One of the things that I do for every patient is review the basic lab work that they’ve had with their GP/NP. This always reveals new insights. So often I see health conditions on there that patients had no idea that they have! Or don’t have!
Reference ranges on lab testing are really misleading. There’s a really big difference between “normal” and optimal”. Reference ranges are set up so that 95% of the population will fall into them – they have nothing to do with optimal health! This is why your doctor might tell you you’re “fine”, but you definitely don’t feel that way. When I’m evaluating labs, I look at the actual number and see if it’s OPTIMAL, not just average
Things are usually missing too. One scenario that I see over and over is an incomplete thyroid evaluation. A patient has only had TSH tested, and been prescribed medication to treat it. They’ve been taking their meds for years, are told their numbers are good, and still have tons of hypothyroid symptoms (see my thyroid post for these)
Missing from your basic thyroid evaluation is:
- Free T3 and T4: when we only test TSH, we’re not testing a thyroid hormone – we’re testing a brain hormone. There’s a common misconception out there that you can guess at what T3 and T4 are doing by only testing TSH – you can’t.
- Thyroid antibodies: the most common form of hypothyroidism is auto-immune (Hashimoto’s). If you’re hypothyroid, you should know what subtype you have. GPs don’t bother running this test because they don’t have a treatment for it. I do.
- Thyroid hormones should be tested first thing in the morning, so if you’ve had your test done in the afternoon or evening, it’s less valid
See how much there is to know about testing? And this is only ONE common scenario! Iron studies are also really commonly lacking in depth
Once I see things missing from your basic eval, I send you for the rest. I also send patients for any testing that they would like, that their GPs have refused to run. Vitamin D is a really common one
Bottom line: chances are the bloodwork that you’ve already had done could use another set of eyes; one looking for missing pieces, optimal values, and at what your body is truly trying to tell you
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