Thyroid UK

Short Synacthen Test Results

I have just had results of my Short Syncthen test. Cortisol readings were 273 (nmol/l) and then 464 (nmol/l) . I am suffering from postural hypotension. I am on a low does of thryoxin due to other symptoms and had a thyroidectomy 30 years ago. My GP says the tests are within the normal range. However the test was carried out at 11.10am does that make a big difference and are these results deemed accurate enough to provide a diagnosis or is it like thyroid testing which seems to leave much to be desired? Stuart

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If you look at pages 68 - 70 of this document :

imperialendo.co.uk/Bible201...

you can see how an SST should be carried out. It tells you about preparation, how to carry out the test, timing, and how to interpret the results.

I don't know enough to know how the test should be interpreted when it is done over 2 hours late. But I'd be dubious about your doctor's comment, to be honest. You might want to ask him how he can justify what he's said. But how you can say that tactfully and not upset him? Since I suffer from a total lack of tact I'm not the person to ask!

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To be fair to the GP he is going back to the consultant to "ask if there is any merit" in the test being run again at 9.00am this time although he doesn't personally think so as the levels went up sufficiently in his view.

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Hi - I can't comment on the adrenal tests, but you say you are on a low dose of levo, How much are you actually on? After a total thyroidectomy it is likely that you would need 100mcg at the very least and probably a lot more, maybe even additional t3. You are very probably undermedicated. Do you have any recent thyroid results you can share? You are entitled to a copy of these by law so ask your gp's receptionist for them. Then post them here with ranges - should look something like TSH 3.5 (0.4-4.2) - and we will be able to advise you better.

You want any results you can get from TSH, ft4, ft3, TpoAb, TgAb, folate, ferritin, vit d, vit b12.

Gillian

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HI Gillian. I seem to have been one of the "lucky" ones who didn't feel too bad over the years and so wasn't on any levo until 8 weeks ago and that was after cajoling my GP to start me on 25mcg. I have had pernicious anmenia for 10 years for which I receive regular B12 injections. The last set of thyroid tests were TSH 2.74 (ref rating uU/mL 0.35 - 4.50 and Free T4 14.9 (ref rating pmol/L 11.00 - 26.0 - taken privately 4 weeks ago. Prior to that 8 weeks ago TSH levels were 2.11 - no T3 or T4 were taken - typical NHS although most of the others you mention were taken and were within the normal range. . I will be seeing the GP in a couple of weeks time and insisting on increasing the dose although he will be very reluctant although generally a good guy. It certainly will not be as high as you say it should be. Stuart

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In that case I would suspect that your thyroidectomy wasn't a total one but partial. A TSH reading of 2.74 on 25mcg levo shows that your thyroid is struggling. The aim for a levo treated hypo patient is to have a TSH around 1 or even lower, with ft4 in top quarter of range and ft3 in top third, or whatever it takes for the person to feel well. Lots of references on here (use search function) for recommendations by Dr Anthony Toft on this.

As you have pernicious anaemia it is likely that you also have hashimotos hypothyroid - another auto-immune. Btw are you on folic supplements alongside your b12?

You say the rest of the nutrients were within the normal range, but just in range is certainly not good enough when it comes to supporting the thyroid and utilising the hormones. They all need to be at fairly high levels and deficiencies are almost universal with hypo. Could I suggest that you ask for copies of all the results and post them here for specific advice? Bringing some of these up can make a substantial difference in how you feel. If you don't have them now, then I would recommend starting a new post with these.

Gillian

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Hi. I will happily post my results. To whom would I address them and do I just use the main address which I presume I will find in the Home page?

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Just write a new post to make sure maximum people see it.

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The only results I can see that match your post above are as follows taken on the 21/3/17. Vit B12 1338, Serum Folate 4.4, Serum Ferritin 192. Other tests since (8/8/17 )have been on bloods, and also sodium 139, Potassium 4.5, Urea 5.1, Creatinine 95, Albumin 44, Alkaline Phos 50, ALT 21, AST 24, Bilinrubin 20, Gamma GT 56, Glucose 5.2, Est Reactive Protein 1, PSA 0.666. all normal!!!!! Let me know what else might be of use such as more info on bloods.

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For future info, always give ranges E.g. tsh 2.3 (0.4-4.2) with results as they differ between labs and it can be almost impossible to interpret without them. but from what I can tell, your b12 is ok from your injections, unless you have an odd range your folate looks to be bottom end - needs to be half way through range - important since it is needed for b12 to work properly. Your ferritin looks to be possibly a bit high, should be half way through range or a bit more - towards top of range or higher can show inflammation somewhere but your crp doesn't indicate this - have you been taking iron?

See what your GP days, but you do need a dose increase. Come back and start a new thread for advice if they won't increase.

Btw, hindsight is a great thing with thyroid, looking back I now realise I had been affected for at least 15 years , probably 20, before diagnosis.

Good luck,

Gillian

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Hi Gillian, Thanks again for advice. TSH 2.74 was in range uU/ml 0.35 - 4.5 and Free T4 at 14.9 between pmol/L 11.0 - 26.0. I am not taking iron. On these few results is there anything I should be taking as a supplement to help in the interim? Should I take folic acid for example? This is all really helpful. Thanks again. Stuart

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Hi - it depends what your particular range is for folate. It seems to have a vastly differing set of ranges, from being over 2.5 to 2.5-52, depending on the particular lab. If you have the ranges for yours then work out if your value of 4.4 is under or over half way. I would say that with b12 injections it is probably better for it to be closer to top of range. You could take folic acid or better would be a multi B Complex containing methylfolate, the more bioavailable form. This would also help balance out your b' s. Are you in the pernicious anaemia group on healthunlocked? They are the real experts on b12 issues.

Apart from that, try to get your vit d tested - serious deficiencies in much of UK population even without hypo issues! If your GP won't t do this, then available at reasonable price through city assays or as part of a wider thyroid package from mefichecks or blue horizons. It would also be useful to know if you have auto-immune hypo or straight primary. That is shown by the TpoAb and TgAb that I mentioned earlier. If you are positive, there are steps you can take yourself to help, though dont expect gp to understand or even know about these as most seem to know very little about thyroid.

For all your other results (not the thyroid related ones) look up labtestsonline for explanations.

Gillian

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Hi Gillian. So much detail and so much I don't know. Will join the B12 group. Also started to take a multivitamin which at least has B numbers and folic acid although also some iron which I probably don't need. Will post again once I have seen GP about more comprehensive thyroid tests. Stuart

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Sorry, should have added, any dose increases can only be by a maximum of 25mcg every 6 -8 weeks.

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Sorry yes it was a partial thyroidectomy. As far as I can remember they took 7/8ths of it. On looking back I realise I probably did need levo well before this but a fairly traumatic set of unstoppable nose bleeds on holiday in Turkey 6 months ago and then some balance issues after that seems to have triggered a reaction although not sure that they had anything to do with it just that they occurred at the same time as my other very typical underactive symptoms got worse.

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l was given one at local Hospital which showed nothing after a Low Cortisol blood test. Had thought l was getting somewhere at last after decades of Hypo - tried to refer me fr ME when l know now its actually Pituitary. Many on here have found that test useless. Good luck

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Thanks for your input. Stuart

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Also l realised after decades - and importantly what my Healer did (sadly now gone) its the Pituitary gland in my case causing the thyroid trouble via low Cortisol - which doesnt show up in the normal basic GP thyroid test. l looked on Pituitary org who have bril free phone line. lt affects less of us - but they did say make sure you see Consultant at Centre of Excellence like Soton General. l am waitiing for my appointment after the useless trip to another hospital. l dont care for having synthetic chemicals pumped into me either and was bit rough 2 days after

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This test is pretty useless, and not carried out at the correct time makes it more useless. All the doctor is interested in is if your levels rise, not how low you start off with. I would say your results are pretty low.

Have you thought about an adrenal stress test at home? If you look under private testing on the thyroidUK main site you will see the information. The test uses saliva and is taken at 4 different times throughout the day until bedtime. Saliva is thought to be pretty accurate for hormones.

When I had the short synacthen test the whole procedure was a joke. Nothing was ready at the hospital, I sat next to a very frail elderly woman, 5 different members of staff tried to get the cannula in her, this went on most of the morning. I have a phobia of hospitals and anything medical, with good reason, and have a long history of problems with cannulas, so I sat there freaking out. The test was very delayed like yours Stuart. My numbers by that time were in the 400's, but of course if you're stressed it messes up the test. I have done two adrenal stress tests now 1 year apart, and they show very low cortisol and DHEA. My morning cortisol on waking is on the floor.

Do you have symptoms like fainting, nausea, weakness, dizziness on standing, not coping with any stress? I get terrible symptoms if I get stressed, I can't think straight, I shake and feel like jelly, it's really awful.

I think the adrenal stress test will give you the information you are looking for, and in your own home you are obviously less stressed.

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Thanks that is all really helpful. Yes I have most of those symptoms and a good few more. I will look up the home adrenal stress test. Will it be accepted by my GP though or are they all primed to ignore "outside influences" like that?

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Just noticed I got your name wrong Stuarth, sorry.

My GP wasn't familiar with the form of the test results, so what i did was write the results like lab results, ie with the ranges in brackets, that way she could easily see that the results were really low. For instance my morning cortisol was only 3 when the range goes up to 21 if I remember correctly . You get a write up from the lab explaining the results. My last test I had reached the adrenal exhaustion stage.

It's hopeless to try and get treatment for low cortisol, my GP put me on hydrocortisone, but then lost her nerve and took me off it ( it's very expensive)

I have unexplained chronic diarrhoea since 1998, when I took my own hydrocortisone that really improved. My stamina is non existent, I also have very dry skin despite a shed load of thyroid meds, my eyesight too fluctuates from double vision to blurred, I always have acne too, pus filled pimples on my face and behind my ears. I lost most of my pubic hair, and my underarm hair has completely gone. I'm really suffering from non stop anal fissures, I read there can be a link with low cortisol.

I'm interested in your symptoms if you want to share them.

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Hi Helcaster. Actually you did get my name right. It is Stuart. It was something to do with having a username that wasn't already in use - hence Stuart with h which is my middle initial. Thanks for the advice on the test. You sound as though you are really suffering. My symptoms are extreme tiredness, insomnia, anxiety, alcohol intolerance, breathlessness, constipation, loss of appetite, low pulse, low mood, memory loss/confusion. Still reckon they are thyroid based considering I only have part of it left after an operation 30 years ago. Also have pernicious anemia for which I have regular injections. Stuart

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Hi Stuart, mine can be so bad that even washing my hair in the shower can cause me to faint. I tried to get snow off my car once, and because it was physical I went into a faint but had to climb stairs to lie on my bed, that was really frightening.

Yes breathlessness, sleep deprived, I never go to bed before 1.30am I can't sleep, I seem to get energy only late at night, low mood too, confusion too. I tried to do my filing, and I just couldn't work out date order, lots of examples like that, I once sat for 20 minutes trying to divide something by 10. I think adrenal and thyroid symptoms sometimes blur. When I need to inject myself with B12 I can get breathless, the same with low iron.

Do you have a good relationship with your GP? You really need someone who will work with you as a partner. My previous GP was like this, no problem with admitting the gaps in her knowledge, so we shared information.

I would recommend the adrenal stress profile, I have always used Genova labs, they are very efficient.

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Forgot to mention alcohol, I have interstitial cystitis so the only thing I can drink a little of is real ale. I probably don't have more than 3 half pints in 6 months. I have found more and more that any alcohol makes me sweat profusely, it's really unpleasant, also I can get diarrhoea within minutes. Before I got diagnosed with both diseases I used to enjoy red wine, just the odd glass, and I used to get terrible stomach cramps and diarrhoea, I had no idea why this was happening.

My ill health started with an untreated hospital infection that led to a haemorrhage. It definitely affected my endocrine system, for years I could barely walk, everything was in slow motion and I felt like I was walking through thick porridge. My mind was always very sharp, that went too. If there was a wheelchair around outside a store I used it, I was absolutely crippled. Of course the doctors all covered their backs, and it took my GP 7 years down the line to admit it was the cause of all my ill health.

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The aim of thyroxine is to get the FT4 -and the FT3 in the top third of their respective ranges. So for a range of FT4 (11-26) then to be in the top third you are aiming for a result of 21+ so you are very undermedicated.

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Thanks for that. Stuart

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