Q. My blood test result shows high FT4, high insulin and low vitamin D. What could be the cause?

Answered by
Dr. Shaikh Sadaf
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 05, 2020

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 5 cm x 2 cm. 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, 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 range. I have attached my blood test results. I am currently taking Tramadol.

Dr. Shaikh Sadaf

Diabetology Endocrinology


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 seem you have any thyroid disease as of now since your TSH (thyroid-stimulating hormone) is normal and your T3 and T4 are at acceptable levels and nothing to worry about that. Some people do have thyroid nodules which should be assessed yearly by ultrasound to make sure they are not increasing in size or texture. My advice for this aspect would be repeat thyroid function tests yearly and do an FNAC i.e an ultrasound-guided biopsy of the thyroid nodule to be sure it is benign.

Yes, you do have vitamin D deficiency and when you have this, you automatically have high parathyroid hormone levels that is called secondary hyperparathyroidism and that occurs usually with vitamin D deficiency and gets better when that is treated. My advice is to have sun exposure 30 minutes 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 I do not think we usually worry about salivary cortisol levels. Try doing a serum cortisol levels if you are worried to be sure in the morning particularly.

I know your serum CRP (c-reactive protein) and immunoglobulins are high but they are signs of allergy or 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 as they suggest that you have insulin resistance. That could be due to polycystic ovaries or sedentary lifestyle or 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 the gynecologist.

In the meantime try to exercise 45-60 minutes daily and sleep for eight hours and consume low carbohydrate, low-fat diet, and avoid sweet drinks absolutely. Take the help of a nutritionist to lose weight. You might benefit from tablet Metformin 500 mg thrice a day. 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.

Treatment plan:

Tablet Metformin 500 mg thrice a day.

Preventive measures:

Lifestyle modification.

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Hi doctor,

Thank you so much for your help.

Dr. Shaikh Sadaf

Diabetology Endocrinology


Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

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