Test results interpretation and advice please

[tomranson85]

Hi again all,

I finally have some new test results back, as follows. I welcome any comments/guidance etc. please For those of you that already "know" me, I posted a very long associated history a couple of weeks ago over at healthunlocked.com/thyroidu...

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medichecks (Country Pathology Ltd laboratory)

Thyroid Check UltraVit rT3, venous blood drawn 04/04/19:

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CRP HS: 0.33 mg/L (Range: <5)

Ferritin: 104 ug/L (Range: 30-400)

Vitamin B9 (Folate): >19.8 ug/L (Range: >3.89)

Vitamin B12 - Active: >300 pmol/L (Range: 37.5 - 188)

Vitamin D: 93.5 nmol/L (Range: 50 - 175)

TSH: 2.67 mIU/L (Range: 0.27 - 4.2) History: 30/08/18: 5.74, 13/12/18: 2.23, 25/01/19: 1.77, 04/02/19: 1.64

FT3: 5.85 pmol/L (Range: 3.1 - 6.8) History: 30/08/18: 5.8, 13/12/18: N/A, 25/01/19: N/A, 04/02/19: 5.5

FT4: 20.7 pmol/L (Range: 12 - 22) History: 30/08/18: 10.0, 13/12/18: N/A, 25/01/19: 15.6, 04/02/19: 10.7

rT3: 18 ng/dL (Range: 10 - 24)

FT3:rT3 ratio: 21.16 (Range: >15)

***TG Antibodies: 154 kU/L (Range: <115)***

TPO Antibodies: 10.3 kIU/L (Range: <34)

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The reviewing GP has commented on my high TG Antibodies, and stated (of course) that this is associated with Hasimotos, however he has also stated that at this time, my thyroid function appears to be normal (and I would tend to agree...based on these results). However.....

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I am quite concerned that my FT4 has been swinging between c. 10 (bottom of normal range) and 21 (top of normal range) over the last 6 months. Admittedly, the historical FT4 results I have are from different labs and thus the results may not be strictly *directly* comparable, however all labs involved use very, very similar reference ranges, so I am liable to think that it is reasonable to make comparisons between all of my historical FT4 results:

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NHS Somerset Pathology Services: FT4 range 7.9- 20.0 pmol/L

Medichecks/Thriva (County Pathology Ltd, who are a NHS lab also): FT4 range 12.0-22.0 pmol/L

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Please do note that I suffer from "bipolar disorder" (unmedicated since November 2018) and, coincidentally, suffer from swings of mental and physical health symptoms over similar time frames to those of my FT4 level swings. It all seems very coincidental...

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Would it be a fair observation (this is my current suspicion, at least) that I am swinging between sub-clinical hypothyroid and sub-clinical hyperthryoid states, and that this could be a reasonable explanation for the drastic swings in my mental and physical health symptoms?

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Also of particular note: I have this last week seen a private liver specialist consultant in London (as my NHS GP practice wouldn't even acknowledge my symptoms... "it's all just anxiety!", GP said), following a reemergence of pain in the area of my liver (I have previously been NHS diagnosed with NAFLD, and experienced liver tenderness/pain in March 2018). Long story short, gallstones have been diagnosed by private scans this time and I have been recommended to have my gallbladder removed (on the NHS). The most interesting point is that, upon taking a full history including my extreme GP-guided weight loss, the private consultant strongly believes that I likely experienced a state of "unintentional internal nutritional starvation" in the second half of 2018 (which was what put me in hospital in November). Frankly, I couldn't agree more, and feel that this is very relevant to my symptoms and overall health complaints since mid-2018 (and I'm still not yet fully recovered). It may well explain some of my historically abnormal thyroid results, too.

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Important supplementation notes:

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Vitamin B9/Folate: Due to confirmed MTHFR mutations and previous low-normal lab results, I take daily supplemental Vitamin B9 Folate @ 800 ug Folinic (not Folic, due to MTHFR mutations) Acid since January 2019.

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Vitamin B12/Cobalamin: Due to confirmed MTHFR mutations and previous low-normal lab results, I take daily supplemental Vitamin B12 (as HoCbl+AdoCbl combined) @ 2000 ug combined (50/50% split) since January 2019. I am also prescribed HoCbl injections, and have received 42x injections on alternate-day frequency between January and March 2019, and am now down to 2-monthly frequency injections (as per NICE guidelines for neurological involvement).

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Vitamin D: Due to previous low Vitamin D (and high suspicions of Vitamin D deficiency), I supplemented daily with Vitamin D3 between January 2019 and March 2019 @ 2000 IU/day (following a much higher loading dose course in December 2018 of 50,000 IU/day for 15 days). I stopped taking supplemental D3 as of mid-March 2019 once I was back in the "optimal" range, however I will need to reevaluate the need to restart supplemental D3 based on future test results (especially for future winters).

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Iron: After commencing the prescribed Vitamin B12 injections, I rapidly became borderline iron deficient (my pre-B12-injection Ferritin was 90, and dropped to only 40 within 3 weeks of injections). I was prescribed Ferrous Fumarate @ 2x 322 mg/day (equivalent to c. 200 mg non-heme iron daily) for 3 months between January and March 2019. I am no longer taking iron at this time, but need to evaluate the need to include low-dose iron daily for prophylaxis of future iron deficiency.

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Multivitamins+Minerals: Given suspected multiple nutritional deficiencies, I also supplement (since December 2018) with various potent multivitamin+mineral supplements which cover most of the other nutrient bases. For those that like details: Holistic Health All in One™ Multi-Vitamin, Holistic Health Ultimate B Complex, Holistic Health Black Bear Energy Spray, Holistic Health BeCalm Spray (holisticheal.com). These have worked well for me and I tolerate them well, albeit I am desperate to find a more financially economical solution!

N.B. My daily multivitamins provide approximately 214 mg of Vitamin B7 (Biotin). I mention this because I have some awareness that Biotin supplements can affect some lab results. I was taking these supplements daily at the time of these latest tests, therefore is it possible that my FT4 etc. results have been affected by this?

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Omega 3: Upon private GP advice (following abnormal Omega 3 index and Omega 6:3 ratio lab results), I have been supplementing daily with a potent 1x Omega 3 fish oil 1000 mg (containing 550 mg DHA per 1000 mg). This has recently been increased to 3000 (containing 1650 mg DHA) mg/day (more on why below).

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N.B. I'm still waiting for my adrenal function test results from Genova Diagnostics Salivary 4-point Cortisol+DHEA+Sec IgA results (due 23/04/19).

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However, following further research and advice re. HPA-axis disfunction, I have already started supplementing with (additional) Omega 3 fish oil (3000 mg/day, containing 1650 mg DHA) and have also introduced Phosphatidylserine (PS) (initially 100 mg/day, now 600 mg/day) - and WOW! What a difference these two supplements have made to my BODY TEMPERATURE REGULATION! Within 3 days of starting the PS, my body temperature has now returned to "normal", regulating between 36.0 and 37.0 degrees. I have suffered since October 2018 with *WILD* fluctuations in body temperature between 33 and 38 degrees (with associated symptoms, most notably constantly feeling FROZEN, but no doubt also having a profound effect on my metabolism).

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I'll stop here for now, as I know I'm rambling... sorry, but there's a lot to say! Many thanks to you all as always for any input you can offer

[SlowDragon Administrator]

Interesting that TG antibodies are slightly raised.....NHS is very reluctant to diagnose Hashimoto's on just raised TG antibodies as they can be raised for various other reasons. They only really like high TPO or high TPO and high TG antibodies as basis for firm diagnosis

Interesting that Medichecks says Hashimoto's

healthline.com/health/antit...

Your psychologist may be most interest in this as underlying issue

Reverse T3 is normal

Vitamins are good

Ferritin could be higher

Your high TSH in November is perhaps underlying issue for ending up in hospital.....

Be interesting to see adrenal stress index results

[tomranson85 in reply to SlowDragon]

Hey SlowDragon,

Many thanks for your response and apologies for my delayed reply.

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I agree that my slightly raised TG Ab's doesn't really confirm Hasimoto's due to the high likelihood that it's another unrelated condition causing their elevation (and likely associated thyroid hormone disfunction (possibly only at a low level now, but likely to become more significant in time) as a result).

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My paternal uncle has Type 1 diabetes (I'm not sure at what age he was diagnosed), therefore I have always had this in the back of my mind as a possibility (given I am 33 now, Latent Autoimmune Diabetes in Adults (LADA), a form of late-onset Type 1 would potentially seem to fit the bill more closely here). Since my hospitalisation in November, and given that I (when well enough) cycle *a lot*, I keep a close eye on my blood glucose anyway with a finger prick monitor (to ensure I am consuming appropriate nutrition when exercising heavily, such as energy gels/dried fruits etc.). As I have become more aware, I started taking some fasting (at least 8 hours after last eating/drinking, first thing in the morning) glucose readings as well around 8 weeks ago. It appears that my fasting glucose is now a fair bit higher than it should be for a "non-diabetic"; it has consistently been at 5.8 mmol/L (104.4 mg/dL) over multiple occasions over the last few weeks, and according to my data, it's been slowly creeping up from around 5.1 to 5.8 over that time (although, I have been much seditory these past two months, as I've been so unwell, and basically I haven't exercised at all between mid-Feb and early-April, although I'm now cycling again (120 km this week) and walking again). So, I'm not sure if my recent enforced seditory lifestyle has contributed to the fasting glucose increase, or if something more sinister is going on). I understand from Diabetes.co.uk that it should be "Between 4.0 to 5.4 mmol/L (72 to 99 mg/dL) when fasting" for a healthy, non-diabetic adult. However, on the flip side my post prandial (90 minutes after eating) glucose readings are "fine", never measured going above 6.9 mmol/L (124.2 mg/dL)- and that one was after drinking high-sugar prune juice. My average post-prandial readings are approx. 6.0 mmol/L. Diabetes.co.uk state that post-prandial should remain under 7.8 mmol/L (140.4 mg/dL) in a healthy, non-diabetic adult. I appreciate that NICE have slightly different reference ranges, and that if those are considered, my fasting of 5.8 mmol/L is still "normal" by their standards, as it's under 5.9, although it's pretty close to the mark.

I've had my HBA1c and fasting insulin privately checked twice (by Thriva), once in late January 2019 and once in early April 2019. Fasting insulin has come come back *abnormal* on both occasions. The NHS have never checked my insulin levels, however my historical HBA1c's have always been 33-39 over the last 6 years. I do note however that HBA1c not considered to be reliable where there is an underlying blood disorder, i.e. B12+Folate+Iron deficiency anaemia (as the RBC lifetime is significantly shorter than the 2-3 month average in healthy people, thereby allowing far less time for the haemoglobin to become glycated, leading to false-low HBA1c measurements), which I have clearly suffered from these last 4 months, therefore I don't trust any of my recent HBA1c readings as far as I can throw them.

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25/01/19:

Fasting insulin <2.78 pmol/L (range: optimal 14-41.7 (normal 14-62)) - abnormally LOW HBA1c 34.63 mmol/mol (range 20-42)

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05/04/19:

Fasting insulin 05/04/19: 69.6 pmol/L (range: optimal 14-41.7 (normal 14-62)) - abnormally HIGH

HBA1c 32.7 mmol/mol (range 20-42)

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I am concerned that I am showing blood sugar disregulation, and that my fasting insulin levels (one abnormally low, then one abnormally high) are a bit perplexing. Especially when considering elevated TG AB's and other potential autoimmune issues.

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The other likely candidate here for my elevated TG AB's is Pernicious Anaemia (Vitamin B12 deficiency). I was prescribed B12 (Hydroxycobalamin) injections every 2 days in mid-December 2018 due to suspected B12 deficiency with neurological involvement (peripheral neuropathy, ataxia, balance and memory issues). I was never referred to neurology or haematology by my GP, as she was quite insistent that I wasn't "deficient enough" (13/12/18: Total B12 assay 279 ng/L) and she didn't take my symptoms seriously at all, even though I was tripping over and staggering around like a drunk in the street (people commented) and I could't remember anything, plus my "mental health" issues history). Personally, I think this (plus many other symptoms) were truly attributed to B12 deficiency, and within 3 weeks of starting the injections, I felt "like a new man for the first time in my life", for about a month. They tested my Intrinsic Factor Ab's, which came back negative, however in contradiction to NICE guidelines, they refused to make a diagnosis of "Negative IfAb Pernicious Anaemia" or continue B12 therapy life-long, and I am still contesting this to this day. I have had to self-obtain and self-prescribe B12 HoCbl injections since late January, as my previous GP withdrew my B12 treatment saying it wasn't "clinically justified". It's a very long story and I've been in conversation with the Pernicious Anaemia society etc. Most importantly, I am now still receiving self-prescribed B12 injections every 2 months (and continuing the NHS fight for life-long treatment), and take self-prescribed B12 as HoCbl+AdoCbl combined sublingual lozenge (50/50 HoCbl/AdoCbl @ 2000 ug total daily), plus 800 ug of Folinic Acid daily.

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"Reverse T3 is normal

" - I agree.

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"Vitamins are good

" - I agree, however they are only good because I took matters into my own hands so far as self-prescribing Vitamin B12, B9 (Folate) and D (plus all of the other vitamins, minerals and micronutrients) goes, because the NHS have been *TOTALLY* ignorant in my care. My D3 for example, was only 52 in July 2017 (range cut off <50); I was borderline deficient even back then (but I didn't realise this at the time), and I most likely became more deficient as time wen't on until January 2019 when, upon further suspicion, I self-prescribed a 50,000 IU/day loading dose for 15 days, and then returned to 1000 IU daily maintenance, and that combinations has only now brought me up into the middle of the optimal range @ 93.5 (I was only 66 in January 2019, immediately after completing the super-high loading doses, so I must have been *extremely* low prior to that).

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"Ferritin could be higher

" - I agree (I was iron deficient in January 2019, and GP prescribed iron for 2 months, but then discontinued it in March as "your Haemoglobin is "fine"") and accordingly I have restarted my self-prescribed Ferrous Fumarate 2x 322 mg/day (c. 200 mg total Iron/day) + Vitamin C taken with, and will continue to monitor for further improvement, and discontinue again only once appropriate in the next couple of months. I required 3 months of 200 mg Iron/day between January and March 2019 to get my Ferritin from 40 to 104 ug/L. I had a full iron panel done by Thriva on 05/04/19, and my Transferrin Saturation

came back low-normal at 32.68% (range: optimal 45-55, normal 20-55), therefore I believe this gives further evidence that I will benefit from further additional iron. And NICE state that iron replacement therapy should be continued for 3-6 months "after heamaglobin returns to normal", so I fully believe my GP was incorrect to discontinue iron after only 2 months (I should expect to continue taking it now for perhaps at least another 3 months, subject to re-monitoring).

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"Your high TSH in November is perhaps underlying issue for ending up in hospital....." - my hunch is that it was a combination of multiple nutritional deficiencies plus over-training (too much cycling and hiking, too soon, after loosing so much weight and being so inactive for so long). I rapidly went from cycling only 200 km/month in August to 1000 km/month in October, and then fell flat on my backside in hospital on 10th November. I think I was loosing weight too quickly and not absorbing sufficient nutrition (not just calories, but nutrients), while asking too much of my body.

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I now also have my Cortisol Stress Profile results- I will post them in a new response below.

[tomranson85 in reply to SlowDragon]

04/04/19 Adrenal Stress Profile (Genova Diagnostics) results:

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Salivary Cortisol nmol/L:

07:00-09:00 (sample @ 07:07): 5.44 (normal range 2.68-9.30) - normal and optimal

! 11:00-13:00 (sample @ 11:04): 2.65 (normal range 0.75-2.93) - high-normal (higher than optimal range)

! 15:00-17:00 (sample @ 15:05): 1.93 (normal range 0.36-1.88) - *abnormally high*

22:00-00:00 (sample @ 22:34): 0.36 (normal range <=0.94) - normal and optimal

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Salivary DHEA nmol/L:

! 2.23 (normal range 0.25-2.22) - *abnormally high* (slightly)

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DHEA:Cortisol Ratio:

! 0.41 (normal range 0.05-0.32) - *abnormally high*

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Secretory IgA ug/mL:

! >1000 (normal range 56-212) - *abnormally high, off the chart!*

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As far as I can tell from my research into these results:

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My Cortisol levels and the curve is generally "OK", with some mild-moderate elevations in cortisol only during the two day time readings. Morning and night levels are good. This suggests acute stressors are causing these elevations (and that would agree with my situation! 5 y/o child, lots of home environment stress, lots of health stress etc.).

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My DHEA level is higher than normal, but no where near significantly enough to suggest anything too sinister (such as an adrenal tumor causing excess DHEA production). My DHEA:Cortisol ratio is thus a fair bit higher than normal.

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My Secretary IgA is off-the-chart high! My research suggests that this is most likely to be caused by an underlying GI infection or dietary intolerance, resulting in persistently elevated immune system response (which probably also explains why for several years I never seem to catch any of the bugs that are going around the home/school, such as colds/flu/stomach bugs etc. Frankly, this is something I have suspected for many years (although the NHS are continually totally ignorant to my complaints and symptoms), as I suffered with irritable bowel type symptoms for months at a time over several years during my mid-20's, and now typically suffer with chronic flatulence and most often constipation. As far as I can work out, my next course of action should be to look at having a comprehensive stool sample completed to look for an underlying yeast/bacterial/viral/parasitic GI infection, and if one is found, getting that treated (however, I have absolutely no faith in the NHS even being willing to look into this for me, so back to expensive private testing). However, if that all comes back negative, then it's most likely to be a dietary intolerance(s)- which will be somewhat harder to bottom-out. I have recently gone gluten-free (to support my wife who has Hasimotos and genetic gluten-sensitivity, and my son has the same genetic risk factors).

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Any thoughts welcomed! N.B. I have also recently seen a private liver specialist; long story short, the cause of my right-upper-quadrant pain is gallstones and they have recommended my gallbladder be removed on the NHS, and I also have NAFLD (non-alcoholic fatty liver disease; this was first diagnosed in March 2018). Said specialist (a Professor of 35 years experience) thinks that my rapid weight loss and over-training in 2018 essentially resulted in a state of internal nutritional starvation (in his opinion, much like that caused by anorexia) and this is likely the cause of my bradycardia, among other symptoms. He also believes my rapid and extreme weight loss is the cause of my gallstones and NAFLD, partially due to the rapid "dump" of triglycerides into my blood stream from the fat burning, and likely a bit too much cholesterol in my diet (total 4.9 when most recently tested, so I'm working on getting that down by reducing intake of saturated fats and cholesterol from dietary sources).

[SlowDragon Administrator in reply to tomranson85]

Have you noticed any improvement since going strictly gluten free?

It can take several months to notice improvements or you can see rapid change

and it does need to be absolutely strictly gluten free to be effective

[tomranson85 in reply to SlowDragon]

Not as yet, and we've (as a household) been strictly GF for a little over 2 weeks now. Frankly I've had more trouble with my GI system being upset since going GF, but of course that's highly unlikely to be related to eliminating gluten (but perhaps is related to something I've stated eating as an indirect consequence).