Could I ask for some help again please? I started on NDT, very gradually, in March and for the past 5 weeks I have been taking 2.25 grains. I was originally on 150mg of Levothyroxine but still feeling lethargic and had other lingering Hypo symptoms. I'd had a full thyroid blood test done with BH and posted results on here. Just for the record, here is my blood result from 8th Feb;
Test Patient Result Normal Range Units Comment
Biochemistry HbA1c-(IFCC) 35 20 - 42 mmol/mol CRP 0.50 <5.0 mg/L Ferritin 148.1 20 - 150 ug/L Magnesium 0.99 0.6 - 1.0 mmol/L
Hormones Insulin 30.8 0 - 88(Fasting) pmol/L
Thyroid Function TSH L 0.11 0.27 - 4.20 mIU/L T4 Total 119.0 64.5 - 142.0 nmol/L Free T4 19.88 12 - 22 pmol/L Free T3 4.48 3.1 - 6.8 pmol/L Reverse T3* 24.0 10 - 24 ng/dL Reverse T3 ratio L 12.15 Normal >15 Ratio Borderline 12-15 Low <12
Immunology Anti-Thyroidperoxidase abs H 38.6 <34 kIU/L Anti-Thyroglobulin Abs 24.9 <115 kU/L
Vitamins Vitamin D (25 OH) 51 Deficient <25 nmol/L Insufficient 25 - 50 Consider reducing dose >175
Vitamin B12 405 Deficient <140 pmol/L Insufficient 140 - 250 Consider reducing dose >725 Serum Folate 12.66 8.83 - 60.8 nmol/L
I posted on here that after approx. 3 weeks on the NDT, I was still feeling tired. It was suggested I had an Adrenal test done, so I had the six saliva test done with BH and here is the result of that;
Test Patient Result Normal Range Units Comment
Biochemistry Biochemistry comment Timings not compatible with expected- actual timings: Sample 1: 06:45 Sample 2: 13:00 Sample 3: 15:00 Sample 4: 17:00 Sample 5: 19:00 Sample 6: 22:30
Saliva Cortisol (Saliva) Waking 20.13 14.0 - 21.0 nmol/L Cortisol (Saliva) 12:00 4.89 4 - 9 nmol/L Cortisol (Saliva) 14:00 H 11.18 3 - 8 nmol/L Cortisol (Saliva) 16:00 L 2.44 2.5 - 7.0 nmol/L Cortisol (Saliva) 18:00 L 2.28 2.5 - 7.0 nmol/L Cortisol (Saliva) Before Bed H 36.59 0.8 - 4.5 nmol/
Over the last couple of weeks, I have noticed an increase in my pulse and occasional surges of 104bpm.- usually in the late evening, or in bed at night.
This is what the BH notes said that accompanied my result;
The timings of the collection are noted - I presume they correlate with your sleep/wake cycle?
There appears to be a normal pattern of cortisol production throughout the period of the collection. The small elevation seen in the third sample is unlikely to be significant, and could represent a natural surge often seen in the afternoon. The last result is likely to be falsely high - was there any chance of contamination (are you taking steroid medication)?
Usually, there is a peak in cortisol production within the first few hours after waking, followed by a steady decline throughout the day. Stress will cause short term elevations, as will eating (and a later afternoon rise is quite common). Assuming the samples were collected correctly, having a low early morning cortisol may imply an underproduction of cortisol. Correlation with a serum sample taken soon after waking would be useful. Repeat 24 hour collection also could be considered to check for consistency.
Persistently low levels of cortisol (particularly around the time of the expected morning peak) have been linked by some to a syndrome known described as adrenal fatigue. This is not a universally accepted condition, but broadly is summarised as follows: Stage 1 represents the normal response to stressful daily events – occasional peaks which may not be detectable on standard testing of four samples taken over 24 hours. Stage 2 is the phase of excessive cortisol production, in response to prolonged stress, and will be displayed on the graph as a later and higher peak, followed by a more steep decline to a day’s end trough. Stage 3 (with its subsets A through to D) represents the later stages of the process, which ultimately leads to low levels of cortisol production over a 24 hour period, and ultimately a loss of the cyclical rise and fall. Stage 4 would be true Adrenal Insufficiency or Addison’s Disease, with little or no cortisol production in the adrenal glands.
I can't understand why they think the final bedtime sample was contaminated as it was done the same as all the others and I am not on any steroids whatsoever. In fact I am on no other medication, just Vit D supplement ( 5000 daily), Vit B12 (1000mcg) daily and Basic B complex (110mg daily) , and Robuvit French oak extract (200mg) .
Can anyone explain things any better please? BH are suggesting I do another six Saliva Test to see if the same pattern is repeated, but it starts getting very expensive! Would you recommend that I repeat it just for (expensive!) peace of mind? I really wish I could find a doctor who understood as much of some of the clever folk on here do! If anyone can recommend one, I would be happy to go anywhere in the country to get a proper and full diagnosis and correct medication, I'd even go Private if necessary, It's all rather scary.
Due to the heart palpitations, would I be wise to come off NDT? And if so, should I try T3 only? So many questions. Where would we be without this Forum??? Many thanks in advance for any help.