New Test Results (feedback please) and Mixed Endo Results (US)

[soupybp]

I would love some feedback on these labs from you wonderful people.

Met with endo and they completed first round of testing (after gp refused to do any increase in NDT medication even though symptoms AND fT3/4 levels were worse). There was good and bad. Endo will not do rT3, saliva cortisol, active B12, D 100OH, and thinks my iron levels are good and doesn't test TIBC/%sat. Endo did test fT3 and tends to treat to symptoms, didn't try to put me on statins for slightly elevated cholesterol (first time that has popped up, they indicated it should come back into range with proper thyroid).

Taking lisinopril (high bp), Vit D3 (10,000IU), Thorne 3-K complete, Thorne B complex #6, Vit C (1000mg), and at time of last testing 60mg NP Thyroid. NP increased to 75mg based on labs/symptoms (fatigue, brain fog, weepy, overwhelmed, still low basal temps)

Here are some of the results (all supplements stopped 1 week before most current testing, NDT taken 12 hrs prior to test, drawn at 8am fasting):

TSH 1.37 (.4-3.74) Prev. 1/24/19 2.35 (.3-3.8) @30mg; 11/24/18 4.53 (.3-3.8) @ no med

fT4 0.8 (.76-1.46) Prev. 1/24/19 1.00 (.8-1.8) @ 30mg; 11/24/18 1.02 (.8-1.8) @ no med

fT3 3.31 (2.18-3.98) Prev. 1/24/19 2.70 (2.3-3.8) @ 30mg; 11/24/18 2.86 (.8-1.8) @ no med

Vit D 25OH 99.9 (75-250) Prev. 11/24/18 7 (30-100)

Folic Acid 10.3 (8.6-58.9) Prev. Folate 11/24/18 10.5 (>4.5)

Total B12 488 (193-986) Prev. 11/24/18 402 (200-900)

Ferritin 22.0 (8-388) Prev. 11/24/18 23.6 (20-324)

Total Iron 54 (50-170)

RBC 4.49 (3.5-5.5)

HGB 13.3 (11.5-16.5)

TPO Ab <10 (0-35) Prev. 11/24/18 13.3 (0-31)

TgA <20 (0-40) Prev. 11/24/18 <10 (0-60)

Thyroglobulin 14.7 (0-55)

Magnesium 2.1 (1.8-2.4)

Calcium 9.1 (8.5-10.1)

Potassium 4.2 (3.5-5.1)

Sodium 142 (136-145)

CRP-High_Sens 8.1 (0-3)

iPTH 23.4 (11-67)

Homocysteine 10 (5-12)

Prolactin 9.85 (1.9-25)

DHEA-Sulfate 304 (35-430)

Cortisol (serum) 8.7 (5-25)

ACTH 11.5 (0-46)

C-Peptide 1.97 (0.9-7.10)

Cholesterol 206 (0-200)

Triglyceride 67 (0-150)

HDL 52 (>40)

LDL 141 (<130)

TRAB pending, will be going in for hormone panel on Friday to test in luteal phase.

So it seems to me I am making some gains on my B12 and Vitamin D levels. The B complex includes some folate. I now have more information to justify some iron supplementation, but I have no idea how much because the doc doesn't agree that there is an issue. Thoughts?

I will also have to do the saliva cortisol testing on my own it seems. I am strongly suspicious of a cortisol issue.

[greygoose]

Why the TRAB test? There's no suggestion of hyperthyroidism there.

[soupybp in reply to greygoose]

It part of their standard protocol for new patients. (I asked the same thing.) The test was drawn at the same time as all the other tests, but the results had not made it back to them by the time of my followup appointment.

[greygoose in reply to soupybp]

How very strange. With most endos, you can't get a TRAB for love nor money!

You certainly needed an increase in something, because your TSH is much too high. And, I agree that your ferritin needs some attention. It is low in range in that test, and given that your CRP is very high, your ferritin could be even lower in actual fact. Doctors know nothing about nutrients, but you should try and convince your doctor to do an iron panel, because you could be anemic.

[soupybp in reply to greygoose]

I know, right? Some things this endo seems really on the ball, and other things way out of touch. A real mixed bag.

I don't recall seeing any information about the relationship between CRP and ferritin levels. I will go looking. GP has said no to my request for full iron panel. Endo thinks that only Iron/Ferritin needed and that those levels are acceptable, so no help there. It looks like I will have to do on my own which really stinks since we are meeting the family deductible on the insurance this year.

In same boat on cortisol...GP says it is outside his purview (which I agree) and Endo says serum cortisol at single time along with ACTH is all that is needed and that levels are fine.

And from my research, this Endo is the best in our area with regards to knowledge on hypo/adrenal and bioidenticals/nutrition.

[greygoose in reply to soupybp]

It's amazing just how bad the best can be! But I think you might have problems raising your ferritin just by taking iron supplements. It is very low. The stupid ranges are just too wide! And they don't know enough to understand that.

[Hashi-Monster]

Your increase of NP by 15mg seems reasonable given your latest labs.

I think you should look at your iron though as both your ferritin and total iron are very low. You need ferritin to be about 80-100 to help with T4 to T3 conversion.

[soupybp in reply to Hashi-Monster]

Totally agree. But since doctor thinks it is fine, I can't get supplement guidance there. I have no idea how much to take to proceed from here.

[Hashi-Monster in reply to soupybp]

Its so annoying when basic care needs are ignored by GPs and especially when its something that could be easily fixed.

I don’t have an iron deficiency myself so cannot advise on supplements. But I have found that eating shellfish (especially prawns) pushed my ferritin above range, since I removed them from my diet my ferritin returned to normal. Also eating liver is good for iron levels, I find chicken liver the most palatable.

Adding SeasideSusie for additional nutrient advise.

[SeasideSusie Remembering in reply to soupybp]

Vit D 25OH 99.9 (75-250) Prev. 11/24/18 7 (30-100)

What is the unit of measurement?

Why 2 different ranges?

Folic Acid 10.3 (8.6-58.9) Prev. Folate 11/24/18 10.5 (>4.5)

This is low, folate needs to be at least half way through range, so with your current level and range it should be 34+. Folate rich foods can help, as can a good B Complex containing methylfolate (not folic acid).

Total B12 488 (193-986) Prev. 11/24/18 402 (200-900)

Is this pmol/L or pg/ml or ng/L?

According to 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."

According to 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 22.0 (8-388) Prev. 11/24/18 23.6 (20-324)

Ferritin is very low. Recommended is half way through range, but I've seen it said around 100 for females is about right, with a minimum of 70 for thyroid hormone to work properly.

Total Iron 54 (50-170)

Is this Serum Iron ?

As both of these are low, to know if you have iron deficiency anaemia you'd need the MCV from a full blood count.

I can't advise on taking iron tablets because iron is so complicated, but you can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

[soupybp in reply to SeasideSusie]

Vit D

UoM for 11/24/18 is ng/mL - tested at the hospital lab

UoM for current is nmol/L - tested in the Endo's onsite lab

Different ranges because different labs.

Folate

Added B-complex #6 from Thorne since November. Includes methyfolate.

B12

UoM for both tests at pg/mL. Again, taken at different labs as shown above.

My plan is to change from Thorne B-complex #6 to B-complex #12 when I finish the bottle I have to give the B12 a better boost.

Iron

Yes, serum iron. Looked on my portal and found that MCV was there but not on the printout they gave me (in US) - 89 fL (75-100). Interestingly, when I look through the list of iron rich foods, I have a VERY strong distaste for the highest level items except for nuts.

[SeasideSusie Remembering in reply to soupybp]

Vit D - OK so the ranges are different due to being different units of measurement.

Your current level of 99.9nmol/L (75-250) is good. The Vit D Council recommends a level of 125nmol/l [50ng/ml] and the Vit D Society recommends a level between 100-150nmol/L [40-60ng/ml].

With the previous result of 7ng/ml (30-100) you were deficient so supplementing has improved your level greatly. You should now consider lowering the dose of D3 to a maintenance dose, which you'll find by trial and error, it may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range.

Are you taking D3's important cofactors - especially magnesium and Vit K2-MK7?

vitamindcouncil.org/about-v...

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 such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray

Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium 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 if taking tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

Check out the other cofactors too (some of which can be obtained from food).

Folate

Your current supplement contains

Vitamin B6 85 mg from 106 mg as Pyridoxine HCl and 15 mg from 25 mg Pyridoxal 5'-Phosphate) 100 mg.

Folate (200 mcg as L-5-Methyltetrahydrofolate† from L-5-Methyltetrahydrofolic Acid, Glucosamine Salt) 334 mcg DFE

That is a lot of B6 considering long term use of high dose B6 can cause tingling of the extremities and nerve damage. Recommended dose for long term use is 10mg daily.

The B-complex #12 still only has 200mcg methylfolate.

I would change to Thorne Basic B which contains 10mg B6 and double the amount of methylfolate at 400mcg.

B12

If you want to give that a boost, I'd just buy one bottle of sublingual methylcobalamin lozenges 1000mcg. Also, an Active B12 test is better as the serum test gives total amount of B12 whereas the Active B12 test shows what's available to be taken up by the cells. Even when serum B12 looks good, Active B12 can still be quite low.

MCV

This is in range, to suggest iron deficiency anaemia it would be below range.

[soupybp in reply to SeasideSusie]

Thank you so much. I truly do appreciate it.

Yes, the 3-K complete contains MK7 and I take that alongside the D3. I was planning to add magnesium, but I wanted to wait until I had levels tested and had some reasonable feedback. Endo requested I stay on the 10,000IU for a bit longer before working to find a maintenance dose - their goal is a level of 150nmol/L (60ng/mL). I am scheduled to return at 6 weeks from the last test for follow up...I can see that the dosage calculators indicate that 10,000IU for that long would probably supplement too far, but it does work out as far as timing if I look at 5,000IU/day until that appointment.

I had purchased the #6 formulation for my daughter as her B12 levels are at the top of the range and I was wanting to address brain issues /PMS for her. This didn't pan out, so I figured I would use them myself rather than throw out the money. I will plan on the Basic B when I order shortly (and keep the balance of the #6 as backup for the future), and I will add in a round of lozenges.

Regarding the total vs active B12, the nurse actually had to go look to see which was being tested because she hadn't been asked that before. They only test for total, so I would have to go on my own for active.

[SeasideSusie Remembering in reply to soupybp]

Sounds like you have everything covered

How good to hear than an endo wants to see a good, recommended level of Vit D! Do as he says, and clone him and send him to the UK

We have to buy our own Active B12 test here too, doctors only do Serum B12.

[soupybp in reply to SeasideSusie]

wrt the MCV/Iron/Ferritin - are you saying that the combination looks good?

[SeasideSusie Remembering in reply to soupybp]

wrt the MCV/Iron/Ferritin - are you saying that the combination looks good?

No, ferritin and serum/total iron are very low in range. So ferritin and serum iron need improving. But MCV being in range doesn't suggest iron deficiency anaemia.

[soupybp in reply to SeasideSusie]

Got it. Thanks.