Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does My Blood Test Reports Indicate?
Question: im a 39 year old male
5'-11"
175lbs
have many cognitive issues of late
depression
have had many blood tests.
total free testosterone 235
total free testosterone tested at 8am twice in two weeks and was low.
have had two mri's in 4 years of my pituitary.
partially empty sella. but no tumor it seems.
most recently had thyroid labs
twice in two weeks.
first one had normal tsh and low free t4
second test he had a free t3 (normal) total t4 low normal and yet again another low free t4 reading.
antibodies were done aswell
not sure I understand why nothing was mentioned on the antityroglobin test as my result was <1 in a flag range of .0.0 -.9
5'-11"
175lbs
have many cognitive issues of late
depression
have had many blood tests.
total free testosterone 235
total free testosterone tested at 8am twice in two weeks and was low.
have had two mri's in 4 years of my pituitary.
partially empty sella. but no tumor it seems.
most recently had thyroid labs
twice in two weeks.
first one had normal tsh and low free t4
second test he had a free t3 (normal) total t4 low normal and yet again another low free t4 reading.
antibodies were done aswell
not sure I understand why nothing was mentioned on the antityroglobin test as my result was <1 in a flag range of .0.0 -.9
Brief Answer:
Testosterone
Detailed Answer:
I follow what you are describing above.
1 I would like to believe that there is a typographical error when you write 'total free testosterone'
Total Testosterone and Free Testosterone are different tests.
The values you have reported are suggestive of it being a Total Testosterone reading.
2 The partial empty sella along with abnormal thyroid labs, in the context of low testosterone merit further systematic evaluation.
3 When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination:
CBC
Electrolytes
Calcium
HbA1c
Liver function tests
Kidney function tests
TSH
25 hydroxy Vitamin D
SHBG
FSH
LH
Ferritin
Prolactin
Free Testosterone by Equilibrium Dialysis method
8 am cortisol
T3 Resin uptake
Total T3
Total T4
TSH
4 I know some of these tests sound repetitive but are relevant.
5 You will be best served by seeing an endocrinologist in person, because pituitary-hormone problems can be complex to handle.
Arriving at the correct diagnosis followed by appropriate treatment is likely to improve your symptoms.
Testosterone
Detailed Answer:
I follow what you are describing above.
1 I would like to believe that there is a typographical error when you write 'total free testosterone'
Total Testosterone and Free Testosterone are different tests.
The values you have reported are suggestive of it being a Total Testosterone reading.
2 The partial empty sella along with abnormal thyroid labs, in the context of low testosterone merit further systematic evaluation.
3 When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination:
CBC
Electrolytes
Calcium
HbA1c
Liver function tests
Kidney function tests
TSH
25 hydroxy Vitamin D
SHBG
FSH
LH
Ferritin
Prolactin
Free Testosterone by Equilibrium Dialysis method
8 am cortisol
T3 Resin uptake
Total T3
Total T4
TSH
4 I know some of these tests sound repetitive but are relevant.
5 You will be best served by seeing an endocrinologist in person, because pituitary-hormone problems can be complex to handle.
Arriving at the correct diagnosis followed by appropriate treatment is likely to improve your symptoms.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for getting back to me. I have recently had many of the tests you recommended above. I have been seeing an endocrinologist since sept 2015. He is a visiting doctor to my area and only comes once a week. Its difficult to get in to see him as often as i'd like. Here are some more blood work results.
11/09/2015
LYTES:
sodium: 140 (L=136--H=145)
potassium: 3.9 (L=3.9-- H=5.2)
chloride: 102 (L=98---H=107)
co2: 29 (L=21--H=32)
TSH: 2.47 (L=.34--H=5.60 uU/mL)
8AM CORTISOL 12.6 ref range AM 6.7---22.6
FREE T4 0.73 L ng/dl (L=0.76--H=1.46)
IGF-1: 183 flag range 83-233 ng/ml
ACTH: 15.4 flag range 7.2 - 63.3
Free T4: .72 L Range .76 ---don't have the high range (this test was done twice and was found to be the same both times @ .72
My free t3 was 2.30 but I don't have the range numbers
total T4 was 5 and the low range was 4.5 but don't have the high range.
total T3 was in normal range.
9/28/2015
8AM free testosterone: 5.4 L flag range 8.7 - 25.1
total testosterone: 257 L flag range 348 - 1197
FERRITIN: 197 (L=8---H=388)
FSH: 1.7 L=1.5----H=12.4
LH: 2.8 L=1.7----H=8.6
prolactin: 10.9 L=4---H=15.2
9/15/2015
FSH: 1.7 range ( 1.5 -12.4)
glucose: 99 (L=74 -H=106)
HGB A1C: 5.4 (L=4.7 - H=6.2)
MEAN GLUC-calc: 94 (L=54 - H=115)
LH: 3.9 L= 1.7 - H=8.6
total testosterone: 229 L=348 H=1197
free testosterone: 8.3 L=8.7 H= 25.1
8/19/2015
vitiman d hydroxyl: 55.8 sufficient 30-100 ng/ml
calcium: 8.7 L=8.5--H=10.1
5/07/2015
CBC
wbc: L @ 4.1
Lymph: H @ 43.5
Neut: L @42.7%
I have more results I have to dig up but here are few to get started.
11/09/2015
LYTES:
sodium: 140 (L=136--H=145)
potassium: 3.9 (L=3.9-- H=5.2)
chloride: 102 (L=98---H=107)
co2: 29 (L=21--H=32)
TSH: 2.47 (L=.34--H=5.60 uU/mL)
8AM CORTISOL 12.6 ref range AM 6.7---22.6
FREE T4 0.73 L ng/dl (L=0.76--H=1.46)
IGF-1: 183 flag range 83-233 ng/ml
ACTH: 15.4 flag range 7.2 - 63.3
Free T4: .72 L Range .76 ---don't have the high range (this test was done twice and was found to be the same both times @ .72
My free t3 was 2.30 but I don't have the range numbers
total T4 was 5 and the low range was 4.5 but don't have the high range.
total T3 was in normal range.
9/28/2015
8AM free testosterone: 5.4 L flag range 8.7 - 25.1
total testosterone: 257 L flag range 348 - 1197
FERRITIN: 197 (L=8---H=388)
FSH: 1.7 L=1.5----H=12.4
LH: 2.8 L=1.7----H=8.6
prolactin: 10.9 L=4---H=15.2
9/15/2015
FSH: 1.7 range ( 1.5 -12.4)
glucose: 99 (L=74 -H=106)
HGB A1C: 5.4 (L=4.7 - H=6.2)
MEAN GLUC-calc: 94 (L=54 - H=115)
LH: 3.9 L= 1.7 - H=8.6
total testosterone: 229 L=348 H=1197
free testosterone: 8.3 L=8.7 H= 25.1
8/19/2015
vitiman d hydroxyl: 55.8 sufficient 30-100 ng/ml
calcium: 8.7 L=8.5--H=10.1
5/07/2015
CBC
wbc: L @ 4.1
Lymph: H @ 43.5
Neut: L @42.7%
I have more results I have to dig up but here are few to get started.
Brief Answer:
Follow up
Detailed Answer:
I have reviewed lab results that you have provided above.
It is good to note that Prolactin, Ferritin, Electrolytes, Glucose, Vitamin D, Calcium, HbA1c and IGF1 are normal.
Based on this I still suggest that a Free Testosterone test by Equilibrium Dialysis method be performed around 9 am.
If this is not possible, an alternative is to run the following two blood tests:
SHBG (Sex Hormone Binding Globulin)
Serum Albumin
Using the results of the above two tests, Free Testosterone concentrations can be indirectly estimated by using online tools which deploy the Vermuelen equation.
This has been accepted by experts as being reasonably close to the direct measurement of Free Testosterone in a laboratory using the gold standard method of Equilibrium Dialysis.
Once it is certain you truly have a low (free) testosterone condition, then the FSH and LH can be interpreted better. For example, in the current situation they should be elevated in response to low blood testosterone levels. The fact that they are not, implies a diagnosis of 'Secondary Hypogonadism' suggesting a problem with the pituitary. It appears the partial empty sella is seemingly the cause of this.
Your endocrinologist and you may also wish to consider doing a test called ACTH stimulation test, to check your adrenal axis ie whether or not you have adrenal insufficiency.
Follow up
Detailed Answer:
I have reviewed lab results that you have provided above.
It is good to note that Prolactin, Ferritin, Electrolytes, Glucose, Vitamin D, Calcium, HbA1c and IGF1 are normal.
Based on this I still suggest that a Free Testosterone test by Equilibrium Dialysis method be performed around 9 am.
If this is not possible, an alternative is to run the following two blood tests:
SHBG (Sex Hormone Binding Globulin)
Serum Albumin
Using the results of the above two tests, Free Testosterone concentrations can be indirectly estimated by using online tools which deploy the Vermuelen equation.
This has been accepted by experts as being reasonably close to the direct measurement of Free Testosterone in a laboratory using the gold standard method of Equilibrium Dialysis.
Once it is certain you truly have a low (free) testosterone condition, then the FSH and LH can be interpreted better. For example, in the current situation they should be elevated in response to low blood testosterone levels. The fact that they are not, implies a diagnosis of 'Secondary Hypogonadism' suggesting a problem with the pituitary. It appears the partial empty sella is seemingly the cause of this.
Your endocrinologist and you may also wish to consider doing a test called ACTH stimulation test, to check your adrenal axis ie whether or not you have adrenal insufficiency.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you
What about a low free t4 and a normal free t3.
I realize my tsh is not very applicable if my pituatary has a problem. If my pituatary was working well, wouldnt it show a rise in tsh to compensate for the loe free t4. My total t4 is barely in the normal range as well.
I dont have any physical signs of low testosterone yet. Mostly feel like shit all the time. Joint pain. Tremors in hands occasionally. Ocular weirdness. Brainfog. Depression. For years now I have noticed these symptoms in a very revolving type of way. Its like one week im ok than I get slammed with these symptoms and many more for two to 4 weeks. Then a reprieve again.Over and over again. What is most concerning is my reprieves seem to be shorter and shorter and not completely without symptoms. Its like these flare ups over and over. I have been on antidepressants at various times in my life. Have tried many different ones. Im tired of going down that road and feel that im not depressed but sick. Ive researched alot about thyroid and hormones. I realize im not an expert. My endo said not treatment necessary for the low free t4. Given my symptoms and that I have not tolerated testosterone thearapy well, nor did it seem to increase my total levels, couldnt the abnormal thyroid levels be a contributor to my symptoms and even pehaps the low testosterone? I may have misinterpreted some things but ive read that there have been clinical trials where le with pituitary thyroid abnomalities sometimes respond abruptly to thyroid treatment and that even their testosterone levels increased. Is this possible? Also I wanted to ask why nothing was mentioned about my thyroidglobin anti body result. It was 1 and flag range was 0 -.9. lastly what would the t3resin up take tell us. Could that test debunk my normal free t3 results. Thank you much for your help
What about a low free t4 and a normal free t3.
I realize my tsh is not very applicable if my pituatary has a problem. If my pituatary was working well, wouldnt it show a rise in tsh to compensate for the loe free t4. My total t4 is barely in the normal range as well.
I dont have any physical signs of low testosterone yet. Mostly feel like shit all the time. Joint pain. Tremors in hands occasionally. Ocular weirdness. Brainfog. Depression. For years now I have noticed these symptoms in a very revolving type of way. Its like one week im ok than I get slammed with these symptoms and many more for two to 4 weeks. Then a reprieve again.Over and over again. What is most concerning is my reprieves seem to be shorter and shorter and not completely without symptoms. Its like these flare ups over and over. I have been on antidepressants at various times in my life. Have tried many different ones. Im tired of going down that road and feel that im not depressed but sick. Ive researched alot about thyroid and hormones. I realize im not an expert. My endo said not treatment necessary for the low free t4. Given my symptoms and that I have not tolerated testosterone thearapy well, nor did it seem to increase my total levels, couldnt the abnormal thyroid levels be a contributor to my symptoms and even pehaps the low testosterone? I may have misinterpreted some things but ive read that there have been clinical trials where le with pituitary thyroid abnomalities sometimes respond abruptly to thyroid treatment and that even their testosterone levels increased. Is this possible? Also I wanted to ask why nothing was mentioned about my thyroidglobin anti body result. It was 1 and flag range was 0 -.9. lastly what would the t3resin up take tell us. Could that test debunk my normal free t3 results. Thank you much for your help
Brief Answer:
Second follow up
Detailed Answer:
1 The lab test method ('assay') for Free T4 is imperfect. So occasionally we utilize the Total T3, Total T4 and T3 resin uptake to give us a better idea of the thyroid hormone levels in the blood. Using the T3 resin uptake value, one can compute the Free Thyroxine Index which is an indirect estimation of the blood concentrations of Free T4.
Likewise, the Free T3 assay is even more unreliable. And hence the need to check for Total hormone levels as above
2 The anti thyroglobulin test is not of much help here. Regardless, the result is negative in your case.
3 I strongly suggest investigating for the possibility of adrenal insufficiency as detailed above.
Second follow up
Detailed Answer:
1 The lab test method ('assay') for Free T4 is imperfect. So occasionally we utilize the Total T3, Total T4 and T3 resin uptake to give us a better idea of the thyroid hormone levels in the blood. Using the T3 resin uptake value, one can compute the Free Thyroxine Index which is an indirect estimation of the blood concentrations of Free T4.
Likewise, the Free T3 assay is even more unreliable. And hence the need to check for Total hormone levels as above
2 The anti thyroglobulin test is not of much help here. Regardless, the result is negative in your case.
3 I strongly suggest investigating for the possibility of adrenal insufficiency as detailed above.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had an Adrenocorticotropic hormone test on 11/10/2015
results were 15.5
range was 7.2-63.3
Is this the test you suggested for adrenal insufficiency?
Secondly, would the assay lab tests for t4 and t3 be a means to determine if there are thyroid insufficiencies or something that should be treated?
Seems like my endo just determined no treatment necessary and that no further tests would be needed.
most importantly I want to make sure all avenues are carefully explored to correctly rule out what isn't. Its intimidating to know how to ask for more with doctors sometimes especially when you feel bad and don't know why so I appreciate the advice
thank you
results were 15.5
range was 7.2-63.3
Is this the test you suggested for adrenal insufficiency?
Secondly, would the assay lab tests for t4 and t3 be a means to determine if there are thyroid insufficiencies or something that should be treated?
Seems like my endo just determined no treatment necessary and that no further tests would be needed.
most importantly I want to make sure all avenues are carefully explored to correctly rule out what isn't. Its intimidating to know how to ask for more with doctors sometimes especially when you feel bad and don't know why so I appreciate the advice
thank you
Brief Answer:
Third follow up
Detailed Answer:
1 The ACTH stimulation has little to do with ACTH blood test. In this procedure, ACTH is given as an injection (a medication), and blood levels of cortisol are measured at specific time intervals. It is a complex test to perform and interpret and is therefore best left to the endocrinologist to conduct.
2 T3 T4 will help ascertain if a true thyroid problem exists or not.
Third follow up
Detailed Answer:
1 The ACTH stimulation has little to do with ACTH blood test. In this procedure, ACTH is given as an injection (a medication), and blood levels of cortisol are measured at specific time intervals. It is a complex test to perform and interpret and is therefore best left to the endocrinologist to conduct.
2 T3 T4 will help ascertain if a true thyroid problem exists or not.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
