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

Sandra Rivera37 said:Well, the doctor just waves it off because the labs look fine. She claims an abnormal MPV doesn't mean anything if everything else is within range.
She doesn't pay much attention to those specific levels if my platelet count and PV are okay.

Ma'am,

Is this bruising tendency a recent development, or has it been going on for a long time? Does anyone else in your family deal with easy bruising? Are you experiencing any other bleeding—nosebleeds, bleeding gums—or perhaps joint swelling? Are you currently taking any medications?

Where do these bruises typically show up? Are they appearing on your torso, neck, or face? Any other symptoms like fatigue, weight gain, thin skin, or purple stretch marks? How would you describe your menstrual cycles—are they normal or unusually heavy?

Roughly how large are these bruises? Larger than a quarter? When you touch them, are they harder than the surrounding skin, or can you feel a lump?

Do they appear spontaneously, or is it more that the bruising seems disproportionately large compared to the impact or injury?

Are you frequently using things like aspirin or other NSAIDs?

What other tests have you had done? You mentioned a coagulation panel.

Generally speaking, spontaneous bleeding falls into three main categories: issues with the blood vessel walls, problems with the number or function of platelets, or disorders in the blood clotting system.

The first two groups usually result in bruising on the skin or mucous membranes. Clotting disorders tend to lead to bleeding into joints and internal organs.

In younger women, spontaneous bruising—mostly on the legs—can occur even when there are no underlying issues with platelets or clotting factors. This is essentially a tendency for small capillaries in the skin to rupture, known as purpura simplex. However, without a clinical exam, it’s impossible to say for certain what we're looking at.

Maria Fisher46 said:Ma'am,

Did this bruising tendency start recently, or has it been an ongoing issue? Is there any history of easy bruising in your family? Are you experiencing any other bleeding—nosebleeds, bleeding gums—or joint swelling? Are you currently taking any medications?

Where do these bruises typically appear? Do you see them on your torso, neck, or face? Any other symptoms like fatigue, weight changes, thin skin, or purple stretch marks? Also, how are your menstrual cycles—are they normal or unusually heavy?

Roughly how large are these bruises? Larger than a quarter? Are they firm to the touch, or can you feel a lump?

Do they appear spontaneously, or are they just disproportionately large compared to the impact or injury?

Are you using anything like Andol, aspirin, or similar products frequently?

What other tests have you had done? You mentioned a coagulation panel.

Generally speaking, spontaneous bleeding falls into three categories: vessel wall issues, platelet count or function disorders, or clotting factor deficiencies.

The first two usually cause bruising on the skin or mucous membranes. Clotting factor issues often lead to deeper bleeding, frequently involving joints and internal organs.

In younger women, spontaneous bruising—mostly on the legs—can occur without any actual platelet or clotting issues. This is often due to fragile capillaries in the skin, known as purpura simplex. However, I cannot give a definitive answer without a clinical exam.

I noticed more bruising than usual last year, but I wouldn't have worried if it weren't for these tiny red spots (petechiae) appearing on my chest and legs. Right now, I also have three slightly larger purple spots, though they are smaller than a quarter—just a bit bigger than the red dots. They aren't hard to the touch. Over the last month, I’ve had two nosebleeds, which is unusual for me. No one in my family bruises easily. I have joint pain, but I attributed that to existing inflammation (though my joints aren't swollen or red right now). I don't have purple stretch marks, and I'm not sure about my skin thickness. 🤷
I am feeling increased fatigue, headaches, and nausea. My weight is stable at 130 lbs (5'7").
My periods are regular; the last two were normal, though the ones before that were heavy.

The bruises appear spontaneously.

I am not taking any medications.

My last coagulation panel was normal. It wasn't even close to the borderline values.

Do you have a recommendation for where I should go for an evaluation?

Thanks for the response. 🙂

What kind of joint inflammation are we talking about here? Do you actually have an official diagnosis yet?

I have Raynaud syndrome. During the winter months, my joints swell up and ache, and my hands get extremely cold and turn a purplish hue. This past winter, my knee swelled up too, which was incredibly painful. I'm assuming we're dealing with some kind of inflammatory process here. :P

So you’ve got Raynaud’s too? (Unfortunately, I’m dealing with it myself.) Did you ever follow up with an immunologist? Usually, that stuff doesn't just show up out of nowhere; they should check if it's just a symptom or the actual underlying issue.

I don't know, honestly. I think your GP is being a bit dismissive. If you already have Raynaud’s and this is happening on top of it, they really ought to be sending you to a specialist. Someone needs to dig a little deeper and figure out the next steps.

melloworca6 said:So, you're dealing with Raynaud's too? Unfortunately, I am as well. Have you consulted an immunologist yet? They can usually determine if this is a standalone issue or just one symptom of a larger underlying condition.

I don't know. I think your general approach is a bit unprofessional. If you’re dealing with Ray and things like this are happening regardless of the clinical findings, you should be sent to a specialist. They need to dig deeper and provide actual guidance if further action is required.

I saw an immunologist quite a while ago, and honestly, they did more for me than any other doctor I’ve been referred to. They put me on some immune-boosting injections and certain drops, then gave me strict orders not to catch more than two colds a year—apparently, that triggers inflammation in the joints, if my memory serves me right.

I’ve always held my OB-GYN in high regard, though I haven't actually sat in her office for at least five years. Honestly, everything would probably be fine if I just nodded along and agreed with every single thing she says. My only concern is finding out the actual cause. If it's harmless, great. If it isn't, I want it fixed. I have two small kids at home; I can't afford to deal with health issues right now.🙂

My doctor ordered hepatitis A and B markers for me. I also have some spider nevi to check out, though they've been there forever. If my liver function tests came back normal, I don't see why I need to run these additional markers. Is it actually possible to have hepatitis even if the initial labs look fine? I’m also seeing an ophthalmologist in two weeks for a deep dive into these headaches. Maybe the eye exam will shed some light on things; from what I understand, you can read a lot into the eyes.

What caused your R. syndrome?

I don't know, I still think you should push them to send you for more testing. The fact that you have Raynaud means it’s attacking your blood vessels.

It’s part of a larger autoimmune issue for me; it's just one of the symptoms.🙂

I wasn't aware that Ray affects blood vessels; I’m actually quite uninformed on that subject. I'll look into getting a referral for a hematologist or just book a private appointment. Thanks for the advice. 🙂

Here are some links for you: http://www.mayoclinic.org/diseases-conditions/raynaud-phenomenon/symptoms-causes, https://en.wikipedia.org/wiki/Raynaud%27s_phenomenon

I explained it to you in plain English before (and I probably didn't get every medical detail perfect), but basically, it causes spasms in your blood vessels. That cuts off the blood flow, so your fingers turn blue from the lack of oxygen and then go white.

It might not have anything to do with those bruises you're seeing, but since you're already dealing with Raynaud, you shouldn't just ignore this stuff.

melloworca6 said:Here are some links for you: http://www.healthline.com/raynaud-disease, http://en.wikipedia.org/wiki/Raynaud%27s_phenomenon

I explained it in layman's terms earlier (and I might not be perfectly accurate), but essentially, it causes blood vessel spasms. This restricts blood flow, which leads to oxygen deprivation in the fingers—making them turn blue first and then white.

It may not even be related to those bruises of yours, but since you already have Raynaud's, you shouldn't just ignore these symptoms.

I suspect it’s linked to my rheumatoid arthritis. I don't recall the exact lab results, but I know my mother told me it's genetic. My RA is fine right now; it's been okay for the last few years, nothing major. It used to be brutal, though—during puberty, I could barely move my fingers.

I sent an inquiry to a private hematologist. I'm just waiting to hear back, assuming they aren't on vacation right now.🙂

Dear David Brown5,

Given what you've shared regarding your medical history, I would strongly suggest scheduling a consultation with an internist. It would be wise to take photos of those specific changes to show them during your appointment.

An eye exam might help rule out certain types of headaches—specifically ocular ones, though those are less common than other causes—but things like migraines, tension headaches, or sinus issues fall outside an ophthalmologist's scope. Generally speaking, an eye exam won't diagnose those types of headaches, so there is no guarantee that a visit to the eye doctor will uncover the root cause of your pain.

It is also entirely possible to have perfectly normal liver enzyme levels while still dealing with viral hepatitis. For instance, nearly a third of patients living with chronic Hepatitis C who show clear physical changes in the liver actually present with normal serum aminotransferase values.

Best regards. 🙂

Maria Fisher46 said:Dear David Brown5,

Based on your medical history, I would strongly recommend consulting an internist. Take photos of those changes you mentioned and show them during your appointment.

An eye exam might rule out certain types of headaches—specifically ocular ones, though those are less common than other causes—but migraines, tension headaches, sinus issues, and most other varieties fall outside an ophthalmologist's scope. Consequently, an eye exam won't necessarily uncover the root cause of your headaches.

It is entirely possible for someone to have normal transaminase levels (liver enzymes) despite having viral hepatitis. In fact, nearly a third of patients with chronic Hepatitis C and confirmed liver damage still show normal serum aminotransferase values.

Best regards. 🙂

Great! Thanks so much for the response. I had an abdominal ultrasound done; my liver looks excellent, but my spleen is enlarged by about 10-20mm. My doctor says it's negligible.

Anyway, I'm going to get my iron levels and thyroid hormones checked next.
My primary care physician is stumped.

I saw a specialist privately, and they suspect an immune issue, especially given the Raynaud's syndrome 🙂 and the psoriasis I've developed.

If the ophthalmologist finds nothing, I'll see a neurologist. I'm hoping all these symptoms stem from a single issue so I can resolve this quickly. 🙂

(I really don't want to bounce from doctor to doctor.)

Nicholas, please, are those proven liver changes detected via ultrasound or through other methods? Thanks.

rustycobra17 said:Old post: Male, early 20s, no underlying health issues or medications, though there's a history of hypertension and one case of leukemia among my grandparents. I went in for testing because for about a month I've been feeling this weird sensation under my left rib cage—mostly in the front—that comes and goes, sometimes for minutes, sometimes for an hour, occasionally every day and sometimes not at all. My temperature was hovering around 98.6-99.0°F in the afternoons for a few days, but it's gone now, along with some nausea on an empty stomach that eventually cleared up. They suggested I might just be anxious, but I pushed for more tests. An abdominal ultrasound showed everything looks good: mucous membranes are normally perfused, and no enlarged thyroid or lymph nodes were felt. All organs are positioned normally and look fine: liver at 13.5 cm, gallbladder head 2.3 cm, body 1.8 cm, spleen 8.9 cm, kidneys 10.5x4.5 and 12x5.5... all within range. Blood, urine, enzymes, and metabolic panels came back: RBC 5.69 (4.34-5.72), Hemoglobin 170 (138-175), Hematocrit 0.497 (0.415-0.530), MCV 87.4 (83-97.2), MCH 29.9 (27.4-33.9), MCHC 342 (320-345), RDW-CV 13.1 (9-15), WBC 9.3 (3.4-9.7), Platelets 275 (158-424), MPV 12.1 (6.8-10.4), ESR 2 (2-13). Glucose 4.9 (4.2-6). AST 17 (11-38), ALT 21 (12-48), GGT 37 (11-55), (S)AMY 50 (23-91), (U)AMY 276 (ketones 1 (0/neg), blood/hemoglobin negative, protein negative, urobilinogen normal, nitrites negative, leukocyte esterase negative, microscopic sediment shows 3-5 leukocytes (0-2), moderate mucus. ..... RESPONSE to post: "The results are normal"

Despite those normal results, they found an elevated TSH. No treatment was prescribed yet, just a plan to recheck TSH, T4, and T3 in three months. Those minor symptoms I mentioned earlier are pretty much gone now (maybe once a month), and the fever has completely stopped.

Results:
TSH 6.21 mU/L (0.55-4.78)
Total T4 98.8 nmol/L (58.1-140.6)
Total T3 1.7 nmol/L (0.9-2.8)

Any thoughts? Is waiting three months okay? If my TSH settles into the normal range, can I stop checking? And if it stays high, should I see an endocrinologist?...

Sandra Rivera37 said:Great! Thanks so much for the reply. I just had an abdominal ultrasound; my liver looks fine, though my spleen is enlarged by about 10-20mm. My doctor says it’s negligible.

No big deal, I'm heading in to get my iron levels and thyroid hormones checked next.
My primary care physician is stumped.

I saw a specialist privately; they suspect an immune issue, especially given the Raynaud's syndrome (leeloo 🙂) and this psoriasis breakout.

If the ophthalmologist doesn't find anything, I'll see a neurologist. I'm hoping this cluster of symptoms points to a single cause so I can put this behind me soon. 🙂

(I'd really rather not bounce from specialist to specialist.)

Nicholas Myers, please—can those specific liver changes actually be seen on an ultrasound, or do you need other tests? Thanks.

Ma'am,

Looking back through your previous posts, I don't see any mention of existing liver lesions or changes.

You mentioned having spider angiomas. While these can indeed be present in patients with chronic liver disease, they also show up in perfectly healthy people, pregnant women, individuals with thyroid issues, or those on hormonal treatments like birth control.

Since vividsailor7 is participating here—and he's a board-certified gastroenterologist—it would be best if you posted your full ultrasound report. He’ll be able to provide a proper assessment and guidance.

rustycobra17 said:Along with these decent results, my TSH came back high. They didn't prescribe any treatment yet—just told me to come back in three months to check my TSH, T4, and T3 levels again. I’m barely feeling those weak symptoms mentioned above anymore (maybe once a month), and I don't have a fever at all.

Results:
TSH 6.21 mU/L (0.55-4.78)
T4 total 98.8 nmol/L (58.1-140.6)
T3 total 1.7 nmol/L (0.9-2.8)

What do you guys think? Is waiting three months for a follow-up enough? If my TSH lands within the normal range, can I stop testing altogether? And if it stays high, should I be seeing an endocrinologist immediately?

Checking your hormone levels once every six months is usually plenty, or depending on how you're feeling, maybe just once alongside an anti-TPO test.

ABDOMINAL ULTRASOUND:

Liver appears homogeneous and normal in size with a standard echostructure. No pathologies detected. Portal vein: 12-13 mm.
Bile ducts show no dilation.
Gallbladder has a narrow lumen and thickened walls (postprandial state) but shows no visible pathology or abnormal contents.
Pancreas is normal in size and echostructure.
Spleen is slightly enlarged (10-20mm), measuring approximately 142mm in longitudinal diameter, with homogeneous parenchyma.
Kidneys are normal in position, shape, and size. No signs of kidney stones or hydronephrosis. No enlarged lymph nodes or free fluid detected in the abdomen or pelvis.

Results:

T3 - 1.47
T4 - 106.7
TSH - 1.37

IRON: 27!
UIBC: 40
TIBC: 67

I know everything looks fine. I have never had iron levels this good.🙂

(When I was eating meat, my iron was down to 2... now that my diet is mostly vegan, I'm at 27!)

Thanks to everyone for your time and answers.🙂

Honestly, I have no idea how to find the cause of my issues. Every single test comes back perfect.🙂 🙂 🙂

Maria Fisher46 said:Ma'am,

I didn't see anything in your previous posts mentioning a change or the presence of a liver lesion.

You mentioned having spider angiomas. While they can be a sign of chronic liver disease, they also show up in perfectly healthy people, during pregnancy, or due to thyroid issues, hormone use, birth control, and so on.

Since Dr. Hrvoje is participating in this thread—and he's a board-certified gastroenterologist—you should probably just type out the full ultrasound report. He can then give you his professional take and tell you what to do next.

I don't use birth control, I don't drink, and I've been pregnant twice, but I'm seeing new spiders appearing now.

Female, 40 years old. For the last 4-5 months, I've been dealing with fluctuating blood pressure, a racing heart, anxiety, and insomnia. I was diagnosed with hyperthyroidism three months ago and was prescribed Propylthiouracil.

Since then, following my endocrinologist's advice, I've had hormone checks done every 3-4 weeks. The treatment seemed to be working well initially; my second-to-last set of results showed T3 and T4 levels within the normal range:
TSH 0.07 (0.4-4.01)
T3 2.95 (2.0-4.9)
T4 1.30 (0.82-1.63)

I stayed on the exact same dosage, but in my most recent labs (taken 3 weeks after the previous ones), there was a sudden spike in T3, even though T4 continued to drop:
TSH 0.03
T3 4.8
T4 0.9
(Using the same reference ranges and the same lab):

Could someone please explain how these results can happen despite being on medication? I'm also quite worried because T3 is now hovering right at the upper limit, while T4 is sitting near the bottom. What could this indicate? Thank you!

Laura Chavez47 said:Female, 40 years old. For the last 4-5 months, I've been dealing with fluctuating blood pressure, a racing heart, anxiety, and insomnia. I was diagnosed with hyperthyroidism three months ago and prescribed Propylthiouracil.

Since then, following my endocrinologist's advice, I've had hormone checks every 3-4 weeks. The treatment seemed to be working well, and my second-to-last set of results showed T3 and T4 levels within the normal range:
TSH 0.07 (0.4-4.01)
T3 2.95 (2.0-4.9)
T4 1.30 (0.82-1.63)

I stayed on the exact same dosage, but in my most recent lab work (done just 3 weeks after the previous one), there was a sudden spike in T3 while T4 continued to drop:
TSH 0.03
T3 4.8
T4 0.9
(Same reference values, same lab):

Could someone please explain why these results shifted so drastically despite being on therapy? It’s also worrying because now T3 is right at the upper limit, while T4 is hovering near the bottom. What could this signify? Thank you!

What's the Propylthiouracil dosage?
Don't sweat it. There's no need to worry.

Sandra Rivera37 said:I don't use birth control, I don't drink, and I've been pregnant twice, yet now these new spider angiomas are popping up.

Seriously, go see an immunologist or a rheumatologist immediately.