T Nation

Blood Work Advice


#1

I'm 29 years old, 5'9 and 210lbs. Been feeling like shit lately, not training, getting fat, and generally sucking at life. A friend suggested I get blood work done, as he suspects my estrogen is elevated. I live in Europe, and I'm not sure if these values and acronyms make sense to you. Would appreciate some input.

A S-FSH...............5.5 IU/1 (1-12)
A S-LH..................6.1 IU/1 (1-12)
A S-Estradiol.........0.13 nmol/1 (0.06-0.14)
A S-Testosteron.....14.8 nmol/I (8.0-35.0)
A S-SHBG.............26 nmol/I (8-60)

ALAT.....................24 U/L (<70)
B-Erythrocytes.......5.2 tera/L (4.2-5.7)
B-Hb.....................16.0 g/100 mL (13.4-17.0)
B-Leukocytes........10.3 giga/L (3.5-11.0)
ER-MCH................31 pg (27-34)
glucose..................5.1
Pt-GFR, estimated/1.73 kvm >60 ml/min
S-ASAT..................23 U/L (<45)
S-FSH....................5.6 IE/L (1.0-12)
S-FT4 (Free T4).......17 pmol/L (9-19)
S-Gamma Gt...........28 U/L (<80)
S-HDL-Cholesterol....1.4 mmol/L (0.8-2.1)
S-potassium.............4.6 mmol/L (3.5-5)
S-Cholesterol............5.1 mmol/L (2.9-6.1)
S-Kreatinin................92 µmol/L (60-100)
S-LH.........................4.2 IE/L (1.1-8.8)
S-Natrium (Na)...........141 mmol/L (137-145)
S-TSH.......................4.6 mIE/L (0.5-3.6)


#2

You have subclinical hypothyroidism. My own TSH level was right around yours and I felt constantly fatigued, had no motivation, etc.

The difference after 7 days of medication was night and day. I felt better than I had in years.


#3

OK I have some questions Doc:

  1. What kind of medication did you take?

  2. My estrogen seems on the high end, and my test on the low end. What do you think about that?

  3. Any good web resources to read up on subclinical hypothyroidism? I will need something to convince my doctor, who says these values are all within the normal range.


#4

First things first, contrary to my username I'm not an MD. (sadly, my username used to be "World's Greatest Lover" but I wasn't that either....)

I take levothyroxine which is synthetic T4.

I would take care of your hypothyroidism first, then retest T and E. The thyroid is relatively simple as far as organs go and well understood. Results are easily measurable both clinically and from a patients QOL standpoint.

While the AACE doesn't necessarily support treatment unless TSH > 5 and there is evidence of a goiter or anti-thyroid peroxidase antibodies, they do feel that with treatment, TSH should be brought down below 3.0. I think with a list of symptoms that match subclinical hypothyroidism as well as an elevated TSH, a cooperative doctor could be persuaded to start levothyoxine treatment.

From my own personal experience, I walked in to my docs office with my labs showing TSH between 4.6 and 5.2 and he started me on 25 mcg immediately.

http://alt.aace.com/pub/pdf/guidelines/hypo_hyper.pdf

You can also check out the "stop the thyroid madness" website, however, I found it's tone to be a bit off-putting. I certainly wouldn't bring in articles off the site to my doctor. Instead, I'd use it to do further research.


#5

It's kind of strange, the lab has marked my TSH result of 4.6 with a *. Like they were going to add a footnote about this, or as a heads up to the doc that this is worth noticing. It does say normal value 0.5 to 3.6, so obviously it is outside of normal. I'll need to have another word with my Doc about this. My life has fallen apart these last two years, and it seems I just can't get motivated to do anything at all. You should see my apartment. lol

Thank you for responding.


#6

I know exactly what you mean. Up until I started treatment, even the thought of taking the garbage out made me tired. Papers piled up on my desk, errands went unfinished, etc.

The difference between being treated and untreated was night and day for me.


#7

You still take the medication? How long have you been on it now, and if you don't mind me asking: how old are you?


#8

You take the medication for life. I've been on it for 2 months and am 38.

If treatment starts, your doc will most likely start you off with a small 25 or 50 mcg dose then retest TSH levels after 8 weeks. Changes in dosages are made slowly to let the body acclimate to the increase in T4. It may take 6 months to finally dial in the correct dosage.


#9

If he won't, I'll find someone who will. lol


#10

Hey...anything that is out of the range on the sheet with have the * next to it. I'd always have creatinine (I think I spelled it right) slightly high back when I was competing in college. My mom (the one that works in the hospital and loves labs)...says it is basically junk in the blood...which can be common among those working out a considerable amount. Note...now that I'm almost ten years removed from college track...it is normal. Point is...the star just means out of range. There will typically be an explanation on one of the sheets as to what it means...especially the ones for blood sugar and HDL/LDL.


#11

There was no explanation, and in fact when I called they insisted that nothing looked out of the ordinary. If I hadn't insisted on picking up a print out of the sheet, I would have never known.


#12

Talking to my mother, I'm finding out that my grandfather and others in my family have had issues with their thyroids, and my aunt had it removed. I've always had a slow metabolism too.

Will be interesting to see what happens, I'll report back after seeing my doc. Thanks again Pangloss.


#13

you really really really need to read stopthethyroidmadness.com/things-we-have-learned/ before you talk with your doctor.

(yes... really)


#14

dessicated thyroid... hmmm. thanks for the link.


#15

I notice that site says that T4 meds dont do the job well enough. However Dr.Pangloss here says he got a lot better just from levothyroxine. I guess we'll have to wait and see how it goes.

Edit: Pangloss, what's your take on meds like Armour?


#16

In 2005, 65 million T4 prescriptions were written (Synthroid plus generics).

What you see on the internet is a case of self-selection. Those who are doing poorly on T4 only are visiting the thyroid boards because they're looking for additional help. Those who are doing wonderfully (myself) don't see any reason to post on the boards (Hi everyone! Doing great just as I am).

The vast majority of people convert T4 to T3 well. For those who don't, Armour or a compounded T4/T3 prescription might be more appropriate.

FWIW, I have 2 studies in front of me that show no difference in clinical markers or patient self-reported QOL between T4 only and T4 plus T3 medication.


#17

With my family history, it's amazing no-one ever caught this. I started gaining weight at the age of 10, in spite of playing sports every day and being very active. The MD diagnosed me with Asthma. I think now that I was misdiagnosed, and that it was and still is a thyroid issue. Chronic low grade depression, slow metabolism etc... and now I'm losing my hair too. LOL

Should be enough symptoms to convince my doc to try T4.

Thanks again for the added input, I really appreciate it.


#18

Are you able to get more thyroid specific testing? tft's, ft3 and your albumin levels so the chemical pathologist has a better idea.


#19

I wouldn't mind getting more specific tests done, but AFTER I start on synthetic T4. I don't want to spend another couple of months waiting.


#20

The Doc ordered more thyroid specific testing, but he doesn't agree that I have subclinical hypothyroidism. My T4 is at the top of the range, so he doesn't want to give me levothyroxine. He's worried I'll get heart palpitations. (Is that the right word?)