My Latest Blood Test Results - Adrenal Insufficiency Query

They didn't do the thyroid antibodies as I asked nor the gonadtrohins (which I didn't ask for but maybe I should have).

Cortisol = 398 (175 – 600)

(note on the results to say >300 means adrenal insufficiency, but if clinical suspicion high suggest discussion with endo) - yet is has been in the 600s last 3 times!

Thyroid TSH = 0.65 ( 0.35 – 4.50)

(slightly lower than last two times)

T3 = 4 (range 3.9 – 6.8)

Similar to last two years

T4 = 14.4 (11 – 24)

Similar to last two years

Blood Sugar = 38

Prolactin = 436 (102 – 496)

Lower than 2014 but higher than 2015

Vitamin D = Wouldn’t do it for free (would have cost £35 + £50 admin fee!!!) Though they made an error and I got my T3 and T4 tests free – said it’s cheaper to supplement

Mar 2014 = 43.1

Feb 2015 = 50.5

Ferritin = 60 (13 – 150)

Two years ago was 10 and needed supps so moving in right direction

B12 = 348 (180 – 2000)

(moving in the right direction slowly)

Thanks

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17 Replies

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  • Foggymoggy,

    It's probably a typo and should say Cortisol <300 indicates insufficiency.

    TSH is low-normal, FT3 is very low in range, and FT4 is also low at less than mid-range.

    How much iron and B12 are you supplementing? Levels are low considering you've been supplementing 2 years.

    You can order a finger prick testing kit to check vitamin D from City Assays for £28.

    thyroiduk.org.uk/tuk/testin...

  • Sorry, Clutter, I didn't make the notes clear. It wasn't a typo, but in full it said 'a random cortisol > 300 makes adrenal insufficiency unlikely. However, if clinical suspicion is high then suggest discussion with an endo'

    I'm no longer supplementing iron after it returned to within range. I've not been supplementing Vit B12 either. I'm trying to add a supplement at a time to see if they help.

    Btw, I'm not diagnosed as having thyroid issues and therefore am not taking any medicines for it. The lows in TSH, T3 and T4 suggest a there may be a pituitary problem but my GP has said that Cushings is extremely rare. The only other thing it might point to is an adrenal problem but I don't know enough about that and whether the results would indicate this or not.

    I am diagnosed with Fibromyalgia

  • Foggymoggy,

    I'm not sure FT4 is low enough to indicate secondary hypothyroidism (pituitary dysfunction) but your GP could order a pituitary function test or refer you to endocrinology if pituitary dysfunction is suspected.

    Cortisol >300 makes adrenal insufficiency unlikely. Cushings is caused by over production of cortisol, usually as a side effect of steroid treatment. nhs.uk/conditions/Cushings-...

    You may want to continue supplementing iron with vitamin C until ferritin is around 100. 75-100 is optimal.

    B12 is optimal around 1,000. Supplementing 1,000mcg methylcobalamin with a B Complex vitamin will raise B12.

    It's a good idea to introduce new supplements at 2 week intervals as it helps identify which, if any, causes adverse results. It can take months to raise ferritin but I found supplementing 1,000mcg methylcobalamin doubled B12 levels in 8 weeks. I continue supplementing to maintain B12 levels.

  • Clutter

    Thanks. The ferritin supplements didn't help with my fatigue tbh. I stopped them a few months ago as they also caused constipation so once my levels were up they also stopped prescribing them.

    My Cortisol levels were over 600 just out of range three times on the run. This is the first time they've been this low in a couple of years. A GP did invite me to have the dexamethasone suppression test if I was worried but I didn't get round to it.

    It therefore seems from your post, Clutter, as if I don't have a thyroid or pituitary problem (as yet) serious enough to warrant treatment so I will carry on dealing with Fibromyalgia as I have been. I don't seem to be getting anywhere with thyroid/pituitary diagnosis and that may be because I don't have a problem that warrants treatment but I did want to rule it out

  • Foggymoggy,

    I don't think FT3 bottom of range and low FT4 rules out a thyroid/pituitary problem. It is much harder to get a diagnosis of secondary hypothyroidism than primary hypothyroidism unfortunately.

  • OK thanks. But I don't know where else to go with this. As I've seen on here it's hard enough to get primary thyroid issues treated. I will just have to keep monitoring it, I guess.

  • A person with thyroid hormone resistance can have normal thyroid labs..but they are indeed hypo at the cellular/tissue level. This is what dr lowe wrote papers on. Nearly all of his fibromyalgia patients had normal thyroid labs.

    In this case, he put them on thyroid hormone.ones with t3 in it, but first replaced other hormones..sex, cortisol and growth hormone. Fibro's almost always have abnormal patterns of growth, cortisol and thyroid.

  • The problem is, I can't get any diagnosis regardless of what Dr Lowe said

  • you won't..not in this day and age. when TSH is the gold standard. You would have to self treat...many of us have to or remain ill. Luckily you can buy without prescription online. In the days before computer, we had no options. T3 and ndt are totally safe.

  • I wouldn't want to self-medicate without supervision. I have seen too many posts/forums where people have bad effects by taking too much. That is very frightening for some people

  • you can cut back the dose and the symptoms stop, in a day or so, on t3 only...it is not dangerous, just uncomfortable. By gradually going up on the dose, the chances of going over by much are slim. Personally, i would rather try it, than let the ignorant doctors leave me in pain and totally misery, for the rest of my life. That is more frightening to me than a day or 2 of possible discomfort from overmedicating.

  • FM,

    TSH ok but T4 & T3 low in range.

    If as you say ... [... > 300 makes adrenal insufficiency unlikely .. ] .. and you had 600's last 3 times, it make adrenal insufficiency unlikely as Cortisol levels are fine.

    Whether diagnosed with thyroid issues (or not) .. "optimal" nutrient //iron levels will enhance thyroid hormone production ... Although iron has reached a level 'within range", it is still under range so far from optimal ... and requires constant supplementing to maintain it ? ? ...

    Vit B12 is too low and requires supplementing .. 1,000mcg methylcobalamin and take a B Complex vitamin to keep the other B vits balanced.

    Vit D appears to be going down ? ? ... Clutter has given info re testing..

    Thyroid antibodies are rarely tested more than once (unless you are lucky ! .. ) .. members use private labs - links below. Have you had previous positive//negative result ? ? ..

    .

    Private labs testing

    thyroiduk.org.uk/tuk/testin...

  • Radd, no I didn't say Vit D levels were going down. There's been an upward trend since I was first diagnosed with deficiency in 2010 when Vit D was 22. It's been going up ever since although it still needed supplementing as still low. But they won't test it any more because they say it's cheaper to supplement it, even though supplements cause me constipation. This time of year I can get it from the best source ie the sun.

    I did have one lot of antibodies done a few years ago and they just told me they were negative. I never got any figures.

  • Sorry FM ..... I misread the year. It's good levels are increasing.

    I get my Vit D from the sun at this time of year too as love the sun.

    I hope you get to the bottom of why you feel so unwell.

    Did you have both TPOAb & TGAb tested ? If you suspect adrenal problems have you had all sex hormones tested ? ? ..

  • Hi Radd

    No, they only tested Thyroid Peroxide antibodies - is that TGAb - and they were negative. I actually wanted them both done but they ended up doing neither. I thought one of them might be private but I thought they might repeat the one they'd done before if I asked because presumably it can change from negative to positive and also I wanted to get the actual numbers. I didn't realize I could at the time. They did the Gonadotrophin levels in 2014 - Serum FSH and LH. Is that what you mean? I discussed them with an endocrine nurse on the phone and she didn't think it was indicative of anything but just to monitor my bloods.

    Yes, I like the sun but not when it's too strong!

  • FM,

    Yes but much more comprehensive.

    ie .. When progesterone is low or oestrogen is elevated it can bind with thyroid hormone carriers stopping it from reaching peripheral receptors. It also binds with cortisol-binding globulin which binds cortisol in the blood reducing the amount of free cortisol available to enter the cell membranes and activate receptors inside.

    In addition, oestrogen dominance interferes with the release of cortisol from the adrenal cortex.

    Also cortisol is made from progesterone and when this is low it can effect cortisol production.. ...or when cortisol is high it can block progesterone receptors, making them less responsive.

    These are just well known issues but there are many more hormones & possible scenarios of why you don't feel well.

    I don't know if you would get really comprehensive hormone testing done on the National Health. Do you have a practitioner who could help you ? / ...

    TPOAb is Thyroid peroxidase antibodys. TGAb is Thyroglobulin antibodys. Either or both determine Hashimotos.

  • Hi Radd

    Yes, I had one of the tests for Hashimotos two or three years ago and it was negative so never repeated.

    As I am going through the change my hormones are all over the place anyway and so are most likely to be confounding the picture. I was trying progesterone cream for a while as it helped by sweats a little bit (cold sweats I have to add) but then my bp was up and as I read more about progesterone cream I saw it could have the same effects as Oestrogen which I refused on those grounds. My bp was up after taking the progesterone cream - I can't say it was that for certain but it is highly likely. I had to have treatment for hypertension caused by bp from being on the contraceptive pill when I was very young so am naturally wary especially as I am older now. I could even feel the blood pounding in me back then

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