I went to an endocrinologist and as she said my values in October were normal for tsh and t4 I was ok.... after my 30 minutes consultation I end up explaining to her that I am not ok and should check other things... but I didn't get anywhere specifically... give up and for my surprise she asked for my GP to do just an cortisol test... my result is:
Coded entry - Serum cortisol level (XE2xW) 227 nmol/L; 9AM cortisol 140-400nmol/L: does not exclude adrenal insufficiency; Suggest seek advice from Endocrinology regarding further; investigation.;
Any advises about this result?
I much appreciate your advice 🙏🏼 ☺️
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Verde1
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I have done extra tests last october. The results are as follow:
Test result - Tissue transglutaminase IgA level Report, Satisfactory, No Further Action (Patient Informed). Result reviewed by Dr Fazeel Ahmad at Park Road Medical Centre (NHS West Yorkshire Icb - 15f) - 01 Nov 2022 15:39
Coded entry - Tissue transglutaminase IgA level (XaJg2) < 0.5 u/mL [< 15]; Anti-tTG Ab results are reported as a numerical value to; facilitate the use of the 2020 ESPGHAN guidelines in CHILDREN.
Test result - Serum total immunoglobulin E concentration;Egg white RAST test;Cow's milk RAST test;Mixed nut (fx1) RAST test;Peanut RAST test;Wheat RAST test Report, Normal,
Coded entry - Serum total immunoglobulin E concentration (XacUL) 6.2 kU/L [1 - 120]; Please note the change to total IgE reference ranges.; The lower limit of the reference range was previously 0.5ku/L; For further information please contact the laboratory (x25550)
Coded entry - Wheat RAST test (XaEMP) < 0.35 ku/L
Coded entry - Peanut RAST test (XaENZ) < 0.35 ku/L
Coded entry - Egg white RAST test (XaIZW) < 0.35 ku/L; ****Interpretation of specific allergen values [kua/L]****; Negative [<0.35]. Weak positive: grade 1 [0.35 - 0.69].; Positive: grade 2 [0.7-3.5], grade 3 [3.5-17.5], grade 4 [>17.5].; Specific IgE Abs can be found without clinical reactions. Their; presence is not proof of allergy. Negative results do not rule; out allergy in patients with a good clinical history.
Coded entry - Mixed nut (fx1) RAST test (XaKbK) < 0.35 ku/L - Nut mix = peanut, hazel, brazil, almond and coconut
Coded entry - Cow's milk RAST test (XaIc9) < 0.35 ku/L
I still have some cTest result - Serum total immunoglobulin E concentration;Egg white RAST test;Cow's milk RAST test;Mixed nut (fx1) RAST test;Peanut RAST test;Wheat RAST test Report, Normal, Need to speak to doctor (Patient Informed). Result reviewed by Dr Fazeel Ahmad at Park Road Medical Centre (NHS West Yorkshire Icb - 15f) - 03 Nov 2022 11:39
Coded entry - Serum total immunoglobulin E concentration (XacUL) 6.2 kU/L [1 - 120]; Please note the change to total IgE reference ranges.; The lower limit of the reference range was previously 0.5ku/L; For further information please contact the laboratory (x25550)
Coded entry - Wheat RAST test (XaEMP) < 0.35 ku/L
Coded entry - Peanut RAST test (XaENZ) < 0.35 ku/L
Coded entry - Egg white RAST test (XaIZW) < 0.35 ku/L; ****Interpretation of specific allergen values [kua/L]****; Negative [<0.35]. Weak positive: grade 1 [0.35 - 0.69].; Positive: grade 2 [0.7-3.5], grade 3 [3.5-17.5], grade 4 [>17.5].; Specific IgE Abs can be found without clinical reactions. Their; presence is not proof of allergy. Negative results do not rule; out allergy in patients with a good clinical history.
Coded entry - Mixed nut (fx1) RAST test (XaKbK) < 0.35 ku/L - Nut mix = peanut, hazel, brazil, almond and coconut
Coded entry - Cow's milk RAST test (XaIc9) < 0.35 ku/L
I am not on a gluten free diet, but stopped eat pasta, and I eat some cheese(soft cheese on my toast in the morning, and occasional some brie and so on)and I eat bread, mainly the one I make just flour yeast, salt and water...
I am thinking now to actually try be gluten free, but I recognise I like my bread in the morning with jam and cream cheese... this week I am on a fruit and vegetable regime, at midday after lunch feel very sleepy... also stopped my coffee. Usually take one in the morning and one after lunch. Last week already give up the one after lunch and I felt better. Thank you Slow Dragon
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working so it essential all four vitamins are at good levels
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.
Most common by far is gluten.
Dairy is second most common.
A trial of strictly gluten free diet is always worth doing
There’s loads of gluten free bread options. Many are excellent toasted
Warburtons sourdough GF or Waitrose brown seeded GF best in my opinion
You need separate gluten free toaster
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
A cortisol blood test is intended to capture the level of cortisol you have at its highest.
Cortisol has a circadian rhythm, and for people who have a "normal" sleep and wake pattern the highest level of cortisol is assumed to be produced at about 9am. If the test was done at 11am or noon or in the afternoon then your cortisol would have naturally reduced by then.
If you work late shifts or night shifts or have really bad insomnia and regularly fall asleep at 5am (for example) then your highest cortisol probably won't occur at 9am.
This is a poor quality graph of what the circadian rhythm for cortisol would look like with a "normal" sleep/wake pattern :
Your result of 227 with a range of 140 - 400 is very low, and it would make sense to me (I'm not a doctor) that endocrinology should give you a Short Synacthen Test (SST). You would have to be referred to them. Whether they would do the test or not I don't know.
Unfortunately for patients, doctors will often not do the complete SST to save money. They won't order an ACTH test be done during the SST, which means that they can't diagnose Secondary Adrenal Insufficiency, they can only diagnose Primary Adrenal Insufficiency. I don't know how Tertiary Adrenal Insufficiency is diagnosed.
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