Need your help with daughters results

[Deb59]

Hi everyone - I would very much appreciate your opinions on my daughters latest blood tests results.

2 months ago her cortisol level was 668 mmol/L (172-497) and has in the past 3 years had high cortisol results.

My daughters has: Hypothyroidism (Hashi) and pernicious anaemia

Her latest symptoms are: Extreme fatigue to the extent of exhaustion and effecting her work/social life; extreme sudden weigh gain, hair has gone strange; aches and pains

She takes 175mg thyroxine x 4 days a week and 150 mg 3 days

B12 injections every 3 months.

These are her latest bloods:

HbA1c -(IFCC) 33 20-42 mmol/mol

CRP 7.00 <5.00 mg/L

Ferritin 32.1 20-150 ug/L

Insulin 100.6 0-88 (Fasting)

TSH 3.16 - 0.27-4.20 ml/UL

T4 Total 147.9 64-142 nmol/L

Free T4 20.66 12-22 pmol/L

Free T3 4.97 3.1 - 6.8 pmol/L

Anti-Thyroid peroxidase abs 364.3 <34

Anti Thyroglobulin Abs 671 < 115

Vit D 73 <25

Vit B12 250 <140 - 250 insufficient

looking at the above results and high dose of thyroxine I am surprised that her TSH is not suppressed more? does this mean her body is really struggling? we are waiting to hear for an appointment with the endocrinologist - should she reduce her thyroxine as her T4 total is showing she is hyper? she had a B12 injection 3 weeks ago - obviously she needs another now - why is she still low? Has had injections since she was 8 years old now 24 years old.

Your help and advice will be greatly appreciated and many thanks in advance

[Saggyuk]

I can't help in regards to why B12 still a little low, the pernicious anaemia forum on here are better placed to answer that. Maybe you could bring this up with the doctor also. Maybe she can supplement the injections in between if it helps improve symptoms.

Her ferritin looks a little on the low side - have you had blood count and possibly iron panel to see if she has iron deficiency anaemia?

Has she had her folate levels checked as works with B12.

although her HbA1c is in range, her insulin is over - which can indicate insulin resistance and early pre diabeties so might be worth a more in depth look at blood glucose levels with a cheap kit from pharmacy to check for issues and making a few changes to lifestyle to get it lower. This can also relate to cortisol levels. There are ways to help your adrenals which you can google but most importantly, does she eat enough? Or does she eat healthily enough.

You can also order a cortisol saliva test to check throughout the day for a more in depth look.

She's not on a really high dose of thyroid replacement, this is quite common. Not sure why tsh is higher than optimal, maybe other issues causing problems. I personally don't think she's hyper. THere's maybe a teeny room for a small increase in thyroid meds but depends on how long she did the blood test after her last dose of thyroid meds. I'm not sure if her total T4 is of much significance but maybe others here can answer that one better than me

Her CRP is over range but could be because of high thyroid antibodies.

Obviously some of these things may be one offs or temporary but these are where I would start looking into further although I really am no expert nor medically trained!

The only other thing I can suggest is a gluten free diet especially where you mention being hugely fatigued and because she autoimmune. This removed most of my issues including unstable sugar levels, fatigue and pain, other autoimmune issues and many of us here find it helps significantly and can help lower thyroid antibodies.

Hope you work it out soon and she start to feel better