Short Synacthen & Blood Results

[ShonaGreen]

Hi,

I'd appreciate your thoughts on results from short syancthen and blood tests (see picture attached). The tests were started at lunchtime. I know it's ideal to do this closer to 9am but the endocrinologist wanted me to have the test whilst I was there, and explained it didn't really matter about the time of the test, it was more about how I responded to the synacthen. The results are below and it's good that I responded well, but wondered if the baseline cortisol level was a bit low for the time of day? Could this still suggest a pituitary problem? There's a bigger gap than 30 minutes between the tests as they struggled to find a vein to take blood each time.

12.40pm - Cortisol 134

1.30pm - Cortisol 548

2.10pm - Cortisol 758

The blood tests were supposed to include TSH and antibodies but they're missing for some reason. I noticed that my Albumin and Calcium levels have decreased since March (when last had full blood panel at GP) and unsure if this means anything? But good news that Vitamin D is slowly increasing.

I have been on 50mg Levothyroxine since April 2019 and increased to 75mg Levothyroxine 3 weeks before the test. My thyroid levels have stayed around the same level for the past few months, especially my Free T3, and thought there would be more improvement from the Levothyroxine. My last test was on 1/8/19 and results were:

TSH - 0.17 (0.27 - 4.20)

Free T4 - 15.3 (12.00 - 22.00)

Free T3 - 3.76 (3.10 - 6.80)

For the last week, I've been on 25mg Levothyroxine and 30mg Erfa and feeling good so far, just more tired than usual.

[Hidden]

Your T4 hasn't improved by a lot considering you've increased your dosage. You responded well to the short synacthen test your cortisol may be slightly on the lower side for that time of day but not by much. Did you have an ACTH blood test done at the same time? It should have been put on ice straightaway if they did. The ACTH shows if there is an issue with the pituitary gland.

[ShonaGreen in reply to Hidden]

Thanks for your reply Hidden , they said they would only do an ACTH test if the synacthen results were abnormal which they weren't. I read somewhere that low calcium and albumin levels could be due to parahypothyroidism but I don't think my levels are that low. I've not had a PTH test but guess this is can only be done by an endocrinologist? I'm seeing the endocrinologist again in 5 weeks so think will have more blood tests then and hopefully see an improvement after taking the Erfa.