Adrenal issues maybe

[TiTre]

Good morning everyone. I'm still on this merry go round and no better. I think ye are fantastic to answer questions. I have been trying to read abt my current problem but its like I cant retain the information let alone make sense. My fatigue, brain fog and pain have been very severe lately. So I went off to see new Dr he reduced my Eltroxin fron150mcg to 100mcg at night and broke my T3 into 3 doses of 20mcg a day. He looked for cortisol testing which has come back but I wont see him for another7 weeks. So I said I would ask for your advice and insight. Any help greatly appreciated x

[TiTre]

Test Name Result Flag Range

Ferritin 77.7 ng/mL 13 - 150

Vit B12 1083.0 pg/mL High 197 - 771

Folate 8.8 ng/mL 3.0 - 26.8

My vitamin B was high for 2 months aswell its now

Vitamin B12 913 ng/L 200 - 1200

Vitamin D 71 nmol/L 50-200

These are my latest Thyroid tests I was off thyroid medication 15hrs before

[SlowDragon Administrator in reply to TiTre]

so these thyroid results were from 150mcg levothyroxine and 60mcg T3?

Personally I would have kept Levothyroxine dose unchanged and SLOWLY reduced T3 dose by 5mcg per day initially…..then reduced T3 again by another 5mcg after 2-3 weeks

And splitting T3 as 3 doses per day

So initially

20mcg waking, 20mcg mid afternoon and 15mcg bedtime

Then

20mcg waking, 20mcg mid afternoon and 10mcg bedtime

Waiting 6-8 weeks then retesting

Quite likely to need further reduction in T3

Test between 8-9am

Last dose levothyroxine 24 hours before test

Day before test ALWAYS….split T3 as 3 doses and last dose 8-12 hours before test

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[TiTre in reply to SlowDragon]

Hi SlowDragon

thanks for your reply. That last test it was 36hours since night time dose of eltroxine and more than 24 for T3. Im not on any supplements at the minute.

[SlowDragon Administrator in reply to TiTre]

so both Ft4 and Ft3 results were falsely low

so you might need to reduce Levothyroxine a LITTLE…..but very unlikely by 50mcg

Dose reductions should be done slowly and cautiously and only ever change Levo or T3 ….never both at same time

Levothyroxine

150mcg …..down to 137.5mcg daily……wait 6-8 weeks….retest

How long since you reduced levothyroxine from 150mcg to 100mcg

[TiTre in reply to SlowDragon]

the levothyroxine is reduced a month there was no change to T3 only broke dose into 3

[SlowDragon Administrator in reply to TiTre]

so retest after 8 weeks on new dose

[TiTre in reply to SlowDragon]

I will thanks for advice SlowDragon

[SlowDragon Administrator in reply to TiTre]

Exactly what vitamin supplements do you take

[SlowDragon Administrator]

Suspect your B12 is falsely high …,known as Paradoxical B12 deficiency, especially as your folate is low

b12oils.com/paradoxical.htm...

suggest you wait until been retested …..but then consider supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance

Difference between folate and folic acid 

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

[TiTre]

That is so interesting I will print this information off so I wont forget any of it

[humanbean]

All percentages have been rounded to the nearest whole number.

1) 8.8 (7 - 30) 8% through the range

2) 3.7 (2.1 - 14) 13% through the range

3) 2.0 (1.5 - 8.0) 8% through the range

4) 1.6 (0.33 - 7.0) 19% through the range

DHEA : 66 (106 - 300) 21% under range

I use the "Reference Interval" throughout the analysis because Regenerus has never explained how their optimal ranges were derived. (That is true for every company I've seen who supplies optimal ranges for anything.)

Optimal results for saliva cortisol are given at this link (see Example 1):

rt3-adrenals.org/cortisol_t...

Optimal results with your ranges :

• Morning at the top of the range --- 30 with your range

• Noon approximately 75% of the range --- 11.025 with your range

• Evening close to 50% of the range --- 4.75 with your range

• Nighttime at the bottom of the range --- 0.33 with your range

Compare your results to optimal :

Sample 1) Optimal = 30 --- Yours = 8.8 --- You produce 29% of optimal

Sample 2) Optimal = 11.025 --- Yours = 3.7 ---You produce 34% of optimal

Sample 3) Optimal = 4.75 --- Yours = 2.0 --- You produce 42% of optimal

Sample 4) Optimal = 0.33 --- Yours = 1.6 --- You produce 485% of optimal

Totals : Optimal = 46.105 --- Yours = 16.1 --- You produce 35% of optimal

Your DHEA is well under range and it is often a good indication of the "direction of travel" of your cortisol, suggesting that your cortisol is likely to continue dropping.

The question is, are your low cortisol results indicative of your adrenal glands being attacked by your immune system, or is a problem developing with your pituitary or hypothalamus? In other words do you have, or are you in danger of developing, a form of Adrenal Insufficiency (AI)? Read about the different forms / types of Adrenal Insufficiency here:

en.wikipedia.org/wiki/Adren...

Note : There is no cure for AI and lifelong treatment with steroids is essential.

I think there is a small possibility that you have AI and I think even a small possibility needs to be tested for because it is so dangerous if left untreated. Ask your doctor for a 9am blood cortisol test to be done and see what comes out of it. Blood cortisol and saliva cortisol are not measuring the same thing, so don't be surprised if the results are quite different. You could have good results for blood cortisol, and poor results for saliva cortisol, or vice versa.

.

Another possibility is that perhaps your low results are not caused by AI and instead your adrenals are "just" unhealthy and could be healed with the correct treatment. Patients and alternative medicine doctors refer to this as "adrenal fatigue", but NHS doctors don't believe there is such a condition and pour scorn on the idea - but that attitude doesn't help patients. The attitude you are likely to face if you mention it to a doctor is shown quite well in the wikipedia article on the subject, so it is a good idea not to mention it to doctors at all and treat it as a "self-help" problem.

en.wikipedia.org/wiki/Adren...

I wrote a whole load of stuff about this for another member whose results were rather better than yours but it could still help you, and rather than write it out again I suggest you read the whole thread :

healthunlocked.com/thyroidu...

Good luck.

[TiTre in reply to humanbean]

Hi humanbean

Thanks for reply. My trouble started after cancer and some difficult financial situation that carried on daily for 7 years so I think this is where my trouble started but its been steadily getting worse as the years go by. I just started the adrenal cocktail wiht orange juice in the morning. Can the 9am cortisol be done by lets get checked or does it need to be doctors.

[humanbean in reply to TiTre]

letsgetchecked.co.uk/home-c...

I've never used that company, nor have I read any reviews. But if you are happy that the company is trustworthy then it looks like the kind of test that is needed.

But I think you should save your money. If the test showed low levels of cortisol your doctor would probably insist on re-testing it anyway. Showing your doctor the saliva results might be enough to persuade your doctor to agree to do a cortisol blood test.

A low result for the blood test might get you a referral to an endocrine consultant and testing.

I live in the UK and only really have experience of the NHS, so it is possible that Irish doctors treat patients and private test results differently to how I'm used to.

An anecdote...

A member of the forum posted some really, really diabolical saliva cortisol test results a few years ago. I encouraged her to show the results to her GP, who said he didn't think the results were "that bad". But he did agree to do a blood test. The lab called and said the patient should be prescribed something immediately because she was in danger of going into adrenal crisis. After referral to an endocrinology department she was tested and eventually she was diagnosed with Addison's Disease. But that GP saying her results "weren't that bad" still shocks me to this day.

healthunlocked.com/thyroidu...

[TiTre in reply to humanbean]

I agree doctors here in Ireland are mis informed about a lot of things when I asked about the high vitamin B he said I must be eating a lot of vit b rich foods i had to laugh

[humanbean in reply to TiTre]

You might find this of interest in relation to high B12 :

academic.oup.com/qjmed/arti...