instruction: hi doctor I would like some help with my blood test results as my doctor has not been able to help I have a multinodular goiter with six nodules the largest is am I am particularly concerned about the high ft4 while ft3 is below optimal level high pth low vitamin high cop and ear high insulin and high ga do you have any suggestions on what could cause these results my symptoms include chronic diarrhea occasional constipation abdominal pain fluid retention extremely irregular periods fatigue with trouble sleeping frequent headaches occasional dizziness bone joint pains and weight gain most of these only showed up in the last few months after goiter was found my saliva cortisol results are also on the very low end of range I have attached my blood test results I am currently taking tramadol
output: hello I just read your query and the results that you have attached it does not seem you have any thyearoid disease as of now since your ash thyearoid stimulating hormone is normal and your to and to are at acceptable levels and nothing to worry about that some people do have thyearoid nodules which should be assessed yearly by ultrasound to make sure they are not increasing in size or texture my advice for this aspect would be repeat thyearoid function tests yearly and do an fac I an ultrasound guided biopsy of the thyearoid nodule to be sure it is benign yes you do have vitamin deficiency and when you have this you automatically have high parathyearoid hormone levels that is called secondary hyperparathyearoidism and that occurs usually with vitamin deficiency and gets better when that is treated my advice is to have sun exposure 30 minutes daily and take vitamin and calcium supplements I do not know what type of hyperparathyearoidism your niece is having but I assure you that yours is not to be worried about your saliva cortisol I do not think we usually worry about salivary cortisol levels try doing a serum cortisol levels if you are worried to be sure in the morning particularly I know your serum cop reactive protein and immunoglobulin are high but they are signs of allergy or immune reaction to any food they could also be the cause behind your bone and joint pains including vitamin deficiency what I am concerned about is your high insulin levels as they suggest that you have insulin resistance that could be due to polycystic ovaries or sedentary lifestyle or impending diabetes or metabolic syndrome my advice would be to have a pelvic ultrasound since you also have irregular periods and you might benefit from a consultation with the gynecologist in the meantime try to exercise 45 60 minutes daily and sleep for eight hours and consume low carbohydrate low fat diet and avoid sweet drinks absolutely take the help of a nutritionist to lose weight you might benefit from tablet metformin 500 my thrice a day it will help you with your cos polycystic ovary syndrome and the metabolic syndrome as well and help with the high insulin levels and also cause slight weight reduction I hope this helps tablet metformin 500 my thrice a day lifestyle modification