Patient: Kamla Sharma, 62Y 4M 18D / Female
Collection date: 19 May 2026, 06:15 AM
Lab Visit ID: RNC25709
Status: PARTIAL REPORT — 6 critical tests still
pending
The bet paid off. Multiple markers we were worried about have improved substantially. Three deficiencies are now resolved (B12, Calcium, CRP). TSH dropped from subclinical hypothyroid range into normal range — a major positive surprise.
But three new concerns emerged that need immediate attention: 1. Potassium dropped to 3.62 (lower limit 3.5) — directly raises QT risk while she’s on Nortriptyline + Domperidone 2. AST mildly elevated (36 vs <34) — possible hepatic strain from NSAID/Chlorzoxazone course 3. Triglycerides moved into borderline-high range (124 → 168) — possibly Pregabalin weight gain risk materializing
Six critical tests are still pending — autoimmune workup (Hashimoto’s check), HOMA-IR, Magnesium, PTH. Final verdict requires those.
| Marker | Nov 2025 | May 2026 | Reference | Verdict |
|---|---|---|---|---|
| TSH | 7.275 | 4.526 | 0.55–4.78 | ✅ NORMALIZED — was subclinical hypothyroid, now within reference (upper end) |
| Vitamin B12 | 170 | 361 | 211–911 | ✅ RESOLVED — was deficient, now solidly normal. YOPREG-NM B12 worked. |
| CRP (Quant) | 5.30 | 2.30 | 0–3.3 | ✅ NORMALIZED — systemic inflammation resolved |
| Calcium | 8.3 | 8.9 | 8.7–10.4 | ✅ NORMALIZED — was below range, now within |
| Fasting Blood Sugar | 103 | 95 | 70–99 | ✅ NORMALIZED — was impaired, now within range |
| HDL | 34 | 40 | ≥50 (women) | ↑ +6 mg/dL improvement — still below target but moving right direction |
| Uric Acid | 6.3 | 5.8 | 2.7–6.1 | ✅ NORMALIZED |
| Hemoglobin | 12.2 | 12.6 | 12.0–15.0 | ↑ Improved, comfortably within range |
| Ferritin | 40.70 | 50.50 | 10–291 | ↑ Improved |
| hs-CRP | 0.87 | 0.64 | <1.0 | ↓ Improved (low cardiac risk maintained) |
| Chloride | 110 | 105 | 98–107 | ✅ Normalized (was mildly elevated) |
| Albumin | 4.00 | 4.30 | 3.2–4.8 | ↑ Improved |
| Transferrin saturation | 15.98% | 15.38% | 16–50% | Essentially unchanged |
| TIBC | 269.1 | 299 | 250–460 | Slight rise, both within normal |
| Marker | Nov 2025 | May 2026 | Reference | Concern |
|---|---|---|---|---|
| Potassium | 4.48 | 3.62 | 3.5–5.1 | ⚠️⚠️ Dropped close to lower limit. Low K+ amplifies QT risk from Nortriptyline + Domperidone. Likely drivers: Domperidone, dehydration during illness, or dietary intake drop. Highest priority safety item from this round. |
| AST (SGOT) | 30 | 36 | <34 | ⚠️ Above range (mild). Likely from Chlorzoxazone (rare hepatotoxicity) or Aceclofenac. Monitor — usually resolves after drug stops. |
| Triglycerides | 124 | 168 | <150 | ⚠️ Moved into borderline-high (150–199). Possible Pregabalin weight gain effect — this was a predicted risk. |
| VLDL | 25 | 34 | <30 | ⚠️ Slightly above normal. Mirrors triglyceride rise. |
| HbA1c | 6.2% | 6.3% | <5.6 | Slightly worse despite FBS improving. Suggests post-prandial spikes. |
| Homocysteine | 18.66 | 17.19 | 3.7–13.9 | Minimal improvement despite B12 normalizing. Other driver present (folate? B6? hypothyroid?). |
| RDW-CV | 14.9% | 15.7% | 11.5–14 | Worsening. Mixed cell sizes — RBC turnover not yet stabilized (takes 120 days post-B12 correction). |
| Phosphorus | 4.60 | 5.10 | 2.4–5.1 | At upper limit. Possibly from Vit D loading; worth watching with PTH (pending). |
| Lymphocytes | 38.9% | 45.3% | 20–40 | Slightly elevated. Mild lymphocytosis — could be viral, stress, or lab variation. |
| BUN/Creatinine ratio | 23.0 | 23.8 | 12:1–20:1 | Stable, mildly elevated. Possible dehydration. |
| Creatinine | 0.76 | 0.84 | 0.55–1.02 | Slight rise but still normal. |
| Marker | Nov 2025 | May 2026 |
|---|---|---|
| Free T4 | 1.20 | 1.11 |
| Free T3 | 2.67 | 2.82 |
| Total Cholesterol | 118 | 153 (still <200) |
| LDL | 60 | 79 (still <100) |
| Non-HDL Cholesterol | 84 | 113 (still <130) |
| Vitamin D (25-OH) | 40.2 | 42.9 (loading dose worked) |
| ESR | 20 | 19 |
| Serum Iron | 43 | 46 (still borderline low) |
| ALT/SGPT | 29 | 37 (within range) |
| ALP | 104 | 113 (within range, but upper end) |
| GGT | 9 | 13 (within range) |
| Bilirubin Total | 0.29 | 0.37 (within range) |
| Total Protein | 6.80 | 7.30 (within range) |
| Globulin | 2.8 | 3.0 (within range) |
| Sodium | 144 | 142 (within range) |
| Urea | 37.45 | 42.80 (within range) |
| Urine R/M | Clean | Clean |
| Test | Result | Interpretation |
|---|---|---|
| Stool R/M (Parasites) | Not Seen (no parasites, no ova) | Important negative. The elevated IgE in Nov 2025 (299) is NOT due to intestinal parasites. If IgE remains elevated in the autoimmune panel results, the working hypothesis shifts to allergic/atopic causes or immune dysregulation. |
These 6 tests determine the next-phase decisions. All confirmed via Tata 1mg app:
| Test | Expected | What It Answers |
|---|---|---|
| Magnesium | 21 May 2026, 07:00 AM | Status + critical QT risk modifier (low Mg amplifies QT, same as low K+). Highest urgency given K+ 3.62. |
| Anti-CCP Antibody | 21 May 2026, 07:00 AM | Rules out early Rheumatoid Arthritis (her bilateral hand CMC pain). |
| HOMA-IR (Insulin Resistance Index) | 22 May 2026, 07:00 AM | Is she insulin-resistant? Drives dietary emphasis (carb reduction vs general healthy eating). Helps explain why HbA1c crept up despite FBS improvement. |
| PTH (Intact) — Parathyroid Profile | 23 May 2026, 07:00 AM | Parathyroid axis status with calcium normalization. Important for bone health interpretation. |
| Anti-TPO + Anti-Thyroglobulin (Anti Thyroid Antibodies Panel) | 24 May 2026, 07:00 AM | Is the hypothyroidism autoimmune (Hashimoto’s)? Even though TSH normalized, antibody status drives long-term prognosis and selenium decision. Last result; full picture complete here. |
Full report timeline: 21 May → 24 May 2026. Final analysis pass after May 24.
IgE Total was in the Tata 1mg cart (cart receipt confirmed). I don’t see it in this partial report, and it is NOT listed in the pending tests at the end. This is a gap — IgE was a critical Round 2 metric for the allergy/parasite question. Stool came back negative for parasites, so IgE trajectory matters even more.
Action needed: Confirm with Tata 1mg whether IgE was processed. If missed, request it be added.
Update: Mixed support. B12 is fully corrected. TSH normalized. CRP normalized. If the metabolic-pain link were true, her pain should have reduced substantially. Need to ask Ravi: is her pain better than it was in April?
Status: Still pending. TSH normalizing without thyroid medication is unusual if Hashimoto’s was driving it — autoimmune destruction typically progresses. This could mean: - (a) She doesn’t have Hashimoto’s; the TSH was transient/situational - (b) She has Hashimoto’s in a remission phase (uncommon but possible) - (c) Vit D normalization is reducing the autoimmune drive - Anti-TPO result will resolve this.
RESOLVED — false. Stool exam clean. Working hypothesis shifts to allergic disease, atopic predisposition, or immune dysregulation. Confirm IgE was tested.
Partial support. Triglycerides moved from 124 to 168 (borderline-high). LDL rose 60→79. Total cholesterol 118→153. All still mostly within desirable range, but the direction is concerning. Need to ask: has her weight changed?
Likely supported but PTH pending. Calcium normalized on Vit D loading alone — supports nutritional/Vit-D-mediated cause rather than parathyroid dysfunction. PTH result will confirm.
Potassium 3.62 + ongoing QT-prolonging medications (if still on Nortriptyline + Domperidone) is the single most important finding.
Mechanism: - Both Nortriptyline and Domperidone independently prolong the QT interval. - Low potassium (and low magnesium, pending) is the #1 amplifier of QT risk. - A K+ of 3.62 is technically within reference (3.5–5.1) but close to the lower limit. - In an elderly female on two QT-prolonging drugs, this combination is what causes Torsades de Pointes.
Immediate actions: 1. Confirm her medication status — is she still on YOPREG-NM and ROWET-DSR, or has the 10-day course ended? 2. Increase dietary potassium — bananas, coconut water, leafy greens, dates, sweet potato 3. Pending magnesium result — if low, this compounds the risk 4. Doctor visit: raise this finding explicitly. Request ECG (it was already on our pending list). 5. Repeat potassium within 1-2 weeks to confirm trend.
Comparing to the 12-month targets in PLAN.md:
| Marker | Baseline | Target | May 2026 | % Progress |
|---|---|---|---|---|
| HbA1c | 6.2% | <5.7% | 6.3% | ✗ Slightly worse |
| TSH | 7.275 | <4.0 (treated) | 4.526 | ~88% (untreated normalization!) |
| HDL | 34 | >45 | 40 | 55% of the way |
| B12 | 170 | >400 | 361 | 83% of the way |
| Homocysteine | 18.66 | <10 | 17.19 | ~17% of the way |
| CRP | 5.30 | <3.0 | 2.30 | ✅ TARGET MET at 6 months |
Verdict: Strongly on track for 4 of 6 measurable markers despite no formal intervention having started yet. The drug course + Vit D loading + improved nutrition (presumed) explain most of this. Homocysteine is the laggard despite B12 normalization — suggests a non-B12 driver still active.
| Decision | Status |
|---|---|
| Start D3 maintenance (2000 IU)? | HOLD — Vit D is 42.9, sufficient. Don’t add more on top until next retest. The loading dose worked. |
| Start Calcium Citrate? | HOLD — Calcium normalized at 8.9. Diet maintenance is enough unless level drops again. |
| Start Magnesium Glycinate? | CONDITIONAL — wait for Magnesium result. But given low-end K+ and QT concerns, dietary magnesium emphasis NOW (pumpkin seeds, almonds, dark leafy greens, dark chocolate). |
| Continue B12 supplementation post-Yopreg-NM? | DECIDE LATER — once Yopreg-NM course ends, recheck B12 at 3 months. The drop from 361 will tell us if intrinsic factor/absorption is the issue. |
| Start Boswellia + Curcumin + Omega-3? | HOLD — CRP already normalized to 2.30. If pain is still significant, OK to start (joint-pain benefit independent of CRP). If pain is improving, defer. |
| Selenium? | HOLD — until Anti-TPO result. |
| Statin? | NO — LDL 79 is still desirable; total cholesterol 153 still desirable. Lifestyle first. |
| Endocrinologist referral? | CONDITIONAL — was high-priority at TSH 7.275. Now TSH is 4.526. Still worth one visit to discuss Anti-TPO result when it arrives and whether the normalization is durable. |
| Cardiology consult? | NEW PRIORITY — given low-end K+ + QT-prolonging drugs. ECG was already pending. |
| Diabetologist? | MODERATE — HbA1c crept up despite FBS improvement; HOMA-IR result will tell us about insulin resistance. |