Posts by Nicholas Myers

Paul Thomas27 said:My hematologist requested uric acid and bilirubin tests, but my referral just lists "bil." instead. Is "bil" some sort of shorthand for both uric acid and bilirubin?

No. It’s likely a typo. They probably meant to write "bil." as an abbreviation for bilirubin, and the uric acid test simply got left off the paperwork.

Lisa Perez37 said:Thanks for the thorough breakdown.
My T4 is 95, they missed the T3 due to a lab error, and free T4 wasn't ordered.

I'm not sure what else to look at besides my thyroid, but the real issue is my primary care physician. She’s perfectly nice and doesn't sting when it comes to writing referrals, but she constantly asks me what I think or where I want to go. I’m not a doctor, nor am I someone who spends their time Googling symptoms (unless it involves skincare), and frankly, I have neither the energy nor the desire to hunt down specialists. I'd much prefer if she just gave me a solution if one exists.😁

Ma'am,

In your situation, caution is necessary. When you have symptoms that mimic hypothyroidism, there's a risk of masking an underlying condition—especially since your T4 levels are normal and your TSH is sitting right at the upper limit of the range. A comprehensive clinical exam is needed, along with basic labs to check for anemia and to assess kidney, liver, and heart function. Since your family doctor is open to suggestions, seeing an internist or an endocrinologist would be a logical next step.

Lisa Perez37 said:I’m not pregnant—I'm 47. The symptoms are piling up. Hair loss is severe, and my eyebrows are thinning out just as badly; even Minoxidil hasn't done a thing to stop it. Then there's the exhaustion. It’s heavy. Sleeping eight hours isn't enough; I’ve had stretches where I slept 14 hours straight and still felt wiped. I can barely drag myself out of bed in the morning. If I manage to get anything done before noon, that’s really it for the day. My lower legs feel heavy and painful, with occasional tingling and burning sensations. My skin is dry and flaky. My eyes are incredibly dry, too—I’ve worn contacts for nearly 25 years without an issue, but lately, they're becoming unbearable. Constipation is getting more frequent. On top of that, my periods have become extremely painful and heavy. I’m also dealing with swelling, particularly around my eyelids. To top it all off, I’ve gained 7 pounds in a year despite eating the same things and forcing myself to stay active whenever my energy levels allow—mostly cycling, swimming, and walking.
I used to handle each of these symptoms in isolation. I never once connected the dots. It wasn't until I started Googling the link between hormones and melasma—since my face was reacting wildly to even SPF 50+—that I stumbled upon the symptoms of hypothyroidism. There’s a clear genetic thread here: my father and sister both have Hashimoto and rely on Euthyrox. My dad also deals with vitiligo and rheumatoid arthritis, which ran in his mother's side, too. It's safe to say there is a significant family history of autoimmune issues.
Much appreciated. Thanks for the response. 🙂

To whom it may concern,

You didn't mention the fT4 (T4) levels.

A TSH level of 4.18 mIU/L falls within the standard reference range, according to the guidelines established by the American Thyroid Association back in 2009. There are exceptions, of course. For pregnant women, the targets shift lower—usually down to 2.5 mIU/L or 3.0 mIU/L depending on the trimester. Conversely, for those over 80, some research suggests that levels as high as 7.0 mIU/L might just be a normal physiological adjustment to aging.

It’s worth noting that there is no consensus on what actually constitutes a "normal" TSH level. Back in 1986, for instance, there were already proposals to lower the upper limit of the reference range to 2.5 mIU/L.

There is no consensus on exactly when to start thyroid hormone replacement therapy based on TSH levels. The only point where there is general agreement is that once TSH climbs above 10 mIU/L, treatment is necessary. It’s worth noting that while we still lack a unified approach for values between 4.5 and 10 mIU/L, the debate has already moved further down the scale—now doctors are questioning what to do with readings between 2.5 and 4.5 mIU/L.

It seems like some colleagues—especially those practicing in private clinics—are already adopting certain American guidelines. They're treating any TSH value above 3 mIU/L as elevated, which leads to them prescribing therapy in quite a significant number of cases.

Treatment should be considered for women with subclinical hypothyroidism who are planning pregnancy, those struggling with infertility, or those currently pregnant. There is also a significant debate regarding whether therapy is warranted in cases involving a goiter, overt symptoms—like chronic fatigue or depression—or elevated antibody levels.

Strictly following our guidelines, if your fT4 levels are within the normal range, the recommendation would be to simply monitor both fT4 and TSH every six months without starting any treatment.

Since you've listed quite a few different symptoms here, we really need to stick to the principle of treating every patient as an individual case. It’s also vital to rule out other underlying conditions that might present with a similar clinical picture.

Given the uptick in inflammatory posts lately—which, for the record, have been removed—I’m going to go ahead and lock this thread.

🙂

Lisa Perez37 said:My TSH is 4.18, and my Anti TPO is 59.96. Is any kind of treatment typically started at these levels? Thanks so much!

Hi there,

To get a clear picture, we need to see the rest of your thyroid hormone levels beyond just the TSH. We also need to know what symptoms you're experiencing and whether or not you are pregnant.

Emily Ortiz27 said:The whole situation is a bit of a blur...
We had the checkup, but the doctor seemed completely indifferent regarding the plasma cells in the smear. From our conversation, I got the impression she’s chalking them up to a cytologist's error rather than an actual finding.

For now, we’re sticking to the current routine and hoping for the best—no changes and no diagnosis yet. If any questions come up, I’ll feel free to reach out again; this group always provides clarity.

Don't hesitate to reach out. I will also let you know once genetic testing becomes available here in the States.

Karen Alvarez40 said:I am attaching the results from the additional tests per your request
and would appreciate your thoughts: https://ibb.co/pQVgWH7 and https://ibb.co/DtyS9Wg

Thanks.

Ma'am,

Certain deviations in lab work can stem from intense training—essentially signs of muscle injury (elevated creatine kinase, along with slightly high LDH and AST levels). To confirm if this is the case, one would need to cease all exercise for seven days and then re-test CK, LDH, and liver enzymes. If those numbers remain elevated, further investigation in that direction is required.

Some deviations cannot be attributed to physical activity, such as iron-deficiency anemia. That particular finding demands significant attention; a young male athlete generally shouldn't be presenting with sideropenic anemia.

Similarly, elevated GGT activity cannot be linked to exercise.

An internal medicine consultation is necessary. Given everything mentioned, a gastroenterologist should be the first point of contact. They ought to take a detailed history—including specific dietary data—perform an exam, and subsequently decide if there is an indication for endoscopic evaluation of the digestive tract, celiac testing, a follow-up abdominal MRI (given the previously noted hemangioma), and determine the next steps.

Emily Ortiz27 said:Thank you so much.
I'm at a loss regarding how to actually get a genetic analysis done. For now, we’re being told the child's condition is "obviously normal," but as a parent, it's hard to accept a version of "normal" that requires constant monitoring and a steady stream of unexpected surprises.
I recall you mentioning that these aren't available here in the States yet, though they might be accessible abroad.

All that's left is to trust our eyes—seeing a kid who is happy, lively, and energetic—while trying to ignore the nagging fear that we're missing something vital.

Ma'am,

these tests are purely diagnostic tools; they aren't crystal balls that can predict who will develop a malignant disease or lymphoma, or when it will happen. They should be becoming more widely available through insurance referrals in the US soon, but for the moment, the fallout from the pandemic has slowed everything down and put things on hold.

Unfortunately, with lymphoproliferative disorders, you're left with constant monitoring and living in uncertainty. That becomes part of the "new normal." Right now, there isn't a single test on the market that can answer who will transform into a malignancy within this spectrum of diseases, or when.

What is truly baffling here, however, is the lack of a definitive diagnosis (the immunologist disputes an ALPS diagnosis, while the hematologist is tracking it "as possible ALPS"?!).

Emily Ortiz27 said:It’s been two months since the last round of tests, so it’s time for a follow-up.

The CBC shows everything within the standard reference ranges, though the cytology smear noted 1% plasma cells.
The MRI showed no significant changes; those enlarged lymph nodes in the neck, abdomen, and armpits are still there.
We’re waiting on an appointment with the hematologist, but in the meantime, I want to be prepared with any necessary questions.

Ma'am,

Nothing much to add at the moment. Those plasma cells shouldn't technically be in peripheral blood, but they remain present in small numbers. In this context, it seems to be the "new normal." You asked earlier if you should pursue additional private testing. My answer remains no. However, my previous suggestion regarding future genetic analysis—specifically a gene panel for ALPS and ALPS-like disorders including FAS, FASLG, CASP10, NRAS, KRAS, CASP8, PRKCD, and STAT3—still stands.

Karen Alvarez40 said:Thank you very much.
Can you recommend a hospital in Washington, D.C. with good internists?

Every hospital has its share of excellent and mediocre internists. My advice would be to book with whoever can see you the soonest.

Karen Alvarez40 said:Hello,

Thanks for the quick reply.
The patient doesn't drink alcohol—maybe a glass of red wine twice a year during the holidays.
No soda either, just plenty of water and tea, with occasional magnesium supplements.

We had a urinalysis done, though I forgot to snap a photo: https://ibb.co/ZXNX8zW

A thyroid checkup was completed back in June along with an internal medicine assessment: everything remained stable (TSH: 3.39 mU/L 0.38-5.33, fT3 4.4 pmol/L 3.2-6.2, and fT4 9.1 pmol/L 8.0-16.3).

Early last year, an abdominal ultrasound was performed: liver size and parenchyma are normal, showing a focal lesion—a roughly 20 mm hemangioma. Gallbladder shows no pathology in the lumen; walls are normal. Pancreas is normal in size and texture. No dilation in the intrahepatic or main bile ducts. Kidneys show normal size and thickness; no signs of nephroliths or congestion. Adrenal glands appear clear. No ascites or abdominal aortic aneurysms detected. Spleen is normal. Bladder is full with no visible abnormalities.

Back then, after the physical, they were sent for more testing, but it turned out to be nothing. The conclusion was that it was just from athletic exertion. Still, we’re concerned and want to find the root cause, but we aren't sure where to start.
When you mention a clinical exam and a detailed consultation, which specialist are you referring to? An internist, a gastroenterologist, or someone else?

Thanks again.

Generally speaking, beyond the thyroid hormone levels and urinalysis already completed, my previous advice stands. It would also be wise to repeat the abdominal ultrasound; if that hemangioma was first spotted a year ago, we need to confirm it hasn't grown, though typically these stay stable.

Given these additional findings, I would recommend seeing an internist.

Of course, there is context missing here that can't be captured on a forum, such as past medical history. For instance, has this person dealt with anemia before? How long has it been known, and is the current level a steady state or a change?

But fundamentally, an internal medicine consultation seems necessary.

Karen Alvarez40 said:To whom it may concern,

Could someone review these results and suggest where to go for follow-up if necessary? This is for a male in his mid-thirties, an active runner. The tests were part of a routine physical. Resting heart rate is 40 bpm. Diagnosed with hypothyroidism two years ago; currently on Euthyrox 25 mcg and 100 mcg of selenium. No steroids or supplements used. Diet is fairly disciplined—complex carbs, low-fat cottage cheese, vegetables, fruit, nuts, honey. Recently cut back on meat and fats.

Is this just a byproduct of high athletic activity, or should we be looking at something more serious?

https://ibb.co/KXv7Xbx

Ma'am,

The individual in these results definitely needs further investigation. Thyroid hormone levels need re-checking. You’ll need to supplement those tests by checking CRP, running a urinalysis if one hasn't been done, and determining LDH, CK, ferritin, TIBC, and UIBC. An occult blood test (stool sample) three times is advisable, along with an abdominal and renal ultrasound. Most importantly, however, a thorough clinical examination and a detailed consultation are required to identify any subtle symptoms that might have been overlooked.

A man in this age group, particularly an athlete, shouldn't be showing signs of anemia. There is also an elevated ESR (sedimentation rate), which could stem from anemia, or conversely, the anemia could be a symptom of an underlying condition driving the inflammation. Additionally, there is a mild liver lesion present (does the patient consume alcohol?).

There are many variables here. My view: start with a solid clinical exam and an in-depth discussion with a doctor before deciding on the next steps.

bluewalker9 said:I'm 24. Over the last week, I've noticed my testicles have increased in size and feel significantly firmer. Previously, they were quite loose and easy to move, but now they feel larger, much harder, and don't shift easily.
Should I see a GP about this, or just wait it out?

What does this have to do with lab results? If you're noticing physical changes like this, don't sit around waiting. Go see a doctor for an exam immediately.

hiddenviper said:Could someone please explain these results?
HLA: A 24 (9), 32 (19); B 18, 44 (12) ; DR 12 (5)

The logic here is simple: certain HLA antigens show up more frequently in people with specific diseases than in healthy populations.

Essentially, having certain antigens is linked to a slightly higher statistical risk. It isn't a guarantee of illness—having the antigen doesn't mean you will get sick, just as not having it doesn't mean you're immune.

The specific HLA markers in your report aren't "smoking guns" for any particular autoimmune condition, though almost any HLA can be tied to some elevated risk if you look hard enough.

One could mention that HLA-DR5 carries a slightly higher association with Hashimoto, which might be relevant to you, but I suspect the doctors weren't screening for that specifically. They were likely looking for something else entirely.

Context matters. If this is for a child, the interpretation shifts. Without knowing which disease group is being investigated or why the typing was ordered in the first place, any answer is somewhat incomplete.

Brian Palmer6 said:Starting a new thread here. Does anyone know if there's a clinic around now that does bone imaging? My boyfriend's bones are really hurting—it’s been about three years since we started dating, and he’s always complaining about hip and leg pain from some old motorcycle accidents. He kept ignoring me whenever I suggested getting an X-ray or something, but lately, it's flared up again and seems way worse... I'm just not sure how to convince him to actually go, or if anyone knows a good private clinic where you don't have to wait 800 years like at a public hospital. Any leads would be great! 🙂

Why exactly does your boyfriend need a bone scan? It’s a pretty non-specific test. Usually, it functions more like a single piece of a larger puzzle—something doctors weigh alongside other diagnostic data and a physical exam. On its own, a bone scan is unlikely to pinpoint the root cause here. As for whether private clinics offer this service: yes, they do. To avoid sounding like an advertisement, just type "bone scan clinic" into Google. You'll find locations quickly enough.

My advice? He should start by checking in with his primary care physician. It’s entirely possible that standard tests at his doctor's office could yield a diagnosis much faster than jumping straight to a bone scan.

The lab results—including those immunoglobulin levels—and the child's diet should be reviewed by a pediatric immunologist to get the full picture.

Dana Morales5 said:First off, thank you! Yes, this was an incidental finding. My baby isn't prone to infections; her only bout of illness was at 2.5 months old—E. coli—which was the only time she ever needed antibiotics. She’s healthy, energetic, and hitting all her developmental milestones perfectly. Her nasal swab and sinus tests came back normal, too. I realize this is speculation, but could a result like this stem from a previous illness, an asymptomatic condition, or perhaps just because her system hasn't fully ramped up gamma globulin production yet? Also, should we stick with our pediatrician, or is it worth seeing an immunologist? We haven't heard back from the pediatrician yet, and I want to stay ahead of this.

The immunoglobulin levels need to be established first. If the child shows no signs of frequent infections and growth/development remains on track, monitoring will likely be enough.

Adam Green5 said:Hi, my ALP dropped to 50, while the lab range is 60-142. I'm feeling constantly exhausted. Could this be related to my thyroid or liver?
Thanks

It’s unlikely that an alkaline phosphatase level of 50 U/L is the direct cause of your fatigue; that isn't a significant enough drop to be the smoking gun. However, it could still be a piece of the puzzle. Essentially, you need to figure out why you're feeling so drained. That starts with a thorough medical history and a full physical exam, as the potential culprits are numerous.

Linda Gray said:Hi, my uric acid levels came back at 385. The lab range goes up to 337. Should I be worried?

A level of 385 μmol/L isn't typically a cause for concern. Crystal precipitation—the kind that risks buildup in your joints or kidneys—usually doesn't become an issue until you cross the 416 μmol/L threshold. For someone without symptoms, we generally don't start digging for underlying causes unless concentrations climb above 480 μmol/L.

On your end, if you're carrying any extra weight, working on gradual weight loss helps. You might also consider cutting back on meat—specifically organ meats—and limiting alcohol intake.

Dana Morales5 said:Can someone help me interpret these results?
An eleven-month-old baby was sent for testing due to some tics, and the globulin levels are outside the reference range.

Albumin (s) 67.1 H % 55.8 - 66.1
Alpha-1-globulins (s) 5.0 H % 2.9 - 4.9
Alpha-2-globulins (s) 13.4 H % 7.1 - 11.8
Beta globulins (s) 9.3 % 8.4 -13.1
Gamma-globulins (s) 5.2 L % 11.1 - 18.8
Albumin (s) 40.93 g/L 40.2 - 47.6
Alpha-1-globulins (s) 3.05 g/L 2.1 - 3.5
Alpha-2-globulins (s) 8.17 g/L 5.1 - 8.5
Beta globulins (s) 5.67 L g/L 6 - 9.4
Gamma-globulins (s) 3.17 L g/L 8.0 - 13.5
Albumin/Globulin 2.04

Are reference values for children the same as for adults (mine seem to follow adult ranges)? What do these numbers suggest, and will further workup be necessary?

Hello,

Reference values are certainly not identical for adults and children. In fact, even within pediatric populations, they vary significantly based on age. Regardless, a gamma-globulin level of 3.17 g/L in a child this age is low. These levels would typically sit at the lower end of the normal spectrum around 4 to 6 months old—that's when maternal IBM begins to taper off and the infant's own IBM production is still ramping up.

Since gamma-globulins encompass immunoglobulins G, A, M, and E—essentially the antibodies responsible for fighting infection—a low gamma-globulin reading suggests low immunoglobulin levels. At this stage, we'd primarily be looking at IBM. Consequently, an immunoelectrophoresis or specific immunoglobulin testing would be a logical next step.

I am assuming this finding is incidental, perhaps caught during the workup for the tics, and that the child doesn't suffer from frequent infections—things like recurring bacterial sinus issues, ear infections, bronchitis, or pneumonia.

Emily Ortiz27 said:Thanks.
We managed to get the smear results back. They show:

• Eosinophilic granulocytes 6
• basophil 1
• Segmented granulocytes 32
• Lymphocytes 51
• Monocytes 9
• plasma cell 1
• blood test results
• platelets in smear +

No signs of metamyelocytes or atypical lymphocytes

The automated count showed eosinophils at 12.5%, zero basophils, 2 unsegmented, 41 segmented, 38 lymphocytes, and 6 monocytes.
The discrepancy between the two is significant. It’s unsettling—how can we actually trust either set of numbers? I'm biting my nails waiting for the hematologist's appointment next week to get an expert opinion and a repeat smear.

Could someone clarify what a plasma cell (or a proplasma cell) is? Any other terms I should search for? Dr. Google isn't offering much clarity here. 😬

Dear user,

As I mentioned previously, automated hematology counters struggle with precision when identifying and classifying every specific blood cell type, particularly regarding abnormal or immature cells. The gold standard remains this: any warning flags regarding abnormal cell populations must be verified via microscopic examination. That said, even a manual slide review isn't infallible, given that the analysis typically focuses on a sample of 100 leukocytes. Both methods serve a purpose in the diagnostic process.

Plasma cells are cells derived from B lymphocytes; their job is producing the antibodies that protect us from infection. Typically, you find plasma cells in the bone marrow, not circulating in the peripheral blood.