Adrenal situation grim?

[Caesard]

Hello,

have been relatively stable lately on hormone substitution after Graves induced TT (2014) but I have considered to have a deeper look into adrenals activity as I felt HRT, vitamins and minerals are well enough but situation stopped improving to a certain point.

Latest vitamin and test are here, last post, showing a very slightly elevated ACTH and Ferritin: healthunlocked.com/thyroidu...

Now, let's see what I have on adrenals:

- 2013, suppression test, passed

- 07.2016

ACTH 28 Normal - [7.2 - 63.3]

Blood Cortisol @ 8am: 312 Normal: a.m. : 138 – 690

- 01.06.2017

ACTH 74 Normal - [7.2 - 63.3]

Blood Cortisol @ 8am: 491 Normal: a.m. : 138 – 690

Ferritin 479 ng/mL Normal [30 - 400]

DHEA-S 164 NORMAL 88.9-427

- 26.06.2017

Saliva cortisol test

6.7 @ 07:15 a.m. NORMAL 6-10 a.m. : < 24.1

5 @ 12:00 NORMAL N/A

<1.5 @18:00 NORMAL 16 - 20: < 9.65

<1.5 @23:00 NORMAL 24: < 11.3

- 01.08.2017

ACTH 93 Normal - [7.2 - 63.3]

increased again from 01.06!!!

Blood Cortisol @ 8am: 445 Normal: a.m. : 138 – 690

Urine Cortisol (24h average) 237nmol/24h Normal: 100-379

The questions:

Is it me or my adrenals are struggling?

On saliva test, especially on 20:00 and 23:00 points....less than 1.5 seems too low and consistent with the slightly elevated ACTH

Urine cortisol 24h test it is mid interval but

If true that adrenal activity has gone sluggish, what could be the progressive steps to be taken? Any correlation to the T4+T3 substitution treatment? (e.g. too much t4 or T3 blocks adrenal output...it's just an example)

What scares the shit out of me is the increasing ACTH! Might this be from too intensive exercising? (though I did much more intensive exercising and never ACTH was above max.) Might be the stress? I am going through a very stressful period at work.

[Caesard]

So, the little I could find alone is that the cortisol production at evening time should indeed be under the detectable threshold, as it was registered (under 1.5 nmol/L, I would guess this means it is under the laboratory (precise) detection limit)

However, I'm puzzled why the max value for 16-20 interval (9.65 nmol/L) is less than the 24:00 max value (11.3 nmol/L)

[Caesard]

Please, some guidance would be terribly needed; I have been scheduled to see the endo for this and meanwhile attempting to repeat blood cortisol and ACTH while having also the urine cortisol measured (as a daily average)

Temperatures tend to be low before hitting the t4/t3 dose, most of the times not reaching 36 but after administration going in the upper side of the 36; pulse is regular and without major variances.

The more I think the more it seems consistent that a adrenal insufficiency might be an explanation for remaining symptoms. Adding T3 in the mix for the last year and tweaking the doses solved most of the brain fog and increased significantly the energy levels but there are still periods when weeks at the time I feel drained, fatigued and low on everything and it is not in my mind, it is real and physical related.