What causes high FT4, PTH, insulin and Ig A levels?

Question

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 1.9 inch x 0.7 inch. I am particularly concerned about the high FT4 (while FT3 is below optimal level), high PTH, low vitamin D, high CRP and ESR, high insulin, and high IgA. 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 and 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 the range. I have attached my blood test results. I am currently taking Tramadol.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query and the results that you have attached. (attachment removed to protect patient identity).

It does not appear that you have any thyroid disease at this time, as your TSH (thyroid-stimulating hormone) is normal, and your T3 and T4 levels are within acceptable ranges, so there is no cause for concern. Some people have thyroid nodules, which should be assessed yearly by ultrasound to ensure they are not increasing in size or texture. My advice for this aspect would be to repeat thyroid function tests yearly and perform an FNAC (Fine needle aspiration cytology), i.e., an ultrasound-guided biopsy of the thyroid nodule, to ensure it is benign.

Yes, you do have a vitamin D deficiency, and when you have this, you automatically have high parathyroid hormone levels, which is called secondary hyperparathyroidism. This typically occurs with vitamin D deficiency and improves when the deficiency is treated. My advice is to get 30 minutes of sun exposure daily and take vitamin D and calcium supplements. I do not know what type of hyperparathyroidism your niece is having, but I assure you that yours is not to be worried about. Your saliva cortisol levels, I do not think we usually worry about. Consider having a serum cortisol level test if you are concerned, to confirm, particularly in the morning.

I know your serum CRP (C-reactive protein) and immunoglobulins are high, but they are signs of an allergy or an immune reaction to any food. They could also be the cause behind your bone and joint pains, including vitamin D deficiency. What I am concerned about is your high insulin levels, which suggest that you may have insulin resistance. That could be due to polycystic ovaries, a sedentary lifestyle, 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 a gynecologist.

In the meantime, try to exercise 45 to 60 minutes daily, sleep for eight hours, consume a low-carbohydrate, low-fat diet, and avoid sweet drinks absolutely. Consider consulting a nutritionist to help you lose weight. You may benefit from taking Metformin 500 mg three times a day as a tablet. It will help you with your PCOS (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.

Answer 2

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.