# All blood test results - new symptoms



## Jo853 (Aug 16, 2013)

Hi,

I've received a report and copy of bloods from my hospital appointment with my Endocrinologist 2 weeks ago. I've decided to put all blood test results down as reference as well as symptoms.

November 2011

TSH - 5.2 (0.27-4.2)
FT4 - 16.8 (12-22)

February 2012

TSH - 2.2 (0.27-4.2)
Ferritin - 29 (30-400)

January 2013

Anti-TPO - 84,000 (<34)
TSH - 0.69 (0.27-4.2)

May 2013

TSH - 22 (0.27-4.2)
FT4 - 10.9 (12-22) -- Started Levothyroxine at 25mcg, then gradual increase to 50mcg and then 75mcg

August 2013

TSH - 4 (0.27-4.2)
Ferritin - 15 (30-400) -- Levothyroxine increased to 125mcg and started Ferrous Fumerate 210mg

November 2013

TSH - 4.3 (0.27-4.2)
FT4 - 15.3 (12-22) -- Levothyroxine increased to 150mcg
FT3 - 5.5 (3.1-6.8)

December 2013

Anti-TPO - 41,000 (<34)
TSH - 4.6 (0.27-4.2)
FT4 - 15.6 (12-22)
Ferritin - 22 (30-400)
Folate - 4.1 (4.6-18.7)
Vitamin D - 43.6 (>75)
Vitamin B12 - 363 (180-900)

January 2014

TSH - 2.7 (0.27-4.2)

Notes from the letter/report she has sent to the GP that have stood out:

"On examination there were areas of patchy, increased hyperpigmentation on her back and around her eyes. Her blood pressure was 122/91 rising approximately to 131/95 on standing. There was no evidence of any joint swelling, skin rashes or Raynaud's and no sign of microstomia.

Her investigations so far show a normal thyroid function with a TSH of 2.7, ferritin of 21 and Vitamin D of 43.6. Her coeliac screen was negative. Her autoimmune profile did show a positive ANA but further tests did not point to any significant disease association.

In view of her ongoing symptoms and clinical signs I think it is important to exclude Addison's disease as soon as possible. There is a possibility that she may have an autoimmune connective tissue disorder but in view of the lack of clinical signs and the normal inflammatory markers there is no real evidence to support this currently.

I briefly discussed the possibility of an endoscopy as a goal standard test for ruling out coeliac disease but I think in the first instance she should go back onto a normal diet including gluten and we will repeat her coeliac screen in a month's time. She has a follow-up appointment with me in three months' time but I will alter this depending on the outcome of her tests.

All blood tests including the short synacthen test were normal. It can take 6 months to recover from Vitamin D deficiency and this may explain some of her symptoms. There is no indication at the moment to repeat a thyroid ultrasound as I note an MRI neck showed a normal thyroid appearance in 2012."

My response to the report:

- I was not told during the examination that I had hyperpigmentation around my eyes but at my legs. So she has now changed her opinion slightly.

- She also told me my blood pressure rose but only a little. This blood pressure reading tells me it went up more than just a little.

- If she had chosen to look at my toes for signs of Raynaud's she would have seen that my toes are purple.

- She did not tell me I was going to have a repeat Coeliac screen in a months' time.

- The ultrasound report was lost, not the MRI one. So how can she justify the normal MRI results over an ultrasound report that no-one seems to know anything about?

Right. Now blood tests.

Short Synacthen Test

Basal cortisol - 622 nmol/L
30 minute cortisol - 915 nmol/L
60 minute cortisol - 985 nmol/L

Cortisol - 345 nmol/L

Haemolgobulin (HbA1c) - 33 mmol/mol

Testosterone - 0.7 nmol/L (0.2-1.7)

Prolactin - 251 mIU/L (0-700)

LH - 1.4 IU/L (Follicular phase 3.2-8.0, Luteal phase 2.4-7.2)

FSH - 2.5 IU/L (1-9)

Rheumatoid Factor - 9 IU/L (<20)

Sodium - 141 mmol/L (133-146)

Potassium - 3.9 mmol/L (3.5-5.3)

Urea - 1.6 mmol/L (2.5-7.8)

Creatinine - 54 umol/L (50-95)

eGFR calculated MDRD - <90 mL/min/1.73m*2

Bilirubin - 7 umol/L (<21)

Alkaline Phosphatase - 59 U/L (30-130)

ALT - 9 U/L (5-40)

Albumin - 45 g/L (35-50)

C-Reactive protein - <1 mg/L (<6)

Calcium - 2.42 mmol/L (2.20-2.60)

Calcium adjusted - 2.37 mmol/L (2.20-2.60)

- I don't understand the cortisol figure on its own (the 345 one)

- LH is low and out of range.

- Urea is low and out of range.

So the blood tests weren't completely normal as in her words, by the looks of things.

Symptoms I currently experience:

* Nausea and headaches which improve after eating something with sugar
* Constipation
* Heavy/early/late/short periods
* Joint pain
* Muscle heaviness/weakness
* Migraines/headaches
* Fatigue
* Cramps
* Excessive sleeping
* Mood swings/depression/anxiety
* Dry/flaky skin
* Fine/brittle hair.

Can anyone help with all of this? This is really confusing!

Thanks.

Jo xxx


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## jenny v (May 6, 2012)

> Her investigations so far show a normal thyroid function with a TSH of 2.7, ferritin of 21 and Vitamin D of 43.6


This stood out to me--is she saying those levels are normal? I hope not, because none of those levels look very good and your Anti-TPO level is horrendous. Did she not check your Free T3 or Free T4 levels at your January appointment?


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## Jo853 (Aug 16, 2013)

jenny v said:


> This stood out to me--is she saying those levels are normal? I hope not, because none of those levels look very good and your Anti-TPO level is horrendous. Did she not check your Free T3 or Free T4 levels at your January appointment?


Hi Jenny, yes she has said the TSH is normal.

She did not check Free T3 or Free T4 at my January appointment but this might be because the TSH result was collected at my doctor's laboratory and not the Endo's. I'm not sure when my test thyroid function is due as they will not act upon an in-range thyroid result.

Thanks

Jo xxx


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## joplin1975 (Jul 21, 2011)

Jo, I've never seen a TPO number that high. The presence of antibodies skews the other tests (TSH and sometimes free t3 and free t4) so those become less reliable.

Your immediate concern should be getting an ultrasound of your thyroid.


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## Jo853 (Aug 16, 2013)

joplin1975 said:


> Jo, I've never seen a TPO number that high. The presence of antibodies skews the other tests (TSH and sometimes free t3 and free t4) so those become less reliable.
> 
> Your immediate concern should be getting an ultrasound of your thyroid.


Hi Joplin, thanks for your reply.

I've received a copy of the report sent from the endocrinologist who has written something about getting an ultrasound done. Here is the passage:

*"Notes to GP: All blood tests including the short synacthen test were normal. It can take 6 months to recover from Vitamin D deficiency and this may explain her symptoms. There is no indication at the moment to repeat a thyroid ultrasound as I note an MRI neck showed a normal thyroid appearance in 2012."*

So now I'm stuck and don't know what to say.

Thanks

Jo xxx


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