Searching for a diagnosis (DESPERATELY) Please helpppp.... Is Hypothyroid possible with these blood tests??? NEW HERE

[Health1989]

Hi All,

I’m new on here and can’t believe just how brilliant this forum is so thanks for having me!!! (Apologies for the lengthy post).

I am a 29-year-old male that has had to return recently from Australia where I’ve been working for 8 years because of my undiagnosed illness, and am living with my parents (until I’m well again).

Hypothyroidism runs strongly in my family (aunty, mother, grandmother, male cousin and sister all have it) and I understand that my symptoms fit the bill. The symptoms that I’ve had for at least 6 months (probably getting worse over years now I think about it) are Extreme exhaustion / fatigue, Head fog / poor concentration, Dizziness / vertigo / balance problems, slow movements, thoughts and speech, poor focussing / double vision, memory loss / confusion, mental sluggishness, muscle cramps / weakness / joint aches, cold hands / feet, shortness of breath, high blood pressure 140/90, chronic cough that comes and goes aches and pains in joints, rash on cheeks that itches, itchy flakey scalp, hoarse voice, lack of coordination, joint stiffness, hot / cold intolerance and alcohol intolerance.

I have had a panel of blood tests which are below (range in brackets) and am currently on no medication. GP said I’m not Hypothyroid - Do you believe that Hypothyroidism is possible with these results? Or if it’s worth going to an Endocrinologist. If not, have you any idea where to point me next as my GP’s have run out of options. Thanks so much for any assistance at all.

In addition to my blood tests I’ve also had a brain MRI, knee MRI and Chest X-Ray that has come back as normal.

Just trying to keep positive at the moment and know that I will eventually get diagnosed. Thanks so much for any advice / assistance provided.

Blood Tests

TSH = 2.83 mU/L (0.30 – 4.40) – Previous test in 2015 was 3.02

FT4 = 15.8 pmol/L (9.0 – 19.1)

FT3 = 4.2 pmol/L (2.6 – 5.7)

Thyroglobulin Ab = 2.3 IU/mL (<4.1)

Thyroid Peroxidase Ab = 2 IU/mL (<6) – Was .8 in Nov 2018

Folate S.Fol (Abbott) = 19.7 nmol/L

Vit B12 = 180 pmol/L (135-650)

Active B12 = 66 pmol/L (>35)

Ferritin = 164 ug/L (30-300)

Iron = 18.7 umol/L (5-30)

Transferrin = 2.4 g/L (2-3.2)

TIBC (calc) = 54 umol/L (46-70)

Saturation = 35% (10-45)

DHEAS = 19.2 umol/L (3-16)***

PSA = 0.46 ug/L (.2-2)

Immunoglobulins

Immunoglobulin G = 10.74 g/L (6.2-14.4)

Immunoglobulin A = 4.46 g/L (.6-3.96)***

Immunoglobulin M = 1.6 g/L (0.48-3.04)

Immunoglobulin E = 101 IU/mL (<100)***

Allergy Serology

Cat epithelium = <0.01 kU/L Class 0 = Negative

Dog dander = <0.01 kU/L Class 0 = Negative

Grass Pollen = 0.34 kU/L Class 0 = Negative

Dustmite = 0.02 kU/L Class 0 = Negative

Alternaria alternata = 0.01 kU/L Class 0 = Negative

Haematology

Haemoglobin = 163 g/L (130-180)

RCC = 5.6 x10>12/L (4.5-6.5)

Haematocrit = .48 (0.39-0.54)

MCV = 86 fL (80-100)

MCH = 29.2 pg (27-32)

MCHC = 338 g/L (310-360)

RDW = 12.9 (10-15)

WCC = 5.8 x10>9/L (4-11)

Neutrophils = 3.33 x10>9/L (2-7.5)

Lymphocytes = 1.91 x10>9/L (1-4)

Monocytes = 0.43 x10>9/L (0 – 1)

Eosinophils = 0.06 x10>9/L (0.0-0.5)

Basophils = 0.04 x10>9/L (0.0-0.3)

NRBC = <1 x100WBC (<1)

Platelets = 249 x10>9/L (150-450)

ESR = 3 mm/h (1-20)

Biochemistry

Sodium = 140 mmol/L (135-145)

Potassium = 4.2 mmol/L (3.5-5.5)

Chloride = 103 mmol/L (95-110)

Bicarbonate = 28 mmol/L (20-32)

Urea = 6 mmol/L (3-7.5)

Creatinine = 85 mmol/L (60-110)

eGFR = >90 mL/min/1.73m2 (>59)

Bili Total = 12 umol/L (4-20)

ALP = 53 U/L (35-110)

GGT = 25 U/L (5-50)

LD = 149 U/L (120-250)

AST = 26 U/L (10-40)

ALT = 50 U/L (5-40)***

Phosphate = .96 mmol/L (.8-1.5)

Magnesium = 0.79 mmol/L (0.65-1)

Corr Calcium = 2.32 mmol/L (2.15-2.55)

Calcium = 2.3 mmol/L (2.15-2.55)

Serum Protein Electrophoresis (EPG)

Total Protein = 74 g/L (68-85)

Albumin = 48 g/L (39-50)

Globulin = 28 g/L (23-39)

Alpha 1 Globulin = 1.7 g/L (1-3)

Alpha 2 Globulin = 5.8 g/L (4-10)

Beta Globulin = 8.6 g/L (5-11)

Gamma Globulin = 9.8 g/L (7-16)

CK = 94 U/L (45-250)

CRP = 0.7 mg/L (0-5)

Cortisol AM = 464 nmol/L (138-650)

Antibodies to Extractable Nuclear Antigen (ENA)

SS-A 60 = Negative

SS-B = Negative

Ro-52 = Negative

Scl-70 = Negative

Jo-1 = Negative

Cenp-B = Negative

Sm = Negative

RNP = Negative

Ribo-P = Negative

Rheumatold Factor (Quantitative)

Rheumatold Factor (RF) = <6 IU/mL (<16)

Epstein-Barr Virus Serology

EBV VCA IgG = Detected

EBV NA IgG = Detected

EBV VCA IgM = Not Detected

Evidence of past, not current, EBV infection

Cytomegalovirus Serology

CMV IgG (CMIA) = Detected

CMV IgM (CMIA) = Not Detected

Suggestive of past, not current, CMV infection

Glucose

F Gluc Plasma = 5.1 mmol/L (3.6-6)

Lipids and HDL

Cholesterol = 5 mmol/L (3.9-5.5)

Triglycerides = 0.7 mmol/L (0.5-1.7)

HDL Chol. = 1.1 mmol/L (0.8-1.5)

LDL Chol. = 3.6 mmol/L (1.7 – 3.5)***

Androgens

Testosterone = 21.9 nmol/L (11.5-32)

SHBG = 35 nmol/L (15-50)

Calculated Free Testosterone = 468 pmol/L (260-740)

Mercury-blood = 53 nmol/L (<60)

Plasma Metanephrines

P-Normetanephrine = 340 pmol/L (<590)

P-Metanephrine = 330 pmol/L (<447)

P-3 Methoxy tyramine = <50 (<181)

Cyclic Citrullinated Peptide Antibodies = <5 U/mL (<5)

Coeliac Serology

Deamidated Gliadin IgA 2 U/mL (<15)

Deamidated Gliadin IgG <1 U/mL (<15)

Tissue Transglutaminase IgA <1 U/mL (<15)

Tissue Transglutaminase IgG <1 U/mL (<15)

Anti-DNA Antibodies (RIA) <5 IU/mL (0-6)

Lyme IgG = Negative

Lyme IgM = Negative

HIV ½ Antigen and Antibody = Negative

Hepatitus C Ab Abbott = Not Detected

Hepatitus C = Not Detected

Chlamydia trachomatis PCR = Not Detected

Neisseria gonorrhoeae = Not Detected

Hepatitis B Surface Ag = Not Detected

Hepatitus B Surface Ab = Not Detected

No evidence of hepatitis B infection

[Health1989]

Sorry forgot the Folate range which was (>7). Thanks.

[SlowDragon Administrator]

That's a serious number of tests.......but I can't see any vitamin D test in there

You can test for £29

vitamindtest.org.uk

B12 is on the low side

No high thyroid antibodies, but it's possible to have Hashimoto's and never have Hashimoto's

The thing that stands out is EBV test is positive and can be a cause of Hashimoto's

Do you remember having or were you aware of having Epstein Barr (Glandular fever)

EBV and Hashimoto's links

thyroidpharmacist.com/artic...

drhedberg.com/epstein-barr-...

hypothyroidmom.com/hashimot...

drchristianson.com/epstein-...

[Health1989 in reply to SlowDragon]

Thank you so much for coming back to me! Haha yes it was an awful lot of tests as I’m so keen to find out what’s going on with my body. Plus in Australia they are pretty keen to test for absolutely everything which they don't seem to do now i'm back in the UK. I didn’t realise that I had EBV (Glandular fever) until the test results came back and the doctor discounted it because he said 90% of the population have had it…. But does EBV NA mean that I’ve had it recently? If so, could this all be chronic fatigue caused by EBV?

Also if I had Hashi would my TSH, FT4, FT3 and antibodies be as normal as they look? Is there a test I can do for Hashimoto’s?

The doctor said there was no point in doing a Vit D test because I live in Australia and always in the sun so my Vit D levels will be high…. But if you think that I should I’ll get one done ASAP.

Thanks again!

[SlowDragon Administrator in reply to Health1989]

Thyroid patients can live in the sunniest place in the world and still be vitamin D deficient

An ultrasound scan of thyroid can help give a Hashimoto's diagnosis is antibodies are negative

Thyroid may look granular or lots of little nodules

I don't know much about EBV. Other than we get quite a few with chronic fatigue after having it turn up on this forum. Those links might have more info.

I think you can have antibiotics.

You have few other very slightly abnormal results. But nothing obvious

ALT - liver function test

DHEA - odd that it's high ....Has this been investigated. Often thyroid patients have low DHEA. Though early stages of Hashimoto's can cause over stimulation of adrenals, before they get exhausted

Raised cholesterol is common with Hypothyroidism and used to one of main ways it was diagnosed prior to invention of thyroid tests. This result is only just out of range

[Health1989 in reply to SlowDragon]

I had no idea that could be the case! 100% worth me getting my Vit D levels checked then… Especially because my B12 are on the low side as you kindly pointed out.

I spoke with a top endocrinologist in regards to a thyroid diagnosis today and he said that “the results you provide do exclude thyroid disease as a cause of symptoms. The trouble is that the symptoms which you list are found in patients with hypothyroidism but they are non-specific and another cause needs to be sought in your case.” So, I may have to drop chasing Hypothyroidism as the diagnosis.

I think the ALT test was slightly over because I had a few beers the day before I had my blood test (this had been tested previously and it came back as normal).

The doctor didn’t really comment on the DHEA being high. When I asked, he said that for my age, build etc its quite normal and because of all the years in the gym lifting weights (prior to me stopping 6 months ago because of all this). However, he did do further tests to eliminate adrenal cancer, tumours or excess growth. Like the Cortisol test and others that came back as normal.

The fact that my B12 is fairly low is a great pick up! Also strange because I make sure that I get heaps of Vit B in my diet so I must have an intolerance to absorbing it. I found this article saying how the reference range is set too low and they have doubled it in Japan - they also treat on symptoms rather that blood test results for this.

mthfrsupport.com.au/vitamin...

Do you think my symptoms would match with B12 deficiency?

Thanks again!

[SilverAvocado in reply to Health1989]

I'm not an expert in B12 deficiency, but it has a profile of symptoms quite similar to hypothyroid, so it could be a possibility.

[Health1989 in reply to SilverAvocado]

Thanks for the input SilverAvocado... I have a doctors appointment on Wednesday so I will discuss with her then. If she’s not up for doing more blood tests then I will organise privately on the link SlowDragon shared to get all my vitimins redone. Cheers.

[SilverAvocado in reply to Health1989]

Good luck!

[MaisieGray]

Just a point to be borne in mind, re.Lyme, not every Lyme testing protocol is effective/accurate, and the lesser ones are known to return false negatives. Americans tend to have a better knowledge of the recommended ones, if there are any US members around? It's debatable if there are any Lyme-carrying tics (Borrelia burgdorferi) in Australia but nevertheless there have been c500 Lyme-like illnesses recorded in past years, and it may be that the tick-borne pathogen responsible for the reported cases of Lyme-like illness is simply yet to be found. So for now it's just a back of mind piece of info that your negative results for Lyme might not necessarily be fully dependable.

[Health1989 in reply to MaisieGray]

Thank you so much Maisie Gray. Yes, I heard that can be the case! But I believe it’s usually because it takes a good three months for the antibodies to build up post tick bite and it can’t be detected until this happens. Many people get tested within the first three months.

I only recently got tested because there have been 3 cases in a 500 metre radius of my house in Aus. But I thought it was a stab in the dark because I didn’t feel like I was bitten or have the circular rash and my symptoms have been there for at least 6 months.

Thanks so much for the input!

[MaisieGray in reply to Health1989]

Not intending in anyway to erroneously push you down the Lyme route, but just to clarify for anyone reading, the issues go beyond the 3 month period you mention. Researchers in the Netherlands evaluated 87 studies for instance, that reported on the sensitivity and specificity of ELISA and Western Blots:

- The sensitivity of the two-tier testing was highly heterogeneous in patients presenting with an erythema migrans. The average sensitivity was 50%.

- The sensitivity of the two-tier testing had an average sensitivity of 77% in patients presenting with neurological Lyme disease.

- In patients with a presentation of acrodermatitis chronicum migrans the average sensitivity of the two-tier testing was 97%.

- For unspecified Lyme disease the average sensitivity was 73%.

- The specificity was around 95% in studies with healthy controls but around 80% in cross-sectional studies.

[Health1989 in reply to MaisieGray]

Wow thats very interesting MasieGray and I had no idea that could be the case. Thanks so much for the further detail!

[Muffy]

Is the rash a ‘butterfly’ rash? Does it go across your nose as well as cheeks in the shape of a butterfly?

[Health1989 in reply to Muffy]

No it’s just on my cheeks - not on my nose at all.

[Muffy]

What time of day was your blood drawn? Needs to be as early as possible for thyroid testing, around 8/8.30 am if possible as that is when TSH is at its highest.

[Health1989 in reply to Muffy]

Yes that’s when I did them - first thing in the morning at 8.30 so they would be my highest levels I think 🤔 I honestly expected the TSH to come back at like 100 given the way I feel 🙁🙁🙁

[Health1989]

Hi Grincho, thanks for the awesome suggestion and great to hear that taking supplements can make a big difference. It’s crazy how much guidance you can get from here! I will give them both a crack and see how I go.

[Health1989]

Hi Grincho, hope I’m not being intrusive but do you get injections for B12? Or take pills? Also did it take long for them to take effect once you started taking them. Thanks.

[Polaris in reply to Health1989]

I agree with others here. All the symptoms and history you've listed, plus low B12 result just inside range, suggest PA/B12 deficiency? The only one that puzzles me is itchy rash on cheeks - have you been tested for Lupus, another autoimmune disease?

The latest BMJ research document below states that, as there is no reliable test, history and symptoms are paramount and neurological symptoms should be treated with injections 'every other day until no improvement' to avoid permanent damage :

bmj.com/content/349/bmj.g5226

pernicious-anaemia-society....

b12deficiency.info/.

As it's generally so misunderstood by GPs and specialists who are not up to date with latest research, it's important to know that vitamin B12 is a primordial molecule we can't do without. It has to be treated urgently and adequately when any neurological symptoms appear before they worsen and become permanent.

Good luck finding answers Health1989.

PS. HAshimotos and PA/B12 runs in my family too. You probably know that 40% of those with Hashimoto's go on to develop PA/B12def. and vice versa.....