102 fl 80.00 - 99.00

MCH *34.8 pg 26.00 - 33.50

MCHC (G/L) 341 g/L 300.00 - 350.00

RDW 12.8 11.50 - 15.00

White Blood Cells

WHITE CELL COUNT 5.1 :1049/L 3.00 - 10.00

NEUTROPHILS 2.07 s1049/L 2.00 - 7.50

LYMPHOCYTES 1.96 s10"9/L 1.20 - 3.65

MONOCYTES 0.35 s10"9/L 0.20 - 1.00

EOSINOPHILS *0.65 a10"9/L 0.00 - 0.40

BASOPHILS 0.03 s10"9/L 0.00 - 0.10

Clotting Status

PLATELET COUNT 164 s10"9/L 150.00 - 400.00

MPV 9.6 fl 7.00 - 13.00

Inflammation Marker

CRP - HIGH SENSITIVITY 0.17 mg/1 0.00 - 5.00

BIOCHEMISTRY

Kidney Function

SODIUM 142.1 mmol/L 135.00 - 145.00

UREA 4.9 mmol/L 1.70 - 8.30

CREATININE 83 umol/L 66.00 - 112.00

ESTIMATED GFR 33.05 60.00 - 250.00

Normal range: >60

Liver Function

ALKALINE PHOSPHATASE 60 IU/L 40.00 - 129.00

ASPARTATE TRANSFERASE 27.3 IU/L 0.00 - 37.00

ALANINE TRANSFERASE 26.4 IU/L 10.00 - 50.00

CK *223 IU/L 38.00 - 204.00

GAMMA GT 17 IU/L 10.00 - 71.00

BILIRUBIN 18 umol/L 0.00 - 20.00

Proteins

TOTAL PROTEIN 68.2 g/L 63.00 - 83.00

ALBUMIN 42.9 g/L 34.00 - 50.00

GLOBULIN 25.3 g/L 19.00 - 35.00

Bone Health

CALCIUM 2.44 mmola 2.20 - 2.60

CORRECTED CALCIUM 2.38 =oda 2.20 - 2.60

Gout

URIC ACID 280 umo1/L 266.00 - 474.00

Diabetes

HBA1C (MMOL/MOL) 37.02 mmol/mol 20.00 - 42.00

BIOCHEMISTRY

Iron Status

IRON 21.44 umol/L 10.60 - 28.30

T.I.B.0 49.84 umol/L 41.00 - 77.00

TRANSFERRIN SATURATION 43.02 % 20.00 - 55.00

FERRITIN 260 ug/L 30.00 - 400.00

Cholesterol Status

TRIGLYCERIDES 0.62 Imola 0.00 - 2.30

CHOLESTEROL 3.96 mmol/L 0.00 - 4.99

HDL CHOLESTEROL *1.78 mmola 0.90 - 1.50

LDL CHOLESTEROL 1.9 mmol/L 0.00 - 3.00

NON-HDL CHOLESTEROL 2.18 mmol/L 0.00 - 3.89

Heart Disease Risk

HDL % OF TOTAL 44.95 % 20.00 - 100.00

[blogsy2]

Have I bamboozled everyone? (as my teenage daughter would say!)