Blood Test Results-Confused!: Hi all This is my... - Thyroid UK

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Blood Test Results-Confused!

MMHGA profile image
MMHGA

Hi all

This is my first post and I will try to keep in brief.

I suffered from hair loss and and fatigue which started some months ago, I went to the doctor and the hair loss on my head they believed was stress, when I lost more hair (several patches on my face) I was diagnosed with alopecia. The fatigue was believed to be stress related.

During this I had blood tests done which came back as follows:

Serum Bilirubin (44E): 8 umol/l

Serum Total Protein Level (XE2e9): 73 g/l

Serum albumin level (XE2eA): 41 g/l

Serum globulin level (XE2eB): 32 g/l

Serum alkaline phosphatase level (XE2px): 96 iu/l

Serum alanine aminotransferase level (XaLJx): 24iu/l

Serum gamma-glutamyl transferase level (XaES3): 49 iu/l

Serum ferritin level (XE24r): 121 ng/ml

Serum TSH Level (XaELV): 6 miu/L

Serum free T4 level (XaERr): 9 pmol/l

Plasma glucose level (XM0ly): 4.2 mmol/l

I was advised I would need another test due to my thyroid (I assume this was due to the TSH level?

The next result came back with:

Serum Thyroid peroxidase antibody concentration (XabCy): 11.9 kU/L

I must be honest these results mean nothing to me, I have tried comparing them with other results people have posted online but I can't seem to match the unit of measure they use in tests (such as miu/l). I was told that I had subclinical hypothyroidism but they don't treat this condition.

Can anyone recommend any further action I can take based on the test results? Or can anyone even tell me what they actually mean since I wasn't given an explanation of the results?

I have read that cutting down on glutten might help but other than that I'm not sure what to do since the symptoms are not going away and it's beginning to have an impact on my performance at work (lack of concentration, mental blocks and fatigue).

I'm thinking my next step may be to go to our occupational health service at work to get their opinion but in the mean time I'm just trying to find out all I can.

Sorry that wasn't very brief, any advice information will be gratefully received.

6 Replies

You can't compare them because you're comparing the wrong thing. What is important is the range, not the unit of measure. As you haven't given any ranges, I can't say how bad your FT4 is, but your TSH is high. Doctors in the UK call it sub-clinical, but it isn't really. You are hypo. It's just that on the NHS, they like to wait until the TSH goes over 10 before diagnosing, which is, in my opinion, sadistic and unnecessary. But, that's the way it is.

So, you are hypo and that's what's causing your symptoms, but you won't get treated for it until your TSH goes over 10. What time of day did you have the blood draw?

greygoose profile image
greygoose in reply to greygoose

Oh, meant to say that gluten-free helps people with Hashi's, not just people who are hypo. Your antibodies don't appear to be high, but we do need the range.

But something you ought to ask your doctor to do is test your vit D, vit B12, folate and ferritin. These could be low and causing problems. They need to be optimal, not just in-range. :)

SeasideSusie profile image
SeasideSusieAdministrator

MMHGA

As Greygoose says, we need the ranges.

Your TSH is definitely over range (TSH range rarely goes above 5ish) but if your FT4 is below range then you could push for a trial of Levothyroxine on the grounds of an over range TSH and a below range FT4. But get the ranges first so we can be sure where your FT4 lies. My lab's range for FT4 is 7-17 which isn't often seen on here, we also lsee 9-19 and 12-22.

MMHGA profile image
MMHGA in reply to SeasideSusie

Thank you SeasideSusie and Greygoose for such a quick reply. I do have the ranges but I have to be honest again and didn't realise they were so important. I thought they related to an average range across the population and therefore not necessarily unique to me and therefore more of a guide. Sorry I'm entering into a whole new world here.

Serum Bilirubin (44E): 8 umol/l

(<20)

Serum Total Protein Level (XE2e9): 73 g/l

(63-82)

Serum albumin level (XE2eA): 41 g/l

(35-50)

Serum globulin level (XE2eB): 32 g/l

(21-35)

Serum alkaline phosphatase level (XE2px): 96 iu/l (38-126)

Serum alanine aminotransferase level (XaLJx): 24iu/l

(0-50)

Serum gamma-glutamyl transferase level (XaES3): 49 iu/l

(12-64)

Serum ferritin level (XE24r): 121 ng/ml

(23-300)

Serum TSH Level (XaELV): 6 miu/L

(0.35 - 3.5)

Serum free T4 level (XaERr): 9 pmol/l

(8-21)

Plasma glucose level (XM0ly): 4.2 mmol/l (4-11)

And second test

Serum Thyroid peroxidase antibody concentration (XabCy): 11.9 kU/L (0-34)

Sorry for not including these in the original post, I think I have a heck of a lot of reading to do to truly understand my thyroid issue. I have to be honest the doctors surgery is extremely busy but despite that I should have probably asked more questions and not simply accepted the whole stress diagnosis. They did ask if I had been suffering from stress and I did undergo a very stressful event recently so simply said yes. What i did forget to mention was that my hair loss began before this, it simply didn't occur to me at the time getting my days mixed up which is something that's been happening more and more recently.

SeasideSusie profile image
SeasideSusieAdministrator in reply to MMHGA

MMHGA

Don't worry, we were all new once, and we learn as we go along. Ranges are individual to labs, there are no universal ranges but they may be similar. So to accurately interpret tests we need the ranges :)

Most of your tests are within range and don't throw up any red flags. Plasma glucose level is very close to the bottom of range. I don't know anything about this but wonder if you have any hypoglycaemic episodes - it might be worth keeping an eye on this.

Serum TSH Level (XaELV): 6 miu/L (0.35 - 3.5)

Serum free T4 level (XaERr): 9 pmol/l (8-21)

Serum Thyroid peroxidase antibody concentration (XabCy): 11.9 kU/L (0-34)

So your Thyroid Peroxidase (TPO) results don't currently indicate autoimmune thyroid disease (Hashimoto's), which is where antibodies are present. This would be indicated by a level above 34. Antibodies fluctuate so it's worth repeating the test in the future. It's also worth getting Thyroglobulin (TG) antibodies tested because you can be negative for TPO but positive for TG and this would then confirm Hashi's.

Your TSH is, as you now know, too high and would actually get you a diagnosis of hypothyroidism in another country, but our doctors/guidelines are cruel.

Your FT4 has barely scraped into range.

What you are looking at, according to NICE Clinical Knowledge Summary (mention this to your GP and you can give the following link and information) is Subclinical Hypothyroidism - I have included information relevant to you but read as much as you can

cks.nice.org.uk/hypothyroid...

Arrange investigations including:

Blood tests for thyroid stimulating hormone (TSH) and free thyroxine (FT4):

◾Suspect subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range. In non-pregnant people repeat TSH and T4 (ideally at the same time of day) 3–6 months after the initial result to exclude transient causes of a raised TSH (such as intercurrent illness) and to confirm the diagnosis of SCH.

•The recommendation on suspecting subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range is based on the clinical guideline UK guidelines for the use of TFTs [Association for Clinical Biochemisty, 2006] and the statements by the Royal College of Physicians The diagnosis and management of primary hypothyroidism [Royal College of Physicians, 2011] and the British Thyroid Association Management of primary hypothyroidism [Okosieme, 2015].

Repeat TSH and FT4 if SCH is suspected

•The recommendation on repeating TSH and FT4 is based on the clinical guidelines UK guidelines for the use of TFTs [Association for Clinical Biochemisty, 2006] and Management of subclinical hypothyroidism [Pearce, 2013], and statements from the Royal College of Physicians The diagnosis and management of primary hypothyroidism [Royal College of Physicians, 2011] and the US Preventive Services Task Force Screening for thyroid dysfunction [LeFevre, 2015].

◦SCH should be confirmed 3–6 months after initial results to exclude transient causes of a raised TSH (such as acute non-thyroidal illnesses) which do not permanently damage the thyroid [Association for Clinical Biochemisty, 2006; LeFevre, 2015].

◦If TSH is raised due to a transient cause, tests will normalize after the illness — thyroid replacement therapy is not needed (and can be harmful) [Royal College of Physicians, 2011].

◦Repeat measurement should ideally be on blood drawn at the same time of day, as serum TSH concentrations fluctuate with a dip in the early afternoon and peak in the evening and night [Pearce, 2013].

Also

cks.nice.org.uk/hypothyroid... (again read the article)

Many people with SCH do not need treatment, but if a decision is made to treat, prescribe levothyroxine (LT4).

◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.

Has repeat testing been discussed? Normally a few weeks is enough for TSH to normalise if it was raised due to illness. I would push for retesting no later than 3 months following these tests.

I would arm yourself with as much information from these articles, and anything else you can find from reliable sources. Print off the list of signs and symptoms of hypothyroidism from ThyroidUK, tick any that apply and show your GP and use this to support your request that he considers a trial of Levo for your apparent subclinical hypothyroidism.

thyroiduk.org/tuk/about_the...

It's not easy, some doctors are more willing to allow a subclinical patient a trial of levo than others.

If you do manage to get Levo prescribed, if it is for 25mcg then you are likely to feel worse to start with. That dose is for children, the elderly and people with a heart condition. Normal starting dose is 50mcg, repeat test after 6 weeks and increase to 75mcg, repeat test after another 6 weeks and add another 25mcg if necessary, etc.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.

When booking thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . This gives the highest possible TSH which is needed when looking for a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It also lowers after eating. [Also, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test.] These are patient to patient tips which we don't discuss with doctors or phlebotomists.

There are several reasons for hairloss, hypothyroidism being one, stress being another, also low levels of some vitamins and minerals which you can see here

hubpages.com/health/16-Vita...

So I would get some of these tested, we always advice the following

Vit D

B12

Folate

Ferritin

Come back and let us know how you get on. If you are prescribed Levo it's important to know that it should be taken on an empty stomach, one hour before or two hours after food, with a glass of water only, and away from other medication and supplements by 2 hours, some need 4 hours.

MMHGA profile image
MMHGA in reply to SeasideSusie

SeasideSusie, thank you so much for the advice and links, there was no mention of follow up testing but once I've read through all the information you have posted I will make a follow up appointment with the surgery.

Again many thanks for your help.

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