Hello, I was hoping some of your learned people could give me an opinion on my latest test results and subsequent dose increase. I am ACTH deficient and have been on Hydrocortisone x3 daily for 8 1/2 years. It seems my Pituitary is now failing on the TSH front too, and while it is doing something, it's not enough! So central hypo really.
I started on 25 mcg Levothyroxine last October when my results were FT3 3.9 (3.5-6.5), FT4 10.8 (10-18.7) and TSH 0.53 (0.55-4.75). I had a terrible start on Teva, but better as soon as I switched onto Wockhardt brand. After 7 weeks my results were FT3 4.5 (3.5-6.5), FT4 12.6 (10-18.7) and TSH 0.28 (0.55-4.75). I stuck on 25mcg, and had tests 2 weeks ago, which were: FT3 4.6 (3.5-6.5), FT4 12.1 (10-18.7) and TSH 0.6 (0.55-4.75). Although the T3 and T4 are much the same, the TSH result is interesting - the highest it has been for 8 years in fact! As I am still symptomatic, although possibly improved since October?, and my levels are still at the low end, the consultant has put me up to 50 mcg/25mcg on alternate days. I'm to have tests in 3 months and then go back to see her, with a view to going up to 50mcg each day.
She has also put on the blood form for my Ferritin, B12, Folate, Vit D to be tested (thank you @SlowDragon), as well as full blood count, Renal, Bone and of course Pituitary/Thyroid functions too. (She said no point checking Thyroid antibodies as my issue is Pituitary in origin.)
How does all of this sound to you guys? Am I on the right tracks? I'm wondering whether all this might be throwing out my cortisol levels a bit too, as I've had to updose on the hydrocortisone a fair bit recently, just to get through the day. It's hard to know just what is causing the exhaustion - the adrenal or the thyroid issue! Or a bit of both?!
Thanks in advance for your thoughts.
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luckyed
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Thank you SlowDragon . Do you think there's anything interesting in the increase in TSH? Obviously, it's still pretty low by normal standards, but initially they were talking about the 25mcg suppressing my TSH (at 0.28), and now it has jumped up to 0.6 (range (0.55-4.75), where it has been steadily on the decline for the past few years.
When people, who previously haven't had adrenal issues, start on Levothyroxine, do they have a specific test to see if they need to start taking Hydrocortisone? Does the Levothyroxine increase the need for cortisol, or is it that it inhibits production/processing? I'm just wondering how to establish how much I might need to increase my daily HC by. Pre-Thyroid issues, I've had day curve tests to see if my HC replacement was at the right level, but not sure if that would be appropriate now.
Most traditional endocrinologists don’t recognise adrenal fatigue...only Addison’s disease
But many long term hypothyroid people seem to suffer some degree of adrenal fatigue. But it’s extremely rare for endocrinologists to even test for this ....or acknowledge it as problem
Also it’s probably much more common, than currently recognised, to have some degree of central hypothyroidism (pituitary affected ) as result of being hypothyroid
Every single cell is affected by lack of thyroid hormones...including pituitary. So it’s likely TSH becomes sluggish or non responsive
I don’t see it as surprising that TSH is becoming more responsive as you start to get some thyroid hormones in your system
Thank you so much SlowDragon , I have read those articles and will re-read tomorrow with a fresh head! I hadn't really appreciated how inextricably linked the thyroid and adrenal functions are. The more I read, the more I realise I don't know! It makes me wonder if my thyroid has been more a part of what I thought were purely adrenal insufficiency issues all along. I'd love to have a hormone profile from back in my 20s, when I was all healthy and full of bounce, that would be so interesting to compare! Thanks again.
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