mild hypo 6

(Abridged version taken from “Why Am I So Tired?” by Martin Budd)
Published by Thorsons ISBN 0-7225-3942-8)

We are all different. Structurally, biochemically and emotionally we are unique. Fatigue is a symptom of many illnesses, yet to unravel any problem there must be a starting point. With this in mind I usually request laboratory tests and other tests on the basis of test>interpret results>discount or diagnose>treatment.
This means that a test is requested (an example being haemoglobin to diagnose an iron deficient anaemia). The results are then assessed in terms of the patient’s signs and symptoms, diet, health history etc. and either eliminated from the diagnosis if negative or treated if the diagnosis is judged positive.
This type of sequence approach to testing ensures specificity in terms of diagnosis, at minimal cost for the patient. Having mentioned the price of medical testing I must add that I do not allow cost to compromise diagnostic accuracy. (Some physicians have been known to request tests with a research priority and not a patient’s priority).
Very few patients require all the tests shown, many are surprised at the variety and complexity of the tests that are available. The procedure falls into three groups of tests. Should the results of group one prove to be inconclusive or negative, I then request group two, and finally if necessary group three if more evidence is needed for a satisfactory diagnosis. If, after group three, I have not obtained any conclusive or useful diagnostic clues I usually seek a second opinion. The procedure for interpreting test results varies with each physician, so a colleague’s opinion can be useful. My protocol for test requesting with chronic fatigue is as follows:

This includes tests for kidney function, liver and gall bladder function, muscle damage, (including heart muscle), protein status, gout and blood sugar (for diabetes).

This includes tests for total cholesterol, HDL and LDL cholesterol, the LDL-Total cholesterol ratio and the triglycerides.

This profile includes haemoglobin, ferritin, iron, red cells, white cells, platelets and the ESR (erythrocyte sedimentation rate).
Haemoglobin reflects the body’s iron status as the red cell haemoglobin comprises up to 65 per cent of the total body iron. The remainder is contained in iron-containing enzymes (5 per cent), or stored as ferritin and haemosiderin (30 per cent). Iron stores can also be measured in the blood.
The platelets are involved in blood coagulation and high levels can lead to raised blood viscosity and clotting. The ESR is raised in the presence of inflammation and infections.
There are various types of white cells that can be measured. This test is known as the differential white cell count. Examination of the white cells can provide clues to a wide range of diseases and imbalances, including immune system status.

This is my most commonly requested profile and includes Free T3, Free T4 and TSH.

With 10ml of blood 35-40 tests can be requested. This supplies valuable information on organ deficits, anaemia, hypothyroidism, diabetes, gout, arthritis, immune deficiency and many other health problems. You will notice that nearly all these conditions feature fatigue as a major symptom.

If the results of the group one tests are normal or inconclusive I request all or some of the tests included in group two. These are largely tests for functional assessment, and tests to identify nutrient deficiencies.

This requires the patient to take a small drink containing poly-ethylene glycol (PEG), a substance which cannot be absorbed, but passes out directly to the bladder. The PEG includes 11 different sized molecules and the normal recovery range is known for each molecule. The patient measures the urine passed over six hours following the drink, and a small sample of urine with the figures for the total amount passed is sent to the laboratory.
The elegant and very simple test which the patient does at home serves to identify a leaky gut or malabsorption.

This blood test measures calcium, chromium, copper, iron, magnesium, manganese and zinc in the blood, and also the magnesium in the red cells.

Red cell magnesium is seen as a valuable test for chronic fatigue patients, who often show a low level of magnesium.