Help with test results

[Arlie123]

Hey everyone

Just wondered if you could help me decipher these results? I've been using the online service Thriva for a while now, initially as I wanted to check for diabetes and then as I was worried about my fertility. I've had symptoms for quite some time, years I think but it has just become the norm.

Is it normal for results to jump around so much? Does this show I have sub-clinical hypothyroidism? When I went to the GP and showed them the results, they insisted on having them done again and they've come back in the normal range and so they've suggested we monitor it and I go back in a month or so. I'm not necessarily desperate to be on medication, would just like to avoid future problems. Any thoughts appreciated!

TSH

Range: 0.27-1 Normal, 1-2.5 optimal, 2.5-4.3 normal, 4.3-10 abnormal, over 10 highly abnormal.

All done first thing and fasting

3.28 Dec 2017

2.31 Oct 2018

2.05 Nov 2018

2.94 Dec 2018

6.36 May 2019

GP results: May 2019 2.78 (blood test was done in the afternoon) (0.27-4.2)

TgAB 0-115 normal

Dec 2017 245 kU/L

May 2019 945 kU/L

TPOAb (0-34)

12.8 Dec 2017

12.7 May 2019

FT4

Range: 0-12 low, 12-17 optimal, 17-22 normal, 22-30 high, 30+ very high

11.5 May 2019

FT3

Ranges: 0-0.31 normal, 3.1-5 optimal, 5-6.8 normal, 6.8-10 abnormal, over 10 highly abnormal

5.97 Dec 2017

5.44 May 2019

B12 (0-112 severely deficient, 110-300 deficient, 301-569 normal)

396

Folate (8.83-40 normal, 41-60.8 optimal)

23.9

Vitamin D (50-75 sufficient, 75-100 optimal)

63.3

[greygoose]

Sorry, we need the ranges for all those tests. Ranges vary from lab to lab, so we need the ranges that were with your results to be able to interpret them.

Were all those TSH tests - apart from the GP one - done early morning and fasting? If the results are in-range, doctors would say they're normal. Between the top of the range and 10, they would say they are 'sub-clinical'. All rubbish, of course, but that's doctors for you.

T4 and T3 tests are of little use. It's the FT4 and FT3 we need to see.

[Arlie123 in reply to greygoose]

Thanks - I've updated post - I think with better info?

[greygoose in reply to Arlie123]

Those are the weirdest ranges I've ever seen. Normally, they're just two numbers in brackets - (11 - 23) And a TSH of 2.5 - 4.3 is really not normal. I'm afraid I don't know what to make of those.

But, one thing is certain, you have Hashi's. And that would be why the levels jump around. So, you need to continue testing at regular intervals to see how things are progressing.

[Arlie123 in reply to greygoose]

Thanks both - will post properly with all info in the AM. Here's Thriva's explanation of its ranges - quite forward thinking? thriva.co/hub/wellness/unde...

[greygoose in reply to Arlie123]

No, not forward thinking at all. In fact, displaying a lack of understanding of hypothyroidism. Optimal isn't a number, it's how you feel. Because a blood test only shows you what's in the blood, where it does nothing. It doesn't show you what's getting into the cells, where it makes you well. And some people need an awful lot in the blood to get anything into the cells. We can't say 'oh, you're in the really optimal range, therefore you should be feeling well'. Or, 'you're in the optimal range but still have symptoms so it must be something else'. That way of thinking is rather dangerous.

Setting the ranges like that may be ok for some things, but not for thyroid labs. And, as I said, for the TSH they've got it wrong. 2.5 - 4.3 is in no way normal.

[Arlie123 in reply to greygoose]

Makes total sense when you explain it like that!

[vocalEK in reply to greygoose]

We can't say 'oh, you're in the really optimal range, therefore you should be feeling well'. Or, 'you're in the optimal range but still have symptoms so it must be something else'. That way of thinking is rather dangerous.

And yet this is exactly what doctors have been telling us just about all our lives. I can't tell you the number of times I've been tested for other diseases that have some of the same symptoms of hypothyroidism. All negative, of course.

[greygoose in reply to vocalEK]

Yes, I know. Or else 'you're in the normal range so there's nothing wrong with you'. And, if they adopt this method of ranges, it can only get worse.

[SeasideSusie Remembering]

Arlie

You can only compare results accurately when tests are done under the same conditions each time. When having thyroid tests we always advise

* First appointment of the morning, no later than 9am. TSH is highest early morning and lowers throughout the day.

* Fast overnight from evening meal/supper the night before, drinking water only until after the blood draw. Eating can lower TSH and drinks containing caffeine can affect TSH.

We also need the reference ranges that come with your results as they vary from lab to lab.

So your TSH could possibly vary because the reference ranges are different, you may have had blood drawn at different times and you may have eaten or had coffee, etc.

Your May 2019 TSH is very likely to be over range from the various ranges we see here.

T4 presumably is Total T4 which isn't a particularly useful test, Free T4 (FT4) is the test that tells us what we need to know.

Your FT4 can't be interpreted without the reference range as we frequently see 7-17, 9-19, 12-22, 11-23.

Your raised antibodies - if Thyroid Peroxidase - suggest autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed. Hashi's causes fluctuations in symptoms and test results so you can be in range for TSH and FT4 with one test but another test may show them out of range.

If TSH is over range (but less than 10) with a normal FT4 plus raised antibodies then you should be diagnosed with subclinical hypothyroidism and because antibodies are raised then you should be prescribed Levo.

Primary hypothyroidism is diagnosed when TSH is over 10.

Some people with Hashi's have found that a gluten free diet helps although there is no guarantee. Supplementing with selenium l-selenomethionine 200mcg daily can also help.

Hashi's can cause low nutrient levels or deficiencies so it's important to test

Vit D

B12

Folate

Ferritin

[Arlie123 in reply to SeasideSusie]

Thank you - I've updated the ranges. All the tests were done fasting and first thing though I would have drunk water. I've tested for nutritional deficiencies. A year or so I was terribly, terribly deficient in Vit D. I'm now normal but not optimal. B12 active is normal but B12 total swings from low to OK. Ferritin has ranged from highly abnormal to abnormal.

[SeasideSusie Remembering in reply to Arlie123]

Does your GP surgery have the same reference ranges as Thriva? If you don't have ranges from your surgery it's best to find out, don't assume they are the same.

Thyroid antibody range of <115 is typically for Thyroglobulin antibodies and there can be other reasons for those to be raised besides thyroid. Raised Thyroid Peroxidase antibodies are generally the ones to suggest Hashi's but not exclusively.

"B12 active is normal but B12 total swings from low to OK"

Normal doesn't tell us anything other than it's somewhere within the range, we need the actual result with the range to comment. If you've had Active B12 done then I wouldn't worry about Serum B12 result. Serum B12 tells us the total B12, Active B12 tells us what's available to be taken up by the cells, if that's less than 70 that suggests testing for B12 deficiency according to Viapath at St Thomas' Hospital in London.

If you can give current results for nutrient levels with reference ranges and unit of measurement for Vit D further comment can be made (although it's bedtime for me now).

[SlowDragon Administrator]

TG antibodies are significantly above range

But TPO antibodies are within range

NHS currently unlikely to diagnose Hashimoto's on just high TG antibodies

healthline.com/health/antit...

[Arlie123]

Hi everyone,

I've done some more nutritional tests which say in range except for ferritin which has always been high. Any further advice? I know I need to look at vid d as I've previously been in the 20s. Much appreciated!

Albumin (35-50) 42.1

Ferritin (13-150) H 312.0

Magnesium (0.7-1.0) 0.79

Sodium (133-146) 142

Calcium (2.2-2.6) 2.26

Corrected Calcium (2.12-2.50) 2.22

Vitamin D (25 OH) (insufficient 30-50) 53

Vitamin B12 (insufficient 145-300) 422

Serum Folate (8.83-60.8) 21.80

Zinc (10.7-17.5) 12.85

Selenium (0.75-1.46) 1.36