Latest Thyroid /hormone profile with Synacthen test

[Granny56]

Hi,

Here is my latest blood results from 12th Jan 2016 which I have only just received, I welcome all comments and suggestions.

My doctor describes the thyroid results as "excellent", so why is my skin so dry, my hair brittle, my muscles aching and the potential remains to fall asleep at the drop of a hat?

TSH 0.564 (0.3-2.5)

FT3 5.07 (3.1-6.8)

FT4 18.2 (12-22)

TPO-AK 9.2 (0-34)

LH 26.6 (7.7-58.5)

FSH 53.8 (25.8-134.8)

Oestrogen 5.09 (0-54). (Post menopausal)

DHEA-S. 48 (10-246)

+C-peptide 4.5 (0.9-3)

Parahormone 29.4 (15-60)

25-OH-Vit D. 51.8 (30-120) ( suplimented since April 2015- Feb 2016, original result 0.9ng/ml)

Aldosterone 179 (17.6-232)

+Renin 232.1 (2.8-39.9) ( reduced from 1532pg/ml in August 2015)

Aldost. Ren. Quo. Index 0.77 (0-12)

Ferritin 153 (30-400)

Vit B12 566.9 (191-663) ( 3 mth inj for PA)

Folate 11.3 (4.8-37.3) (taking supplements

Homocystein 7.1 (0-9)

ACTH-0 pg/ml 16.9 (6.3-72.2)

Cortisol-0 ug/dl 13.4 (6.2-19.4)

Cortisol-30 ug/dl 23.1

Cortisol-60 ug/dl 25.5

[Hidden]

My FT3 needs to be a lot higher than that to feel well. Round about 6. Or 6.2

I can see why he thinks they're good....your FT4 looks very healthy.

Can't really comment on your synacthen test I'm afraid.

[Granny56 in reply to Hidden]

Thank you, it took a long time to self- regulate my tablets to improve my blood results. Maybe I am like you and just need the FT3 to move up the scale a wee bit.

Although annoying, my residual symptoms are tolerable when I think back to a time when I was at my worst. I never want to go there again.

[headinjuryhypo]

My comment on your short synacthen test is that it rules out primary adrenal insufficiency, because your cortisol levels went up fine. However, I would be less sure about secondary adrenal insufficiency (i.e. caused by a problem in your pituitary or your hypothalamus), which is much more common.

If the basal cortisol, the level before you get the injection, is less than 4ug/dl or more than 18ug/dl, that rules out secondary AI, but if the figure is in between, as yours was at 13.4, then further tests are needed.

Here's a quote from a paper by Natalia Thorogood and Stephanie Baldeweg about this:

Thorogood N, Baldeweg S E, Pituitary Discorders: an overview for the general physician, Symposium on the Head and Neck, BJHM, April 2008 Vol 69 No 4. "A morning cortisol value below 100 nmol/L indicates adrenal insufficiency. Cortisol values of 500 nmol/L or greater are consistent with an intact hypothalamic-pituitary-adrenal axis. The values in between do not exclude secondary adrenal insufficiency and dynamic testing is therefore warranted."

Having the figures in nmol/L instead of ug/dl is confusing, but there are websites that will convert for you if you want to check. By 'dynamic testing' they mean the insulin stress test or the glucagon stimulation test. With the symptoms you have, plus your 'in-between' basal cortisol level, you need one of these tests. You may get told that the insulin test is really dangerous and that the glucagon test is unreliable, but the insulin test is the 'gold standard' and always used to be used automatically, and if you're supervised it's safe, and the glucagon test is a whole lot more reliable than the SST!

The SST is notorious. I can't imagine why it's still being used. In this review by Dorin annals.org/article.aspx?art... three decades of the literature were examined and it was found to have only 60% reliability, i.e. missed 2 cases for every 3 it found.

I hope you can find some tactful way of telling your doctor all this, and I wish you luck!

Joanna

[Granny56]

Thank you, your suggestions and comments are most helpfull.

In 2005, I was diagnosed with a pituitary adenoma. At this time my pupils were unequal with 50% reduction in reaction in one eye. However, in 2010 a repeat MRI scan could not find the adenoma, my pupils had equalised and so no further follow-up was carried out.

In Sptember2015, I had symptoms of an adrenal crisis, my cortisol was -1ug/dl and I was extremely ill. In Nov 2015, it was 5ug/dl so to be 13,4 now is a bonus.

I am still waiting on the report being sent to my local doctor, but I don't understand why these results from January don't seem important, especially as he diagnosed adrenal insufficiency, diabetes Mellitus and potentially some other hormone related illness. My pulse is always over 100bpm at rest and my BP has dropped dramatically from >200/110 to 90/50.

I have so many illnesses to deal with that I am struggling to cope. Doctors seem also unable to cope with my complex array of diagnosis and so I always need to be one step ahead.