Blood test results - adrenal insufficiency?

[OllyTojo]

I have received more blood test results and I wonder if anyone can shed any light on the results. I have formerly been diagnosed with adrenal insufficiency and it looks possible again from the results?

Serum cortisol 9am 267nmol/L (150 - 600) Lab have added 'Reference range refers to 9am cortisol and assumes established circadium rhythm. In a well patient cortisol levels above 400nmol/L made adrenal insufficiency unlikely. Midnight and post dexamethasone <40nmol/l'. I didn't have any dexamethasone?

Other results:

serum folate 10.6 ug/L (3.0 - 20.0)

serum b12 493ng/L (180 - 640)

serum ferritin 188 ug/L (15 - 200)

Free T4 12.4 pmol/L (9 - 19)

TSH 2.09 (0.35 - 4.94)

serum oestradiol <37 pmol/L (Post menopause <102 pmol/l ) which I am but way under and out of range. I have progressing osteoporosis

prolactin 211mu/L (109 - 557)

testosterone 0.91 (0.5 - 1.2)

My GPs surgery have told me all is fine, 'no further action required'. I spoke to the pituitary foundation helpline yesterday and they told me to get urgent call out to endo to get adrenals investigated as 'my hormones are in crisis'. Put the wind up me. Any light that can be shed or pointers would be greatly appreciated. Maybe this is outside the thyroid forum - just starting my research into all of this and taking charge of my own health, so apologies if I'm getting this wrong and being a pain.

Thank you

[SlowDragon Administrator]

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On 50mcg levothyroxine and 10mcg T3

These results suggest you are under medicated for thyroid

On levothyroxine plus T3 we frequently need GOOD FT4 and Ft3

Typically 60-70% through range

Suggest you get increase in levothyroxine up to 75mcg

Bloods should be retested 6-8 weeks later

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Day before test - Last 1/3rd or 1/4 of daily T3 dose 8-12 hours before test

So as only taking 10mcg T3 - split dose and take 5mcg waking, 2.5mcg mid afternoon and 2.5mcg at 9pm

Test 9am

On levothyroxine plus T3 you would expect TSH to be very low

Who reduced your T3 dose

How long have you been on just 50mcg levothyroxine

When under medicated adrenals try to compensate for lack of thyroid hormones and can become exhausted

[OllyTojo in reply to SlowDragon]

Hello SlowDragon, T3 became reduced about 5 months ago from 12.5mcg to 10mcg as I moved from cytomel to thybonn Henning as I take half a tab a day and cytomel is 25mcg and thybon is 20mcg. I didn't think such a small amount would make a difference and GP didn't pick it up or comment.

I have been on 50mcg thyroxine for about 2 years. It was reduced down from 75mcg because I was having night sweats. Reducing down certainly stopped the night sweats immediately.

About 15 years ago I went to see Dr P who said with me it was all about my adrenals. I took 30mcg of hydrocortisone for a couple of years. Stopped dead a couple of years later as didn't realise the protocol and ended up in A&E. I didn't think to tell them about the hydrocortisone as I didn't see a link so was discharged later on. Was very ill for a long time, got shingles, etc. Only years later understood what had happened and how dangerous it was. I don't think my adrenals have ever recovered. Feeling particularly bad with it at the moment and am concerned by cortisol test result.

I'd like to go privately but that hasn't worked either in the past.

(If anyone knows a good endocrinologist in the south east of England, if they could message me with details)

Thanks for getting back SlowDragon

[SlowDragon Administrator in reply to OllyTojo]

Night sweats is frequently low B12 .....extremely common when under medicated

75mcg plus 2 x 6.25mcg T3 was lowish dose

(Especially if T3 was Timorel)

What were results on this dose ??

Looking for Ft4 and Ft3 at least 60-70% through range

[OllyTojo in reply to SlowDragon]

Thanks for this. I'll go back and look through my results. I know I felt best when TSH was under 0.5 and it was like this for many years. Has been creeping up since switch from Pfizer cytomel to Ace cytomel and didn't feel so good on the Ace. Went up to 1.5 TSH. And then test last November TSH was 3.5 - I am pretty convinced due to the last Ace prescription not having been stored properly (out of the fridge) and near end by date. T4 has always been low, mostly out of range and only recently got into 12, in the last year. So endo is happy I am now in range

[SlowDragon Administrator in reply to OllyTojo]

So endocrinologist is useless

Suggest you email Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3 ......NHS and Private

[e-mail]

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2

When adequately treated, TSH will often be well under one.

Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

If you have Hashimoto’s then frequently strictly gluten free diet is essential too

Have sent you a PM

[OllyTojo]

Yes insufficiency, not fatigue.

[nellie237]

Is ferritin 188?

[OllyTojo in reply to nellie237]

Yes 188 - made a typo on the ranges. Ferritin range is 15 - 200

[nellie237 in reply to OllyTojo]

I should have realised that, doh. I hope you manage to find the answer.

[OllyTojo in reply to nellie237]

Thanks nellie237. Thank you for looking at the results. Much appreciated. I have been pointed in the direction of an endocrinologist so my fingers are crossed