Test results, following up from a month ago

[beryltortoise]

Hello. I posted on here a month ago asking for advice before an endo appointment. I was feeling very poorly - a lot of joint pain, brain fog, falling over, dizzy, ears ringing etc. Your advice was really helpful, thank you. I ended up having levothyroxine increased from 50 to 75mcg, liothyrinine left at 10mcg.

Your advice was to request B12, folate, ferritin and vit D tests and come back here with the results.

My GP ordered a comprehensive range of blood tests and I’m posting the results below (long! Sorry). Everything is within reference range. I am still struggling with pain, quite severe dizzy spells, ringing in ears etc.

Thanks in advance if anyone can share any insight xx

Full blood count

Haemoglobin concentration 134.0 g/L [120.0 - 150.0]

Total white blood count 6.6 x10*9/L [4.0 - 10.0]

Platelet count - observation 333 x10*9/L [150.0 - 400.0]

Haematocrit 0.431 [0.36 - 0.46]

Mean cell volume 99.3 fL [83.0 - 101.0]

Red blood cell count 4.34 x10*12/L [3.8 - 4.8]

Mean cell haemoglobin level 30.9 pg [27.0 - 32.0]

Mean cell haemoglobin concentration 311.0 g/L [315.0 - 345.0]

Outside reference range

Neutrophil count 3.72 x10*9/L [2.0 - 7.0]

Lymphocyte count 2.18 x10*9/L [1.0 - 3.0]

Monocyte count - observation 0.60 x10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.09 x10*9/L [0.02 - 0.5]

Basophil count 0.03 x10*9/L [0.02 - 0.1]

Nucleated red blood cell count 0.00 10*9/L

Note: Changes to FBC profile and reference ranges

from 6th April 2017

Erythrocyte sedimentation rate 5 mm/h [3.0 - 15.0]

Serum lipid levels

FASTING STATUS NOT INDICATED. .

Serum cholesterol level 5.5 mmol/L

LIPID GUIDELINES (NICE 2014)

Secondary prevention of CVD: use atorvastatin 80 mg.

(Start with 20 mg if CKD or high risk of interactions)

Primary prevention (inc. T2 DM): atorvastatin 20 mg if

QRISK2 >10%, T1 DM >40 y, CKD +/- albuminuria.

Recheck non-HDL cholesterol at 3/12 aiming for 40% fall

Special cases: high trigs, familial lipids: seek advice

Serum triglyceride levels 1.3 mmol/L [< 1.9]

Serum HDL cholesterol level 1.95 mmol/L [1.1 - 1.6]

Outside reference range

NON-HDL CHOLESTEROL 3.6 mmol/L

Serum cholesterol/HDL ratio 2.8 [< 5.0]

Urea and electrolytes

Serum sodium level 139 mmol/L [135.0 - 145.0]

Serum potassium level 4.2 mmol/L [3.5 - 5.5]

Serum urea level 4.1 mmol/L [2.5 - 6.5]

Serum creatinine level 83 umol/L [55.0 - 100.0]

GFR calculated abbreviated MDRD > 60 ml/min/1.73m2

ESTIMATED GFR FOR CHRONIC KIDNEY DISEASE (CKD)

See guidelines: renal.org/CKDguide/ckd.html

eGFR >60 excludes CKD in the absence of other evidence,

but indicates stage 1/2 CKD if protein-/haematuria, etc

ACUTE KIDNEY INJURY Not applicable

Unable to calculate AKI score: no previous creatinine

LFT

Serum bilirubin level 8 umol/L [< 20.0]

Serum alkaline phosphatase level 99 u/L [35.0 - 104.0]

Serum alanine aminotransferase level 13 u/L [< 45.0]

Serum total protein level 80 g/L [60.0 - 80.0]

Serum albumin level 50 g/L [35.0 - 50.0]

Serum calcium level 2.48 mmol/L

Serum adjusted calcium concentration 2.42 mmol/L [2.2 - 2.65]

Serum globulin level 30 g/L [19.0 - 33.0]

Plasma C-reactive protein level 3 mg/L [< 5.0]

Please note new Reference range from 31/10/17

HbA1c between 6.0 - 6.4% (42 - 47mmol/mol) are consistent with Non-

Diabetic hyperglycaemia (NDH), unless the patient has known diabetes.

HbA1c level (DCCT aligned) 5.6 % of Hb

Haemoglobin A1c level - IFCC standardised 38 mmol/mol [< 48.0]

Serum vitamin B12 level 418 ng/L [190.0 - 910.0]

Serum ferritin level 43 ug/L [10.0 - 291.0]

Ferritin <20 - Iron Deficiency

Ferritin 20 - 30 - Depleted Iron Stores

Please investigate and correct if appropriate

Serum folate level 6.4 ng/mL [3.9 - 26.8]

VITAMIN D 74.8 nmol/L

VITAMIN D GUIDELINES (Total 25-OH Vitamin D, inc D2+D3)

<30 nmol/L Deficiency: High dose treatment and long

term maintenance dose required.

30-50 nmol/L Insufficiency: long term maintenance dose

required

50-75 nmol/L Adequate: lifestyle advice

>75 nmol/L Optimal levels

MENOPAUSAL HORMONE PROFILE

Serum LH level 76.7 u/L

Serum follicle stimulating hormone level 75.7 u/L

Female Ref Ranges: FSH(U/l) LH(U/l) OEST(pmol/l)

Follicular phase 2-10 2-10 130-500

Mid-cycle phase 14-60 520-1470

Luteal phase 2-10 2-10 110-620

Post-menopause >30 >30 <100

[shaws Administrator]

Others will respond. I will state that your high cholesterol level is most probably due to you having undiagnosed hypothyroidism.

Once you begin levothyroxine you're TSH should begin to lower (with the usual increase in levothyroxine every six weeks). Your cholesterol levels should also reduce.

Excerpt:

"Taking the thyroid hormone replacement medicine levothyroxine (Levothroid, Synthroid) to treat an underactive thyroid can also help lower your cholesterol level.

Thyroid Issues and Cholesterol: Is There a Connection?

Your body needs thyroid hormones to make cholesterol and to get rid of the cholesterol it doesn’t need. When thyroid hormone levels are low (hypothyroidism), your body doesn’t break down and remove LDL cholesterol as efficiently as usual. LDL cholesterol can then build up in your blood.

healthline.com/health/thyro...

[SlowDragon Administrator]

Vitamins are ok, but could be slightly better

Serum vitamin B12 level 418 ng/L [190.0 - 910.0]

Serum folate level 6.4 ng/mL [3.9 - 26.8]

VITAMIN D 74.8 nmol/L

Serum ferritin level 43 ug/L [10.0 - 291.0]

What vitamin supplements are you currently taking?

Looking to improve vitamin D to at least around 80nmol and around 100nmol maybe better

B12 at least over 500

Folate at least half way through range

Ferritin at least over 70

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

[SlowDragon Administrator]

As you have high antibodies this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Come back with new post once you get full Thyroid results after 6-8 weeks on new dose

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test