Blood Work Results - Some Opinions Needed

Pharma / TRT Testosterone Replacement
21

PLEASE tell me that you are getting your cortisol checked? Please get the blood draw at 8am.

cortisol and thyroid are a great place to start - so that is good.

his views on Testosterone and estradiol are not so good. so it is a mixed bag which is actually better then most encounters. I would count this as a partial win. He didn’t throw you out of the office which is a good start.

good luck. get your results in your hands and post them here BEFORE you meet with the doctor again. No need to walk into the meeting and pay for it without being armed before hand with your own recommendations/thoughts.

22

[quote]iroczinoz wrote:
A few things that did not go well was the fact that we discussed my Testosterone levels. Once again if I am within normal limits I will not see any improvement if I am 350 or 700 [/quote]

Bullshit

[quote]
He did however say that testosterone fluctuates throughout the day and to really know if I am on the low end scale all day long we would have to take 30 tests in a day and that is just impractical. So really he was saying that if I was on the lower end of the scale and it was like that for the whole day then yes it could be a concern. But I think he believes I fluctuate say between 10 and 20 just depends on the time etc. [/quote]

You can confirm or deny this using a 24 hour urine test…though I doubt your doctor would be willing to humor this, since he is an idiot…

Judging from what little you’ve said about this doctor, I wouldn’t hold my breath…Your TSH would probbaly have to be sky high for him to do anything…

23

I had the blood draw today at 8.30am.

Purechance to be honest I am not sure if he did in fact write down cortisol on the blood sheet. I hope so or maybe he plans on running a few more tests once he gets back the results.

When I gave him my sheet of what I wanted, he said I could have 20 of these sheets all with different blood tests. He went on to say he wants to have a systematic approach, So we will see. As soon as I get the results I’ll post them up. Should be Tuesday or so when they come in.

24

[quote]PureChance wrote:
PLEASE tell me that you are getting your cortisol checked? Please get the blood draw at 8am.

cortisol and thyroid are a great place to start - so that is good.

his views on Testosterone and estradiol are not so good. so it is a mixed bag which is actually better then most encounters. I would count this as a partial win. He didn’t throw you out of the office which is a good start.

good luck. get your results in your hands and post them here BEFORE you meet with the doctor again. No need to walk into the meeting and pay for it without being armed before hand with your own recommendations/thoughts.[/quote]

Unfortunately getting my results sooner than visiting the doctor is not possible. I was called today that the results have come back and that there are a few issues and the doctor needs to talk to me. So going to see him in a couple hours. Once I get back home I’ll post the results and give you a run down on what was said. If need be I can just make another appointment and see him.

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Okay saw the doctor and have a copy of the results. I have scanned them and attached.
So it looks like I missed out on these tests: E2,Cortisol,Vit D,rT3. I was dosing myself with cod liver oil (1 tablespoon a day) so I might be okay with Vit D but the rest who knows.

Well doctor looked over the results with me and had the following to say:

TSH is showing an upward trend and I have a sub-clinical Hypothyroidism condition.

Free T4 and Free T3 are in range and he said that my brain is working harder and harder to try and level out the TSH issue.

Cholesterol is elevated but this is not due to diet but related to the TSH. I kind of knew my cholesterol was not associated with my diet. I eat pretty clean and went on a 12 week diet which was extra clean and had no change.

Blood pressure was 138 over 95 which he said was elevated.

I asked would my thyroid be contributing to maybe lower test levels? He answered NO, but Testosterone might not be utilized effectively because of my under active thyroid. Not sure if this is true?

I said I wish my testosterone level would be a bit higher in the range, because as of now I am like a 60 year old. He pretty much seems to think my testosterone is fine, maybe I can try and have it boosted naturally (but I don’t think any of those things work) I am pretty lean, I exercise, don’t smoke or drink so I am not sure what else. So looks like no luck in having any testosterone help is going to go through.

Well I might feel a lot better once I start taking this medication he prescribed me. In 2 weeks he wants to see me and in 1 month I will have another blood test. So if there is anything I should bring up when I see him next, input is appreciated. He will adjust the dose after my next blood test. I guess I should ask to go below 1 in TSH value, so maybe 2 tablets might be needed but we will see.

I have been prescribed:
Thyroxine Sodium Tablet 50mcg x 1 tablet daily.

In a way I am happy that finally something is being done and I might start feeling better. I did want to ask you guys what are my chances of feeling stronger, making gains and feeling back to normal if I sort this Thyroid issue out with taking these pills?

I have really struggled to put on weight and strength over the last few years.

He sounds pretty convinced I will feel much better and have better energy as well as strength, so I am hoping so too.

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Consolidated scanned results

27

iroczinoz - this forum does not do very well with images, so I can’t read the text on that (I don’t think other people will be able to, either). Could you please type out the results with units of measure and lab normal ranges?

28

you can click on the image to enhance it.

or then again… maybe not. the second image is still too small even when enhanced…

29

[quote]PureChance wrote:
you can click on the image to enhance it.

or then again… maybe not. the second image is still too small even when enhanced…[/quote]
Yeah, and right-clicking the image does the same thing as left-clicking it.

I used Firebug to get the URL for the image: http://images.T-Nation.com/forum_images/7/e/7e201_ORIG-consolidated.jpg - you should be able to zoom in on this and see the results well enough.

I’m not used to using moles as the unit of measure, so I’m having difficulty comparing the chart to other people’s results (that are typically in IU/L). It would be extremely helpful to have a chart of conversions.

Here’s what I can figure out… your LDL (‘bad’) cholesterol is a bit high, and you may want to look in to lowering that some. It looks like your liver is moderately stressed (ALT/AST are near the maximum of the range), which I believe can interfere in some manner with hormone synthesis.

Your thyroid antibodies are in the “holy shit” range. Go here: Hashimoto's - Autoimmune Thyroid Attack - Stop The Thyroid Madness - read everything on that page and in the links on the left. Graves’ disease ( Graves' disease - Wikipedia ) is a possibility, though it sounds like Hashi’s is more likely.

Edit: you mentioned earlier that your TSH came back at 8.33. You have a serious thyroid disorder that needs to be treated ASAP.

30

Thyroxine Sodium Tablet 50mcg x 1 tablet daily = PLEASE go read 18 Summaries of Things We Have Learned - Stop The Thyroid Madness

T4 only medication does not work for most people.

  • you REALLY REALLY need to test your cortisol levels BEFORE you start on any thyroid or hormone replacement plan. without sufficient cortisol everything else is doomed to fail (or cause additional problems).

your B12 is in the pits. Good = 700+ I believe. You need to supplement this.
ferritin looks good.
hormones don’t look hideous.

!!! wait !!! what did the doctor say about your thyroid antibodies? that is a HUGE red flag. Doesn’t that equal hashimoto’s or something like that. your body is attacking your thyroid. I don’t know much about that, but you REALLY need to do some more research on that. Did the doctor just ignore that?

31

Hello, yeah I just noticed the image issues so I’ll type them out when I get a chance to sit down for a while.

I’ll buy some Multi Vit which contains B12 and supplement or should I really be using inject-able B12 to supplement?

The doctor did not say anything about Hashimoto’s disease. On the results page it mentions this and graves disease. It also goes on to mention that these levels can also come back elevated in normal healthy people. Treatment should be guided by symptoms and thyroid function tests rather than by antibody concentrations.

So I assume he heard all my symptoms and made a conclusion based on that, fatigued,dry skin, strength issues etc…

I’ll read through the links and make some points to discuss with him again. I might try and see him on the weekend and ask for that cortisol test to be done to make sure it is in check.

The doctor gave me 2 options, either just keep monitoring or try some medication. So it looks like he would have been alright with me not taking any medication and just coming back in 6 months and getting the TSH levels checked. He said it is mildly elevated (probably because of T3 and T4 in range), but a value or 8.33 seems too much just to have mild elevation.

Anyway I’ll be back after I do some research and type the values out.

32

‘Elevated’ probably means something like +/- 10% on the range. You’re at over 50% over the max range. You should absolutely begin medication. A TSH of 8.33 is extremely elevated.

See here: TSH Levels: What Do High and Low Levels Mean?

Print this: http://www.aace.com/public/awareness/tam/2005/pdfs/tsh_backgrounder.pdf
Print this: http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/thyroid/3c_thyroid.doc (Word doc; note “(a) TSH Upper Reference Limits” on page 34 states that the limit will likely be reduced to 2.5 in the future)

Bring the printed studies to your next appointment.

33

Okay I went over my results and have been reading up what you guys have posted and also a bit of my own research.

The doc said I have sub-clinical Hypothyroidism and this is usually when TSH is elevated and FT4 and FT3 are in range and appear to be normal. It is also optimal if the Ft3 and Ft4 values are at the upper limit of the ranges, which I do have. I have been reading into this and I read that treatment for this situation is debatable… Other places I have read that if your TSH is elevated you should take medication.

I can give medication a try and see how I feel as I have nothing to lose really. As Purechance mentioned I should have my cortisol level checked so that will be my next plan of attack. If what Purechance says is correct, no matter what I do to treat TSH if my cortisol levels are off nothing will work. So be good to rule that out.

I went on to read that thyroxine has a 50-50 chance of being successful and that the natural dessicated thyroid like Armour is probably the better way to go. So I will ask for a prescription for that.

Hopefully after taking medication my Cholesterol will also come down to normal limits, as my elevated cholesterol is not diet related but rather metabolic.

Creatine I supplement so that is most likely why that is elevated.
GGT elevation doc said nothing to worry about. A value of 60 is trivial, he went on to say that if I have a beer that value will be like 400…

Ferritin looks good greater than 100 and lower than 200.

Testosterone equates to about 400 in your metrics… What do you guys think of this value is it okay?

Vitamin B12 - do you think I should supplement this with Multivitaim tablets or is injectable B12 the way to go? How much should I be dosing B-12?

Next blood test I will try and push for: Cortisol, Iodine, RT3 and E2.

FT4 16.6 pmol/L (10 - 19)
TSH 8.33 mIU/L (0.5 - 4.00)
FT3 5.1 pmol/L (3.5 - 6.5)
Anti-Thyroid Peroxidase 104 kIU/L (<60)
Anti Thyroglobulin 92 kIU/L (<60)

Cholesterol 6.1 mmol/L (0.0 - 5.5)
Trig 1.8 mmol/L (0.5 - 2.0)
HDL 1.1 mmol/L (0.9 - 2.2)
LDL 4.2 mmol/L (<3.4)
CHOL/HDLC 5.5 mmol/L (<5.0)

Sodium 142 mmol/L (136-146)
Potassium 4.7 mmol/L (3.5-5.0)
Chloride 103 mmol/L (95-110)
Bicarbonate 28 mmol/L (22-31)
Urea 7.0 mmol/L (2.3-7.6)
Est. GFR 62 mL/min (>60)
Creatinine 118 umol/L (60-110)
Bilirubin 9 umol/L (0-20)
ALT 47 U/L (0-55)
AST 36 U/L (0-40)
ALP 53 U/L (35-110)
GGT 60 U/L (0-40)
Tot. Protein 81 g/L (65-85)
Albumin 50 g/L (38-50)
Globulin 31 g/L (22-38)

Haemoglobin 16.2 g/dL (13-18)
WCC 6.0 x10^9 /L (4-11)
Platelets 236 x10^9 /L (150-450)
PCV 48.6 % (40-54)
MCV 90 fL (80-96)
MCH 30.1 pg (27 - 32)
MCHC 33.3 g/gL (32-36)
Neutrophils 3.3 x10^9 /L (2-8)
Lymphocytes 1.9 x10^9 /L (1-4)
Monocytes 0.5 x10^9 /L (0-1)
Eosinophilis 0.2 x10^9 /L (0 - 0.5)
Basophils 0.0 x10^9 /L (0-0.2)
ESR 7 mm/hr (0-15)

Glucose Fasting 4.6 mmol/L (4-6)

C-Reactive Protein < 3.0 mg/L (0-10)

FSH 2 IU/L (1-10)
LH 2 IU/L (1-10)

Ferritin 162 ug/L (20-300)
Iron 24 umol/L (10-30)
Transferrin 2.4 g/L (2.2-3.7)
Transferrin Sat 40 % (13-47)

Total Testosterone 13.9 nmol.L (8.3 - 30.2)
Sex Hormone Binding Globulin 29 nmol/L (13-71)
Calculated Free Testosterone 304 pmol/L (225-725)

Vitamin B-12 336 pmol/L (150-700)
Serum Folate 21.6 nmol/L (> 7.6)

34

[quote]PureChance wrote:
Thyroxine Sodium Tablet 50mcg x 1 tablet daily = PLEASE go read 18 Summaries of Things We Have Learned - Stop The Thyroid Madness

!!! wait !!! what did the doctor say about your thyroid antibodies? that is a HUGE red flag. Doesn’t that equal hashimoto’s or something like that. your body is attacking your thyroid. I don’t know much about that, but you REALLY need to do some more research on that. Did the doctor just ignore that?[/quote]

Yeah he never talked about Hashimoto’s disease. He said Sub-clinical Hypothyroidism which is what I have since my FT3 and FT4 values are in range. I will need to do more reading on this!

Akaji thanks for the links.

Just found this:

Subclinical hypothyroidism

Subclinical hypothyroidism occurs when thyrotropin (TSH) levels are elevated but thyroxine (T4) and triiodothyronine (T3) levels are normal.[14] Prevalence estimates range 3â??8%, increasing with age; incidence is more common in women than in men.[50] In primary hypothyroidism, TSH levels are high and T4 and T3 levels are low. TSH usually increases when T4 and T3 levels drop. TSH prompts the thyroid gland to make more hormone. In subclinical hypothyroidism, TSH is elevated but below the limit representing overt hypothyroidism. The levels of the active hormones will be within the laboratory reference ranges. There is a range of opinion on the biochemical and symptomatic point at which to treat with levothyroxine, the typical treatment for overt hypothyroidism. Reference ranges have been debated as well. The American Association of Clinical Endocrinologists (ACEE) considers 0.45â??4.5 mIU/L, with the ranges down to 0.1 and up to 10 mIU/L requiring monitoring but not necessarily treatment.[51] There is always the risk of overtreatment and hyperthyroidism. Some studies have suggested that subclinical hypothyroidism does not need to be treated. A meta-analysis by the Cochrane Collaboration found no benefit of thyroid hormone replacement except “some parameters of lipid profiles and left ventricular function.”[52] A more recent metanalysis looking into whether subclinical hypothyroidism may increase the risk of cardiovascular disease, as has been previously suggested,[53] found a possible modest increase and suggested further studies be undertaken with coronary heart disease as an end point “before current recommendations are updated.”[54]

But according to my blood work my thyroid antibodies being elevated are typically associated with Hashimoto’s disease and Graves.

So really it looks like I have Hashimoto’s disease as pointed out by Purechance. I guess the only interesting thing is that my FT3 and FT4 are in healthy ranges. hmm

35

Hello everyone well finally I have had another blood test done. This test was done almost 2 weeks ago but I was just able to see a doctor today to get them (no free time with work).

I should say 1 thing 1st and that is that I am definitely feeling better since I have started T4 medication. Feel like I have lots more energy and body has changed for the better. Looks like I have lost some BF while added some muscle.

Date - 29.1.11
FT4 - 16.6
FT3 - 5.1
TSH - 8.33

Date 24.3.11 ( After being on T4 for 2 months at 50mcg a day)
FT4 - 20.4 pmol/L - (10-19)
FT3 - 6.1 pmol/L - (3.5-6.5)
TSH - 3.37 mIU/L - (0.5 - 4.0)

I asked if we should strive for a figure of 1 for TSH and he said won’t make a difference and no. He said as it is now it is perfect FT4 is out of range and he does not want it much higher than it is. So if we were to lower my TSH down to 1 FT4 would be in the 22’s he said.

So he wants me to stay on 50mcg. If I strive for a TSH value of 1 he said excess strain on the body will be put. I asked for T3 basically no.

Any thoughts on that?

Cortisol (8.05am draw)
458 nmol/L - (119-618)

Urine Creatine - 13.9 nmol
Urine Iodine (ug/L) - 2063
Urine Iodine (nmol/L) - 16244

No deficiency UIE >100ug/L (787nmol/L)
Mild Iodine deficiency UIE 50-100ug/L (394-787nmol/L)

So looks like my iodine is not deficient and cortisol looks to be in range.

I also asked about my blood pressure if I should be treating it or not. I said it has been around 140/95 for the last year or so that I know of. So he did a reading and sure enough I was around that.

So he gave me Atacand 8mg to try for 2 weeks and then he wants to see me.

Cholesterol levels I did not get checked had issues with a doctor who I saw to get the referal so will next time. But they should be lower since my TSH has come down.

What do you guys think TSH is good enough or should I mediate myself with 75mcg to get it to 1 or so.??

36

I personally am worried that you are a train wreck just waiting to happen…

you really really really need to go find a thyroid specialist (not an endocronologist - although they may be better then this guy)…

I don’t have any information on hashimoto’s or other related conditions, but having such a high TSH + such a high FT4 and FT3 + high antibody scores scares me personally. plus his failure to even check Reverse T3 when your T4 numbers are so high is also a concern.

I had high blood pressure as well. Mine dropped drastically when I started treating my low Aldosterone with sea salt (1/2 teaspoon 2-3 times daily downed with a full glass of water).

37

[quote]
VTBalla34 had written:

Idiot doctor…your active thyroid hormone is T3 (T4 converts to T3, ideally anyways…yours doesn’t appear to be doing that)…and your T3 is below range from taking T4 meds!!! Jesus how these morons get out of medical school is a mystery to me…

He’s right that taking more T4 to lower TSH is not the answer (but he probably didn’t get there the right way…blind squirrels find nuts occasionally)…you need T3 meds or to figure out why your T4 is not converting to T3…more T3 will lower your TSH…[/quote]

Edit: All of the above is now OBE since OP edited his post to correct FT3 value

38

Thanks for the honesty guys. Looks like I have to keep looking into this by the answers you have provided. I am back in Europe in about 1.5 months, I have a good friend who is doctor (diabetes specialist) but she has lots of contacts at the hospital. I am going to have to ask her for assistance in getting me into someone who knows their stuff with thyroids. Otherwise I will not get anywhere. To be honest this doctor that I am seeing now has been the best one I have been able to find. But obviously he is not good enough. Damn a little disappointed in all of this.

What do you guys think should I trial the high blood pressure tablets or give them a miss for the time being.

The sea salt thing is interesting. I have always been concerned with eating salt, how it effects arteries and veins… So taking 1/2 a teaspoon 3times a day is something that I have never really thought about. Purechance how was your sodium levels after taking such high doses of salt? How long did you keep at this or is it something that needs to be done for extended periods of time?

So after taking T4 meds I should be seeing higher T3 values?

If I am supplementing with T4 I would have expected to be off the charts in the T4 department which I am but not by much 20.4 (range top = 19)

Worst case scenario I will have deal with it as it is now and then hopefully get a good doctor in Europe.

I guess I am not having much luck at the moment.

I made a typo with the values from last result - so sorry! I have edited my previous post.

39

Apologies just checked my previous post and I made a typo.

here are the correct readings:

Date 24.3.11 ( After being on T4 for 2 months at 50mcg a day)
FT4 - 20.4 pmol/L - (10-19)
FT3 - 6.1 pmol/L - (3.5-6.5)
TSH - 3.37 mIU/L - (0.5 - 4.0)

Does this change anything for the better?

40

sea salt - most people attribute high blood pressure, etc. to high salt, but in some cases low sodium (not detectable by sodium blood tests as your body maintains blood salt to the detriment of all other systems) causes the exact same symptoms/problems.

low sodium = water retention, high blood pressure, increased heart rate, excess urination, excess sweating (sweating when barely warm, dripping during a light workout, etc.), and/or swollen ankles.

there is info on sea salt and aldosterone on the stopthethyroidmadness site and an easy pupil test you can do to confirm or you can simply try an experiment - just toss 1/2 teaspoon of COARSE sea salt to the back of your throat and chug a full glass of water and wait an hour. If your energy and mood go through the roof then you have your answer.

Simply taking sea salt has dropped my blood pressure from 140/100 to 120/70 plus has had countless other benefits. It still blows my mind that something so simple (it’s freaking salt) has had such a dramatic impact on me. I am still taking it, and I got off trac for a month or so and couldn’t figure out why I started feeling so bad and reverting back to how things had been until I realized I wasn’t taking my salt anymore. I started back up, and BAM 100% better.

as for your T4 - no one I have heard of has ever had T4 numbers over the range regardless of the medication they were taking. stopthethyroidmadness does a great job explaining how your system should handle T4. Something is very wrong with your system and you need to get it resolved. I don’t think people with Hashimoto’s simple ignore it and go on with life. You need to deal with it. How? I have no idea, but the STTM site would be a good start.