Lab results: thyroid problem or not???
Please help! I have diabetes and have been on a more and less strict LC diet since diagnosed in 2002. That combined with metformine seems to have kept my numbers fairly good. Lately, though, I've been so tired that I've been trying to see what might be behind the depression and fatigue I feel. I went to an endo but he was no help. He thinks I should get on insulin and move on. He also thinks I'm not depressed, since I can "come into a doctor's office and have an animated discussion about my health. That's not what depressed people do. They sit at home unable to do anything. You're clearly not depressed." :annoyed: I almost said, "Guess what I was doing before I came to this appt? And guess what I'll be doing after!", but I knew that wouldn't have helped anything. I want to keep friendly with him in case I have to stay with him. Horrible to feel so compromised but I really need help, what else can I do?.... :dunno:
My sister has Graves, Disease and she told me that she would have a hard time getting out of bed with a TSH of 3.7 and I almost surely have a thyroid problem. Since this specialist hasn't helped, maybe I should find another but it's not so easy to do. My sister suggested I go straight to my GP and see if he'd be willing to prescribe Synthroid, which she takes with very good results. I'm not so keen on going to anybody else until I'm much more informed myself. Otherwise, I'll just get dismissed and come away feeling more discouraged. When I read a list of the symptoms for Hashimoto's, I feel like I can check every box off! However, when I look at these labs, I get confused as to whether they are signaling a thyroid problem at all.
Can some of you more experienced folks interpret just a little bit for me? I thought I did good to get Antibodies tested, but now I'm not sure I tested the right ones. Did I? If you can tell me what else to ask for, maybe I'll try asking the GP to test for me at least...
Please help. I'm really doing my best to keep positive but I could sure use a little supportive boost from someone who knows a bit about how this feels!:help:
Thanks in advance,
Ery 4.2/pl so low in a range of 4.0-5.2
Leuco 9.7, so high in a range of 4-10
Lymphos 3.33, so high in a range of 1-3.5
Thrombo 323, so high in a range of 150-400
Creatinine 45, so abnormally lower than range of 50-90
CRP <1, so low in a range up to10
Alk. Phosph. 45, so low in a range of 35-105
Cholesterol 4.6 so high in a range of 3.5 – 5.0 (a month before it was out of range at 5.3)
HDL Chol 2.2, so higher than normal range of 1.1-2.1
Tryglyceride .5, so lower than normal range of .6-2.2
Glucose 7.3, so higher than normal range of 4.0-6.1
HbA1c 37, so high in normal range of 20-42
Vit. B12 624, so high in a range of 150-700
Folic acid >45, so higher than the normal range of 5-25
T3 1.3, so low in a range of 1.1-3.1
TSH 3.7, so high in a range of .4-4
Insulin 9.2, in a range up to 15 (seems solidly normal)
C-Peptide .82, in a range of .2-1.2 (although the doctor said it would be better to see this at 1 and a month later it was down to .47.
GAD 65 <3 where positive is indicated by 5 and higher
IA2 <5 where positive is indicated by 8 and higher
I responded to your other post in the diabetes section.
First, that's a Total T3 test result, not a Free T3 result.
You need the Free T4 and Free T3 tests done at the same time the TSH is done, then TPO Antibodies (Hashi's test).
I've found that if I'm not sure what a test is, I look them up, to see if high or low in the range is good or bad - it makes a difference by test. Not all high in the range is bad, just as not all low in the range is bad. It depends on the test. Depending on which test, you may Want to be low...Or high in the range. For instance, look up creatinine. That's kidney function. Low is Good. Do a web search on low creatinine test result. The higher the HDL the better.
So I think I'll go straight to the GP (I've got an email in elsewhere looking for another endo but I am doubtful I'll hear back) and ask him to test Free T3, Free T4, TSH, and TPO Antibodies. Anything else? Wish me luck!
About the kidney function - creatinine connection, actually I had read that. It made me more confused. To my mind, if I sometimes have sugars as high as 288, so the kidneys should maybe be at risk for damage. That would show up as higher creatinine. In my case, they're lower than normal, so maybe that means I'm just a very lucky woman to have such healthy kidneys to handle whatever auto-immune circus is going on in my body? Or maybe I'm just all together off track thinking there's anything wrong at all. Maybe I've got type 2 diabetes, it's under control in the big picture, and I just need an anti-depressant! :D Your thoughts?
lol. Or, you may/probably just need some T3 instead of anti-depressants, who knows? I just listed to Dr. Bernstein's webcast last night, archived from last week. He said something interesting (I thought, and agree with). He said, and I'm paraphrasing.... 'Pdocs should not treat a person for depression Before testing Free T3 and medicating with it if it's low'.
If your doc Knows thyroid and will interpret the T results correctly and take your symptoms into consideration, that will help. Also, I may be wrong about that T3 result. Normally Total T3 results are in whole numbers from what I've seen and Free T3 is with a decimal point,...in the U.S.A. anyway. I'm not sure where you are and I know that different lab ranges vary a Lot all over the States.
My hubby is Type 2 diabetic so I'm always watching his lab results and looking up what they are if I don't know.
If your doc won't do those tests, and you are in the U.S. you can always get your own done via healthcheckusa or direct labs (I'm sure there are others too), online sign-up, and they send the results back to you via email and regular mail. I have to do that to get the FT3 done as my medical won't run FT3 adn I take both T4 and T3. I want to Know where it is.
Hey, watcher! Thanks for the laughter, it gives a lift. I'm in the Netherlands, generally a very progressive country but IMHO not so much so where medical care is concerned. In a way, their reluctance to medicate looks like a healthy contrast from the US approach, which can sometimes be characterized as "drug first, ask questions later." But I think the reluctance here goes pretty damn far.
For example, that endo I saw was at first unwilling to give me a scrip for 1000mg of Metformine even though I was already taking it and my numbers were visibly reduced. He skimmed over my little tracking chart, said I seemed to eat very healthy and that worked well enough. If not, I needed insuline. My husband got frustrated then... "It's not only her good diet; that's *with* 1000mg of Met," he almost growled. A lightbulb went on, he gave me the prescription, and he let me go with no future plans except a check-in in 3 months. IOW, he let me leave knowing I'd keep on the same treatment I'd developed for myself, even though *I* knew it wasn't enough, that there's something missing.
He said I'm not depressed, even though I said I was. He said he's "not too worried" about my tiredness, even though I said that's what drove me to seek out medical help.... I really hope I can find a better one, but ppl think he's one of the two best in my area (the other's an older guy also and working in the same hospital, so I feel fairly sure they think alike).
I really want to get treated via someone at the research hospital which is about an hour and a half travel for me, but I'm also a little leery of them due to experiences with my husband's treatment there. He's in good hands now but we sure had to do lots of self-advocating along his road. :(
The best hope I have is with my local GP. I've read on the Dutch Thyroid site that GP's can treat so I'll go to him and tell him so/ ask him to be so kind. But if that doesn't work out, I'm screwed. I won't be able to get referrals to specialists w/o a GP referral so I *have* to stay on his good side.... That's why it's so critical for me to be very exact in what I need, but also have studies, etc. to back it up. And all the better if they're Dutch ones or at least European bc my impression is they carry more weight in these parts. (But if you have quick links to major US studies showing that my labs warrant further investigating, they're most welcome!)
The question then is, why am I typing here on the boards instead of poring over Dutch research sites? Because I'm so tired of feeling tired and it gives me LOTS of fuel to keep going to see so many ppl come out on the other side of these symptoms. And to feel supported in general. Yay!!! I'm *not* crazy!!!:jumpjoy:
Okay, off I go to try to take care of business. Next time I post I hope to have some info that might prove helpful to someone else down the line about what to do when you live in Holland and think you've got thyroid issues.
Have a great day and THANKS AGAIN for your help.:shake:
I only have this listing for Netherlands....and it's from 2005...but I know T3 is available (synthetic, of course) from this doctor:
Dr Holwerda, GP/homeophathy, Oudwijkerdwarsstraat 50, 3581LG Utrecht, Tel: +31 (0)30 2523865, fax 030 2519796
Thanks! I found her (I hope it's a "her" but here only some women doctors call themselves "Dr"; many keep the "Mvrw" [Ms] in front of their names, indicating it's a woman; since there's no first name, I can't really guess) also on a website for Top Thyroid Doctors, the only one in this country listed. I tried to find a website and what I found was closed temporarily. I called the phone number and there was an answering machine (set not to receive messages) which said phone appointments are Tue-Fri 9-12. I don't have an email so tuesday I'll try my luck.
Hope our insurance covers it. I found her also on a natural healthcare site but can't get direct info on her. But it does look like my ins might cover some. And if not, if she can prescribe what I need and she listens and tests well enough to figure that out-- I'll travel and I'll pay out of pocket while I keep searching for moreaffordable help. Like what so many others I've seen here have said. :sad:
Where did you find her, btw?? Maybe there's more info I missed! Or even a Dutchie out there struggling, too, that you saw in some other forum?:)
I had cause to help a young lady a few years ago and she happened to be near Holland...and she went to that doctor and did well. The young lady told me, at the time, that there seemed to be more doctor who would give porcine thyroid or a T4/Cytomel combo in Germany...I'm here in the USA so all I can do is keep my ears and eyes open for others.
The majority of inquiries to me from Europe have come from Scotland actually....and very few from Netherlands (I dream of visiting Holland someday...hopefully it won't 'just be' a dream, lol)
Oh, and search for the British thyroid foundation...they have some great information at that site.
Thanks, Lokarbiebarbie! I'll do that. In the meantime, I've made a plan since tomorrow is an appointment with a fertility specialist who is also an endo, I'm going to begin with him. If he's not interested, I'll go to my GP and just try to get the testing while still searching for a good endo. And if that doesn't work, I'll try the Homeopathic DR in Utrecht you mentioned. And if that doesn't work.... I'll go crazy!:stars:
Just kidding, I think if by then I haven't found a lead on a good endo in Holland, I'll try to do testing at home next time I'm in the states and see if my old gp there won't diagnose me and then treat me from afar.
Something important, though, for you, Leo, and Watcher to know: I went back to my papers and see now that the Free T4 was done on the same date as above info. It was 16 in a range of 10-24, so solidly in the middle. Also, Anti-TPO was done then as well, and it was 6, where the range is up to 35. I didn't put these in the original post since I thought their being normal meant no need to mention. :o
On that note, in case it's also helpful to mention:
Cortisol 0.3 in a range of .20 - .70
ACTH 4.3 in a range of 1.5 - 10.0.
Sorry to leave out important pieces. Still very curious to know what you all think of my current (and very amateur) analysis: I'm probably slightly hypo (but not Hashi-), and the only issue I have is with T3, so that should be supplemented and my tiredness problem will be improved.
Am I even close????:confused:
I know my laundry list of symptoms and will of course share as needed, but if he's another labs-focused kind of dr, I should point out my regular cholesterol was above normal (although triglycerides, LDL, and HDL were all out of range but in a good way, whatever that might mean! :p), and that my T3 is high acc. to some ranges. and hopefully the clencher, that I've got family history...
What other labs here would pique his interest, do you think? Is high B12 something to consider with thyroid issues? Here's a link that talks about something else, methylation... High b12 - Thyroid Disorders Message Board - HealthBoardsAnyone here familiar?
From what I've seen so far, both low folic acid and low B12 are associated with hypothyroidism. I'm high in both. Am I ruled out of the hypothyroid camp after all??? Or is that just due to my daily supp, which has both: 500 mcg of B12 (2000%), and 200 mcg (100% RDA) of folic acid?
Really want to go in with a succinct message tomorrow... Have I mentioned how much I appreciate the feedback. :o
Based on my own experience, I don't think your high B12 has anything to do with whether or not you're hypothyroid.
I've been hypo (Hashi's) for more than 10 years, and when my T3 dropped the last time (8 months ago), my endo also checked my B12 in case that was causing my fatigue. My B12 was way off the charts high--so much so that I was concerned. But my endo told me that in light of all my other great lab numbers, my B12 can't be too high--that it's a good thing.
My point is that low B12 doesn't correlate to hypothyroidism necessarily, since my own B12 is very high.
Thank you, Leo. So then as far as labs, the only thing that's thyroid-relevant is the (kind of) high TSH? Do you understand the connection with the cholesterol and is there one in my case?
(p.s. - how can I edit a previous post? This one gave the option to edit as soon as it was up but a previous one doesn't have an "edit" button. I want to make the 16 bold on my Free t4 since right now only the six is in bold..)
Well, you need a Vitamin D test, and it's not usually folic acid that's low in hypothyroidism...it's storage iron, called ferritin. And a 'one time draw' of am cortisol doesn't show the 'entire picture' but a 4x in one day salivary cortisol would show the 'ebb and flow' of the adrenals much clearer.
Low Vitamin D can wreak havoc on the endocrine system as well as other hormones. You also need a RT3 testing (at the same time as TSH, FT4, FT3). And we never say 'in another range I've seen'...doesn't work..you need to use the range given.
My T3 (total T3) is about where yours is. BUT my Free T3 (FT3) is barely in the bottom range. Totals show what's just 'circulating around in the blood' and Free's show 'what's usable to your body'.
Sometimes we make quite enough T4 (my FT4 is great at just BELOW middle of range, yet if my FT3 isn't 3/4 of the range..I feel like dirt dragged through mud) and instead of converting to FT3 it actually makes into RT3 (reverse T3). Many with good FT4 (just at midway of it's range) have this problem...the T4 is there...and it's all converting over to reverse T3. You can search for 'reverse T3 and symptomology and labs' and probably come up with a lot.
Just for the record, with me being a lowcarber for a long time, my B12 is very high also...but if my Vitamin D falls below a certain point...I'm toast..no matter my thyroid hormones. So...that needs checked. If low enough that can also make a thyroid panel look 'less than stellar'.
Just a few suggestions...
Great information, Lokarbiebarbie! I'm going in tomorrow but will check back here once again in the morning (the middle of the night tonight, for all you Americans!) to see if there are other suggestions. Wish me luck!:up:
I may have missed it, but I only see the HDL number (cholesterol) which is high--but it's GOOD when the HDL is high, so that's not a problem.
When you're hypothyroid and untreated, the LDL cholesterol number can go up (mine did) and usually goes down slowly once you're on Rx thyroid hormones (mine did).
I'd like to second the suggestion that you get your Vit. D checked. I could not believe the difference in how much better I felt once I raised my D level (which was low).
Just above where I posted the HDL, I posted just plain "cholesterol" (which is how it reads on the form). It was 4.6 in a range of 3.5-5.0, so closer to the high end but still in range. However, a previous test I had flagged it because it was 5.3. The first (and worse) reading was from 5 April, the second 6 May.
Also, CH/HDL ratio was 2.4 in May, 2.1 in June (ratio up to 4.0)
LDL was 2.8, then 2.2 (up to 4.4)
FWIW, May 2 was when I stepped metformine up to 1000mg and around that time I also began to eat with more care and got more serious with running (up to 6x/week 30-35 mins).
Sorry not to be more clear! I have so many numbers, I can't tell what's important. I thought I was making it simpler to put only the outliers up but I didn't do that so well anyway, it looks like..... Hope you can see something in this.
Here's the problem. If that 'cholesterol' is actually the total (HDL + LDL), then it's meaningless that it's high because it could be due to your high HDL, which, as I mentioned, is a good thing. My labs always flag my cholesterol as high, even though my LDL is in range because my HDL is so high. My doctors envy me my cholesterol numbers because of that HDL. So lab flags can be deceiving.
But back to your initial question. If you have untreated hypothyroidism, it tends to result in a high LDL that will come down once you're treated. You really don't need to be concerned about cholesterol until you get your thyroid diagnosed properly.
Here's an example of the cholesterol thing: A few years ago my cholesterol was a little high. My TSH was also on the high side. My doctor at the time had me up my dose a little and get labs done 4-6 weeks later and my cholesterol numbers came down 30 points. I also felt better because my TSH and FT4 were more in line to where they should be.
So, it really is all connected.
List of what will be tested
Thanks, Watcher. So I guess overall my cholesterol isn't pointing to low thyroid... Let's hope that if I have it, the tests that were ordered today will be enough to show it. PLEASE let me know if I should try to squeeze anything in.
I have mixed feelings about the visit overall. My husband and I went to the fertility-endocrinologist today of course because we'd like to have a baby but now very specifically to make sure they understood we think there's SOMETHING wrong with my hormones after so many years of infertility, the iffy sort of LADA/MODY/Plain Type 2 diabetes question, and the laundry list of symptoms that to me really scream hypothyroidism.
I won't bore you with the details, but it was definitely a "pick your battles" kind of meeting. He didn't want the conversation to go where we wanted it to and that was clear. Lots of deep breathing exercises as I repeated and repeated to myself, "don't tell him that... *maybe* this can be brought around... maybe... maybe..." And then, just as he was wrapping up his own points, GOTCHA!, he glibly said that of course ultimately I was the boss and what matters is what I want. :jumpjoy:
Well, Doctor, since you ask... :eek:
I explained that baby or no baby, good sperm or no good sperm, etc. I was convinced that fertility has to do with good hormone health and mine's not good. He started to say that he could see the numbers in the computer and it looked ok to him, but I went back to what he'd said himself: what did I want? And I just want to rule out the possibility of a thyroid issue so could we please test the items on the list I'd brought? He said ok, with a couple caveats I'll explain below. I'm just SO happy that I'm getting the tests done.
I read that TSH scores register higher in the morning, fasting. Is that TRUE? I took the lab form with the intention to go back tomorrow fasting. Any other suggestions to help the numbers read higher? Not because I want that but because that's the only way *they* will accept it. We already touched base on the fact that the Brits changed the upper level of the range to 2 back in 2002 but he dismissed it out of hand, mine being 3.7 in a range that goes up to 4.0, period.
Here's THE LIST I ORDERED FOR LABS:
I got all of the above with those last few (*) exceptions:
The TG Antibodies he said he doesn't know/have, but he was throwing in an extra that is probably the same in other terms "TSH receptor antibodies." I just read up and it's NOT. It's for finding hypER, specifically Graves.' :confused: I can't see anything on the form that looks like it must be the Dutch version of TGAb... :confused: Just looked this link up NVKC - Informatie over laboratoriumtesten and it does exist, abbreviated as "Anti TG"; It's nowhere on this form so this hospital lab just doesn't do it, I guess! :dunno:
Moving on, The only T4 I see is free, which I'm getting. Does it matter that I'm not getting Total T4?
T3 Uptake, he just put a line through and that was it. It's not on the form. Is that important enough for me to figure out some Dutch name for it and go back and beg for it?
There's still time since I have the form and haven't gone in. The things that aren't on the form can be written in, that's what they did with the Free T3 and the TSH receptor anti-stoffen, also Vitamin D.
Thanks in advance,
Positivity (positive about getting... somewhere!... today):)
I don't know about your other tests, but you don't have to be fasting for thyroid testing--and I doubt it will make any difference at all in your TSH.
Keep in mind that a good thyroid doctor will treat someone with a TSH of 2.0 or above if the individual has symptoms.
I was diagnosed when ALL my values were 'in range,' and my endo at the time said that's not uncommon--I was severely hypothyroid, but the labs didn't show the extent at all. That's why good thyroid doctors consider everything.
The 'free' is more accurate, so it really doesn't matter if you're not getting a total T4. It's odd that he ordered both for the T3 and not the T4, and that could just be his mistake. I wouldn't worry about it.
Good luck with this.
Would that it were so simple. From what I understand, they don't use the new range here. It's still up to 4.0 so at 3.7, I'm "normal," nevermind my symptoms, etc.
There are exceptions, have to be; I just need to find them. General searches in English only turn up the dr. Lokarbiebarbie mentioned above. I just got off the phone with the office and feel just a little bit... set back in my travels. The woman was so curt and would not help me at all. They're not taking new patients, period. I explained that I'm not from here and am trying to find a Dr who uses the new TSH range, that Dr. Holwerda is supposedly one, so EVEN IF she's not taking new patients perhaps she could help me find someone who would treat a patient with my TSH and she just refused, refused to help. Very sharp. "Sorry but I cannot help. We cannot help. Goodbye." And then *click*, gone. Gee, thanks.
That's why I asked about morning TSH testing. I'm at the point where I have to find ways to push myself out of the normal range (on paper, at least) in order to get heard. I looked more and it does make a difference so I'll go early tomorrow am. And try to find the dr and beg him to please add TG-Ab since it does indeed exist here (he said he thought it didn't; that it's the same as the TSH-receptor Ab test but I discovered that's for finding Graves'). Also that it is sometimes necessary to diagnosing Hashi's since TPO's sometimes don't turn it up. Here's hoping he'll tolerate my pushing... I think I'll try to find a very clear, very esteemed journal article spelling that out in case he doesn't buy it. Anyone with a quick link, you are most welcome to drop in with it! :)
Now I have to seriously wade into the Dutch thyroid boards. I speak some Dutch, I can use Google translate but still... it's hard to read such technical info in a second language. So far I saw one woman complaining that her dr thought she was fine with a TSH of 10. :p And I haven't seen a thread called "great doctors who really listen, use the 2.0 top limit, and are in this country!" or anything similar;) But I will do my best to keep focused and dig.
Thanks again for keeping up with my progress and contributing along the way. It really helps.
I'm sorry you've having so much trouble, but note that I said "good thyroid doctors." I'm afraid that good ones are difficult to find here in the U.S. too. I've been lucky, but many, many people have difficulty finding a doctor who is 'good' with thyroid.
You'll have to tell me whether fasting actually raises your TSH. I'm usually tested fasting because my endo does a lipid panel at the same time which requires fasting.
But I've be tested non-fasting a couple of times when I was having T3 problems, and, honestly, there's been no real difference in my TSH whether fasting or not.
I hope you have some success in getting treatment.
Here's one link I found on the topic of lower scores in the morning. Optimum Time and Conditions for Thyroid Blood Tests: When Should You Test, Should You Take Thyroid Medications Before Testing, and Should You Fast? A guy named Richard Shames is mentioned there. I've seen him elsewhere on the web. Do you know anything about him?
I got the TGAb test added on and labs were done today. Will have results in a month. :jumpjoy:
In the meantime, I found a list from a thyroid org of thyroid-specializing clinics in the country who recognize 3 as the top of the TSH range. I'm in the process of finding out how to get in with them. :jumpjoy:
This was a banner day for self-advocacy in my little world! Hurray! I actually am getting somewhere! :high5:
Thanks all of you for helping me along! Will let you know when there is more news...
Glad you're making progress!
That's fantastic! Even my medical here in the U.S. still uses an upper lab range of 5 or 5.5 so they are still way behind the times, and it was changed 10 years ago now.
Thanks, Watcher. There was actually a slight detour. I was so excited about a clinic in Arnhem and managed to get one of their "thyroid nurses" (just the fact that they even have such a creature thrilled me) and I explained that I had a 3.7 TSH and was looking for someone who used the upper limit of 3.5 and the national org said they do. She was so very nice but said that if my TSH is under 4 and my free T4 normal (which it is), I would probably do well to look elsewhere. She was sure the doctor would see me and sympathize but doubtful he'd actually treat. Bummer. Still, so nice to talk to a helpful human.
Emailed again with the thyroid org guy and he (also very kind) referred me to a Dr. Hennemmann. He's not at all close to me, but almost sure to help. I googled him and found a nice article in a women's mag where he explained to readers how it's very common for docs to mistake thyroid issues for menopause and that women should check their TSH more frequently. Also said docs should treat more for symptoms and not obsess over the numbers only. Did not say yet what *his* magic number is but I'm emailing him today. Wish me luck!
He emailed back, very positive, and I've made an appt for mid-August... HURRAY!
Can't wait to hear how the appointment goes positivity...and some of the appointments for great thyroid docs here in the USA are six months out...so August is really good.
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