Your lab tests are only as useful as their interpretation. I may have told you to ask for certain labs or maybe you have read on the internet what the best labs to ask for are to figure out why your thyroid isn’t working well.
Maybe your doctor will order the labs you ask for but do they know how to interpret them beyond the standard lab ranges offered? Do you? Probably not. So you have all this information and no plan to get you feeling better.
I’ve even seen functional medicine lab ranges that are more narrow than the standard or conventional lab ranges not be good enough to figure out a problem. The reason behind that is that the functional lab companies are getting their ranges based on the people who are coming to them for tests.
What does this mean? It means that the sick people going to a functional medicine doctor to get their labs are the people who’s results are making the lab ranges. This is true for most labs.
Does that sound like a way to figure out whether or not YOUR labs are out of range or within range? They might be within range of a bunch of other people who feel like crap and don’t know why.
Basic blood chemistry labs like a CBC, CMP, lipid panel, iron panel, thyroid panel can be super helpful but also know that your symptoms matter regardless of what your labs say. The labs are a way to help put the pieces of the puzzle together.
Your symptoms are your body’s way of telling you something is up. They help gauge whether an intervention is working or not. I saw plenty of people who could not help my fatigue because they were not looking in the right place or they were trying to bandaid the symptoms without really getting at the root cause.
Today I wanted to share with you my old labs and how they were interpreted by my practitioners at the time and show you what was missed based on the scientific research based lab values I use.
I was looking in a file cabinet for some financial documents and then got side tracked with all the stuff that could be thrown out in the file cabinet and I came across a green folder with a hand written schedule of appointments for a plan I paid for through a certain chiropractic office. I dug into it and found so much stuff related to my health and trying to feel better over the years. I thought this would make a great podcast episode since many of you have been to multiple practitioners and still feel like crap.
I’m taking you back to 11/25/2011 which is the first wellness plan I found from the 1st holistic practitioner I saw. She was a naturopathic doctor and from what I can tell from my research on her, she was out of ND school/residency about a year or less when I saw her. She was a kind, passionate doctor. I saw her for a few years until it got to be too far of a drive and I still wasn’t feeling great. She was actually on to why I wasn’t feeling great and it was an emotional component I wasn’t dealing with and her suggesting we work on it scared me away. I quit working with her after that and kept looking for the magic pill with other practitioners and never ever felt quite right.
I remember one visit with her where I had brought her a list of supplements I was taking based on testing I had done in my nutritional therapy practitioner training and she said, “I don’t even know what to do with this.”. I could tell she was super annoyed and I get it now as a practitioner because when a client/patient is taking stuff outside of the protocol that was set for them it may or may not be detrimental to the outcome. Plus, you might also just be wasting your money.
Anyway, I went to her for fatigue, hypothyroidism, mood issues, blood sugar issues, and apparently heavy bleeding during my cycle- super heavy. I’m sure there was other stuff but I don’t have my intake form.
Any of this sound familiar to you?
She recommended to me before testing was done:
Coconut oil for low blood sugar/shakiness
Flax meal, 1-2 T daily (she suggested mixing in applesauce) all month
Omega 3: super EFA liquid 1 tsp/day all month
GLA: 1000mg flax and 1000mg EPO days 15-28
Vitamin D3: start at 2000IU/day, get tested within 2 weeks
Probiotics: HMF Neuro caps 1/day
Acupuncture for mood support
Labs to get: TPO Ab, Tg AB, FT3, FT4, TSH, rT3 ($155); 25 OH Vit. D, 22IgG Food intolerance test
See a gynecologist to get pelvic/transnational ultrasound to rule out organic causes of heavy bleeding with menses
Schedule next appointment in 6 weeks
I did some testing on 12/9/2011: Intestinal barrier assessment 22 IgG through Pharmasan Labs. Just for reference, I was 40 years old (I’m 51 now) and my kids were 11, 9, and 6. I was working as a social worker 20 hours a week and not a very happy person.
Results were:
Intestinal barrier assessment showed a moderately leaky gut
Food parameter summary/food sensitivities detected
Yogurt was high
Baker’s yeast, egg white, tuna, wheat were moderate
Cows milk, gluten, goats milk, oats, shrimp were low for presenting antibodies
Vitamin D test was at 33.3 on 12/8/11 and she told me the range was 40-100
I saw her on 1/2/2012 to go over these test results.
The wellness plan was:
Avoid yogurt, bakers yeast, egg white, wheat, milk, gluten, oats for at least 4 weeks. Then trial reintroduce the low foods one at a time in this order: oats, milk/cheese- wait at least 4 days in between reintroducing when not eating oats. So eat oats for 4 days, wait four days then reintroduce milk/cheese but don’t eat oats while doing that.
Breakfast ideas: quinoa porridge, organic chicken sausage, avocado with sea salt, egg yolk
Flax seeds 1-2 tablespoons/day all month
Super EFA liquid 1 tsp/day all month
GLA: 1000mg flax and 1000mg EPO days 15-25
Vit. D: 10,000IU per day for one month, then reduce to 4,000IU/day
B6 complex 1/day with breakfast
Probiotics: HMF neurocaps 1/day
Slow Flow- use day 1 of period 3 caps every 3-4 hours
Progesterone cream: day 15-28, stop if period comes before day 28, 1 pump per day at bedtime
Permeability complex II- 1 cap 2x/day with meals
She will contact me with thyroid results
Retest vitamin D in 3 months
Pelvic/transvaginal ultrasound due to menorrhagia to rule out other causes before getting ablation
Schedule next appointment in March.
On the back of the plan was a drawing of leaky gut
The wellness plan for my next visit on 3/9/12 went like this:
substitute sugar for yacon syrup, read labels and eat less than 20-30g of sugar per day and watch to see how skin reacts.
Snack ideas: celery/nut butter, carrots/hummus
Same supplements as before with addition of
orthothyroid 2 caps/day
Remove IUD
Next visit 8-10 weeks, discuss periods, skin
I’m missing a years worth of labs and wellness plans from her- I do remember her diagnosing me with Hashimoto’s after these thyroid labs were done so I was off to see about medication changes from my doctor because ND’s in MN cannot prescribe medication.
I got more labs done on 1/8/2013 from Pharmasan Labs. The panel was called the Endocrine Health Basic and it was a saliva test.
The cortisol test wasn’t horrible as far as results go- it was a little low in the morning and stayed below range until about 2 pm where it barely went within the range and then was a little high around 9pm. This is a typical pattern for someone with thyroid problems. According to the reference range, my cortisol was below reference range all day long- could be why I was so tired all the time and my blood pressure was super low (I was also freezing all the time).
DHEA was 274.5 with reference range for women at 57.0-615 so that was normal
Estradiol was off the charts low at <0.8 and it should have been between 1.0-14 according to the lab range.
Estrone was 0.8 and that was within the range for my age group.
Progesterone was 566 so high for the range of 38.0-462 but she had me on progesterone cream so I can only imagine that it was probably in range before that.
Testosterone was 26.2 which was also within this labs range.
I wrote her an email on 2/20/2013 saying i got a new presecription for thyroid meds with an increased dose. I got a referral to an endocrinologist which I did not use because I have not found them helpful in the past and they are more expensive to see. I was getting heart palpitations on my new medication so I was taking half a pill and working my way up to a full pill to let my body adjust. I told her I didn’t feel clear headed, probably brain fog, and I was super forgetful and having a hard time concentrating. I said, ‘my kids think I’m crazy’. I told her I was worried about taking a higher dose and asked if I should take it and see how it goes.
She replied that my thyroid needs more support so it might be worth trying to see how my body tolerates it. She wondered if there was something in the medication that my body didn’t like. I believe the real problem was that my cortisol was so off still, I didn’t handle stress well and my body was just responding to the T3 in the new medication. She suggested I ask my doctor for Westhroid or Naturethroid and to ask my pharmacist about the medication I was taking and why I might be having palpitations on it.
I do remember taking Westhroid and doing really well on it and then there was a shortage or whatever and I had to find something else. Story of my life!
On 10/25/13 I redid the Endocrine Health Basic lab panel
cortisol was within normal range except at 8pm it was high at 3.3 and it should have been below 1.5. She told me to take magnesium at 7pm. I remember the first time I took a powdered magnesium in water. I felt a rush of calm over my whole body from top to bottom. That is the only supplement that has made me feel a physical difference.
DHEA was at 58.6, remember last time it was in the 200’s. It was still within the normal lab range but much lower this time. My notes say DHEA is a counter balance for cortisol
All the sex hormones were within the lab normal range. The healthy lab ranges I have are for blood and not saliva so I can’t compare the two. One thing to know is that even functional medicine labs are making their ‘normal’ lab ranges based on the results of people who use the lab. Who goes to practitioners who use ‘functional medicine’ labs? Sick people! I think my hormones were off because I was still a long ways from feeling good with severe mood swings, poor sleep, angry all the time, terrible blood sugar and more.
I must have had a visit on or around December 4th 2013 because I got a wellness plan via email with 24 things on it
Supplement protocol changed a bit- ground flax in applesauce was making me throw up shortly after taking it.
Floravital iron and herbs at 10ml per day to see if tolerated and reduce dose if it caused constipation
NO RAW brassica veggies or soy because they can interfere with thyroid function- we now know this not to be true unless all you ate was brassica veggies and nothing else in huge amounts every day.
Add a pinch of sea salt to my water
Cornus Sanguinea for autoimmune thyroid support 1 spoonful in the morning (I don’t remember taking this)
Adrenal support 2 caps with breakfast
EstroMend 2 caps with dinner for memory/estrogen support instead of Femmenesence Pro Peri
Take a break from Sepia 200ck for at least one month to see if PMS is manageable without it (she was throwing supplements at this mood problem and nothing was sticking)
Repeat thyroid labs in 5 weeks
Glutenzyme by Pharmax in case of accidental gluten exposure - at the time we were not sure if I had celiac disease because I never got tested. I felt so good off gluten I didn’t want to go back on to be retested. At this time I was very strict with avoiding gluten.
Exercise: do yoga and she wanted me to go to a Qoya class which was about a 40 minute drive for me from my house and I never went. I don’t like driving that far for a workout- even now, my gym is 5 minutes from my house.
Grounding/visualization: imagine roots growing from your feet that firmly connect you to the earth. I still do this when I feel stressed. She said the roots provide you with nourishment/energy and offer a way to release any unwanted energy back to the earth to transform it.
We discussed removing my mercury fillings from my teeth.
Return visit in 8 weeks.
The next set of labs is from 11/26/2014 so almost a year later. By this time I probably did have my fillings removed. I did 1/4 of my mouth at a time with a dentist who knew how to remove mercury safely.
By this time I had found an MD willing to treat my symptoms along with my labs and I don’t think I was seeing the ND anymore- she was too far away for me. That said, I was driving almost an hour to the MD but she took my insurance so the visits were way cheaper. I had also gotten my nutritional therapy practitioner certification by this time. The notes on the reason for the visit was that I was here to check on thyroid, I fell really good, not fatigued, sleeping 7-8 hours, feels well physically, stress is reduced, had heart palpitations when tried raising dose of thyroid meds last time. This doctor was the only doctor in her practice willing to use something other than levothyroxine to treat thyroid so I tread lightly with her in order to continue to get the meds that made me feel good. I’d also make a note that I was not feeling tired even though my iron levels were super low- I think this was attributed to being filled up with friends in a community of like minded people who I really enjoyed. I had previously lost a friend group in 2010 and had found friends through my certification program.
FT3 2.0 (lab range 2.0-4.4) normal but low by my ranges
FT4 0.74 (0.82-1.77) low by lab and my ranges
TSH 5.070 (0.450-4.500) High by lab and my ranges
TPO Ab 69 (0-34) high
Tg Ab 1.0 (0.0-0.9) high
RT3 11.4 (9.2-24.1) lab range only
Again, these are lab ranges here that are done on probably both healthy and sick people because it was the lab at the doctors office though some of this, like Reverse T3 and the antibodies may have been sent out to Quest diagnostics. Had my doctor used the ranges I have which are based on healthy people and from the research, it may have painted a different picture. Here I have low T3, low FT4 and High TSH which indicates I’m not making enough T4 and not converting it for whatever reason. My meds were raised.
Fatigue was back with a vengeance and by January 2015 I was going to a chiropractic office that had a medical doctor on staff. My hope was that I would be able to see the doctor and have him prescribe my meds. The funny thing is, I never asked the chiropractor if I could do that. I just assumed. When they presented their plan and the cost, there was no mention of the doctor. I figured out later, he was a place holder so they could do certain things in their clinic that needed an MD on staff. I don’t think he was ever there. I didn’t have my voice, I was too timid to ask about seeing the doctor.
So for this office, their treatment plan was for my complaints of low energy, anxiety, brain fog, constipation. Based on my history and his exams he recommended the Nutritional Function lab test, GI Effects Stool test, Cyrex Array 4 for food hypersensitivity with the knowledge that I may need further testing based on the results of these tests.
Their plan included 6 visits with the nutrition chiropractor and 16 visits doing oxygen therapy which was their fix for my fatigue. He put me on the Apex Energetics RepairVite Diet and their powder. I did feel really good after this diet but it was restrictive. They used the IFM MSQ each visit to see how things were either improving either for the better or worse. In 2015 this plan cost me $1235 after discounts.
They did a body composition by hooking me up to some electrodes and having me lay on my back for around 10 minutes or so. I got a super fancy report showing my BMI at the time was good. It also had something on it called phase angle and mine was low. This report indicated that that is consistent with cell death or cell breakdown which could very well have been the case. I was thin and tired and brain foggy. It is said to be a predictor of malnutrition and I do think at the time I was not absorbing nutrients really well. It also showed that I was about 31.4% body fat so likely losing muscle and what you might call skinny fat. All that from a really fancy nine page report.
I did have my blood drawn for a CBC at their clinic. They didn’t give me the actual results but a fancier paper with each marker, my lab value, functional ranges and laboratory ranges. The entire thing was highlighted line by line in green for normal, yellow for out of the functional range and red for out of the laboratory range.
This blood draw was from 2/24/2015 - I was originally going to go through each lab marker and tell you the differences between their lab range and my lab ranges but I think that is going to be too much so I’m going to skim over them. The point I’m trying to get across is that this chiropractor missed some things that I would catch with my lab ranges. These things would be minor for the most part and could be fixed with some diet changes and supplements.
They missed low albumin, high AST and ALT liver markers, low sodium, high CO2, high bilirubin, low glucose, high HBA1C, low HDL cholesterol, high iron, low ferritin, low neutrophils, and high lymphocytes. They had shown high monocytes and eosinophils where my ranges said they were normal.
When the lab ranges vary so crazily from lab to lab and practitioner to practitioner, things can get missed. The blood chemistry training I received from my former professor allowed me to get scientific research based lab values on healthy individuals that are sound with ranges tight enough that I’m able to catch things before they get bad so to speak. This lab also showed TSH was a little high and T4 was low which would indicate I was in need of an upped dose of medication which I could not get from them because their doctor on staff was not actually on staff.
I was more mad at myself about that whole doctor thing because I didn’t have the confidence to ask them about it. I was intimidated by the chiropractors for some stupid reason. Things would definitely be very different now- I have found my voice! I would have questioned them about seeing the doctor. I was just so desperate at the time.
They also had me do a Cyrex Labs Array 4 - Gluten Associated Cross Reactive Foods and Fodds Sensitivity which is for IgG and IgA antibodies. Nothing was out of range but soy and corn were considered to be just slightly out of the normal range. He put me on the RepairVite diet for 3 or 4 weeks then when my MSQ showed I felt really great he told me I could go back to my normal diet. That was it. According to him my gut was healed.
Next was a Genova Diagnostics GI Effects stool test. A huge fancy report with graphs and pictures in color on the first page that told me nothing. I had undigested fat in my stool and some species of bacteria were low. So the solution was to take HCL with meals.
They also did a comprehensive melatonin profile which came back normal. I think he did that one because I was so tired. Remember that they missed low ferritin which will make one tired so I think this test was a waste.
In April 2015 they had me to the Adrenocortex Stress Profile which is a saliva test. It showed my cortisol was high all morning and high normal in afternoon and normal at night. I think the stories in my head contributed to my stress levels. I was not a happy person and I was wound up pretty tight.
Once I was done with their program I told them I was still fatigued and they told me to go back to my doctor to have my thyroid checked. And that was it.
I was back at my doctor that took insurance in August 2015 and had a CBC done again. There was about a 5 months difference between the two labs and this one was showing anemia and likely micronutrient deficiencies. RBC, Hemoglobin and Hematocrit were all low and MCV was high by my ranges all of which indicated I needed some nutrients. I had my B12 tested too and it cam back normal by the lab range. I don’t have a different range for that but it would be interesting to dig through the research which I might do at some point. All of this would point to fatigue for sure but it was missed by my doctor.
Same doctor tested my thyroid on October 6, 2015. FT3 was normal (low by my range) at 2.0, FT4 was low by both ranges at 0.74, TSH was high by both ranges at 6.130. I was on naturethroid at the time and struggling with palpitations when the dose went up so this is when I started splitting the dose and taking it twice a day. When TSH and T4 are low it could mean an iodine deficiency (not likely though I was not eating a lot of processed foods and using sea salt), autoimmunity- so antibodies could be high, and there was likely less conversion of T4 to T3 because there was less T4. There was a definite thyroid gland dysfunction.
Fast forward to April 2017 when I had my blood and urine tested for life insurance.
By my ranges, glucose was low, BUN was low, Creatinine low, Uric acid low, bilirubin low, liver enzyme ALT high, AST high normal but better than the previous years labs, GGT low (indicated oxidative stress), protein low (low by their range too), albumin low, globulin low normal (low by their standards), calcium low, LDH low (indicative of glucose issues), HDL low (inflammation), cholesterol/HDL ratio leaning towards an increased risk of CVD. They missed a lot of stuff with their ranges and I got the best life insurance rating you can possibly get.
My latest labs were done at my last visit to get my prescription renewed. I’m grateful to have a quality nurse practitioner willing to work with me based on my symptoms. She is cash pay though so I do pay out of pocket every time I see her. She is also functional medicine trained. The first time I saw her, she had me do a Dutch test and a Cyrex leaky gut panel- that was around $1000 for the two tests. I didn’t learn much from either- stuff I kind of already knew. I also did a food sensitivity panel from Cyrex that came up positive for foods I had been eating a lot of and tuna and shrimp. Since those two were on that very first food sensitivity panel I did back in 2012 I wonder if there isn’t some significance to that.
I did a gut healing protocol- a mix of following her recommendations and my own gut healing protocol from my GI class. It worked. I have been able to reintroduce dairy on a limited basis, meaning I don’t eat it every day, and nuts.
Back to my latest labs- done in April 2022. I compared them to the labs I had done July 2020 which was fun for me given my blood chemistry background.
What was missed?
Everything came back normal according the the lab values from the lab which was Quest Diagnostics.
My lab ranges revealed some white blood cells were high indicating a potential for low cortisol, a virus, parasite, and general inflammation. My blood sugar was low at 70 but can be low if cortisol is low or in hypothyroidism. My HDL cholesterol was low indicating the need for gallbladder support and triglycerides were high which can be high if there is hypothyroidism or elevated estrogen. My cholesterol to HDL ratio was high which can indicate an increased risk for cardiovascular disease.
My calcium was low indicating potential need for getting more in my diet or poor absorption. It could also be a mineral deficiency but I can’t confirm that because the minerals were not measured.
Creatinine was low which would either be decreased muscle mass or poor protein intake. LDH was high which can be high with hypothyroidism and my TSH was 20.39, FT4 0.7, FT3 2.2.
Clearly my thyroid labs say I was hypothyroid which affected the results of my other labs.
Why was I so hypo? I forget to take my afternoon dose of NDT a lot. I retested in June of this year after being more diligent about taking that afternoon dose and my TSH was 0.44, FT4 1.1, and FT3 3.7.
Why did I share all of this with you?
So you know you are not alone on this journey. I get what it feels like to feel bad.
I’ve done the work to understand what your labs might be saying about what’s going on in your body and I can help you figure it out.
I also want to point out that a lot can change in a couple of months of giving your body what it needs or what it is asking for so one bad lab result does not mean you are doomed. That lab draw is just a picture in time of what is going on and retesting with the same labs after a couple months of changes can help me see if things are going in the right direction.
Let’s figure this out together. I am on your team.
Thanks for tuning in.