Test Result Comments Welcomed Pre Endo Appt

[PDS1]

Dear Unlockers,

I’ve got a telephone consultation with my endo this Friday and am writing to ask for your views on my test results in advance.

I had a lot of blood work done in April in preparation for an endo appt which was rearranged, so I had to repeat the thyroid panel this month. There was very little difference – my results have remained roughly the same for a while.

Test Result Range Average % Average

Thyroid Panel (All “Tell patient normal” apart from TSH (suggest may be over replaced etc)

Serum FT3 5.1 pmol/L (3.8 - 6.0) 4.9 104

Serum FT4 12.1 pmol/L (7.9 - 14.4) 11.15 109

Serum TSH 0.04 miu/L (0.38 - 5.33) 2.86 .01

B12/folate level

Serum vit B12 (April) 599 pmol/L (133 - 675) 404 148.3

Serum vit B12 (July) 342 pmol/L (133 - 675) 404 85

Serum folate >20 ug/L (3.10 - 19.9) 11.5 ?

Serum ferritin 108 ug/L (11.0 - 306.8) 158.9 67.5

Liver function test (all serum)

Serum total protein 68 g/L (60 - 80) 70 97.1

Serum albumin 39 g/L (35 - 50) 42.5 91.8

Serum ALT Level 26 iu/L (0 - 35) 17.5 148.6

Serum Alk Phos 91 iu/L (30 - 130) 80 113.8

Serum Total Bilirubin Level 8 umol/L (5 - 21) 13 61.5

Serum Globulin 29 g/L (18 - 36) 27 107.4

Serum Magnesium 0.8 mmol/L (0.7 – 1.0) 0.85 94.1

Com’d Total Vitamin D2 + D3 1 v 1 80.6 nmol/L (50 - 150) 100 80.6

Bone Profile

Serum Total Protein 68 g/L (60 - 80) 70 97.1

Serum Calcium 2.43 mmol/L (2.2 – 2.6) 2.40 101.2

Calcium adjusted level 2.51 mmol/L (2.2 – 2.6) 2.20 104.58

Serum alkaline phosphatase 91 iu/L (30 - 130) 80 113.8

Serum Inorganic phosphate 1.08 mmol/L (0.80 – 1.50) 1.15 86.4

Serum Albumin 39 g/L (35 - 50) 42.5 91.8

Serum Globulin 29 g/L (18 - 36) 27 1.07

Full Blood Count

Haemoglobin estimation 139 g/L (115 - 164) 139.5 99.7

Total WBCs 4.5 10*9/L (4.0 – 11.0) 7.5 60

Platelet Count 165 10*9/L (150 - 400) 275 60

RBCs 4.46 10*12/L (3.9 – 5.60) 4.75 93.9

Haematocrit 0.418 (0.36 – 0.47) 0.42 99.5

Mean corpuscular volume MCV 93.5 f1 (78.0 – 96.0) 87 107.5

Mean corpus. haemoglobin MCH 31.2 pg (28.0 – 34.0) 31 100.6

Mean corpus. Haem. conc. MCHC 334 g/L (320 - 360) 340 98.2

Differential White Cell Count

Neutrophil Count 2.6 10*9/L (1.9 – 7.5) 4.8 54.2

Lymphocyte Count 1.4 10*9/L (1.0 – 4.0) 2.5 56

Monocyte Count 0.4 10*9/L (0.2 – 1.0) 0.6 66.7

Eosinophil Count 0.1 10*9/L (0.0 – 0.4) 0.2 50

Basophil Count 0.0 10*9/L (0.0 – 0.1) 0.05 0

I followed the HU protocol for pre-test medication.

I take Lio 5 mcg am and late afternoon, Levo 75 just before bed and sublingual Vit D + K.

My diet is restricted (Low FODMAP AIP) following working with a nutritionist in 2019 (stopped 2020). I could do with reviewing this, but

I think I’m very lucky symptoms wise, but am on a long waiting list to see if I have Sleep Aponea which can be common with Hashi’s. My nails are very brittle and break if I look at them. My skin is very fragile and a brush with a cardboard box leaves a blood bruise similar to a blood draw in the back of an elderly person’s hand (I could be classified as elderly – but not by me!)

I’ve not had the vaccine and may have had non-symptomatic covid judging by Beau’s lines. I am careful when going out etc. to protect myself and others.

Interestingly, in the last few weeks I’ve noticed that my deeply scalloped and canyon sized fissure down the middle of my tongue have reduced significantly – no idea why.

Greatly appreciate any thoughts on the test results, discussion with endo, supplements etc.

Many thanks.

PDS1

[SlowDragon Administrator]

I take Lio 5 mcg am and late afternoon, Levo 75 just before bed and sublingual Vit D + K.

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Was test done as recommended…..levothyroxine 24 hours before test

B12 has dropped significantly

You’re not currently supplementing B12?

….you might want to consider adding a daily vitamin B complex

Perhaps you need to add a 2nd 5mcg dose T3 daily

[PDS1 in reply to SlowDragon]

Many thanks Slow Dragon for your comments.

Yes I followed the instructions exactly.

I don't know why the B12 has dropped. I'm not supplementing because I've only just got the results which show the reduction in level. Previously I thought it was OK.

I take two 5mcg - one am and the other late pm. The endo wouldn't give me more - I'm lucky to get any.

I forgot to ask (serious brain fog - MRI and CAT scans, various tests and more to come):

If you can tell if I’m converting T4 to T3?

Do I need to/can I take any action to improve:

• the low Serum ferritin, Serum Total Bilirubin Level, Total WBCs, Platelet Count and all Differential White Cell Count

• the ‘high’ Serum ALT Level results?

Look forward to your replies

[SlowDragon Administrator in reply to PDS1]

You say you are on low FODMAP….are you on strictly gluten free diet

[PDS1 in reply to SlowDragon]

Hello SlowDragon,Yes, I'm strictly gluten free. It really is restrictive, but I really enjoy my salads twice a day.

[SlowDragon Administrator in reply to PDS1]

You can’t tell how well you convert once on levothyroxine and T3

But you can see both Ft4 and Ft3 results are at reasonable levels

FT4: 12.1 pmol/l (Range 7.9 - 14.4) 64.62%

FT3: 5.1 pmol/l (Range 3.8 - 6) 59.09%

Who did this test?

NHS or private test?

Ft4 range is very small - many labs have range 12-22

Ferritin is at good level

[PDS1 in reply to SlowDragon]

Hello Again,Could you tell me how you calculated the %? I take the midpoint between the range.

All the tests were done by the NHS.

Thank you

[SlowDragon Administrator in reply to PDS1]

Sorry meant to add the calculator

thyroid.dopiaza.org

[SlowDragon Administrator]

My nails are very brittle and break if I look at them. My skin is very fragile

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) might help

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

Thorne Basic B recommended option that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

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

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

How other member saw how effective improving low B vitamins has been

healthunlocked.com/thyroidu...

[PDS1 in reply to SlowDragon]

Hello SlowDragon,Many thanks for all of your replies - I've downloaded all the articles you've referred me to. I'll read them this afternoon.

And I'll get the supplements as you suggest.

Do you know of a table or anything else which shows the US and the UK ranges for the same tests and how to convert the UK results to the US ones? May not be expressing that very well, but hope you'll know what I'm trying to say.

[SlowDragon Administrator in reply to PDS1]

You can use the calculator

Put result in first box and ranges in 2nd and 3rd boxes

Gives % through range

[Charlie-Farley in reply to PDS1]

Hi PSD1

The percentage within range is the only way I have come across to legitimately compare results from different labs, wherever in the world the results are taken. The accuracy of the results will only be known to the lab and instrumentation will (should) be checked regularly with reference samples to ensure consistent results.

We have to understand the limitations of blood work. We all respond differently to medication and our bodies will be optimal at different levels. This is when things start to get tricky. However we do have SYMPTOMS. Sadly Doctors would rather work with blood results that they don’t know how to interpret than actually carry out an assessment including consideration of symptoms.

Doctors treat the upper and lower intervals on any blood test i.e. the range as a pair of goalposts and getting somewhere in between them is good enough. It is down to us to calibrate the results to how we feel and this is when we have to argue for adjustments to medication for our own health. I haven’t yet spoken to a Doctor who was aware of the possibility of comparing lab results by using percentages within range.

Hell, they don’t even know that TSH is the least reliable of all the measurements. They should be focusing on thyroid hormones not something made in the pituitary.

So just because doctors do not understand percentages within range, do not take this to mean it is not a valid method, it is simply the case that they are not taught how to interpret data and have a very poor understanding of stats (in the main) this can also be extrapolated to endocrinologists.

Since becoming hypo I have had to come to the conclusion, there is a gulf of difference between ‘doing science’ and ‘doing medicine’.

[PDS1 in reply to Charlie-Farley]

HI Charlie-Farley,

Thanks for getting in touch – made me smile when I needed a lift.

At least my endo is willing to go ‘off piste’ into negative territory – credit where credit’s due.

Good luck on your health journey

PDS1

[Charlie-Farley in reply to PDS1]

Hi again 😊

If your endo turns out to be a ‘keeper’ 😂 you might want to add them to the list thyroid UK Endos list. Not sure exactly how you do that - perhaps a quick email to secretary? 😊👍

[PDS1 in reply to Charlie-Farley]

Good thought C-F. I'll mull it over after consultation.Have a great w/e

PDS1

[Batty1]

Beau’s line what is this and how does this show if you had covid or not?

[PDS1 in reply to Batty1]

Hi Batty1

Deep horizontal ridges or depressions, known as Beau’s lines indicate something caused the nail to stop growing temporarily. Triggers can include, according to an NHS website, covid symptoms.

They are transverse lines and ridges due to intermittent inflammation causing growth arrest followed by hyperproliferation in the proximal nail matrix. The lines and ridges move out distally as the nail grows.

I’ve read that if you measure them and then divide by – forgotten – it will tell you how long ago the event(s) tool place.

When I saw mine and cast my mind back I realised that I may have had covid and been to all intents and purposes asymptomatic – couple of hours of sniffles or very slight cough.

I’m trying to get an anti-body test to identify whether I might have antibodies and therefore probably did have it. Trying to identify the best test is difficult as major manufacturers are loath to commit to giving usable responses – certainly no recommendations and even if they would not in my life time – chase – chase - chase.

Hope that helps

PDS1

[PDS1 in reply to Batty1]

"As the toenails grow at a rate of about 1.62 mm per month, the distance of the Beau lines from the proximal nailfold in our patient reflects the timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection"

[Batty1 in reply to PDS1]

Interesting and I guess Im good to go no beaus lines

[PDS1 in reply to Batty1]

Hi, I don't think can assume that just because you've no lines that you haven't had covid. Being asymptomatic is tricky. And the lines can be caused by other conditions - nothing's simple!