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The Good, The Bad, The Ugly; Blood Work

Brendon.Dean

Well-Known Member
Messages
136
Location
Canada
Type of diabetes
Type 1
Treatment type
Insulin
So I've been dealing with bizarre health issues and couldn't figure out what was up but I stayed persistent and tried different tests for my blood work.

I have been extremely healthy nutrition/fasting wise and exercise wise yet my body has slowly built up symptoms which were/are scaring me and that my current health care team is not handling in a way I see fit.

I thought it was low testosterone because of my sex drive disappearing but my numbers were just lowish but within range. Now I'm thinking it's hypothyroidism as a couple more symptoms have "popped" up over the past few weeks.

Well, my blood work confirmed some things and also shocked me.

TSH- HIGH 4.23 mlU/L
TS3- LOW 2.9 pmol/L
Alanine Aminotransferase- HIGH 54 u/l
Creatine Kinase- EXTREMELY HIGH 623 u/l
Albumin- EXTREMELY LOW <5 mg/l

HDL Cholesterol- REALLY GOOD 2.02 mmol/L
Non HDL Cholesterol- IDEAL 2.60 mmol/L
LDL Cholesterol- OPTIMAL 2.40 mmol/L
Cholesterol/HDL Cholesterol- IDEAL 2.3

Without having seen a doctor yet, from what I gather is yes there is a hypothyroid issue, liver and kidney issue, and muscle or heart issue. I did suspect hypodthryoidism, and knew from the bubbles in the pee I was having an issue with protein but the tests kinda have my mind blown away.

For anyone interested these are my symptoms:



-Eyesight more and more blurry
-Floaters in left eye (Eye doctor says my eyes look great)
-Puffy eyes
-Dark circles extremely dark now
-Dry fuzzy tongue at back of mouth, sort of numbness
-Faint heart beat (52-54 beats per min)
- LOTS of bubbles in urine
-Random Headaches
-Feel hyperglycemia most of the day
-Low sex drive
-Numbness/Tingles in hand/wrist/pinky/elbow/rhomboids
-Get cold pretty easy (I've noticed this for years)
-When I eat (keto diet, or high carbs, or junk, or low cals) I feel super tired and drained
-In the evening I cannot stop eating because I feel this unfamiliar need (not a want) to keep eating. It doesn't matter if it is healthy or junk it does not go away no matter how much I consume.
-I get random throbbing in the testicles one at a time that occurs randomly throughout the day and some days it doesn't happen.
-My breathing has slowed drastically and it feels hard to breathe.
-My mood swings have become uncontrollable, filled with rage to sadness that spiral out of my control.
-Weight loss has stopped
-My body has gone from 1.5 U of insulin per meal to bolusing multiple times totaling anywhere from 5-10 U at higher blood glucose levels.
-Feelings of vertigo or confusion
-Forgetting things. I was going to check my blood sugar so I needed to wash my hand, I went to get my meter and said to myself "wait did I wash my hands yet" I had no recollection of what I did for the past minute. The only reason I knew I washed my hands was because they were wet. Stuff like this
is frequenting much more often.

I thought it was important I share this with the community because I was on top of the world, on top of my game, the healthiest I'd ever been and then bam it was all snatched away just like that. Even though I persisted on continuing my routine it began to become harder to maintain and the consuming of food became uncontrollable.

I am in the process of getting referrals to try and see Dr Jason Fung or get into his clinic or another clinic in which he has trained other professionals so that a proper diagnoses can be done as well as further testing to identify the causes of everything.
 
@Brendon.Dean are you seeing a doctor soon as many of your symphoms are similar to my friend who was diagnosed with severe hypothyroidism a couple of months ago. Her levothyroxide dose has been increased steadily and she is currently on 100 mg per day but may have to increase it depending on her next results. Like you she’s always been active and the symptoms crept up on her however she is feeling a lot better and has just started swimming again and back to her usual weight. Good luck with your referral
 

Brendon - You really need to have a chat with your Doc about those bloods. I don't say that because there's alything in there making me thing "Holy cow,........ look at that x, y or z", but more because the bloods you mention there aren't the full picture of anything. Just for starters the results of any decent thyroid panel would have a few more tests than you report there.

Yes, some of those numbers are outside the assays used at my local lab, but assays, and therefore the meaning of any given number in a test result can vary from lab to lab.

I'd agree some of your blood and symptoms suggest your thyroid could be struggling a bit, and of course that is annoyingly common hand-in-hand with diabetes, but as an example, you don't report a thyroid antibody test these, even though you already have one AI condition.

In your shoes, I'd be trying not to jump to any conclusions too quickly, but would certainly want a wider blood panel done to look at the full thyroid panel and some wider antibody tests. Trying to give a condition a label, without full diagnostic justification can be very damaging.

Some of your symptoms point in certain directions, but then lets face it, some of them are pretty random, or could be attributed to many, many conditions.

In my experience it can take some time to even close in on a probably diagnosis, when it comes to anything hormonal, due to their natural variances during the circadian cycles. Where possible, I always have my bloods done first thing in the morning (8am), fasted, then at least that creates a common playing field.

Good luck with it all. It's pretty rotten feeling rotten.
 
Hi Brendon. Out of interest how is your HBA1c? Are you in Canada? Jason Fung is a kidney doctor who helps type 2s to reverse their diabetes so why pick him? I love the guy by the way for the work he has done!
There may be a root cause of all your symtoms such as malfunctioniing adrenal/thyroid glands but I would not go down too many rabbit holes before considering whether your bgs are consistently in target given that many symptoms including hunger relate to your body not being able to get energy from what you are eating/insulin resistance. It also sounds as if you are struggling mentally with anxiety/depression about how you are feeling?
A good naturopath who is also trained in Western medicine may be useful in approaching this from a systemic point of view. Sorry but I have no idea of how to locate one of those or even if your health care system allows for this?
 
I'm just a lowly T2, but your symptoms and bloodwork do indicate a thyroid problem (with the disclaimer that I'm not a doctor, just a Hashimoto's patient)... Does the breathing thing feel like someone has a hand on your throat all the time? Happens to me when my dose needs changing, because the thyroid swells up, pressing on the airways. When it gets really bad I get panicky and add hyperventilating to the mix, which is't very usefull. Forgetfulness, cold, moodswings, stopped weightloss, less sex-drive, tingling, reactions in bloodsugar... All sounds very familliar. And thankfuly, it's easily solved with hormone tablets. Just takes a little while to figure out the right dose and when it's upped, there's some arrithmia/heart pounding for a few days, but that's normal. Can't comment on the other bloodwork, but... Do see a doc about this. It makes such a difference when you tackle this.

Good luck!
Jo
 

That's amazing that your friend has regained control

I see my family doctor on November 31st which I aim to ask for more vitamin testing that my diabetes health care team wouldn't do. I'm going to try to get referrals to see specialists but I need to in the mean time figure out who that is.

Thank you for replying
 
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I absolutely 100% agree with you. Unfortunately I see my endocrinologist once a year for 15 minutes. My family doctor will not advise me on anything as it's beyond her expertise. I'm left trying to play doctor by saying "Ok Brendon, these are the results, this is what you could have happening. What tests do you need to ask to be done in order to start eliminating the route cause?" When I went to pick up the lab test paperwork I told one of the members of the diabetes team I suspect there's an issue with my thyroid and they proceed to ask me "What do you want to check on the test?" I'm not a health care practitioner but I'm having to figure this out alone!

I'll tell you one thing, my circadian clock is definitely nothing to mess around with. My best blood sugars have been no eating past 7pm or before 1pm, wake up 5am, sleep at 9 to 11pm. Failing to follow this has further complicated stuff for me.

If you had to say, alongside with checking for thyroid antibodies, what else should I check for? I can at least go to my health care team monday morning and get another lab sheet with more tests to be done.

Thank you for replying
 
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Right now my A1C is 6.8. When I felt very good it was 6.1. IMHO I think those A1C's suck. My health care team thinks I'm crazy for wanting to get into the low 5's and don't support low carb or fasting. I'm actually in Toronto Canada not far from his clinic. I picked him because I read two of his books, fasting and the obesity code. I feel like he would be able to identify the proper testing necessary as well as be able to address insulin resistance issues but further more rule out anything and actually provide much needed assistance.

I agree with you, I can't self diagnose and need to figure out the route with a professionals help. I don't feel as though my blood glucose has been in consistent control. Even on my best weeks I could not maintain sugars between 4.0-8.0 for more than 2 full days without messing up and hitting somewhere between 10-16 in the evening, over night and in the very early AM.

I feel like either my metabolism is slow or it is insulin resistance (some how) but it makes no sense to me with the knowledge I have. Thinking about it I'm most likely eating to much food in one sitting and that can be causing major issues.

Mentally yes I am struggling. The anxiety and depression is manageable because of exercise and I know it's going to go away once this is all sorted. But stress on the other hand. That is causing mood swings consistent of frustration, anger and crying. I moved back into a very stressful and toxic environment with bad poisonous people. Every day I grind and work diligently to remove myself from this situation but like anything this isn't an over night thing.

I have no idea either but i'll definitely google it and ask around because everything is worth considering.

Thanks for replying
 

It feels like I just finished speaking and exhausted all of my air and need to breathe literally right now with a deep short breathe. Thank you for sharing your story, it helps me mentally gain calmness. I think finding the route source of this is so important. I'm currently in the process of re-reading some of the books I have in angst I can find something I missed or neglected.
 

As I said before, I'd want a fully thyroid panel done, which would be:

TSH
FT4
FT3
TGAb
TPOAb

I'm fairly astonished you had FT3 done, but not T4, as in the UK, labs will rarely test or report on T3, unless FT4 is out of sorts, but I have no reason to doubt what you say.

These are the additional antibody tests I had done (by a somewhat bewildered Endo), but there are some less likely things on there, to be honest:
ANA (Lupus)
ANCA (Autoimmune vasculitis)
P-ANCA
Anti-cyclic citrullinated peptide antibody - CCP - RA
Serum anti nuclear antibody test
ENA (Mixed connective tissue disease)
Coeliac Disease screen
MPO-ANCA
PR3- ANCA

A decent vitamin panel would be good too, because low Vit D can wreak havoc with all sorts, and lastly, if you haven't recently, a full general panel, to knock out the common anaemias.

I'm not advising you as an HCP, as I'm not one, but only as someone who has had lots of tests, in an effort to pin some things down, but I will comment that even in the light of all that lot, and more the Docs are still at odds with the root cause of some things going on. As I said before hormonal stuff gets very complex and most Endos tend to have their expertise in diabetes, so finding a decent thyroid expert can be a challenge - in UK anyway.

I wish you well, Brendon. It could be a bit of long road ahead of you, unfortunately. I hope I'm very wrong.
 

That is my fault for not posting the complete report. I didn't know if people would have really been interested.

To open the images of blood tests right click them and click open in new tab.



I will most certainly bring all of those tests up with my health care team. I just started supplementing Vitamin-D for just a few days for 5000 IU daily. I honestly have no idea if supplementing should be done throughout the day or just all at once. I say this because potassium I have to take like 16 tablets throughout the day to hit my range.

I appreciate your opinions and knowledge you are sharing with me it's helping quite a bit.

You make a very good point with an edo's expertise being diabetes and not thyroid. Thank you for taking your time with me, this is absolutely invaluable to me and I truly appreciate this more than you know
 

Brendon, in my view, you definitely need your thyroid panel expanded to include the antibodies. Your TSH is elevated from the ideal (1 or less, although in UK, there's interest at 5+, or 10+ where asymptomatic. No idea about Canada. Your T4 is low in range, and ideally would be towards the top end of the range, and T3 is low, suggesting your body could be struggling to convert T4 to T3.

In essence, the TSH is produced by the pituitary gland to stimulate thyroid hormone production (it does what it says on the can?). The thyroid produces T4, which should convert to T (hence the need for all those values). So, you can see how it appears your thyroid is struggling a bit.

The antibodies now become important to begin to understand why that might be. As a pre-existing T1 and therefore the proud owner of at least one AI condition, with a higher likelihood of collecting others, you need to understand if you have, and if so, which.

The other antibody tests are important to ensure anything needing to be observed is.

When I was beginning my investigative journey, I created an account here: https://healthunlocked.com/thyroiduk , as I really needed to learn lots about the hormonal side of things. In my view the clever folks on there are the equivalent of heere, but for thyroid issues. Maybe have a look? I am, by no means, an expert. You can trust me on that one!

As I said up front please don't be too keen to give anything a definite label. Keep your mind open. If things have gone a bit out of kilter, then you might as well find out what's gone wonky and by how much. That's likely to be key to you feeling well again.

The thyroid, is a very strong hormone, as it controls our metabolism, so it has wide-reaching implications we shouldn't ignore, but please do make sure you have as many parts of the jigsaw available to you prior to deciding on the scene you are viewing.
 
Hi there. I have also read The Diabetes Code and it is a great book for Type 2. I understand your fight for the right to normal blood sugars however IMO this is almost impossible to achieve if you are under stress. I do low carb, exercise but still my liver chugs out glucose at unexpected times. You body is craving food for a reason but that will mess up control if intake is inconsistent and if you are like me and use exercise as a stress reliever, then even that can sometimes throw a blood sugar curve ball.
If you did google naturopath in Toronto you might come up with somewhere to start if you can find someone who has a foot in the Western MD camp too. I really hope you can get a mental break from this and some perspective from someone you feel you can trust.
I am a fan of Toronto. Never been but it has produced Jordan Peterson, Jason Fung and Lenard Cohen!
 
Hi @Brendon.Dean, As a long term patient, not as professional advice or opinion:
Please see your doctor NOW is my request to you.
Your Gp is trained to do more than order blood tests, She should be able to interpret them (and often the pathology report is accompanied by an comment such as (purely an example not an interpretation of your results- low thyroid function, thyroid antibody tests recommended). And your GP should have the nous to pick the phone and ring the doctor reporting the blood test results if unsure about that other tests might need to be done as follow-up).
I would not expect other members of the health team to know these things as it is not fully within their training.
With further tests and even perhaps on the strength of current tests certain treatment and referrals to ? specialists/ for other tests can be forthcoming. That is your GP's job. If she is not up to it, you may need to find a better one NOW.
A basic urine test can at least confirm that you may be losing albumin in your urine (no blood test needed). Your GP can advise on further tests/referral and your endocrinologist might need to be stapled to his/her desk for more than 15 minutes to do his/her bit in sorting things out, too. Look up the usual level for albumin in the blood - if you have reported your result correctly then < 5 mg/ml is low in any one's language. The significance of that is what the doctor is there to interpret as well as the CK result.
Are you taking any other medications, just in case they might to affecting your blood work?
## You need attention now not in two week's, one month's time. Find a GP who will act NOW and not delay and palm you off.
 
@kitedoc - I have no idea what GP services are like in Canada, where I understand Brendon is based, but in UK, in many experience, expertise in thyroid issues is sparse. I have also seen two Consultant Endos, one Rheumatologist (to eliminate something) and had a further non-consulted referral to a further Endo. The non-consulted referral was my GP asking for further, in depth interpretation of my blood panels. The response from the last one was effectively that I was well enough and that my GP should desist requesting tests for T4 and T3 as my TSH, on medication, is in range. This despite my symptoms (albeit atypical symptoms) persist and my combined results suggest I am merely under-medicated, with a further review required on the T4>T3 conversion once my TSH is in the euthyroid range.

You are clearly entitled to your view, and as a former HCP, you will be inclined to look at things in a particular way, but in UK, it seems finding someone with decent thyroid knowledge is very difficult. My next referral (not on the NHS) will be to someone a couple of hours away, because in my world, well enough, with the continuing symptoms I was diagnosed with is just not good enough.

Based on the non-consulted referral, my GP now feels she is out of a limb, medico-legally, if she prescribes any further upward titration on my medication. No wonder so, so many UK thyroid patients find themselves self-medicating.

Sorry to deflect your thread @Brendon.Dean . I do hope your experiences pan out more satisfactorily than mine so far.
 
Thank you @DCUKMod, fore clarifying about Brendon's whereabouts. My GP in Australia here, can ring the pathologist who reported my test result ( either a biochemistry doctor, a haematologist or a Infectious diseases specialist) for further advice on interpretation and further applicable tests.
He can commence treatment/alter treatment if confident he has the full complement of results he needs, ring the specialist if there is a need for an urgent test, dosage change if he is unsure.
If he is unsure about the results and the way forward he can also fax a referral to whoever he thinks is the most appropriate specialist requesting advice _ ? further test etc and this can enable the specialist to determine if there is a need to shorten the referral interval. ( a referral appointment 6 months hence is not always practical or safe).
I appreciate that doctors may perceive medicine as becoming more litigious and doctors fear doing something wrong also with repercussions from the GMC or other countries' medical boards/licensing boards..
But procrastination, unwillingness maybe to keep up to date, or stick-in-the-muddedness are not excuses.
Perhaps as a group of local GPs each takes on study/training and validation in study of one or more special interest topics so that conditions like thyroid conditions can be managed locally with greater ease.
 

My GP can do all those things, in terms of referrals, and indeed has done. I have never, ever felt I was being kept at arms length from any expertise. The issue appears to be a shortage of appropriate expertise. She always attempts to work collaboratively, but had admitted Endo subjects aren't where her strong suits. She is always very keen to help me, but has stated several times that I am a very informed patient who takes an interest in anything impacting me.

The non-consulted referral I described is exactly the referring up process you describe in terms of taking more senior advice. The reason that she feels medico-legally exposed is the strong directive from an Endo consultant that she desist from testing my T4/T3, and rely purely on TSH. Now, we both know that the TSH is only a stimulating hormone, it doesn't prove anything happened as a result of the stimulation. not to even test for Triiodothyronine - the only hormone in the thyroid suite to actually do anything in the cells, is plain old bonkers. She was rather appalled by that and had admitted that that aspect will be passed over, but the further directive that my meds are at the correct dosage is harder for her to rail against.

Part of the issue with thyroid medicine at all in UK at the moment, is how much the NHS are contracted to pay for some of the avilaible mde; and in particular for T3. The following is copied from the NICE BNF.



The shocker is, it can be bought, from reputable sources in places such as Cyprus, for £60 for a three month supply. How bonkers is that?

I'm sure you can tell that it is a situation I have found frustrating. I have discussed my predicament with a friend who worked for several years alongside the local Endos in various roles, although mainly diabetes focused, and I am assured I've seen the best of them, so the prospect of choosing another GP who would only be referring into the same pool simply doesn't appeal. My practice is seriously flawed, but bearing in mind I know at least 4 (hospital) medics who are patients there, I'll be a little comforted by that.

As I say, my next referral is going to be out of area. This whole exercise, spanning over the last 2 years hasn't been cheap; but what price health and wellbeing?
 
Thank you @DCUKMod. I guess some of my comments were about the description Brendon gave about his GP.
But I am glad to hear that the non-consulted referral system is in use. And that you have found a GP you get along with.
From the mayoclinic.org - Hypothyroidism - Diagnosis and Treatment - the writer points out that TSH is a very sensitive test for the presence of hypothyroidism and for monitoring thyroid replacement therapy.
Healthline.com - T3 test - indicates that T3 test is useful for detecting overactive thyroid, or where pituitary gland malfunction is the problem affecting the thyroid gland's ability to produce of thyroxine.
There is a general consensus that replacement therapy should be in the form of T4 with some recent interest/opinion forming in use of a mix of T3 and T4 medication.
It may be for the above reasons that your GP was advised to stick to TSH as the main test for management of your condition.
In Australia we also have Government negotiating with drug companies to reduce drug prices.
I would not be surprised if said companies were to inflate their prices to ensure their profits are less impacted by negotiation !!!
 

I'm afraid I simply don't agree that TSH is an adequate monitoring tool in someone with thyroid malfuntion. It's akin to saying the A1c is an adequate monitoring tool for someone with blood sugar regulation issues.

Anyway, I have deflected @Brendon.Dean 's thread quite enough already. I apologise Brendon.
 
kitedoc said:
From the mayoclinic.org - Hypothyroidism - Diagnosis and Treatment - the writer points out that TSH is a very sensitive test for the presence of hypothyroidism and for monitoring thyroid replacement therapy.
Click to expand...
https://www.nahypothyroidism.org/inadequacy-of-thyroid-stimulating-hormone-test/

I'm 100% in agreement with @DCUKMod. I find I'm better on Natural Dessicated Thyroid (T4 and T3)along with a 'suppressed' TSH. My GP would sooner have me on Levothyroxine, and treat me according to my TSH.
Geoff
 
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