Raising TSH and low Cortisol

[maplewood]

Hi everyone. I hope you are all keeping safe with the current situation. I am under the endo now but slow going. Yesterdays bloods TSH 7.3 ref (0.35- 4.7) and T4 9.5 ref (7.8-21.0). They also took cortisol 251 (200-700) and prolactin 220 (70.0-550.0) as they wanted to rule out Addisons. These bloods were taken at 9am. Not sure if anyone can translate the above. Still not on any medication but GP has asked the hospital for the ok of a trial of T3. Waiting to hear. Would this be any better than t4 which after two trials i was found not to tolerate. Thank you xx

[SlowDragon Administrator]

Just testing TSH and Ft4 is completely inadequate

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

If vitamins are very low it makes levothyroxine or T3 extremely difficult tolerate

Which brands of levothyroxine have you tried?

thyroiduk.org/tuk/treatment...

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and vitamins

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

[maplewood in reply to SlowDragon]

Hi thank you for reply, I have spoken to you before and i did get private bloods done and antibodies were ok. My vit's etc were all under and i am currently taking supplements. I am just waiting on getting med's now as i had dreadful reactions to levothyroxine numerous brands. I am not sure how the cortisol works with it all however and wondering if i have other issues apart from the thyroid but related to it. x

[SlowDragon Administrator in reply to maplewood]

Adrenal exhaustion common when hypothyroid

As Hidden says...important to establish if adrenals are not working...or worn out due to being hypothyroid....

If “just” adrenal exhaustion.....then starting levothyroxine cautiously and increasing slowly...plus optimal vitamin levels

[Hidden]

Your cortisol is on the low side, the reference range is for the whole day but cortisol should be at it's highest level first thing in the morning, so ideally your result should be nearer to 450+. Hopefully your Endo will do a short synacthen test to see how your adrenal glands respond to the artificial ACTH, the results should reach over 450nmol/Ls. However it is important that they do an ACTH blood test at the start, which needs to go on ice straight away. The test shows if the adrenal glands are responding while the ACTH shows if the issue is with the pituitary gland.