Help with blood results, hypothyroid and adrenal insufficiency

[Runner95]

Help with blood test results, Hypothyroidism and Adrenal Insufficiency

I have been diagnosed with Hashimoto’s (hypothyroid) and Addison’s disease (adrenal insufficiency). It is tough to distinguish symptoms of these two diseases since many of the symptoms overlap. But currently, I believe my hypothyroid symptoms have worsened. Please look at my labwork below. I would appreciate any and all thoughts and recommendations.

My cortisol level is low due to Adrenal insufficieny and i have to be cautious with thyroid medicines due to this. I am currently taking 60 mg NP Thyroid. I have had a bad reaction to Synthroid, Levo and Tirosint. Lately, I have not been feeling well, bad headaches, blurry eyes, sensitivity to light, joint and muscle pain, really tired, hungry but nausea, dry itchy skin, etc. Thanks for your thoughts and help. I also take Hydocortisone daily for Addisons disease and a Vitamin D supplement which seems to help.

TSH 6 ref range (.30-4.0j

Free T3 4.2 (3.0-6.5j

Free T4 12.0 (10.0-20.0)

Ferritin 20 (20-380)

Serum iron 10 (10-30)

Transferrin sat .15 (.15-.50)

Total protein g/L 63 (66-84)

Albumin g/L 37 (32-48)

Globulin g/L 26 (25-41)

Lymphocytes 4.8 (1.0-4.0)

Vit D 140 (50-150)

[caledoniancat]

Members may need more info to comment, e.g. How are you being treated for your Addison's? Hydrocortisone? Fludrocortisone? Doses? Were you diagnosed with both conditions at the same time, at different time? How long have you been on medication?

[Runner95 in reply to caledoniancat]

Here is my history, diagnosed with Addison’s disease in 2015 and diagnosed with Hashimoto’s ( hypothyroidism) approximately a year or so later). I take 30mg of hydrocortisone daily in 3 doses, 15, 10, 5. I do not take Fludrocortisone but I overly salt everything and have done this all of my life. I am currently taking 60mg NP thyroid every morning. I can tell that my low thyroid is still causing problems in addition to my ferritin and iron sat level.

[Bramble83 in reply to Runner95]

Hi there,

Interested in your post as I also have Addison’s and have just in the last two weeks been put on Levo by our IVF clinic due to mildly elevated TSH (3.1).

My Addison’s has been really well managed since diagnosis 2 years ago and I hardly ever have symptoms, but since starting the Levo, I feel rubbish and tired and sick and trying to figure out what’s causing it.

I notice you only take your HC 3 times a day; have you ever tried splitting it into smaller and more frequent doses? I know it’s not for everyone, but it made a huge difference to me when I switched to that about 12 months ago.

[Runner95 in reply to Bramble83]

Yes, My Addison’s disease was managed pretty well prior to my Hashimoto’s/ hypothyroid diagnosis too. I went into Adrenal crisis due to taking small amounts of Levo and Tirosint. My symptoms (some) were nausea, vomiting, pain in my abdomen and lower back and legs, bad headache, joint and muscle pain, weakness, feeling really unwell. This went away after stopping the Levo (which I needed to do right away) and increasing the hydrocortisone for a few days. What are your symptoms?

[caledoniancat in reply to Runner95]

I think you might still need fludrocortisone, it replaces the lack of aldosterone caused by your Addison's (primary adrenal deficiency). It helps to balance salt and potassium and in turn your blood pressure. It should also reduce salt cravings. Some of your symptoms are likely to be associated, headaches, blurry eyes, joint and muscle pain, tiredness, nausea. It is worth asking about. 30mg hydro sounds like it could be ok, but will depend on your weight and activity level. My daughter was originally started on 30mg having been diagnosed after an Addisonian crisis but that was eventually dropped to 25. Research recommends splitting hydro 3 times over the day with largest dose in the morning, someone else has also recommended this and yes some people split it down to 4 tmes a day. Hydro stays in your system for around 4-5hrs only, hence splitting helps to stretch that out. When you are treated for hypothyroidism I believe that will then increase the speed of cortisol clearance, so again splitting doses of hydrocortisone may help.

[Runner95 in reply to caledoniancat]

That makes sense, I will talk to my Dr about this when Insee him next. Thanks.

[caledoniancat]

Should have said that if you have Addison's you would normally be prescribed fludrocortisone in addition to hydrocortisone. Are you a runner, a frequent runner? If so you may need slightly higher doses than the norm for Addison's.

[Runner95 in reply to caledoniancat]

Yes, when I run I increase the dose of hydrocortisone. Due to not feeling well, my running has slowed down and i run short distances since my addisons disease diagnosis.

[caledoniancat in reply to Runner95]

Agree with grey goose too re ferritin and serum iron, seems that needs a top up too.

[McPammy]

Hi. I’m sorry to hear how unwell you are. I completely understand as for 12 months I too had adrenal insufficiency and hypothyroidism.

I was not diagnosed with Addison’s. I was told I was borderline. My cortisol was as low as 68(155-607). At 9am it was 150.

I struggled so much with no energy or strength for nearly 12 months. Hospitalised 3 times. Kept collapsing. It wasn’t until I went private after being directed to cardiologist and neurologists in the NHS after NHS Endocrinologist said I had no Endocrine issues. I did!!

Finally I was diagnosed with not converting T4 to T3. I was privately prescribed T3 medication. Within one day all my symptoms went!!! I could not believe that all I needed was T3 medication. My cortisol more than doubled in the first 4 weeks from 150 to 311 at 9am. My cortisol has not been that good in a whole year. All I needed was T3 meditation. The problem with UK NHS is that they wouldn’t pay for it therefore would not diagnose it. It is an absolute disgrace that they let me suffer for so long. Now I am back to normal.

[Runner95 in reply to McPammy]

Thanks for sharing, I will bring this up to my Dr when I see him next. I am traveling currently for work which is difficult when you don't feel well but I have battled adrenal insufficiency for some time now and have learned how to manage my adrenal insufficiency symptoms most of the time. It is an ever changing process.

[IgnoranceSound in reply to McPammy]

Hey! I have the same issue as you. I tried T3 with ct3m method + doses split during the day. I started to having heart palps, anxiety, shakiness ect so I had to stop. How you were able to manage T3 with such a low cortisol?

[McPammy in reply to IgnoranceSound]

At first it was difficult. Every day at noon then again at 6pm ish I’d go into a big slump. I continued with the T3 5mcg twice a day. I had to split my Levothyroxine dose in two. I took it at 12.30pm and again at 4.30pm. My own decision I was just trying work around cortisol. I found after 4 weeks I was back to normal. And still am a year later. Hope this helps you in some way.

[IgnoranceSound in reply to McPammy]

Did you were using ct3m method by Paul Robinson or just T3 in the day time?

[McPammy in reply to IgnoranceSound]

I do have Paul Robinson’s book. I purchased it after I’d tried out my own routine. I take T3 twice a day plus Levothyroxine twice a day.

When I first started T3 I had pains in my lower back just were your kidneys are. Adrenals sit in top of kidneys. I think it was my adrenals waking up or pushing hard to keep up with the T3. Before T3 my cortisol at 9am was 150 (155-607). It had been as low as 68! Synacthen test I passed so not Addison’s. My T3 was very low 3.9(3.7-6.0) on Levothyroxine alone. After 4 weeks taking T3 plus Levothyroxine twice a day, my cortisol at 9am increased to 466(155-607) from 150. I felt brilliant too. From barely walking ten steps to being able to walk ten miles. It truly was incredible how a small amount of T3 saved me. I later did the DIO2 gene test. I’m positive. Therefore struggling to convert T4 to T3. So now I know what was wrong and why.

[IgnoranceSound in reply to McPammy]

Great! I am so happy for you!

Hmm My Ft3 is not so bad but ft4 is low and I don't feel any better on ft4. Still with low cortisol all day :/ Paul in his book states that symptoms are the most important.

[McPammy in reply to IgnoranceSound]

Have you had a synacthen test.

It may not be lack of T3.

How low is your cortisol. Have you had any tests.

Also my ferritin and B12 were deficient. I’m now on ferris fumerate and B12 3 monthly injections. This also helped me. How are your vitamins.

I’m a vegetarian so that’s why my ferritin and B12 are deficient.

[greygoose]

Ferritin 20 (20-380)

Serum iron 10 (10-30)

Looks to me like your problem lies in those two results. Please don't tell me that your doctor thought they were 'fine'!

[jgelliss in reply to greygoose]

Your So Right greygoose .When Finally one gets a Dr that test for all the markers . They don't look at the whole picture in front of them . That's because very few Dr's really *GET IT* . It takes more than thyroid meds to make the thyroid meds work well for us . Vitamin "D"/K2 , B-complex , B12/folate , Iron if one is low , magnesium , Vitamin "C" , Celtic Sea Salt for adrenals/electrolytes .

[Runner95 in reply to greygoose]

No he hasn’t. I took these test before I left on a business trip and just got the results. I have been having problems understanding my symptoms since they overlap, adrenal, hypothyroid and iron deficiency. All of these drain you and give similar symptoms. Do you, agree? How does one distinguish between these diseases so they can focus on healing the underlying problem? My Dr. is running more labwork when i return to get to the bottom of this.

[greygoose in reply to Runner95]

Well, that's where lab tests come in. You can't work on symptoms alone.

You probably are having a lot of hypo symptoms still, because you're still hypo. But, best to work first on the iron, because ferritin needs to be at least 70 for your body to be able to use thyroid hormones correctly.

[Runner95 in reply to greygoose]

Thank you, This is very helpful. Just wish I knew what is causing the low ferritin level, etc.

[greygoose in reply to Runner95]

Full investigations of the gut should be carried out to make sure there's no internal bleeding, for a start. Your doctor should know what to do.

Do you have low stomach acid? He probably wouldn't know about that.

[Runner95 in reply to greygoose]

I have had iron deficiency in the past and stomach issues, gastritis and ibs. The iron deficiency went away after iron iv treatment. This was back in 2010. I will talk to my Dr about this when I see him next.

[greygoose in reply to Runner95]

Yes, you really must.

[Runner95 in reply to greygoose]

Greygoose, can hypothyroid cause low ferrtin or iron deficiency or vice versa? Just wander what your thoughts are relating to this. My TSH has raised since my last bloodtest to 6 from 3.3.

[Hidden in reply to Runner95]

I totally understand. It's so hard. I have hypothyroidism, adrenal "problems" (getting tests for) and low iron. Difficult to pinpoint the symptoms as they're all non-specific.

[Runner95 in reply to Hidden]

Thank you for your reply. Hope you find out what is causing your adrenal problems and how to heal them. It is a slow process that requires a lot of patience and understanding.

[Hidden in reply to Runner95]

Thank you. I hope you get sorted too. I'm getting tested for Addison's disease as I tick a lot of boxes for it. That's what drew me to your post. Can I ask, on diagnosis for AD were your sodium/potassium normal? Mine are but I eat loads of salt and have done for years.

[Runner95 in reply to Hidden]

Yes, my sodium is normal. I eat a lot of salt and have always done this. You can have Addisons disease with normal sodium. Many Dr’s have a problem understanding this. Hope you feel better soon. Take care and update me after your adrenal tests. You have to be proactive with your own health.

[Hidden in reply to Runner95]

That's interesting. I've read about several people who have had normal sodium levels but failed the short synacthen test. Will bear this in mind when I see my endo. Thanks a lot It would be interesting to compare symptoms.