Lab results - looking for opinions [PLEASE READ 1ST POST]

irongull13 said:So, here’s the situation... even though I decided to go ahead with my military service, the whole process involved a full medical screening at the Cleveland Clinic, which included a complete blood panel. Everything looked perfectly fine, except for my bilirubin, which was sitting at a high 98. I should mention that right before getting my blood drawn, I had been traveling all the way to NYC 124 miles, barely sleeping or eating anything all day, let alone staying hydrated. I showed up to the lab starving and absolutely exhausted, which might be relevant because when the doctors reviewed the results, they suggested I likely have Gilbert's syndrome. All my other markers—AST, ALT, GGT—were at the bottom end of the normal range. They explained that if you actually have Gilbert's, being sleep-deprived and hungry will send your bilirubin levels through the roof. Anyway, they asked me to come back and redo the tests within 20 days.

I went back and did everything again, and this time the bilirubin was 64, while everything else remained totally normal.

Then, just recently, I had some follow-up blood work done to check things over, and the bilirubin came back at 48. Here are the links to my full blood work and urinalysis.

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I’m an athlete, 30 years old, about 5'9" and 165 lbs... honestly, I haven't seen a doctor since I was a kid, so seeing that bilirubin number really caught me off guard. My doctor tells me there's nothing to worry about since my liver enzymes are great, but nobody has ever given me an official diagnosis of Gilbert's, nor have they sent me for any specialized testing. Should I be looking into scheduling a liver ultrasound or more intensive screenings? And I should probably mention, I remember friends joking ten years ago about how my eyes looked a bit yellow... I never thought much of it back then, but now I realize it was likely the bilirubin. Thanks for any insight.

It looks like those previous links aren't working, so I'll post some new ones instead...
https://postimg.cc/TyX4yvbp
https://postimg.cc/LhhN88Wx

Hey, I also need someone to take a look at my urine results.
Lately, I've been dealing with pain in my upper right abdomen. At first, I thought it was just my stomach, but then the pain moved all the way to the right side, and for the last few mornings, it’s been radiating to the back near my right kidney. My endocrinologist sent me to the CIA for blood work after our first checkup.
The results are here: https://postimg.cc/fSjy8.1 miles

I'm 25. I have hypothyroidism, but I've been on steady medication for five years now, so that hasn't been an issue. About three months ago, they found an endometriotic cyst on one of my ovaries. It felt like hip pain at first, but it turned out to be my ovaries. I'm getting a pelvic MRI soon to see if there are any other lesions.

Diet and weight-wise, nothing changes. I'm a normal build (5'7" / 141 lbs) and I've always been active. No surgeries.

The only thing bugging me in these results is the elevated bilirubin. It was even higher on my last blood test (30). Does that point to anything?

Amy Cox79 said:I went ahead and started taking a B12 spray on my own. My primary care physician didn't suggest any supplements yet; instead, he scheduled follow-up labs (glucose, iron, UIBC, and TIBC) for next month. Thanks for the heads-up on potassium—I'll make sure to check my ferritin levels. These labs were done fasting. One thing I have noticed over the last few months is increased hair loss. Also, I'm not sure if it’s worth mentioning, but I experience heart palpitations. They don't cause much distress, but I once read they might be linked to potassium levels. Thanks!

Hello,

Potassium levels around 3.5 mmol/L shouldn't typically trigger cardiac issues, as that's right on the borderline. However, it might be worth digging deeper if you're feeling symptoms. My previous responses assumed a systematic review of a healthy individual without complaints, but you've noted some specific issues.

In my view, you should re-test your fasting glucose, along with a two-hour postprandial test or an OGTT. Checking ferritin specifically is also highly recommended, rather than just repeating Iron, UIBC, and TIBC. Have you had your thyroid levels checked? You should probably re-run your electrolytes in a little while as well.

We have a dedicated thread for cardiac concerns, so it would be better to move this discussion there (Heart Palpitations).

irongull13 said:The links I posted earlier aren't working, so here are updated ones.
https://postimg.cc/TyX4yvbp
https://postimg.cc/LhhN88Wx

To whom it may concern,

It looks like we're dealing with Gilbert's syndrome. It would be wise to check the conjugated bilirubin levels as well. Genetic confirmation via UGT1A1 genotyping is also an option; it isn't prohibitively expensive—likely around $100—and can be handled at places like St. Jude Children's Research Hospital, Mayo Clinic, or Cleveland Clinic.

Melissa Long82 said:Hi, I'm also looking for an interpretation of these results, specifically the urine analysis portion.
For the last few weeks, I've been dealing with pain in my upper right abdomen. At first, I thought it was just my stomach, but then the pain shifted further right, and lately, some mornings it's even radiating to my back near the right kidney area. After an initial checkup, my endocrinologist referred me to the CIA for blood work.
The results are available here: https://postimg.cc/fSjy8.1 miles

I'm 25. I have hypothyroidism, but I've been on regular medication for five years now, so it hasn't been an issue. About three months ago, they found an endometriotic cyst on one ovary. Initially, I felt it as hip pain, but it turned out to be ovarian. I have a pelvic MRI scheduled soon to see if there are any other lesions.

Regarding diet and weight, nothing has changed. I have a standard build (5'7" / 141 lbs) and stay active with sports. No history of surgery.

The only thing bothering me in these results is the elevated bilirubin; it was actually even higher at 30 during my last blood test. Does that indicate anything?

Hello,

The symptoms you're describing are non-specific. They require imaging, much like your endocrinologist suggested. As for the urine analysis, everything looks within the normal range. Based on what you provided, the bilirubin level in this report is 24 mcmol/l, not 30.

Maria Fisher46 said:Hi there,

Based on everything being described here, it really looks like we're dealing with Gilbert's syndrome... It might be worth getting a direct bilirubin test to get the full picture. You could even look into genetic testing to confirm the UGT1A1 genotype, which isn't usually a massive expense—I'd imagine it costs somewhere around $100—and you can have that done at places like St. Jude Children's Research Hospital, Mayo Clinic, or even the Cleveland Clinic.

Hello, when I had my full blood panel done in Washington, D.C. a few months back, my total bilirubin was sitting at 98, while the conjugated levels were around 10, though they're supposed to stay under 5... I haven't bothered checking the conjugated levels since then, just the total, which has been hovering between 50 and 60 u/mol over my last three tests.

irongull13 said:Sir, when I had my full blood panel done in Washington, D.C. a few months back, my total bilirubin was at 98. My conjugated levels were at 10, while anything under 5 is considered normal. Since then, I haven't checked the conjugated levels specifically—just the total, which has hovered between 50 and 60 u/mol over the last three tests.

Sir,

In that case, the conjugated bilirubin made up about 10% of the total. That still points toward unconjugated hyperbilirubinemia. When you factor that in with the clinical history and symptoms already mentioned, it fits the profile of Gilbert's syndrome perfectly. My previous suggestion stands: get a genetic test to confirm via UGT1A1 genotyping.

Is it normal for my blood sugar levels to actually drop after taking the glucose drink compared to my fasting levels?
My OGTT results:
Fasting: 4.3
1 hour after load: 4.0
2 hours after load: 3.6

Just a heads-up: between those last two readings—after the one-hour mark but before the two-hour mark—I dealt with a sudden bout of severe diarrhea. I'm not sure if that threw the numbers off, though the doctors just told me to avoid any sudden movements.

I'm currently 29 weeks pregnant, and we were actually worried about gestational diabetes because I've been gaining weight rapidly and feeling constantly hungry and exhausted.

Are these lower values under 4.0 even considered normal, or am I looking at hypoglycemia?

Hi everyone, I was hoping someone could help me make sense of these results. They were ordered primarily because of hyperthyroidism diagnosed back in August (my TSH was under 0.01, though it climbed to 1.63 at my one-month follow-up), as well as some other ongoing issues—specifically dealing with daily hives, which is why we ran a protein electrophoresis.

Albumins 61.5 % - 52.0 - 68.0
(S) Alpha 1 globulins 2.7 % - 2.0 - 5.0
(S) Alpha 2 globulins 7.8 % - 7.0 - 11.0
(S) Beta globulins 7.6 % L - 9.0 - 14.0
(S) Gamma globulins 20.4 % H - 12.0 - 20.0
(S) Albumins 45.5 g/L - 35.00 - 49.00
(S) Alpha 1 globulins 2.0 g/L - 1.00 - 4.00
(S) Alpha 2 globulins 5.8 g/L - 4.00 - 11.00
(S) Beta globulins 5.6 g/L L - 6.00 - 10.00
(S) Gamma globulins 15.1 g/L H - 8.00 - 14.00
(S) Albumin/Globulin 1.60 1

(S) Anti-cyclic citrullinated peptide (CCP) antibodies - 0.2 kU/l - <5 CMIA
(S) Thyroid-stimulating hormone (TSH) - 5.07 mIU/L H - 0.35 - 4.94 CMIA
(S) Triiodothyronine, free (FT3) - 4.13 pmol/L - 2.43 - 6.01 CMIA
(S) Thyroxine, free (FT4) - 9.96 pmol/L - 9.01 - 19.05 CMIA

Thanks in advance!

Sarah Wells23 said:Is it normal for blood sugar to be lower after consuming glucose than it was while fasting?
OGTT results:
Fasting: 4.3
1h post-load: 4.0
2h post-load: 3.6

Note that between the last two readings—specifically between the 1-hour draw and the 2-hour draw—I had a severe bout of diarrhea. I'm not sure if that skewed the numbers; the doctor just mentioned I shouldn't strain myself.

I am 29 weeks pregnant. We were actually suspicious of diabetes because I’ve been gaining weight rapidly and feeling constantly hungry and exhausted.

Are values under 4 even considered normal, or is this hypoglycemia?

Hello,

This isn't hypoglycemia. In pregnancy, hypoglycemia is typically defined as values below 3.5 mmol/L (sometimes even below 3.3 mmol/L).

Your glucose pattern during the OGTT is unusual, as we generally look for a steady rise and fall.

The most atypical part is the drop during the first hour. While seeing lower values in the second hour following higher initial peaks happens occasionally, your specific trajectory is odd.

The clinical significance of such a pattern isn't well established. Some studies have tracked pregnant women who developed hypoglycemia (under 3.5 mmol/L) during their test. In those cases, the dip usually occurs at the 2-hour mark rather than the 1-hour mark. Interestingly, those patients often went on to meet the criteria for gestational diabetes, particularly regarding elevated fasting levels.

However, that doesn't apply here since you don't meet the entry criterion of being under 3.5 mmol/L.

The wisest move would likely be to discuss a monitoring strategy with your OB-GYN, especially given the symptoms you described.

Hannah Stewart27 said:Hi, could someone please help me interpret these results? They were ordered primarily due to hyperthyroidism diagnosed back in August (TSH was under 0.01, then rose to 1.63 at the one-month follow-up), and also because of various health issues—specifically daily hives. I had protein electrophoresis done as well.

Albumin 61.5 % - 52.0 - 68.0
(S) Alpha 1 globulins 2.7 % - 2.0 - 5.0
(S) Alpha 2 globulins 7.8 % - 7.0 - 11.0
(S) Beta globulins 7.6 % L - 9.0 - 14.0
(S) Gamma globulins 20.4 % H - 12.0 - 20.0
(S) Albumin 45.5 g/L - 35.00 - 49.00
(S) Alpha 1 globulins 2.0 g/L - 1.00 - 4.00
(S) Alpha 2 globulins 5.8 g/L - 4.00 - 11.00
(S) Beta globulins 5.6 g/L L - 6.00 - 10.00
(S) Gamma globulins 15.1 g/L H - 8.00 - 14.00
(S) Albumin/Globulin 1.60 1

(S) Anti-CCP antibodies - 0.2 kU/l - (S) Thyroid Stimulating Hormone (TSH) - 5.07 mIU/L H - 0.35 - 4.94 CMIA
(S) Free Triiodothyronine (FT3) - 4.13 pmol/L - 2.43 - 6.01 CMIA
(S) Free Thyroxine (FT4) - 9.96 pmol/L - 9.01 - 19.05 CMIA

Thanks in advance!

Hello,

It’s difficult to interpret these without clinical context. Are you currently taking any medications? Is the hyperthyroidism being treated, which might explain the current state? And why was the anti-CCP requested?

Regarding the serum protein electrophoresis: there are minor deviations indicating hypergammaglobulinemia. This can be seen in cases of infection or chronic inflammation in its broadest sense—keeping in mind that inflammation isn't always an infection. There is also a slight decrease in the beta fraction, which is typically associated with malnutrition or low protein intake. However, it could also relate to liver or kidney issues, or perhaps hypolipoproteinemia.

Hello,

I appreciate you clarifying things; I apologize for the confusion given how sparse my initial information was. A low TSH level was flagged during a routine checkup four months ago, which was subsequently confirmed through several follow-up tests. My initial treatment involved Athyrazol, but after just two weeks, I began running fevers and breaking out in hives all over my body. Suspecting an allergic reaction, my doctor switched me over to Propylthiouracil (starting at three times a day for two weeks, then moving to twice a day, which I am currently doing). Alongside this, I was diagnosed with iron-deficiency anemia. Given a family history of colorectal cancer, I underwent both a gastroscopy and a colonoscopy. To summarize, in addition to chronic gastritis, GERD, and a hiatal hernia, they found H. pylori in my duodenum, which has been properly treated with triple therapy—today’s results came back negative. However, the hives haven't let up for a single day since they started, and despite regular TSH monitoring, my doctor is ordering further tests. I shared those results here for interpretation because of the holiday season, though honestly, I'm struggling to understand the reasoning behind some of these exams; my most pressing issue remains the unbearable urticaria (for which I take Letizen 2 x1). As for the anti-CCP, I assume that was ordered due to the persistent, intense pain and a lump in my elbow that has been bothering me since August, which my doctor diagnosed as tennis elbow. I am 43 years old, maintain a healthy weight, and follow a balanced diet.

Thanks again!

Hannah Stewart27 said:Hello,

My apologies for the lack of detail; I appreciate you clarifying things given the sparse data. A low TSH was flagged during a routine checkup four months ago, which subsequent tests have confirmed. My initial treatment was Athyrazol, but after two weeks, I developed a fever and hives all over my body. Suspecting an allergic reaction, my doctor switched me to Propylthiouracil (starting at 3x1 for two weeks, then moving to 2x1, which is my current dose). Alongside this, iron-deficiency anemia was detected. Given a family history of colon cancer, I underwent both a gastroscopy and a colonoscopy. To summarize: in addition to chronic gastritis, GERD, and a hiatal hernia, I had H. pylori in my duodenum, which was treated with standard triple therapy and is now testing negative. The urticaria hasn't let up since it started, and despite regular TSH monitoring, my doctor is ordering further tests—which I’ve posted here for interpretation—due to the holiday season. Honestly, though, I’m struggling to see the logic behind some of these tests because my primary issue remains the unbearable hives (I'm taking Letizen 2 x1). I assume the anti-CCP was ordered because of persistent, intense pain and a lump in my elbow that has been present since August; my doctor diagnosed it as tennis elbow. I am 43, maintain a healthy weight, and follow a balanced diet.

Thanks again.

Hello,

Were anti-TSHR (thyroid-stimulating hormone receptor antibodies) ever tested?

Maria Fisher46 said:Hello,

are anti-TSHR antibodies ever actually tested?

No, they aren't.

Hey there. Our son was recently diagnosed with metabolic renal tubular acidosis, so he’s currently on a regimen of potassium and sodium citrate. We’ve been doing regular blood work to monitor his acid-base status, and these were the most recent results: https://imageupload.io/i/yfE9eSvzdj

I’d really appreciate it if anyone could share some insight or tell me more about what this means.

Arterial or capillary ABG?
Lactate is slightly elevated, pCO2 is trending low, but everything else looks fine.

brightgull95 said:Was it arterial or capillary ABG?
Lactate was slightly up, pCO2 was a bit low, but everything else seemed fine.

Thanks for getting back to me, van.
It was a capillary ABG, just from a fingerstick. From what I could gather through some digging on Google, his bicarbonate levels were sitting below the normal range.

Regarding the lactate—which specific parameter are we looking at here?

LAC refers to lactate levels. A reading of 2.0 is perfectly within the normal range.
An HCO3- level of 19.3 mmol/L? Honestly, that could still pass as low-normal.
And look, definitely make sure to ask for some clarification at the follow-up appointment in two weeks if you're still feeling uneasy about it.

Harold Garcia60 said:Hi there. Our son was diagnosed with metabolic renal tubular acidosis, so he’s currently on potassium and sodium citrate. We monitor his blood work regularly (acid-base status), and these are the latest results: https://imageupload.io/i/yfE9eSvzdj

I would appreciate any insight anyone could offer.

Hello,

For a child dealing with renal tubular acidosis, the target bicarbonate levels should be at least 22 mmol/L (ideally sitting between 22 and 24 mmol/L). That explains why the citrate dose is elevated. The rest of the acid-base profile looks solid. Those slightly elevated lactate levels are likely just a byproduct of squeezing the finger during the draw; nothing to worry about. As for the partial CO2 pressure, it's negligible—most kids start breathing faster (hyperventilating) right before a prick, so seeing a lower pCO2 is perfectly expected.

All in all, from what I can see, everything is being handled flawlessly.

Hannah Stewart27 said:They aren't

Ma'am,

I suggest expanding your testing—specifically, seeing an immunologist or a dermatologist. Regarding hyperthyroidism treatment, you might consider tapering your Propylthiouracil dose further, though I can't say for certain without tracking your hormone levels over time.

Since the double dose of Letizen hasn't worked, it seems time to switch antihistamines. Try Levocetirizine (Xyzal) at 2 x 5 mg. If there’s no improvement in a week, move to 5 + 0 + 10 mg. If still no response after another week, go up to a quadruple dose, or 2 x 10 mg.

That said, I would still advise getting those specialist tests checked first.