מקרי שימוש ופלט לדוגמה

# Test results

Covers 2022 to 2024. 7 entries across blood labs, imaging, and consultations.

## 2024

### 2024-09-12 — Thyroid panel
Type: Lab — Thyroid function
Ordering: Dr. R. Patel, Endocrinology · Lab: Quest Diagnostics

| Test               | My value | Units      | Reference range | Flag    |
|--------------------|----------|------------|-----------------|---------|
| TSH                | 3.42     | uIU/mL     | 0.40–4.50       | normal  |
| Free T4            | 1.1      | ng/dL      | 0.8–1.8         | normal  |
| Free T3            | 2.6      | pg/mL      | 2.3–4.2         | normal  |
| TPO antibodies     | 142      | IU/mL      | < 35              | HIGH    |
| Thyroglobulin Ab   | 8        | IU/mL      | < 20              | normal  |

Doctor's notes (verbatim): "TSH trending up over past year (was 2.1 in
2023-03). TPO Ab elevated, consistent with autoimmune thyroiditis. Continue
levothyroxine 75mcg, recheck in 6 months. Discussed Hashimoto's diagnosis."

### 2024-04-22 — Annual physical labs
Type: Lab — Comprehensive metabolic + lipid + CBC
Ordering: Dr. S. Liu, PCP · Lab: LabCorp

| Test               | My value | Units      | Reference range | Flag    |
|--------------------|----------|------------|-----------------|---------|
| Glucose, fasting   | 96       | mg/dL      | 70–99           | normal  |
| HbA1c              | 5.4      | %          | < 5.7             | normal  |
| LDL cholesterol    | 124      | mg/dL      | < 100             | HIGH    |
| HDL cholesterol    | 52       | mg/dL      | > 40              | normal  |
| Triglycerides      | 89       | mg/dL      | < 150             | normal  |
| Vitamin D, 25-OH   | 22       | ng/mL      | 30–100          | LOW     |
| Ferritin           | 38       | ng/mL      | 15–150          | normal  |

Doctor's notes: "LDL up from 108 last year. Vitamin D consistently low
despite supplementation, recommend increase to 4000 IU/day. Repeat in 3 mo."

## 2023

### 2023-03-18 — Thyroid panel
Type: Lab — Thyroid function
[... continues ...]

# Research: Thyroid health
Updated: 2024-09-13 (after new thyroid panel)

## Why this matters for ME

Confirmed Hashimoto's thyroiditis based on elevated TPO antibodies (142 IU/mL,
ref < 35), found in 2024-09 thyroid panel. TSH trending up: 2.1 (2023-03) →
2.8 (2023-09) → 3.42 (2024-09), all within "lab normal" but moving in the
wrong direction on the same 75mcg levothyroxine dose. Free T3 at 2.6 pg/mL is
in the lower third of range, often associated with persistent fatigue (which
I noted in the interview).

## Connections to my other data

- LDL up from 108 to 124 over same period. Under-treated hypothyroidism is a
  known driver of LDL rise — these may be related
- Vitamin D chronically low (22 ng/mL). Vit D deficiency is associated with
  worse outcomes in Hashimoto's. Worth addressing aggressively
- Mother diagnosed with Hashimoto's at 45 (family history confirms autoimmune
  thyroid pattern in maternal line)

## The science (current state)

[... continues, ~800 words on guidelines, T3 conversion, autoimmune triggers,
selenium, gluten and Hashimoto's, etc. ...]

## Plan for the next 12 months

This week:
- Increase vitamin D to 5000 IU/day with K2 100mcg, re-test in 8 weeks
- Add selenium 200mcg/day (evidence for reducing TPO Ab in Hashimoto's)

Next 3 months:
- Repeat thyroid panel at 3 months (not 6) given upward TSH trend
- Discuss with Dr. Patel: is 75mcg still the right dose given the trend
- Discuss with Dr. Patel: free T3 vs free T4 — would liothyronine help?
- Trial 6-week strict gluten elimination, track symptoms (modest evidence
  for Hashimoto's outcomes)

Next 12 months:
- Quarterly TSH, free T4, free T3, TPO Ab
- Annual thyroid ultrasound (small evidence, but cheap)

## Red flags to watch for

- TSH rising above 4.5 with stable dose
- New onset constipation, cold intolerance, hair loss, brain fog
- Hoarseness or neck swelling (rare but ultrasound-worthy)

## Questions for Dr. Patel at next visit

1. Given my upward TSH trend on stable dose, is dose adjustment due?
2. Free T3 is low-normal and I'm fatigued — would T4+T3 combination help?
3. Should we add reverse T3 to my next panel?
4. Are you tracking my TPO Ab trend? Should we be aiming to reduce it?
5. Selenium and dietary changes — any specific recommendations?