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Any Thoughts about these blood tests?

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Aquila, May 31, 2012.

  1. Aquila

    Aquila

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    So after having ME for over 12 years I decided to have a few tests done privately and these are the results. A few things below looked interesting but I'm quite foggy. I know they're are lot of knoledgeable people on here so any thoughts about the results would be interesting to hear. I'm going to see my GP next week and will mention the low TIBC to him. I got the an e-mail from the Lab saying I should ask him about Chronic illness Anemia which I hadn't heard of before.


    Epstein-Barr Virus Screen
    EBNA IgG antibody *52 U/ml (< 5 U/ml Negative)
    EBV Early Ag ab.(IgG) 9 U/ml (<10 U/ml Negative)
    EBV VCA ab.(IgM) 10 U/ml (<20 U/ml Negative)

    The white blood cells and herpes virus screens were normal.


    Kidney Function
    SODIUM 144 mmol/L (135 - 145)
    POTASSIUM 4.0 mmol/L (3.5 - 5.1)
    CHLORIDE *97 mmol/L (98 - 107)
    BICARBONATE 22 mmol/l (22 - 29)
    (this gives an Anion gap of 29. The nurse said I should ignore that as I don't have any symptoms of serious disease and it was a fasting blood test but I thought I'd write it on here for completeness anyway)

    UREA 3.2 mmol/L (1.7 - 8.3)
    CREATININE 76 umol/L (66 - 112)

    Beta-Carotene 0.27 umol/L (0.28 - 2.33)
    My vitamin A was normal and I eat loads of carots so I'm not sure why this was a little low.

    Folate
    Red cell folate 293 nmol/L (158 - 1099) The reference range on wikipedia is quoted as above 400 so I don't know if it's lower here because of a different method or because of a different base in the UK)
    Method used: Architect CMIA

    Proteins
    TOTAL PROTEIN 69 g/L (63 - 83)
    ALBUMIN 50 g/L (34 - 50)
    GLOBULIN 19 g/L (19 - 35)

    IMMUNOGLOBULINS
    IMMUNOGLOBULIN G 9.63 g/L (7.0 - 16.0)
    IMMUNOGLOBULIN A 1.34 g/L (0.70 - 4.00)
    IMMUNOGLOBULIN M 2.18 g/L (0.40 - 2.30)


    HAEMATOLOGY PROFILE (this is all normal but I put it here for reference because of the abnormal TIBC)
    Red Blood Cells
    HAEMOGLOBIN 15.0 g/dL 13.0 - 17.0
    HCT 0.429 0.37 - 0.50
    RED CELL COUNT 4.79 x10^12/L 4.40 - 5.80
    MCV 89.6 fL 80 - 99
    MCH 31.3 pg 26.0 - 33.5
    MCHC 35.0 g/dL 30 - 35
    RDW 12.7 11.5 - 15.0

    Clotting Cells
    PLATELET COUNT 193 x10^9/L (150 - 400)
    MPV 12.4 fL (7 - 13)

    Iron Profile
    Iron - Serum 16.1 umol/l (7.2 - 28.7)
    T.I.B.C *28 umol/L (41 - 77)
    TRANSFERRIN SATURATION *59 % (20 - 55)

    Waking cortisol
    6.2 nmol/L (12-22)


    I have also had the Acumen mitochondira profile done ages ago where i seemd to be low on everything but I can't copy and paste and so i will leave that.


    I also had a Geneova diagnostics Gut profile done ages ago. This showed low PH, high bile acids, no helicobacter pylori or other pathogens, No Lactobacilus and loads of Strep bacteria.



    So there you go! Sorry that's alot andy thoughts would be interesting. I had M.E. for 12 years I had gradual onset. My worst symptoms are problably brain fog, dizzyness, staying upright for long periods, IBS, prostatitis and palpatations/chest pain. Thanks in advance for any thoughts! :)

    Aquila

    These are some results that came out Normal for reference:

    Lymphocyte Immunophenotype
    CD3 percentage 62.6 % 57.22 - 86.8
    CD3(T Lymphocytes) 1271 cells/uL 870 - 2510
    CD3(T Lymphocytes) 1271 cells/uL 870 - 2510
    CD4 percentage 35.00 % 29.0 - 61.0
    CD4 710 cells/uL 440 - 1470
    CD4 710 cells/uL 440 - 1470
    CD8 percentage 30.50 % 15.89 - 40.37
    CD8 619 cells/uL 290 - 1050
    CD8 619 cells/uL 290 - 1050
    CD4/CD3 percentage 34.70 % 30.58 - 60.81
    CD4/CD3(Helper T Lymphs) 704 cells/uL 560 - 1460
    CD4/CD3(Helper T Lymphs) 704 cells/uL 560 - 1460
    CD8/CD3 percentage 24.70 % 9.8 - 36.47
    CD8/CD3(Cytotoxic T Lymph) 501 cells/uL 250 - 990
    CD8/CD3(Cytotoxic T Lymph) 501 cells/uL 250 - 990
    CD4/CD8 ratio 1.40 0.54 - 2.97

    White Blood Cells
    WHITE CELL COUNT 6.45 x10^9/L 3.0 - 10.0
    Neutrophils 3.75 x10^9/L 2.0 - 7.5
    Lymphocytes 2.12 x10^9/L 1.2 - 3.65
    Monocytes 0.49 x10^9/L 0.2 - 1.0
    Eosinophils 0.19 x10^9/L 0.0 - 0.4
    Basophils 0.06 x10^9/L 0.0 - 0.1
    Lymphocyte percentage 31.5 %

    Inflammation Marker
    ESR 7 mm/hr 1 - 10

    Gout Test
    URIC ACID 313 umol/L 266 - 474
    Diabetes Test
    RANDOM BLOOD GLUCOSE (FL) 4.3 mmol/L 3.5 - 7.9
    FASTING BLOOD GLUCOSE (FL) 4.3 mmol/L 3.5 – 5.8
    Lipid Profile
    TRIGLYCERIDES 0.8 mmol/L < 2.3
    CHOLESTEROL 3.7 mmol/L Optimum <5.0
    HDL CHOLESTEROL *1.7 mmol/L 0.9 - 1.5
    LDL CHOLESTEROL 1.6 mmol/L Up to 3.0
    Heart Disease Risk
    HDL % of total 46 % 20 and over
    ENDOCRINOLOGY
    Thyroid Test
    FREE THYROXINE 17.3 pmol/l 12.0 - 22.0

    VITAMINS
    Vitamin A (Retinol)
    Vitamin A (Retinol) 1.67 umol/l 1.05 - 3.84
    Deficiency < 0.66
    toxic > 4.87
    Beta-Carotene 0.29 umol/L 0.28 - 2.33
    Vitamin B1 (Thiamine) 35.9 ug/l 15 - 70
    Vitamin B2 55.6 ug/l 40 - 140
    Vitamin B6 (pyridoxine) *78.1 ug/l 8.7 - 27.2
    Vitamin B12 413 pg/ml 191 - 663
    Vitamin C 39.2 umol/L > 11.4

    25 OH Vitamin D 183 nmol/L
    Interpretation of results:
    Deficient <25 nmol/L
    Insufficient 25 - 50 nmol/L
    Consider reducing dose >200 nmol/L

    Vitamin E (alpha Tocopherol) 52.2 umol/l 28.4 - 114.0
    Red cell folate 293 nmol/L 158 - 1099
    Method used: Architect CMIA

    MINERALS
    Calcium - Serum 2.45 mmol/l 2.16 - 2.62
    Chromium - Serum <0.5 ug/l < 1.0
    Copper - Serum 12.2 umol/L 11.0 - 22.0
    PHOSPHATE 1.12 mmol/L 0.87 - 1.45
    Magnesium - Serum 0.85 mmol/l 0.75 - 1.00
    Manganese - Serum 1.3 ug/l Less than 3.2
    Zinc - Serum *1670 ug/l 700 - 1200
    Test repeated
     
  2. nanonug

    nanonug Senior Member

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    Do you have gastrointestinal symptoms? If yes, GI specific tests would probably be a good idea. In addition, as viral infections go, testing for Hepatitis A, B and C also seems prudent.
     
  3. Aquila

    Aquila

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    Thanks for your reply Nanonug. Yes I have IBS. Actually I'm sorry i didn't word my first post very well at all i was really looking for comments about the test results rather than ideas for new tests. I've changed it so it makes a bit more sense now. Interesting about the GI tests I'll look them up. I've had a few GI tests from my GP to test to see if I caught anything from a trip to Uganda and they were all negative. I think my GP has done Hep tests before.
     
  4. nanonug

    nanonug Senior Member

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    Is it IBS diarrhea-predominant or IBS constipation-predominant?
     
  5. Aquila

    Aquila

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    IBS-A so I get both often alternating. I'm off wheat and diary as they both make it alot worse.
     
  6. nanonug

    nanonug Senior Member

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    OK, here is something you might want to show your doctor, then:
    Rifaximin therapy for patients with irritable bowel syndrome without constipation.

    Rifaximin is the treatment of choice for SIBO (along with neomycin or metronidazole if one also has constipation). In many cases, wheat and dairy sensitivities are symptoms of SIBO as well.

    In my case, treating an Helicobacter pylori infection (something I suggest everyone test for, by the way) along with suspected SIBO completely cured me from all IBS and CFS symptoms a few years back.
     
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  7. Aquila

    Aquila

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    Thanks for this I'll take a look. I got tested for Helicobacter pylori ages ago and didn't have it but the SIBO stuff looks interesting.
     
  8. Xandoff

    Xandoff Michael

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    I have read that most Doctors do not understand the IgG or IgM results. If you look on my homepage here you will see my listings of tests that I had from a real ME CFS Doc. I learned after seven years in the typical medical practice that all my tests were normal. Finding a real ME CFS Doc to interpet and order the "RIGHT" tests is very important. Good Luck Goldenaqila! Nice Avatar & name.
     
  9. Xandoff

    Xandoff Michael

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    P.S> I forgot to mention that I was anemic for seven years and now take an Iron supplement. Some people say it increases Biofilm but I need it to survive.
     
  10. aquariusgirl

    aquariusgirl Senior Member

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    I have just stumbled on the anemia of chronic disease thing. I think Prof. nancy Klimas of the University of Miami had a a paper on this recently.. it's posted on this forum.

    I suspect that that is what dog person/christine is treating with her B2 protocol.. it's not iron deficiency anemia.. it's a problem with iron transport.

    You can search for her posts. I think she would say that supplementing iron is exactly the wrong thing to do...
     
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  11. aquariusgirl

    aquariusgirl Senior Member

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    Amy yasko is finding most of her patients have h pylori.. even if they are not positive on standard tests.

    Where did you run these tests?
     
  12. nanonug

    nanonug Senior Member

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    Do you know what your iron, ferritin and TIBC levels are? Supplementing with iron is a double edged sword and needs to be done very carefully, in particular if one has or suspects to have any kind of ongoing infection.
     
  13. Aquila

    Aquila

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    Yes I was told by te lab in the notes specifically not to suplement with Iron because of my TIBC.

    Thanks Xandoff it's a picture of me in the lake district. I'm going to show the tests to my GP and see what he thinks. I did see doctor Myhill a few times but it killed me to get there and my improvements were modest I may go and see her again but was just trying to work out whether it was worth it. I ordered the tests myself partly so that I could decide to go and see and pay for a private person only if there was good reason to.

    That's interesting Aquariusgirl I'll look that up.

    Does anyone know if the high IgG for Epstein-Barr is standard if you've had glandular fever in the past? Also does anybody know about what a high Anion gap might mean and whether it is on any interest. Mine was 29 and the reference range was 11 to 15. There seem to be quite a few comments to do with D Lactic Acidosis on here mentionig it.
    I'm just wondering what to bring up with my GP as usually I only get to ask about a couple of things.
     
  14. Xandoff

    Xandoff Michael

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    Goldenaquila,

    I spent seven years with a wonderful GP who thought I was plum crazy. Regular Docs just don't know about the the right tests and where to get them nor how to interpet them. Perhaps you could find a ME CFS Doc closer on the Co-Cure List which is a website that recomends ME CFS Docs. Your local GP has been told by the CDC for thirty years that CFS is all in your mind.. They really believe what they learn in med school. They just don't perform the tests we need and they can't read the results correctly. I don't know your situation but I understand the travel, it kills me to drive 160 miles south one way to see my Doc, but It is worth it. Please check out a co cure List for your State. Love the photo-it is even better knowing it is you out there on that beautiful water.
     
    Goldenaquila likes this.
  15. nanonug

    nanonug Senior Member

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    I just noticed your iron profile. Have you tested ferritin? I am asking because that elevated transferrin saturation could be an early sign of hemochromatosis...
     
  16. Ema

    Ema Senior Member

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    These results indicate an old infection in my non-medical (but having EBV for 20 years) opinion. In a chronic infection, one would expect the EA-IgG to be positive. It is normal for the NA-IgG to be positive in an old infection as well though that result is certainly highly positive.



    There is a kind of primary immunodeficiency called selective subclass deficiency that is reasonably common in many with ME/CFS/Lyme/fibro etc. Because your overall results tends low, I would consider getting the IgG result broken into the four subclasses to see if you fall into a low subclass 3. This is all explained much better here:

    http://www.immunedisease.com/about-pi/types-of-pi/igg-subclass-deficiency.html

    Treatment may help with susceptibility and overload of infections both viral and bacteria.



    The metric system is not my friend. At all. But I have attempted to convert these and it appears that your serum iron is 90 in ug/dL. That iron result is not horrible in my opinion- my doctor considers serum iron between 100-110 ug/dL ideal. The TIBC does indicate that there is not any room to safely take or store more iron but I'm not sure that anemia of chronic disease applies here. I'd be curious to know what your ferritin looks like.

    I would certainly think about testing thyroid however as a low thyroid is often seen along with low TIBC. TSH is not a very good measure of thyroid function (though it is the most commonly done unfortunately). To get a true measure, one needs to look at FT3, FT4, and possibly also RT3 though I know that is harder to test in the UK.


    This is really quite low (out of range low!) even though a blood test is not the best measure of cortisol. It should be at the highest point around 8AM and certainly up near 18-20 in a healthy individual.

    I would consider getting a 4x/day saliva cortisol test to assess your overall cortisol rhythm and production across the day/night.

    I would also think with a below range AM cortisol, you shouldn't have any trouble convincing your GP to run an ACTH stim test to rule in/out Addison's. Keep in mind that a stim test will miss about half of the people who actually do have secondary Addison's but I would definitely do it with a below range cortisol result anyway. If you have Addison's and get properly treated, it can seriously change your life overnight.

    I think following up on this is vitally important. Dizziness was my biggest low cortisol symptom.

    Ema
     
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  17. rlc

    rlc Senior Member

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    Hi Goldenaquila, two things stand out immediately in your tests that need to be further investigated; unfortunately they are conditions which most doctors know very little about and often get it wrong! Your TIBC test is low, and your transferrin saturation is high, this raises the strong possibility that you have Hemochromatosis (genetic iron overload) don’t know if you have had ferritin done as well but anything above 150, especially in combination with your other results can mean you might have it, Hemochromatosis is a very common genetic disease, it is estimated that one in every two hundred and fifty people have it, However most doctors know virtually nothing about it and if they do their information is often out of date and wrong. If it is diagnosed early enough it is treatable, treatment is phlebotomy the removal of pints of blood this takes out the excess iron.
    The most up to date source of information on Hemochromatosis is the Iron overload diseases association site http://www.ironoverload.org/
    It explains how to diagnose it properly here http://www.ironoverload.org/information/diagnosis-pt1.htmland http://www.ironoverload.org/information/diagnosis-pt2.html
    They state that the only way to make sure of the diagnosis is to remove blood for several weeks, this will confirm or deny diagnosis and is the only reliable way to tell, if you don’t have it your iron levels will drop back to normal quickly. There are genetic tests for it, but they only test for the two most common genes which cause about 85% of the cases of Hemochromatosis, there are over forty genes that can cause it and these don’t get tested for, so if you get tested and have the common genes great it will confirm diagnosis, but if you have it and it is caused by the genes they don’t test for, almost all doctors don’t know this and you mayl be told you don’t have it, and it will become very difficult if not impossible to get treated. It is for these reasons that the Iron overload diseases association do not recommend genetic testing see http://www.ironoverload.org/information/objections-pt1.html You are also likely to come across depending on what your results say that your ferritin and iron are not high enough for it to be Hemochromatosis, this is not true High ferritin can be a very late sign of it and people can have symptoms of it for years before they get these kind of results.
    Sorry if this is all a bit complicated, but unless you have failed genetic tests and a very high Ferritin you may experience difficulties in getting it diagnosed and treated properly, but the Iron overload disease associations recommendation are the ones that should be followed for it to be diagnosed correctly, most doctors are out of date on this disease.
    There is a good article on Hemochromatosis being misdiagnosed as CFS here http://www.haemochromatosis.org/chronic-fatigue-syndrome-fibromyalgia.htmlWhat TIBC and transferrin saturation mean is explained here http://labtestsonline.org/understanding/analytes/tibc/tab/test low TIBC and high Transferrin saturation mean you are not anaemic and have high iron levels.
    The other thing that stands out in your tests is your Cortisol result it is way under range! Although low cortisol results can be found in ME patients they are normally subtly low compared to healthy people, yours are very low! This raises the possibility that you may have Addison’s (Adrenal insufficiency) this causes the same kind of symptom pattern as ME and can be caused by Hemochromatosis! It is again one of those diseases that most doctors are not very good at diagnosing. How to tests for it is explained in this article http://suite101.com/article/adrenalinsufficiency-a1543 It says
    When adrenal insufficiency is suspected, blood for an AM cortisol level along with an ACTH level and an aldosterone level is drawn. With a normal range of 9-25, mcg/dl, blood cortisol levels higher than 19 generally rule out the possibility of adrenal insufficiency. Levels lower than 3 suggest adrenal insufficiency, and levels between 3-19 are indeterminate. In primary adrenal insufficiency, the blood ACTH level is high. A low cortisol with a high ACTH is sufficient to diagnose primary adrenal insufficiency; a low ACTH with a low cortisol level is seen in secondary adrenal insufficiency. Further tests can be used to differentiate pituitary from hypothalamic causes in secondary conditions.
    Regardless of the cortisol level, if adrenal insufficiency is highly suspect, an ACTH stimulation test is performed. In this test the patient is given an injection containing cosyntropin, a synthetic form of ACTH. Cortisol levels are tested prior to administering the drug and at 30 and 60 minutes after the ACTH is given. In adrenal insufficiency the rise is blood cortisol levels is negligible. A longer version of the test can be used to determine if abnormal results are due to pituitary or adrenal disease.
    So you need serum ACTH and Aldosterone tests done and will probably need a ACTH stimulation test done as well depending on the results.
    High IgG results for EBV mean that you have had it in the past, your other results show you are not currently infected so you don’t need to worry about EBV.
    Hope this helps, I’m not a doctor, but from what the above articles say, your Iron and Cortisol results should be investigated further, because they indicate the possibility of serious diseases that have very similar symptom patterns to ME, unfortunately they are illnesses that a lot of doctors often don’t have up to date knowledge of how to tests for them so you may have to do a bit of reading and print out information to take to doctors, the good news is that if you do have them they are very treatable!
    Thank you for taking the time to write out all your results it makes it a lot easier to get an idea of what might be going on.
    All the best
     
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  18. Xandoff

    Xandoff Michael

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    Emma and Rich, Thanks for the valuable info you are sharing.. Yes Emma, you are right about my EBV results from 2010 (if I am repsonding to the right person) they were idicative of a past or recent Epstein Barr infection.It is interesting to note my youngest Sister had Epstein Barr/ Yuppie Flu at 17 back in the 70's that turned in to Crohns Disease and my other Sister was diagnosed with 4 stage Lymphoma at 19. She survived it and made medical history. I am sorry to say she just passed last winter at the age of 54. The herpes viruses are associated with Chrohns, Lymphoma and ME CFS.... I do think this illness starts with the nature of your genes and is influenced by our environment and stress. I came down with my illness at around 52-53.
     
  19. Aquila

    Aquila

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    Thank you so much Ema and RIC for writing all that out I'm very grateful! That's really interesting. I'm going to ask my doctor for a Ferritn test next week. I will report back when I get it.

    Ema that's interesting about the Immunoglobulins. I did the test partly because of Selective IgA Deficiency gene showing up on a Genetic test. I will looking in to get the subset tested again. I'd never heard of this and of IGG subsets so I'm thankful you brought it up and test certainly seems worth doing just in case.

    My thyroid TSH was normal and I have had FT3 and FT4 in the past which were borderline low but have never had RT3. I took Thyroxine under doctor Myhill for a while but didn't show any benefit.

    Ema and RIC. As for cortisol I had a salivary test years ago with alternative health practioner and it came out almost as low. The results for that were 6.4, 1, 2.3, 0.7. And 0.4 and 0.38 for DHEA I thought I've had low Cortisol for a few years because of a number of symptoms so that's really interesting. I think i will get it re tested though as my sleep goes round and round the clock and i had to book an appointment for a blood test so it really ended up being 2 hours after I woke up which may. I will talk to my doctor about it.

    Ric that's very interesting about Hemochromatosis. I will definately get my Ferriten tested. I have actually had a Gene test. Hemochromatosis is the only thing I came up with for carrier status but I'm only a carrier I only have one Gene. Here is what it says:

    "Has one copy of the C282Y mutation in the HFE gene. A person with one copy of this mutation typically has no increased risk for iron overload. May have other mutations in the HFE gene (not reported here)"


    Thanks again for all the help I will report back after I had my blood tests and seen my doctor. Interesting I have also finally got my doctor to take an interest in my palpatations, very heavy heart beats and chest pain without Tachycardia so will be having a heart rate monitor soon. I'm also after many years having treatment for Prostatitis. So I'm carefully hopeful, If even one of those avenues leads to a ten percent improvement I will be very happy. I've added a few other test result to the first post which were normal like TSH to add a clearer picture. I didn't add them at the start as I didn't people to have to do too much reading.
     
  20. Ema

    Ema Senior Member

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    I'm really glad that you are going to follow up on the testing with your doctor. I would not delay at all in getting the ACTH stimulation test in particular. Low cortisol is nothing to fool around with!

    FT4 is best in the middle of the range with FT3 in the top third of the range. So if you were testing borderline low, it is likely that you were really quite low by optimal standards. Heart palpitations are really very common as well in those that are hypothyroid. I would really try to get this tested currently as if it is the reason behind your heart palps, it is a simple fix.

    Many people do not do well with T4 alone especially those with ME/CFS due to problems converting the T4 to the active hormone T3. If you find you are hypothyroid, I would consider trying either a T4/T3 combo like Armour or Naturethroid or T3 alone. But you won't likely be able to tolerate anything with T3 until the adrenals are well supported and cortisol levels are adequate because cortisol is necessary for proper utilization of thyroid hormone.

    Good luck and keep us posted!
     
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