Latest bloods and cortisol

[AleB]

Please could anyone help... I've been feeling really rubbish these past 3 weeks... My latest bloods taken on 12th November, fasting and at 9am

TSH 12.60ml (range 0.27 - 4.2

FT3 3.76pmol/L (range 3.1 - 6.8)

FT4 14.700pmol/L (range 12 - 22)

Vit D 124.00nmol/L

B12 Active 150pmol/L

Ferritin 137.00ug/L (range 13 - 150)

Thyroglobulin Antibodies <10kIU/L (range <115)

Tyroid Peroxidase Antibodies 25.59kIU/L (range <34)

75mcg levi and 1.25lio 6am

1.25lio at 1.30pm

0.625 lio at 9.30pm

After this blood draw I decided to increase the lio slightly to 2.5mcg at 6am, 2.5mcg at 1.30pm and 1.25mcg at 9.30pm

My adrenals are killing me, hence the cortisol result below:

Waking 4.330nmo/L

Range 6.0 - 21.0

12 noon 5.620nmol/L range 1.5 - 7.6

4pm 2.140nmol/L range 0 - 5.5

Bedtime 9.30pm 1.5nmol/L

Range 0 - 2

My symptoms are, fatigue, dizziness, heart palps, pain in right flank, bleeding when I pass stools, cold feet, muscle weakness. Not been out the house for 6 weeks, except for blood draw last Thursday (12th). My question is, should I increase the levi back to 100mcg and go back to 1.25mcg dosage x 2 and 0.625 or increase T3? Thanks, I'm pretty desperate at the moment!

[SlowDragon Administrator]

Recommend you increase levothyroxine back to 100mcg and retest in 6-8 weeks

After next test, you may be able to then increase T3 up

Typically we add 3 doses of 6.25mcg per day

Like most endocrinologists, your endo reduced levothyroxine far too much.

Looking at previous posts....before T3 was added, on just 112mcg levothyroxine, your Ft4 was only mid range. You may eventually need to increase again to be on 112mcg .....But only increase levothyroxine in 25mcg step

[fuchsia-pink]

My goodness, you must feel dreadful! I don't think I have ever seen such a high TSH reading for someone who is on thyroid meds, let alone taking lio, which automatically suppresses TSH!

Agree with SlowDragon: increase levo first by 25 mcg, wait 6 - 8 weeks and re-test. If that doesn't bring your free T4 up at least to half-way through range, I'd add another 25 mcg. Then at the next test look and see where both free T4 and free T3 are: you will likely feel well when both are in the top third of the range, but go slowly so you don't miss your "sweet spot". Don't worry how low TSH goes ... mine is below the bottom of the range because I'm on lio and levo, but I'm properly medicated and feel great so don't worry about it at all x

[AleB in reply to fuchsia-pink]

Thank you both... Can I take 25mcg levo now?

[fuchsia-pink in reply to AleB]

I would - unless (given it's lunchtime) you have eaten in the last 2 hours or intend to eat in the next hour

But yes, if you have it in stock, I'd start as soon as you can!

[AleB in reply to fuchsia-pink]

Thank you, thank you both... Should I keep the new T3 dose only been on for a week of 2.5mcg at 6am and 2 5mcg at 1.30pm and 1.25mcg at 9.30pm? Sorry to ask all the questions!

[fuchsia-pink in reply to AleB]

I'd only change one thing at a time, and it's a teeny-tiny amount, so stay on the same T3 dose for now

[AleB in reply to fuchsia-pink]

Thank you fuchsia-pink... I could give you such a hug! 🤗👍😊

[fuchsia-pink in reply to AleB]

Aww thank you We all need a hug from time to time x

[humanbean]

Waking 4.330nmo/L Range 6.0 - 21.0

12 noon 5.620nmol/L range 1.5 - 7.6

4pm 2.140nmol/L range 0 - 5.5

Bedtime 9.30pm 1.5nmol/L Range 0 - 2

I would suggest you show your cortisol results to your doctor - your first result is deficient. You might need to get tested for Addison's Disease. Your GP should give you a cortisol blood test, and the blood should be taken at around 8am - 9am. If the result is very low then he/she should prescribe steroids immediately and refer you to an endocrinologist urgently.

Hidden is very knowledgeable on the adrenals and cortisol.

[AleB in reply to humanbean]

I acyually had a Dhea blood test at 9am on the same day I did the saliva test... unfortunately the lab haven't received it! Medichecks did say, bif not received by Friday they would send another out... May have to get GP to do this as urgent!

[Hidden in reply to AleB]

Your first cortisol result in low although the rest of the day they aren't too bad. Hopefully the Endo you see will be conversant with pituitary/adrenal issues as not all of them are. They might suggest a short synacthen test to see how your adrenal glands respond to the artificial ACTH. If your adrenal glands respond then the issue may be due to a pituitary problem, they should do an ACTH blood test at the start of the SST, this needs to go on ice, ask if they will do it as well.

[AleB in reply to Hidden]

Oh thank you Pauline's, I will be ready with my results and requests for the doctor and endo... do you know if I can take anything natural to help with the pain, other than pink salt and orange juice?

[AleB]

Thanks human bean, I'll have to go back to the doctor tomorrow - the GP didn't want to know, said it was too specialised beyond a GP - have managed to get endo appointment moved forward to Friday morning! Meanwhile, my right flank is achingly sore and I feel dizzy standing/sitting! Oddly I have had persistent uti infections since February this year, when I came off NDT to go back to levo, but have been under medicated ever since... only foer endo to lower t4 further to allow for T3! I despair!! If it wasn't for this site I think I would be in a right pickle, well, more so than I am now!

[humanbean in reply to AleB]

Right flank pain could be gallbladder or gallstone-related. I think that might require an ultrasound to diagnose, but then I've never had gallbladder problems and don't actually know for sure, so it would be worth researching to see if it fits your symptoms.

Gallstones and gallbladder problems are very common in people who have followed low-fat diets for long periods of time during their lives. I don't know whether this fits you?

.

Regarding the Short Synacthen Test (SST) mentioned by PaulineS above, for info on this test, how to prepare, what to expect, and how to interpret the results, see the "endocrine bible" :

imperialendo.co.uk/Bible201...

The document gives info on every test a hospital endocrinology department is ever likely to do. The SST is described on pages 68 - 70. Make sure to read the last paragraph in the introduction to the document on page 2, about reference ranges.

[AleB in reply to humanbean]

Thank you for the link to SST... I have dropped my results to the GP and a letter requesting a Dhea test and possible Synacthen test, Endo appointment tomorrow morning (via phone). I appreciate your help, not sure about gallbladder... Will look into this, bit of a struggle this morning,.