THYROID AND ADRENAL FATIGUE SYMPTOMS

I am a 24-year old man and have poor health symptoms which might indicate thyroid and/or adrenal fatigue conditions e.g. severe fatigue, muscle weakness, brain fog. I believe they were caused by side effects from a GP-prescribed medication which I stopped 6 months ago and has also contributed to other symptoms e.g. sexual.

Hopefully I will get some advice on this from the Community in confirming or denying these conditions and treatment. For the past 2-3 months, I have drastically altered my diet and am set to increase my supplements to address these conditions.

Examples of my blood test results:

(i) TSH and T4; 4-5 months ago are relatively low at ~1.3miu/l and 10.7pmol/l albeit in the "normal" range and so not progressed by GP.

(ii) Cortisol; ~5 months ago was 210-257 nmol/l

(iii) Vitamin D; 77.7 nmol/L ~2 months ago (after GP-prescribed supplement - was even lower ~5 months ago)

36 Replies

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  • Welcome to the forum, Userotc.

    TSH 1.3 is euthyroid (normal). I can't tell whether FT4 10.7 is particularly low without seeing the FT4 range (figures in brackets after results). NHS doesn't diagnose hypothyroidism unless TSH is over range (usually >5-6) or FT4 is below range.

    I can't comment on Cortisol, hopefully another member will.

    Vitamin D is replete 75-200 and most people are comfortable around 100. I would continue supplementing D3 until April when ultraviolet levels are high enough to stimulate natural vit D.

  • Thanks Clutter.

    The normal ranges that I previously found (and their sources) are shown below:

    (i) TSH: 0.4 - 4.0miu/L (http://www.btf-thyroid.org/information/quick-guides/97-thyroid-function-tests)

    (ii) T4 free: 9-25 pmol/L (same source)

    (iii) Cortisol: 193-772 nmol/l (http://emedicine.medscape.com/article/2088826-overview)

    Hence I think I am low/borderline for (i)-(iii).

    I have ordered Vitamin D3 and plan to dose at 2000IU/day indefinitely.

    Re hypothyroidism, I understand your comments re NHS but I think I read last week on the Thyroid UK site an expert comment that the TSH/T4 readings may be misleading (?) so I may have the condition.

    Do you think I may have thyroid/adrenal problems?

  • Userotc,

    Labs use ranges recommended by the manufacturer of the analysis machinery they use and the local population samples taken. You can't compare your results with any range other than the range your lab uses. Your GP practice or the hospital lab pathology dept should be able to tell you what ranges your lab uses.

    TSH 1.13 rules out primary hypothyroidism but without seeing where in range FT4 10.7 is it isn't possible to rule out secondary hypothyroidism.

    While it is likely that symptoms may precede abnormal thyroid results by months, perhaps years, NHS diagnoses on abnormal thyroid levels, not borderline levels or symptoms.

    I don't know enough about cortisol to comment usefully other than to say you need to find out what your lab's range is as above.

  • Clutter, I must confess to not understanding all of your response but my experience with our GP suggests its a waste of time asking them for the details you suggest.

    Any other advice as to how I might find out if I have thyroid/adrenal problems or not? Whilst Ive seen an endocrinologist and found him not very useful (he tested my testosterone and related measures only), I could try him if you think it's useful.

  • Userotc,

    Either ask your GP receptionist or practice manager for the ranges the lab used for your results or order your own private thyroid labs. Blue Horizon Thyroid Plus 11 is quite comprehensive and tests TSH, FT4, FT3, thyroid antibodies and ferritin, vitamin D, B12 and folate.

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

  • Thanks Clutter. Since I can see my results online, I can also see the "Normal Range" alongside which are:

    (i) TSH: 0.3 - 5miu/L

    (ii) Serum-free T4: 10 - 18.7pmol/L

    (iii) Serum cortisol: No range shown

    (iv) 25-OH Vitamin D: 50 - 250nmol/L

    Hence the comment in my original post that my TSH and T4 are (just) in the "normal" range at ~1.3miu/l and 10.7pmol/l resp. Is that enough to say I dont have adrenal fatigue/thyroid isues? I repeat that I think I read on Thyroid UK that blood readings may be unreliable?.

  • Userotc,

    TSH 1.3 is low-normal but FT4 10.7 is low in range. Results are currently euthyroid (normal) because they are within range but I think you should retest in 6 months in case FT4 drops below range. If it does without TSH rising your GP should consider secondary hypothyroidism due to pituitary dysfunction. Thyroid blood tests are a snapshot in time and there is no reason to think they are unreliable. What may happen is that symptoms will precede abnormal blood levels by months/years.

    I don't know enough about cortisol or adrenal fatigue to venture an opinion.

  • Many thanks Clutter. I do indeed plan to ask for a retest for TSH and T4 (and T3) plus others Vits B, C, E, folate, ferritin, Mg, Ca. That will be next month so let's see then.

    I think it's good that you qualify T4 as low despite being "in-range". My GP and endocrinologist don't want to know if in-range.

  • Userotc,

    Unfortunately most doctors find anywhere in range acceptable whereas most thyroid patients on Levothyroxine will need TSH low and FT4 high in range to feel well.

  • Clutter,

    Since my last message, Ive had further tests with the results shown below which I think indicate an improvement in possible thyroid condition with FT4, PTH, TSH higher than ~6m ago (almost doubled for the last two). Can I now relax?

    The additional tests seem to indicate an higher than normal iron level although the GP is totally unconcerned. Note, however, that Ive just read that tests could be affected by various factors including my use of B-12 supplements webmd.com/a-to-z-guides/iro...

    Serum free T4 level: 11.5 pmol/L (10 - 18.7)

    Intact PTH: 2 pmol/L (0.8 - 7.7)

    Serum TSH level: 1.96 miu/L: (0.3 - 5)

    Male Testosterone: 17.3 nmol/L (8.4 - 28.7)

    Serum inorg. Phos: 1.31 mmol/L (0.8 - 1.5)

    Serum vitamin B12: 725 ng/L (170 - 730)

    Serum folate: 24 ug/L (3 - 19)

    Serum iron level 20.4 umol/L (8 - 32)

    Sat. Fe binding capac 46.4 umol/L (Not shown)

    Unsat Fe binding cap 26 umol/L (27.8 - 53.7)

    Transferrin sat index 44 % (20 - 50%)

    Serum ferritin 130 ug/L (22 - 320)

    Corrected serum Ca 2.29 mmol/L (2.2 - 2.6)

    Serum bilirubin level 37 umol/L (3 - 20)

    Footnote: 3 out of range, 1 borderline/near out of range.

    Oliver

  • userotc,

    TSH has risen to stimulate better production of T4. FT4 has improved but is still low in range.

    Bilirubin labtestsonline.org/understa...

    Other results are within range (normal).

  • Clutter, thanks. Is my increased TSH (and PTH) a good sign though?

    Ive now asked my endo to check FT3 as my GP couldnt/wouldnt do. Im not confident my endo will either but let's see.

  • Userotc,

    Rising TSH isn't desirable. It means the thyroid is being flogged to produce adequate T4 and T3.

    I doubt there is any significance to PTH rising to 2.0.

    NHS rarely tests FT3 unless TSH is suppressed <0.03. They are looking for evidence of high T3 in hyperthyroid patients not low FT3 in euthyroid or hypothyroid patients.

    Blue Horizon Thyroid Profile Plus 6 tests TSH, FT4 and FT3 or Thyroid Profile Plus 11 adds thyroid antibodies and some vitamin and mineral results.

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

  • Clutter

    Which of the test options would you recommend bearing in mind that I already have TSH, FT4, Folate, B12, Vit D, serum Ferritin and Transferrin saturation index data?

    If ultimately diagnosed, Im reluctant to take a drug (a drug is where I started 14mths ago - see my original post 25 days ago) but I understand it may difficult to get NDT from physicians?

  • Userotc,

    I would opt for Thyroid Plus 6 then but if you recently had thyroid tests it probably isn't worth retesting for 12 months.

  • Clutter, Im unsure what you mean re "thyroid tests". Ive had various blood tests including those listed but no physician has diagnosed me with a thyroid condition. Are you now saying there's no point getting the Blue Horizon tests done for another 12 months?

  • Userotc,

    TSH and FT4 aren't likely to change quickly so the only reason to order a thyroid test within 12 months is if you want to know what your FT3 level is.

  • Clutter, so is the quickest/easiest thing to just get FT3 tested or are the antibodies also important?

  • Userotc,

    It's useful to know whether antibodies are negative or positive. If positive it is likely you will become hypothyroid but it probably won't get you a hypothyroid diagnosis or treatment any sooner. Blue Horizon Thyroid Plus 11 includes FT3 and thyroid peroxidase and thyroglobulin antibodies.

  • Clutter,

    As you previously advised, Plus Six seems to be a more focused/better option including: TSH, FT4, FT3, TT4, Thyroid Peroxidase Antibodies, Thyroglobulin Antibodies. Agree? Only TSH and FT4 would be "wasted"/repeated and maybe BH would be willing to reduce the cost if these are not done?

  • Userotc,

    Plus 6 doesn't include antibodies. Plus 11 has TSH, FT4, FT3, TT4, Thyroid Peroxidase Antibodies, Thyroglobulin Antibodies.

  • Clutter,

    According to the link that you sent and the Blue Horizon PDF, Plus 6 just has the tests that you listed with Plus 11 having more eg ferritin, folate etc which Ive had. I'll recheck by calling BH.

    Before I order tests, do you have any views on:

    (i) My use of sea kelp supplements at 150mcg/day (100% NRV) for past ~3 months.

    I note paper thyroiduk.org.uk/tuk/resear...

    (ii) Ive now stopped taking vitamin B Complex and multivitamins following my last tests which showed relatively high vit B (725 ng/L) and transferritin saturation (44%), under-range Fe binding and over-range serum folate (24 ug/L).

  • userotc,

    Plus 6 does not have thyroid peroxidase and thyroglobulin antibodies.

    I personally would not supplement Kelp which has high iodine content unless I had tested and found to be iodine deficient.

    I suggest you write a new post asking for advice on transferrin saturation and ferritin binding results, I don't know much about them.

  • Clutter,

    For your information, I ordered Plus 6 yesterday from Blue Horizon and it includes thyroid peroxidase and thyroglobulin antibodies, as per spec given on their weblink. Ive also ordered an iodine test.

  • Clutter

    Please see below my BH results for 22/12. Any advice appreciated including:

    (i) Should I now stop my 150mcg kelp supplementation?

    (ii) Do any of the results (and/or changes) indicate a thyroid problem?

    (i) Iodine: 46 ug/L (40-80)

    (ii) TSH; 0.96 miu/L (0.27-4.2)

    (Change since June = -34%, since 2 Dec = -51%)

    (iii) FT4: 14.4 pmol/L (12-22)

    (Change since June = +35%, since 2 Dec = +25%)

    (iv) TT4: 68 pmol/L (59-154)

    (v) FT3: 4.4 pmol/L (3.1-6.8)

    (vi) Thyroid perox'se; 6 (0-34) (vii) Thyroglobulin; <10 (0 - 115)

    Footnote: Ive never been diagnosed with a thyroid problem so not on any medication.

  • Clutter, as you haven't replied to my last post. I must assume that you think I should continue with iodine supplementation but that my thyroid is Ok.

  • Us3erotc,

    That would be an incorrect assumption. I hadn't seen your post of 4 days ago and happened upon your recent reply when I was scrolling through Newsfeed. If you used the green Reply tab underneath my reply to you I would have been sent email and onsite notifications that you had replied to me.

    TSH 0.96, FT4 14.4 and FT3 4.4 are euthyroid (normal) and don't indicate thyroid dysfunction. Thyroid antibodies are negative for autoimmune thyroid disease (Hashimoto's).

    Iodine 46 is within range so not deficient. I personally would not supplement kelp unless I was iodine deficient but 150mcg is not an excessive dose if you want to supplement.

  • Clutter, thanks for the reply. Must be a comms problem as I did press the green reply button (unsure what else I could do other than start a new post?). Anyhow, Re your answer it's good to know I am now eurothyroid despite continued symptoms that may indicate otherwise -including (but not restricted to) a return of sinus problems in past few days. Is it possible/likely that symptoms lag bloods so symptoms may now start to ease? By the way, I've never understood meaning of "positive" antibody indications for thyroid - do mine confirm no problem just because they are within the normal ranges given? Much appreciated.

  • Userotc,

    You are biochemically euthyroid so I think any symptoms are likely to be non-thyroidal.

    Thyroid peroxidase antibodies are <34 and thyroglobulin antibodies <115 which means they are negative for Hashimoto's. A few people can be sero negative for Hashimoto's (no antibodies) but may be diagnosed with Hashimoto's due to typical Hashimoto's damage seen on an ultrasound scan.

  • My latest (16 March) NHS blood test results are confusing. As indicated in previous posts, the trend seemed to be heading in the right direction with a euthyroid indication just 2 months ago but that's changed. Can you/anyone please explain the new results below?.

    TSH; 0.08 miu/L (0.3 - 5).

    Note: Previously 1.46, 1.15, 1.96, 0.96 (in order up to latest results)

    FT4: 7.9 pmol/L (10 - 18.7)

    Previously 10.7, 11.5, 14.4

    FT3: 3.7 pmol/L (2.5- 5.5)

    Previously 4.4 (for range 3.1-6.8, so similar)

    FSH 5.6 iu/L (1.6 – 18)

    Previously 3.7

    LH 2.7 iu/L (2 – 18)

    Previously 3.2

    Prolactin 49 miu/L (45-440)

    Previously 112

    Vit D: 86 nmol/L (50 - 250)

    Previously 18, 78

    Besides clarification of the results, I would also greatly appreciate your views on:

    (i) The potential that my 17-day juice fast (including raw kale) mid-end January affected the results. Should I retest in June? I fasted to try to help my gut/candida/digestion problems which remain or have worsened.

    (ii) The potential that relatively gentle exercise a few days before the test affected the results. I had previously avoided exercise as it made me feel worse and I now face having to stop again.

    (iii) I am following the recommendation of others who recoverered from the prescription drug-induced syndrome which initiated my symptoms and theirs. So, for low thyroid (presumably caused by adversely affecting the pituitary gland), I plan to use pine pollen herbs and maybe iodoral supplement i.e. 5mg iodine uk.iherb.com/pr/optimox-cor... This seems to have worked for at least some of them but any views appreciated.

    Note that I'm currently still on 150mcg iodine (kelp), magnesium, vit D, C, zinc, NAC, other amino acids and herbs including ashwagandha. Because of my above experience, I'm reluctant to take pharms and so am following a protocol developed by the others mentioned above including diet (mainly paleo), supplements and specific exercise, when ready.

  • userotc,

    I suggest you write a new post with your questions so more members will see them as updates are easily overlooked on Newsfeed. I know very little about nutrition and fasting but Kale is a goitrogen which can inhibit production of T4 and T3 and supplementing iodine can also inhibit T4 and T3. I don't believe iodine should be supplemented unless you have tested deficient for iodine. It's unlikely gentle exercise will affect results.

    TSH fluctuates throughout the day so you need to arrange blood tests at the same time of day to be able to usefully compare results.

    FT4 has dropped below range which may be due to the kale juices and the iodine you are supplementing but I would have expected TSH to rise not become suppressed. FT3 has dropped because FT4 is low and TSH is not stimulating the thyroid to produce and convert more.

    My advice is to stop supplementing iodine and see whether FT4 and FT3 rise.

  • Thanks, Clutter I will start a new post.

    The advice from various sources (including many TUK posts) on iodine is confusing and conflicting - ranging from being essential to best to avoid. Whilst Ive not been tested as deficient, the only test done (Blue Horizon in December) showed I was low - your earlier comment after that was "Iodine 46 is within range so not deficient. I personally would not supplement kelp unless I was iodine deficient but 150mcg is not an excessive dose if you want to supplement".

    So, at present, I can only think of following your advice to stop iodine and see how I feel (I dont think I can be retested for ~3 months). If no different (or worse), I will hope pine pollen helps otherwise I'd be tempted to try the higher-dose iodine supplement that I mentioned in my last post since that appears to have helped another who recovered from the syndrome which initiated my pituitary-related thyroid symptoms.

    Re TSH testing time, the latest test was done late morning compared with mid-afternoon previously but would that account for >100x reduction? Ive noted a study which reports late morning non-fasting TSH tests declined by an average of 26.39% when compared to early morning with fasting. ncbi.nlm.nih.gov/pubmed/154... I didnt fast for any.

  • userotc,

    This graph shows how much TSH fluctuates during the day and night healthunlocked.com/thyroidu...

    TSH drops after eating and drinking so a fasting test may show higher TSH.

  • Clutter,

    The graph is interesting and my results trend do bear slight similarities in trend (using the different results over a 9-month period). However, as previously indicated, it is the SCALE of the reduction that is most alarming eg TSH min for me 0.08 compared with ~1.2 for the graph you linked. Also Ive just realised that this result was effectively fasting since I don't eat before ~1pm now (intermittent fasting)!!.

    Hopefully your advice to stop 150mcg iodine supplement (which Ive now done) is the solution.

    If my latest results are genuine, what symptoms might I expect and when?

  • Userotc,

    Your results are genuine. They are what they are. It is unusual for TSH and FT4 to drop. I don't know whether it will make you symptomatic or not.

  • I've just been reading other posts in which replies have indicated that you can expect a doctor's report with Blue Horizon results. For mine (shown here 2 months ago) the only comment included was that I should share with GP. Is that good enough? I can start a new post headed BH results if best but any comments appreciated here.

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