interpreting my blood test results

[humlies]

Hello again

I posted here about a month ago, and received really useful information about what blood tests for hypothyroidism should reveal. I have now had the results of the tests, which are quite lengthy, but do not seem to have any information on T3 and T4 levels. Please could some wise person comment on my results - 28 Jun 2022 20:22Urea and electrolytes; Liver function tests; Serum lipid levels; Plasma C-reactive protein level; Acute kidney injury warning stageReport ID: 1-66288733630300

Follow-up action: No Further Action

Urea and electrolytes (X77Wi)

Specimen: BLOODCollected: 28 Jun 2022 10:29

InvestigationNormalityResult

Urea and electrolytes (X77Wi)

Serum sodium level (XE2q0)139 mmol/L [133.0 - 146.0]

Serum potassium level (XE2pz)3.9 mmol/L [3.5 - 5.3]

Serum creatinine level (XE2q5)69 umol/L [50.0 - 98.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres (XacUK)73 ml/min/1.73m^2

Liver function tests (X77WP)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Annual review.

InvestigationNormalityResult

Liver function tests (X77WP)

Serum total protein level (XE2e9)66 g/L [60.0 - 80.0]

Serum albumin level (XE2eA)43 g/L [35.0 - 50.0]

Serum globulin level (XE2eB)23 g/L [18.0 - 36.0]

Serum alkaline phosphatase level (XE2px)56 iu/L [30.0 - 130.0]

Serum total bilirubin level (XaERu)17 umol/L [1.0 - 20.0]

Serum alanine aminotransferase level (XaLJx)13 iu/L [1.0 - 55.0]

Serum lipid levels (XE2q7)

Specimen: BLOODCollected: 28 Jun 2022 10:29

InvestigationNormalityResult

Serum lipid levels (XE2q7)

Serum HDL cholesterol level (44P5.)1.6 mmol/L [0.9 - 1.8]

Serum LDL cholesterol level (44P6.)3.2 mmol/L

Serum non high density lipoprotein cholesterol level (XabE1)3.7 mmol/L

Serum cholesterol/HDL ratio (XaEUq)3.3

Serum cholesterol level (XE2eD)5.3 mmol/L

Serum triglyceride levels (XE2q9)1.0 mmol/L [0.4 - 1.7]

Plasma C-reactive protein level (XE2dy)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Plasma C-reactive protein level (XE2dy)1 mg/L [0.1 - 5.0]

Acute kidney injury warning stage (XabmE)

Acute kidney injury warning stage (XabmE)No result

May be consistent with AKI dependent on clin. context

28 Jun 2022 20:52Serum TSH levelReport ID: 1-66288751610014

Request Receipt: Request Comments:

Follow-up action: No Further Action

Serum TSH level (XaELV)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Annual review.

InvestigationNormalityResult

Serum TSH level (XaELV)3.7 miu/L [0.35 - 4.94]

28 Jun 2022 20:22Urea and electrolytes; Liver function tests; Serum lipid levels; Plasma C-reactive protein level; Acute kidney injury warning stageReport ID: 1-66288733630300

Issued: 28 Jun 2022 20:22Provider Comments:

Arrived: 28 Jun 2022 21:30Service Type: NewFinancial Details:

Follow-up action: No Further Action

Urea and electrolytes (X77Wi)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Urea and electrolytes (X77Wi)

Serum sodium level (XE2q0)139 mmol/L [133.0 - 146.0]

Serum potassium level (XE2pz)3.9 mmol/L [3.5 - 5.3]

Serum creatinine level (XE2q5)69 umol/L [50.0 - 98.0]

eGFR using creatinine (CKD-EPI) per 1.73 square metres (XacUK)73 ml/min/1.73m^2

Liver function tests (X77WP)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Liver function tests (X77WP)

Serum total protein level (XE2e9)66 g/L [60.0 - 80.0]

Serum albumin level (XE2eA)43 g/L [35.0 - 50.0]

Serum globulin level (XE2eB)23 g/L [18.0 - 36.0]

Serum alkaline phosphatase level (XE2px)56 iu/L [30.0 - 130.0]

Serum total bilirubin level (XaERu)17 umol/L [1.0 - 20.0]

Serum alanine aminotransferase level (XaLJx)13 iu/L [1.0 - 55.0]

Serum lipid levels (XE2q7)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Serum lipid levels (XE2q7)

Serum HDL cholesterol level (44P5.)1.6 mmol/L [0.9 - 1.8]

Serum LDL cholesterol level (44P6.)3.2 mmol/L

Serum non high density lipoprotein cholesterol level (XabE1)3.7 mmol/L

Serum cholesterol/HDL ratio (XaEUq)3.3

Serum cholesterol level (XE2eD)5.3 mmol/L

Serum triglyceride levels (XE2q9)1.0 mmol/L [0.4 - 1.7]

Plasma C-reactive protein level (XE2dy)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Plasma C-reactive protein level (XE2dy)1 mg/L [0.1 - 5.0]

Acute kidney injury warning stage (XabmE)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:

Acute kidney injury warning stage (XabmE)No result

May be consistent with AKI dependent on clin. context.

Message Recipient: GP Practice: L83086 (Healthcare Organisation)

28 Jun 2022 20:52Serum TSH levelReport ID: 1-66288751610014

Follow-up action: No Further Action

Serum TSH level (XaELV)

Specimen: BLOODCollected: 28 Jun 2022 10:29

Provider Specimen Comments: Reasons for Request:t

Serum TSH level (XaELV)3.7 miu/L [0.35 - 4.94]

I am sorry - I hoped just the link would come up! Thank you so much.

 

[crimple]

humlies, your serum TSH level is 3.7 and most of us here would say you are on the road to hypothyroidism. However, you really need to have T4 and T3 results and possibly antibodies tested too. What symptoms are you suffering from? TUK has a list and you can tick off your symptoms. I didn't really notice any other tests being out of their range. Hopefully others will come along and comment.

[humlies in reply to crimple]

Thank you crimple. I have been taking levothyroxine now for about 25 years; I also have polymyalgia and COPD, but after reading posts on this forum, I have been wondering whether my extreme fatigue is due to low T3 and T4. I specifically asked my doctor if both could be tested, and she agreed, but it appears this was not done.

[SeasideSusie Remembering in reply to humlies]

humlies

I have been wondering whether my extreme fatigue is due to low T3 and T4. I specifically asked my doctor if both could be tested, and she agreed, but it appears this was not done.

This happens a lot. If TSH is within range the lab wont do FT4 and FT3. In this case many of us do our own private test. If just wanting TSH, FT4 and FT3 the best lab to do it is Monitor My Health (MMH) which is an NHS lab at Exeter hospital and if there is any cause for concern then because it's an NHS lab it will be difficult for your GP to not recognise the results like they would with a private lab.

MMH offer this as a fingerprick test for £26.10 and details can be found here:

thyroiduk.org/help-and-supp...

You have a comprehensive list of tests already done (similar to my annual review and I have COPD) and they are all nicely within range and no cause for concern except that your TSH is high in range. I see that the blood draw was 10.29am and if you'd had it at 9am then your TSH would be higher (it's highest early morning and lowers throughout the day). If it was at the top of it's range or over range then your GP may have considered an increase in your dose of Levo.

Did you do your test as we always advise (apart from the time of the test of course:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

COPD can cause fatigue, is yours stable at the moment and not causing you any problems? I understand that polymyalgia can also cause fatigue.

What about key nutrients - Vit D, B12, Folate, Ferritin - these all need to be optimal for thyroid hormone to work properly, and low levels of these will bring their own symptoms.

[humlies in reply to SeasideSusie]

Thank you so much for this very helpful reply. I did all the right things before the test, EXCEPT that I forgot about not having breakfast! My vitamin D and iron levels have been measured fairly recently, and they were normal. I will go for the private test that you mention.I think COPD is fairly OK, except that I am becoming more breathless when climbing up our Devon hills. This of course could be the PMR; this is why I am keen to find the cause of breathlessness.

[SeasideSusie Remembering in reply to humlies]

humlies

My vitamin D and iron levels have been measured fairly recently, and they were normal.

Do you have the actual results? Normal just means somewhere in range which may not be optimal.

Was an iron panel done or just ferritin tested?

With my COPD I find that all different weathers can affect it. I couldn't climb a hill (I live in Wales) if paid me, just walking up the slope to my house is difficult on a cold, windy day, or a hot humid day, so the breathlessness kicks in. But low iron or low ferritin can cause breathlessness.

Do you know your normal oxygen sats? Mine is usually 94%.

Optimal nutrient levels are:

Vit D - 100-150nmol/L

B12 - top of range for Total B12, if Active B12 is measured then over 100

Folate - at least half way through range

Ferritin - half way through range although some experts say the optimal level for thyroid function is 90-110ug/L

If an iron panel is done then serum iron is recommended to be around 55%+ through range for a female and transferrin saturation percentage around 35%+.

[humlies in reply to SeasideSusie]

Thank you SeasideSusie. Your reply made me realise again how little I know about how my body works. I have some previous blood test results and will try to discover the answers; I don't know what an iron panel is, so will look that up. Interesting that humidity affects you as well - I definitely find the same. I will send off for a home testing kit for T3 and T4, because this is something I need to know as well. I think I am very fortunate compared with many; I am able to walk 1/2 mile to the beach, swim, and then (with a struggle) walk back up the hill. I am told that exertion stretches the lungs, so is good. You clearly have a great deal of knowledge, and it is wonderful to have people like you both on this site and the PMR site. I will be in touch with answers!

[SeasideSusie Remembering in reply to humlies]

An iron panel includes:

Serum iron

Transferrin saturation percentage

Total Iron Binding Capacity

Ferritin

If serum iron, saturation percentage and ferritin are low and TIBC high this suggests iron deficiency. Testing ferritin alone can't confirm iron deficiency and that's why we shouldn't supplement with iron without first doing an iron panel to check for iron deficiency, if serum iron and saturation percentage are good then taking iron would take them too high and lead to toxicity.

[humlies in reply to SeasideSusie]

Thank you again. I will arrange this if I can, though not very optimistic that the local GP will sanction it. Maybe it will have to be another private test. At the moment we are arranging for our family - 11 including children and grandchildren - to go camping in Jersey, so I might be somewhat distracted for the next month....however I have put a note in my diary to start the ball rolling when we return. I hope you are enjoying the summer in spite of restrictions, and I will be in touch again.