Phase 3 HPA axis (adrenal ) dysfunction & Hashimoto's

[fizzygig]

Hi have attached my Regenerus saliva cortisol results which shows that my mirning cortisol & DHEA are very low with a comment that I have Phase 3 HPA axis adrenal dysfunction. Following duscussion with GP serum cortisol done (NHS) & this was 229nmol/L (satisfactory) range 200.00-500.00nmol/L.

I have an appointment next week to discuss result but as serum cortisol is satisfactory I suspect she will be reluctant to refer to endo. Should I be worrued about my results?

Aside: my Medicheck TSH was 1.61( range 0.27-4.20) on 9/11/18 & my NHS TSH was 0.41(range 0.35-5.50) on 28/11/18. Inbetween tests I started to take my medication at 4am when I wake, instead of with breakfast, introduced zinc, selenium, magnesium. Is this drop good or bad?

[SeasideSusie Remembering]

fizzygig

Normal results should follow the green band, following the "curve" of cortisol being highest on waking and gradually lowering throughout the day to the lowest level at night. Optimal levels

are:

• Morning at the top of the range

• Noon approximately 75% of the range

• Evening close to 50% of the range

• Nighttime at the bottom of the range

As you can see, your morning result is way too low and your noon result should be higher than your evening result.

Are you taking any medication or supplements that could be affecting your levels, there is a list here

rt3-adrenals.org/does_it_af...

Here's an article about the different stages of adrenal fatigue:

drlam.com/adrenal-fatigue/a...

Aside: my Medicheck TSH was 1.61( range 0.27-4.20) on 9/11/18 & my NHS TSH was 0.41(range 0.35-5.50) on 28/11/18. Inbetween tests I started to take my medication at 4am when I wake, instead of with breakfast, introduced zinc, selenium, magnesium. Is this drop good or bad?

Were both tests done under the same conditions - i.e. same time (early morning, before breakfast), left off Levo for 24 hours, water only to drink before test? The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well. So a lower TSH is good but it's important to know if both tests were done under the same conditions. Also, TSH alone isn't enough, what were your FT4 and FT3 results?

[fizzygig in reply to SeasideSusie]

Serum cortisol - only taking Levo at time of test, so nothing that could effect results. Worried about these results - thanks for link.

TSHlevels - First test at 8am 2nd at 9.30. I had not taken medication for 24 hrs prior to test & had only drank water, no food.

GP would not do my FT3/FT4, but Medicheck FT3 was 4. 61& free thyroid was 18.800?

[SeasideSusie Remembering in reply to fizzygig]

Assuming the usual ranges we see for Medichecks then

FT4: 18 (12-22) = 60% through range

FT3: 4.61 (3.1-6.8) = 41% through range

So these could be a lot better.

How are your Vit D, B12, Folate and Ferritin levels?

[DippyDame in reply to SeasideSusie]

SeasideSusie ...many thanks for the Dr Lam article above. I'm looking into my cortisol/DHEA results in greater depth and this is exactly what I need.

T3-only has made a big difference but I feel something else is still amiss ....deeper reading reqd but I think the answer is here!

You are a star!

In haste...

DD

[Hidden]

What time was your blood cortisol taken? If it was around 8-9am then it is not satisfactory. The reference range is for the whole day, cortisol fluctuates throughout the day & should be the highest first thing in the morning & should be doubled what has said to be "satisfactory". A figure of that number warrants further investigation & you need to be referred to an Endocrinologist to have a short synacthen test done, you also need an ACTH blood test done at the start of the test to see if the issues is with your pituitary or adrenal glands. (The ACTH blood test needs to go on ice straight away. ) Have a look at the UK Addisons website for more help or if you are n Facebook then join the UK Addisons info & support group for help. Oestrogen will give elevated results so ideally you would need to be off the pill or HRT for 6 weeks prior to testing. Don't get fobbed off by being told that the result is normal as it isn't!

[fizzygig in reply to Hidden]

Thanks for your reply , the Serum cortisol was taken at 9.30am , no hormones only taking Levothyroxine? I have not been called back to see GP about these results I guess they think the levels are OK. I asked for a print out & made an appointment myself for next week. I have not been well for a long time & intend to request endo referral but guess thus could take months.

[Hidden in reply to fizzygig]

Sadly many GP's don't have experience of pituitary/adrenal problems so don't understand that these are not normal results. You need to ask for a referral to an Endocrinologist. Get in touch with the UK Addisons for help & advice. addisons.org.uk