# New Lab work - any help appreciated



## dantetila (Jul 24, 2010)

To do a quick summary of my health (25 year old male):

2008 - Pacemaker for severe bradycardia (heart rate around 30-40 when resting, 20 when sleeping, 3 times heart stopped for about 10 seconds) with cardioinhibitory vasovagal syncope
2009 - Diagnosed with Celiac Disease & Autonomic Dysfunction due to Celiac
2010 - Diagnosed with autoimmune adrenal insufficiency

I recently saw my Endocrinologist due to feeling weak and tired. He sent me for a whole wack of blood work to make sure my adrenal insufficiency was under controls and to check my thyroid/pituitary glands or any other cause for the way I feel. Here they are below. My endocrinologist told me every looks great and he didn`t think there was anything else wrong. He increased my florinef medication and said maybe that will help. I have highlighted some lines that are low or are on the low end. My concerns are:

- TSH is normal but why are free`s on the low end. I have two autoimmune diseases, so I always worry about Thyroid issues.
- How can LH be low and FSH be borderline low, yet he says it is great, why bother checking then. I am a 25 year old male, I`d think my LH FSH would be higher.
- My RBC and WBC are both low which worries me. Again how is this normal.

Anyways, I know this is a thyroid board and I apologize for the rant and the extra lab work, but I was curious if anybody knew about this. THanks a million!
*
Thyroid
-------*
TSH - 1.4 (range 0.35 - 5.00)
Free T4 - 15 (range 12 - 22) <-- LOWISH
Free T3 - 3.7 (range 2.6 - 5.7) <-- LOWISH
Thyroid Antibodies - all came back negative (ones for hashi, graves)
*
Hormone - Adrenal/Pituitary
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LH - 1 (range 2 - 10) <-- LOW
FSH - 3 (range 2 - 12) <-- LOWISH
Cortisol - 238 (range 80 - 600)
Prolactin - 6 (range < 18)
Free Test: Pending...not complete yet

*Hematology
------------*
Hemoglobin: 120 (range 140 - 170) <-- LOW
Hematocrit: 0.36 (range 0.39 - 0.49) <-- LOW
RBC: 3.99 (range 4.30 - 5.70) <-- LOW
MCV: 89 (range 80-97)
MCH: 30 (range 27-32)
MCHC: 342 (range 320 - 360)
RDW: 12 (range 11.5 - 15)
WBC: 3.8 (4.2 - 11.0) <-- LOW
Platelets: 170 (range 150 -400) <-- LOWISH
MPV: 9 (7 - 11)
ABS Neutrophils: 2.09 (range 1.80 - 7.00)
ABS LYmphocytes: 0.99 (range 1.00 - 4.00) <-- LOW
ABS Monocytes: 0.42 (range 0.00 - 0.80)
ABS Eosinophils: 0.27 (range 0.00 - 0.40)
ABS BAsophils: 0.04 (range 0.00 - 0.20)

*Chemistry
-------------*
Fasting Glucose: 3.9 (range 3.6 - 6.0) <-- LOWISH
Calcium: 2.31 (range 2.20 - 2.65) <-- LOWISH
Sodium: 136 (range 135 - 145) <-- LOWISH
Potasium: 4.5 (range 3.3 - 5.1)
Alkaline Phosphatase: 40 (range 40 -120) <-- LOWISH
B12: 148 (range 150 - 900) <-- LOW
Ferritin: 45 (range 16 - 300)


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## lainey (Aug 26, 2010)

Hmmm, low B12, low hemoglobin, low hemocrit--has anyone talked to you about anemia and iron supplements? That would explain a lot of your fatigue. Serum ferritin would be nice to see. Women tend to be naturally low in this area, but not men.

Your thyroid numbers look fine. With no antibodies, you really are not in a place where you are a candidate for replacement medication.

Your glucose should be low in the range, that's where you want it.

A lot of the blood electrolytes can vary quite a bit from the range. Sodium, for example, varies based on your hydration level at the time of the test.
Small variations are common.
Calcium is almost always fine as long as it is in range.

WBC counts can vary quite a bit, but generally don't cause concern until they are several times out of the range in either direction.

LH and FSH are the hormones that stimulate ovulation in females. As a male, you really don't want any!

Speaking of hormones, where is the measurement for testosterone? That needs to be well up n the range for most males.


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## dantetila (Jul 24, 2010)

Wow...thanks for the response Lainey...very informative 

The serum ferritin is the last test on my list, it was 45 (range 16 - 300). The lab report said it was Reduced, but not deficient. My Free Testosterone is still pending, the results are taking a bit longer than the rest. My last Free Testosterone was last year and showed 66 (range 19 - 210).

From everything I've read your Free T3/T4's are supposed to be in the upper portion of the range in order to feel your best. Both of mine are in the 30% of range, isn't this below optimal? I'm not disagreeing with you as I came here for help, but just curious.

As for LH, I read low LH can indicate pitiutary issues with males. Is this unlikely for males?

The anemia is new to me, but my Endo says everything looks normal, so I don't know what to do really as I'm stuck.

Thanks again!


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## lainey (Aug 26, 2010)

When you see things about "optimum" as far as frees, usually it is in reference to people who are on replacement. Studies comparing those on thyroid replacement to "normal" individuals show that people who are medicated tend have higher free T4 levels. The exact reason is unclear, but it is thought to be related to exogenous T4 and the conversion process. Doctors generally don't parse the numbers to see at where they fall in the range, just whether or not they are outside of it. I don't personally believe there is a lot of value in it, as people can feel well over a wide range of numbers--hence the ranges themselves as the basis for "normal".

With your TSH close to one, and your frees where they are, once again, I really don't think you are going to make a good case for, nor do you really need, thyroid replacement medication.

TSH and free T4 and T3 show daily, weekly, monthly as well as annual variability. Illness, stress, exogenous medications (such as steroids), hormones and other factors affect their levels.

Your ferritin is on the low side for a man, as is your testosterone. Both have symptoms that cross over heavily with hypothyroidism. I would talk to your doctor about how these could be improved and see where it goes.


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## struggling (Aug 31, 2011)

Weak and tired = anemia. When your hemoglobin starts to fall you become very easily fatigued (this is the molecule that carries oxygen to your organs, so you are in an essence getting less oxygen). You need to be tested for possible pernicious anemia as your B12 is low, which is fairly common with celiac or UC or any gastro auto immune disorders. Have you ever had B12 injections?

I'd maybe start with that and then re-examine your thyroid/adrenal levels and see if they improve. Can't believe your endo didn't say anything about that, maybe they assumed your gastro was already on top of it.


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## Andros (Aug 26, 2009)

dantetila said:


> To do a quick summary of my health (25 year old male):
> 
> 2008 - Pacemaker for severe bradycardia (heart rate around 30-40 when resting, 20 when sleeping, 3 times heart stopped for about 10 seconds) with cardioinhibitory vasovagal syncope
> 2009 - Diagnosed with Celiac Disease & Autonomic Dysfunction due to Celiac
> ...


Your Free T3 could stand to be higher and this would probably bring down that TSH a tad which would be a good thing. FT3 is below the mid-range of 4.1 as per the range provided by your lab. Most of us like our FT3 @ about the 75% mark of that range.

The single thing that stands out the most is your low ferritin. You do need to work on that and dollars to donuts this could be a huge part of the problem.

Ferritin http://www.thewayup.com/newsletters/081504.htm
(should be 50 to 100; the closer to 100, the better)

And may I suggest that you also get testosterone lab test run if you have not done so. Many men w/autoimmune have very low testosterone.

Both of these things if low, can impede the efficacy of your thyroxine replacement.

Sadly, I don't have time to do all your labs BUT you can..............

Here:
http://www.labtestsonline.org/

And do bear in mind that "some" results should be low and/or should not be present at all.


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## dantetila (Jul 24, 2010)

Thanks everyone!

Lainey: I agree with you, I don't think my thyroid is a problem right now. My only concern is that with Celiac/Addison's, Thyroid problems are common and I went to him for fatigue. But you're right, with my numbers as they are, it is just a wait and see type scenario. Just for info's sake here are my last 4 Thyroid test results:
*
Dec 2009 : TSH-1.01 (0.35-5.00) FT3-5.4 (2.6-5.7) FT4-20 (12-22)
July 2010 : TSH-1.15 (0.35-5.00) FT3-5.2 (2.6-5.7) FT4-19 (12-22)
Dec 2010 : TSH-2.50 (0.35-5.00) FT3-4.5 (2.6-5.7) FT4-16 (12-22)
Sep 2011 : TSH-1.40 (0.35-5.00) FT3-3.7 (2.6-5.7) FT4-15 (12-22)*

Struggling: Pernicious Anemia? I'll mention that at my next appt, thank you! My doctor told me because my blood smear showed my cells were normal size and shape, that it wasn't B12 related, since that causes size changes. B12 shots sounds like a good idea to me, but my doctors feel like 148 is ok, yet it falls in deficient...so it confuses me. Thanks for the info.

Andros: I feel like the Free's are too low as both fall about 30% of the range, but Lainey was right, my Endo is only concerned with out of range, not low range. My only concern is the drop in Free's over last two years, but I may just be paranoid because of my other autoimmune issues. As for Ferritin, nobody has mentioned it as an issue for me as 16 is the bottom of the range. I thought the range of 16-300 is more for women and not men, as men usually don't have troubles. My Free Testosterone test is coming, but no results yet. My last Free Test was last year and it came back as 61 (range 26 -220) which I feel is too low for a 25 year old male, but no doctor said anything. Thanks for the help!

You all are great, thanks for everything!


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## Andros (Aug 26, 2009)

dantetila said:


> Thanks everyone!
> 
> Lainey: I agree with you, I don't think my thyroid is a problem right now. My only concern is that with Celiac/Addison's, Thyroid problems are common and I went to him for fatigue. But you're right, with my numbers as they are, it is just a wait and see type scenario. Just for info's sake here are my last 4 Thyroid test results:
> *
> ...


Men I have read should have higher ferritin but I can't find my source.

If your doc won't get your frees where they need to be, please consider finding one that will.

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.
http://www.drlam.com/articles/hypothyroidism.asp?page=3


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## lainey (Aug 26, 2010)

> Dec 2009 : TSH-1.01 (0.35-5.00) FT3-5.4 (2.6-5.7) FT4-20 (12-22)
> July 2010 : TSH-1.15 (0.35-5.00) FT3-5.2 (2.6-5.7) FT4-19 (12-22)
> Dec 2010 : TSH-2.50 (0.35-5.00) FT3-4.5 (2.6-5.7) FT4-16 (12-22)
> Sep 2011 : TSH-1.40 (0.35-5.00) FT3-3.7 (2.6-5.7) FT4-15 (12-22)


Consider for a moment that if you actually were on replacement, the doctor would find no reason here even for a med adjustment. While the frees have trended down slightly, the numbers are generally stable.

It is watch and wait as far as thyroid at the moment. While yes, autoimmune diseases do come in clusters, if you were going to have an autoimmune thyroid problem, you would have an excess of thyroid antibodies to begin with (not that you have to have antibodies to have a thyroid problem, mind you).

Keep in mind, estrogens tend to bind thyroid hormone. If your sex hormones are off --lowered testosterone usually yields higher estrogens (the amounts are relative to the sex)--if those have been shifting, or your testosterone is a little on the low side, you would see a corresponding change in the thyroid numbers. Men in general have slightly lower TSH/higher frees than women for this reason. Androgens are easily shifted with topical creams as a starter (and a doctors' guidance of course).

B12 you can supplement orally, as you can iron. You certainly have the lab results to begin discussing doing that with your doctor.

I suspect that your symptoms lie more with correcting these "deficiencies" or in the characteristics of the Addison's that you are already treated for, rather than thyroid.


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## dantetila (Jul 24, 2010)

Hi all.

My doctor just called me with the Free Testosterone results:

LH: 1 (range 1-9)
FSH: 3 (range 2 - 12)
Free Testosterone: 3 (range 50 - 200)

Looks like that explains why I am so tired. He has sent me a script for Androgel or something like that. He never said what would of caused this, does anybody have experience with this? He said it was the lowest he has ever seen for man my age (so nice haha). Oh well, I hope this helps me feel better.

Thanks to everyone, but with the fatigue I wanted to make sure my Thyroid levels looked ok. I appreciate all you did to help.


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## Andros (Aug 26, 2009)

dantetila said:


> Hi all.
> 
> My doctor just called me with the Free Testosterone results:
> 
> ...


Holy cats! One possible cause is diabetes. Have you had a glucose test? I know you will be glad to get your Rx and get going on that!

You must be exhausted?


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## dantetila (Jul 24, 2010)

I asked for a copy of my labs. His assistant had the numbers a little off (no idea what she was reading over the phone), but it is still too low.

Free Testosterone: 4 (range 35 - 100)

That is the original reason I went to see my Endo. For the last few months I've been exhausted and I've been losing weight (muscle mostly). It has just been a struggle to get out of bed and even walking has left me wanting to sleep. My marriage has been struggling because I have not been myself emotionally. I thought it was due to the fatigue and I thought the fatigue was due to my Addison's or Celiac Disease. Turns out this is the case. I'd like to know what it is happening though and what I can do to fix it because the Testosterone Therapy is expensive. My health plan doesn't cover it, so 200 a month. I hope I'll only be on it a short while.

I know this is a thyroid board and I apologize for any time I wasted, but if anybody does know anything about this, I appreciate it.


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## lainey (Aug 26, 2010)

Don't apologize. We're here to help you think this through.

There are a couple of men in the forum who are doing testosterone therapy. You might want to post the question directly in a new thread and see if any of them find you.

I hope this helps you get back on track and feeling better soon.


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## Andros (Aug 26, 2009)

dantetila said:


> I asked for a copy of my labs. His assistant had the numbers a little off (no idea what she was reading over the phone), but it is still too low.
> 
> Free Testosterone: 4 (range 35 - 100)
> 
> ...


No time has been wasted. I believe that most of us here are happy to help and be supportive no matter what the medical cause.

So you just keep us in the loop on all of this if you so desire!


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