Lipid panel improvements mega-thread — need advice

Short answer first, then the reasoning. A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin and B12, and a full blood count. That set catches the things that change, the things that explain symptoms, and the things that alter the prescribing decision. Almost everything else on the long circulating lists is either invariant, uninterpretable without a specific question, or an incidental finding waiting to cause an unnecessary workup.

Dr.SleepRoch said:

A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin…

Agreed, and reference ranges are laboratory-specific. Comparing your number to somebody else's range, or to a screenshot from another country, is how people convince themselves something is wrong.

MASHdoc_SA said:

My prescriber ordered three tests and this board recommends about twenty, and I would like to know which of those two lists is right.

Can confirm the pattern MASHdoc_SA describes. The single most useful discipline is bringing the whole panel to a clinician rather than one flagged value. One out-of-range result in isolation generates anxiety and unnecessary tests; the same result next to the trend and the rest of the panel usually generates a shrug.

That is the short version; the long version is somebody else's post.

From the other side of the consultation, briefly.

PSA: get baseline labs BEFORE starting baseline bloodwork therapy. You need a "before" picture to measure progress. My recommended pre-treatment panel:

1. CMP + A1C + fasting insulin
2. Complete lipid panel with particle count if possible
3. hsCRP, ferritin, B12, vitamin D
4. Thyroid panel (TSH + free T4)
5. CBC with differential
6. Liver panel (ALT, AST, GGT)
7. DEXA scan or body composition

Total cost at Quest without insurance: ~$200. Worth every penny for the data.