Help with blood work, please

[robs2nd75]

I have never had so many things off in my BW before. Have felt like garbage for a couple of months. Any thoughts would be appreciated.

Lab Test Results lipid panel

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comp. metabolic panel (14)

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hemoglobin a1c

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vitamin d, 25-hydroxy

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tsh

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thyroxine (t4) free, direct, s

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triiodothyronine (t3)

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[jger242]

Just my opinion however Your hba1c and glucose were high out of range. Insulin resistant and or diabetes. Did you fast for 12 hours before the bloodwork?

Smaller frequent (every 3 hrs) protein rich low glycemic carbs meals should help. With insulin resistance or type 2 diabetes metformin (2000 mg) per day will help.

Your vit. D is low. Get sunshine (10 a.m. - 2 p.m.) and add 10000 iu per day of vit. D3. Vit. K2 (mk7) 150-200 per day will help.

Also make sure to sleep 7-9 hours per day and try to keep the same sleep schedule every day.

 

[Gene Devine]

Missing a lot of labs, especially hormonal, to make any real assessment.

 

[Nelson Vergel]

robs2nd75

It will be very hard for you to lose fat with LDL, triglycerides and glucose values like those (assuming they are obtained from a fasted state). Triglycerides are the juice that keeps fat cells full and happy specially in a high glucose/insulin environment.

Ways to decrease LDL, triglycerides and glucose:

Exercise (3-4 times a week, 1 hour sessions)
Low simple sugar, high fiber, high protein diet with good fats
Metformin (over 1000 mg/day)
Testosterone supplementation (if low)
Thyroid supplementation (if low)

 

[Vettester Chris]

Agree with Gene. The thyroid will also need FT3, RT3 & Antibodies. What you presented doesn't look too bad, but there's no way to know if your T3 is productive and ATP is adequate.

Here's a post I made in the BW forum regarding some needed follow up labs ... (Gene, feel free to add or comment on anything I may have overlooked)

Total Testosterone Serum
Free & Bio Testosterone
SHBG
Estradiol (E2) Sensitive
Prolactin
DHT
Cortisol (4x Saliva Panel) ...
... ACTH (not always needed, but it will portrait the feedback loop productivity with the adrenals, and help if certain diseases are in question i.e., Addison's, Cushing's,)
... Aldosterone (Again, probably not on the 'standard' follow up requisition list, but something to consider if adrenal issues persists, and other variables like High BP is a factor, i.e., ruling out Conn Syndrome)
DHEA
Thyroid Panel ...
... -TSH, Free T4, Free T3, Reverse T3, Thyroid Antibodies (TPO, TgAb for Hashis and Graves)
Iron (TIBC & Saturation % if possible)
Ferritin
CBC w/Diff
Comprehensive Metabolic Panel
Lipid Panel
PSA
IGF-1
Vitamin D3 (essential with the effective management of SHBG, and much more!)
Vitamin B12

 

[robs2nd75]

Ty all for your responses....I have diabetes type II / metabolic syndrome. TT is 900s, free T was in the high 30s, and e2 was in the low 40s. Doc is considering adding T3 based on my symptoms but she's on the fence. Have always had slightly elevated calcium and was wondering if this could be having an adverse effect on my metabolism. PSA is always good <1. Ferritin, B12, and Prolactin are always normal....Nelson, I'm doing everything you listed w/ the exception of thyroid supplementation....thanks again for all of your thoughts. Any further thoughts would be greatly appreciated!!

 

[Nelson Vergel]

High calcium can be a sign of something like hypothyrodism or hyperparathyrodism. Are you taking Vitamin D? It is known to improve function of the parathyroid gland.http://endocrinesurgery.ucla.edu/patient_education_High_Calcium.html

 

[robs2nd75]

High calcium can be a sign of something like hypothyrodism or hyperparathyrodism. Are you taking Vitamin D? It is known to improve function of the parathyroid gland.http://endocrinesurgery.ucla.edu/patient_education_High_Calcium.html

5000 I.U. daily has only raised my D slightly and from what I've read it may be causing abnormal labs. I've mentioned the possibility of hyperparathyroidism to several physicians and they've all concluded that it would be far more elevated.

 

[Vettester Chris]

Rob, IMO you need to get a PTH (Parathyroid) assay. Depending on the state of your glands, the magnitude of hyperparathyroidism could vary from minimal to extreme, as what we see with hyper or hypothyroidism, or even hypogonadism. Anyone of us, physician or not, can speculate on this, or the lab can be ordered just as easily and take the speculation out of the picture.

On the comment about your doctor being on the fence for T3 therapy ... Your FT4 is at 40% of it's range value. 50% to 80% would be the goal (again IMO) to aim for both FT4 and FT3 when everything is optimal. So, going on this, your FT4 is a tad low. I'd like to compare that with the FT3, not the total T3 that you posted. Even if the FT3 were in the same range, or lower, I would highly encourage you to get the Reverse T3 checked and compare ratios with your Free T3 value (FT3/RT3). Diabetes alone can be a factor with elevated RT3 ratios. Additionally, cortisol, iron, magnesium, and of course D3 needs to be factored with knowing that T3 is actually working at the cellular level. Again, additional labs are needed before doing much more. Thyroid pooling would not be a good thing ... Just my .02

 

[robs2nd75]

So if I may recap? Run PTH, Ft3, RT3, cortisol, iron, and magnesium. Are thyroid labs pretty consistent? Wondering if FT4 needs to be run again or if there is more than a modicum of certainty that it will remain nearly the same?

 

[robs2nd75]

Rob, IMO you need to get a PTH (Parathyroid) assay. Depending on the state of your glands, the magnitude of hyperparathyroidism could vary from minimal to extreme, as what we see with hyper or hypothyroidism, or even hypogonadism. Anyone of us, physician or not, can speculate on this, or the lab can be ordered just as easily and take the speculation out of the picture.

On the comment about your doctor being on the fence for T3 therapy ... Your FT4 is at 40% of it's range value. 50% to 80% would be the goal (again IMO) to aim for both FT4 and FT3 when everything is optimal. So, going on this, your FT4 is a tad low. I'd like to compare that with the FT3, not the total T3 that you posted. Even if the FT3 were in the same range, or lower, I would highly encourage you to get the Reverse T3 checked and compare ratios with your Free T3 value (FT3/RT3). Diabetes alone can be a factor with elevated RT3 ratios. Additionally, cortisol, iron, magnesium, and of course D3 needs to be factored with knowing that T3 is actually working at the cellular level. Again, additional labs are needed before doing much more. Thyroid pooling would not be a good thing ... Just my .02

Endo is now running tests for PTH as calcium remains elevated.