I have question regarding lab

[wonderwoman]

I have something I need help with. I was supposed to make a followup appointment with the GI doctor one month after my colonoscopy on February 8, 2010 and didn’t, mainly for reasons regarding his knowledge of diet and CC. Lately I feel I am exceptionally tired during the day. This is not normal for me. I fight taking a nap during the day as I want to be sure I sleep through the night. Anyhow, today I called my primary care doctor to make an appointment, someone else I’m not crazy about, and find he is on vacation until May 3. I can get in this next Monday with a doctor who must be new there as I have not heard of him. I want this doctor to order lab tests.

My question is, are there specific lab tests I should request? I had my TSH and T4 done December 29th for my endocrinologist and it was a little bit elevated at that time. I was supposed to have it rechecked the beginning of March and didn’t because of the change in diet and everything else I was going through at that time that I wanted to wait a little longer. Now because I'm so tired, I want my TSH and T4 rechecked. My Levothyroxine RX may need adjusting.

I had extensive lab done on January 13 for the GI doctor so I don’t know if this primary care doctor I’m seeing will want to repeat them now.

I have read here about testing the Vitamin D, B12, and something else, but I can’t find where that is.

The book Gluten Free for Dummies says to do a CBC, ESR, CRP, CMP, VITAMINS D, E, B12, and stool fat levels. My Enterolab results are posted somewhere here. That fecal fat test showed digestion and absorption of nutrients was normal when collected Feb 27th.

What do you think. I need all of your expert humble opinions regarding this before Monday.

[tex]

This is just my opinion, but I always request that Free T4 be tested, rather than Total T4, because it shows the amount that is actually available for conversion to thyroid hormone, rather than the amount in storage, (which may or may not be available for use). In my case, my Total T4 and TSH were normal, but my Free T4 was below range. We had to double my dose twice, (after starting with a minimum dose), to get the Free T4 up sufficiently into the normal range. All the while, my TSH remained in mid-range.

There are two common vitamin D tests, but one of them is worthless for our purposes. If you have your vitamin D3 blood level checked, be sure to specify the 25-hydroxy vitamin D test, IOW, the 25(OH)D test, because this is the active form of vitamin D.

Many meds can cause those symptoms, (as side effects). Are you taking any blood pressure meds, or statins, for example?

It shouldn't be necessary to recheck your fecal fat level, if it checked OK recently.

Anytime you need to review your Enterolab test results, you can find them here:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=10089

I notice that you have the HLA-DQB1 *0603 gene. That gene predisposes to neurological issues, due to gluten.
It's possible that gene could be connected with your abnormal tiredness, (such as Hashimoto's disease, for example). I would request a test for thyroid antibodies, (to rule out Hashimoto's).

Tex

[wonderwoman]

Thanks Tex, You are so knowledgeable about this condition and so helpful. I cannot believe you are not a doctor. It is my understanding you did not even work in the medical field.

To answer your questions, the only RX’s I take are six Balsalazide 750 MG a day for my CC, and one Levothyroxine 75MCG for hypothyroid. In late December my TSH really jumped (that's also when my gut problems started to escalate) but the doctor did not want to change the dosage but rather wanted to retest in early March and then adjust RX if necessary. I have a referral to a wonderful Endocrinologist because several years ago my thyroid lab tests were up and down like a yoyo.

My Endocrinologist orders the Free T4 but since I am not seeing her on Monday I will make sure this doctor orders the Free T4. I checked on my back lab slips and the 25(OH)D was done in 9/08 and 9/09 and both times it was normal. Will make sure it is this one if he does it again. The B12 was normal as well.

Thanks for the reminder of my predisposition to neurological disorders with my gene. I will mention this to him and suggest he test for thyroid antibodies, to rule out Hashimoto's.

I know I have read here that often times the primary care doctor is more helpful than the GI doctor. But now I'm wondering if it would be to my advantage to be discussing this with my Endocrinologist. Would she be the one that would be more in tune with treatment, testing, and diet? Does an Endocrinologist work with autoimmune diseases? I'm asking because I don't know what she treats other than thyroid. One thing is I can always go to her if I feel this doctor is not helping me. First I need to give him a chance. I'm getting way ahead of myself.

Now I think I better start making some notes regarding what I want to discuss with him.

[tex]

Charlotte,

Fatigue is a listed side effect of Balsalazide, and it's considered to be a serious side effect, (as in "see your doctor immediately"), but in the absence of other serious side effects, I doubt that's the cause of your fatigue. I would certainly mention the possible connection to your doctor, though, so that he is aware of it, just in case.

Endocrinologists specialize in treating diseases of the endocrine system, which of course, includes diagnosing and treating diseases such as diabetes and thyroid issues, but many of us have found that these days, a good rheumatologist is more likely to know more about autoimmune diseases in general. IOW, as always, the optimal choice of specialists, depends on the likely source of the problem, but unless the problem is likely to be due to endocrine issues, rheumatologists tend to know more about autoimmune diseases in general, than probably any other medical specialist.

Who knows, maybe you'll luck out and find your new doctor to be a winner, and you'll want to keep him.

Tex