Blood Test Help

[ShazSim]

Can anyone help me to understand these results please? I have no idea what any of them mean. Been feeling 'not quite right' for a while. I've been getting 'twitching' or what I describe as my eye forcing itself closed and heart beats in my ears....lots of bloating, tiredness and irritability. Are any of these things related to an underactive thyroid? TIA.

HBA1C Hypothyroid, on med, muscle twitch.

New recommendations for identification of hyperglycaemia in PREGNANCY

during Covid-19:

Please refer immediately to local Diabetes Specialist Midwives if:

HbA1c >=41 mmol/mol or random plasma glucose >=9.0 mmol/L at antenatal

booking.

HbA1c >=39 mmol/mol or fasting plasma glucose >=5.3 mmol/l or random

plasma glucose >=9 mmol/l at 28 weeks' gestation.

Haemoglobin A1c level - IFCC standardised 41 mmol/mol

WHO (2011) recommend 48 mmol/mol as the diagnostic cut-off for type 2

diabetes.

Full blood count Hypothyroid, on med, muscle twitch.

Total white blood count 6.8 10*9/L [3.9 - 10.2]

Red blood cell count 5.10 10*12/L [3.9 - 5.2]

Haemoglobin concentration 145 g/L [120.0 - 156.0]

Haematocrit 0.442 L/L [0.355 - 0.455]

Mean cell volume 87.3 fL [80.0 - 99.0]

Mean cell haemoglobin level 28.5 pg [27.0 - 33.5]

Red blood cell distribution width 14.0 % [11.0 - 16.0]

Platelet count - observation 294 10*9/L [150.0 - 370.0]

Plateletcrit 0.230

Mean platelet volume 7.7 fL

Platelet distribution width 44 %

Neutrophil count 4.44 10*9/L [1.5 - 7.7]

Lymphocyte count 1.77 10*9/L [1.1 - 4.5]

Monocyte count - observation 0.26 10*9/L [0.1 - 0.9]

Eosinophil count - observation 0.20 10*9/L [0.02 - 0.5]

Basophil count 0.05 10*9/L [0.0 - 0.2]

Bone profile Hypothyroid, on med, muscle twitch.

Serum albumin level 39 g/L [35.0 - 50.0]

Serum calcium level 2.32 mmol/L [2.08 - 2.65]

Serum adjusted calcium concentration 2.39 mmol/L [2.2 - 2.6]

Serum inorganic phosphate level 0.84 mmol/L [0.8 - 1.5]

Serum alkaline phosphatase level 75 U/L [30.0 - 130.0]

FERRITIN Hypothyroid, on med, muscle twitch.

Serum C reactive protein level 15 mg/L [0.0 - 6.0]

Above high reference limit

Serum ferritin level 91.3 ug/L [10.0 - 291.0]

Ferritin rises to an unpredictable extent with the acute phase

response. If CRP is over 30 mg/L, the ferritin result may be high and

uninterpretable.

FOLATE (SERUM) Hypothyroid, on med, muscle twitch.

Serum folate level 5.42 ug/L [> 5.38]

Serum Folate Reference Range = Greater than 5.38 ug/L If the patient

cannot be fasted be aware that a folate rich meal, eaten less than 3

hours prior to venesection, may increase serum folate concentrations.

Serum lipid levels Hypothyroid, on med, muscle twitch.

Fasting Sample Req:: Yes

Please see NICE CG181: Lipid Modification Guidelines.

Serum cholesterol level 5.0 mmol/L

Serum triglyceride levels 1.67 mmol/L [0.3 - 1.8]

Serum HDL cholesterol level 1.41 mmol/L

Serum LDL cholesterol level 2.83 mmol/L

Serum cholesterol/HDL ratio 3.5

Serum non high density lipoprotein cholesterol level 3.59 mmol/L

Liver function tests Hypothyroid, on med, muscle twitch.

Serum albumin level 39 g/L [35.0 - 50.0]

Serum total bilirubin level 7 umol/L [0.0 - 20.0]

Serum alkaline phosphatase level 75 U/L [30.0 - 130.0]

Serum alanine aminotransferase level 26 U/L [10.0 - 49.0]

Please note change to ALT reference range.

Thyroid function test Hypothyroid, on med, muscle twitch.

Serum TSH level 3.64 mU/L [0.35 - 5.5]

Serum free T4 level 13.4 pmol/L [10.5 - 21.0]

Please note change to free T4 reference range.

Urea and electrolytes Hypothyroid, on med, muscle twitch.

Serum sodium level 139 mmol/L [133.0 - 146.0]

Serum potassium level 4.3 mmol/L [3.5 - 5.3]

Serum creatinine level 67 umol/L [44.0 - 97.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres ≥ 90 mL/min/1.73m*2

Please note change in eGFR equation to CKD-EPI.

eGFR calculation assumes Caucasian origin.

VITAMIN B12 Hypothyroid, on med, muscle twitch.

Serum vitamin B12 level 537.0 ng/L [211.0 - 911.0]

[humanbean]

Haemoglobin A1c level - IFCC standardised 41 mmol/mol

This suggests that you are on the lower border of being pre-diabetic. You don't need any treatment for this but you can improve your result and reduce your risk of becoming overtly diabetic by reducing carbs and sugar, and replacing the calories you lose with protein and fat.

You can get lots of advice on how to reduce your risk of becoming overtly diabetic on this website :

dietdoctor.com/

dietdoctor.com/diabetes

...

Your Full Blood Count doesn't show anything to be concerned about, and you don't show signs of being anaemic.

Your Bone Profile looks fine.

...

Serum C reactive protein level 15 mg/L [0.0 - 6.0]

The high CRP above suggests that you have high levels of inflammation but unfortunately won't tell you where that inflammation is. The commonest sites for inflammation are in the gut, and/or the muscle and joints, and/or the lungs. Many people with thyroid disease do well on a gluten-free (g-f) diet. It has to be maintained ruthlessly to be effective. You can't be "almost" gluten-free. It's all or nothing I'm afraid. It isn't necessary to have coeliac disease before giving up gluten. Many of us have been tested for it, been found to be negative, and yet have benefited from going gluten-free. If going g-f doesn't help you after you've tried it religiously for 2 - 3 months then you may as well go back to eating it again.

...

Serum folate level 5.42 ug/L [> 5.38]

Your serum folate level is awful. You would feel better with a result which was at least in double figures and possibly somewhere between 15 and 20. Reference Ranges for folate vary a lot and often have no upper limit, so it is difficult to say what a healthy level is. If you had an upper limit for the reference range we usually suggest getting your result for folate into the upper half of the range.

To learn about the appropriate type of folate to supplement with see this link :

chriskresser.com/folate-vs-...

Folate supplements can easily be bought on Amazon and other sites selling supplements.

...

Serum vitamin B12 level 537.0 ng/L [211.0 - 911.0]

Your B12 level isn't too bad but getting it to the top of the range is worth doing for many of us if you want to give it a try. Opinions on the optimal level do vary, and can be :

1) Above 500 ng/L (which yours is already).

2) Upper half of the reference range.

3) Top of the reference range up to a maximum of about 1000 ng/L.

A good choice of vitamin B12 to supplement is methylcobalamin which can usually be bought from the same sites as folate.

...

Your cholesterol is fine.

Your liver function test results are fine.

...

Thyroid function test results

Serum TSH level 3.64 mU/L [0.35 - 5.5]

Serum free T4 level 13.4 pmol/L [10.5 - 21.0] Approx 28% of the way through the range

Your high in range TSH and low in range Free T4 show that you are under-medicated and need an increase in your dose of thyroid hormones. I don't know which thyroid hormones you are taking. Levo? Getting a higher dose of thyroid hormones would raise your Free T4 and lower your TSH.

You might find this link useful :

healthunlocked.com/thyroidu...

...

Your urea and electrolytes look fine.

eGFR using creatinine (CKD-EPI) per 1.73 square metres ≥ 90 mL/min/1.73m*2

A result of > 90 for eGFR shows your kidneys are functioning well.

[humanbean in reply to humanbean]

In summary...

Increase your folate and B12.

Try a gluten-free diet for 2 - 3 months.

Try reducing carbs and replace the lost calories with healthy fats and natural proteins.

Ask for an increase in your thyroid hormone dose. If your doctor agrees to raise your dose make sure to get your thyroid re-tested in about 6 - 8 weeks.

There are several mentions of pregnancy on your results. Are you pregnant? Or planning to get pregnant?

[Thenightowl in reply to humanbean]

I agree about the folate level. The b12 that you do have cannot work properly unless folate higher. They work together.

I felt pretty awful with a folate level of 5.

[humanbean]

I forgot to mention...

You don't have a result for vitamin D.

It can be tested for separately with a finger-prick test :

vitamindtest.org.uk/

You have to order the test, follow the instructions on how to get a finger-prick blood sample then send the sample back to the lab through the mail.

...

I also forgot to mention one cause of twitching, which is low magnesium.

If you don't supplement with magnesium then you really should - so many people are deficient. Testing magnesium levels is unreliable so isn't worth doing. As long as your kidneys are functioning (and yours appear to be very healthy) you can supplement magnesium and if you take more than necessary then it will be excreted by the kidneys via your urine.

The daily dose of magnesium required is about 250mg - 400mg per day.

For info on your options with regard to magnesium supplements :

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

[ShazSim in reply to humanbean]

Thank you so much for this very detailed reply.

I'm definitely NOT planning to get pregnant but am menopausal so maybe this has something to do with it???

[SlowDragon Administrator in reply to ShazSim]

How much levothyroxine are you currently taking

Do you always get same brand of levothyroxine

Contact GP and request 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks after any dose or brand change in levothyroxine

Low folate and B12 likely due to being under medicated

B12 tends to drop as we age too

supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Important to regularly retest vitamin D

vitamindtest.org.uk

[ShazSim in reply to SlowDragon]

Thank you. I take 100mg of Levo per day - the brand is Accord and I've always had this brand.

[SlowDragon Administrator in reply to ShazSim]

So see/contact GP for 25mcg dose increase in levothyroxine

Accord doesn’t make 25mcg....so ask GP for prescription for 50mcg tablets and cut in half for 25mcg per day

Work on improving low vitamin levels

Only add one Vitamin supplement at a time and wait at least ten days to assess before adding another

Retest thyroid and vitamins 6-8 weeks after levothyroxine dose increase and last supplement added

[SlowDragon Administrator in reply to ShazSim]

Strongly recommend following humanbean Excellent detailed advice on vitamins and reducing high Hba1C by looking at reducing carbs, increasing protein and good fats

Dr Michael Moseley has good books/website

thebloodsugardiet.com/the-l...

Dr Xander Van Tullken on why to avoid beige carbs

bbc.co.uk/news/health-44368601

On strictly gluten free diet we often end up cutting a lot of those sort of carbs anyway

Don’t want to reduce carbs too severely as this can reduce conversion of Ft4 to Ft3

Essential to test vitamin D

Come back with new post once you get result