High cortisol hashimotos hypothyroid high B12 high magnesium T4 T3 Cushings? Help

[HealthySam]

Hi

I had a load of private bloods done as had to give up work as getting worse. I stopped B12 supplements 5 weeks before test and bloods taken at 9am fasted before taking Levothyroxine and Liothyronine.

I self medicate the Liothyronine (T3) as I have the DIO2 gene and not funded in my area. Endocrinologist not helpful. (Since the test have started an increase in the T3.)

Just done a 24 hr urine test via my GP re the high cortisol. Cushings? (I have many symptoms)

I have hashimotos hypothyroid, Fatty liver (NAFL) mostly gluten and dairy free. Take x2 brazil nuts for selenium each day. Drink x2 cups green tea with matcha fuel (mix ashwangatha etc) for inflammation each morning. Eat salad for lunch healthy dinner no fizzy drinks or caffeine, don’t smoke or drink alcohol. Take ginger in my decaf tea and nutmeg in my green tea. Walk 5000 steps per day. Get heavier when walk more!

Clinically Obese 5ft - 11 stone - size 18 look very pregnant (yet most of my life size 10 8 stone) weight came on rapidly possibly after Co v .. id.

Symptoms Very high weight gain cannot shift, fatigue (better since T3), brain fog bad mixing words a lot, choking on spit or tiny quantities of food, very bloated, difficulties breathing (bloating?) etc etc

I have an appointment coming up with a GP who has hashimotos herself (private). Yes I’m getting desperate now!!

Is there something I’m missing?

Bloods:

Cortisol high 560 at 9 am (83.8-507)

TSH high 4.91 (0.27-4.20)

Free T4 low 10.3 (12-22)

Free T3 OK 3.6 (3.1-6.8)

T4 Total OK 77.7 (66-181)

B12 High 627 (145-569)

Active B12 High >150 (37.5-150)

Magnesium High 1.07 (0.66-0.99)

CRP OK 1.02 (<5)

Iron OK 14.3 (5.8-34.5)

HbA1c OK 39 (20-42 -39 is non diabetic)

Vit D 65 OK (50-200)

UIBC OK 42 (24.2-70.1)

TIBC 56 OK (45-81)

Transferrin saturation OK 25.4 (20-50)

Ferritin OK 56.50 (13-150)

Serum Folate OK 9.70 (8.83-60.8)

Any insight helpful hadn’t considered Cushings before but high cortisol has started me looking down that line.

Thanks in advance.

[greygoose]

TSH high 4.91 (0.27-4.20)

Much too high - you're under-medicated. It should come down to 1 or under.

Free T4 low 10.3 (12-22)

This is very low but expected on T3 only. This may or may not be a problem. Why are you taking only T3? Just because you have the dio2 gene mutation doesn't mean you don't need any T4 at all.

Free T3 OK 3.6 (3.1-6.8)

Also much too low - it most certainly is not ok! - and is the cause of your symptoms - a lot of them, in any case. How much T3 are you taking?

T4 Total OK 77.7 (66-181)

Irrelevant.

B12 High 627 (145-569)/Active B12 High >150 (37.5-150)

Actually, that's not particularly high. It's the top of the range that is too low. But even if it is high when supplementing, it's not a problem because excess is excreted.

Magnesium High 1.07 (0.66-0.99)

No point in testing magnesium because the results are not reliable.

Iron OK 14.3 (5.8-34.5)

Not OK. Too low. Should be at least mid-range.

Vit D 65 OK (50-200)

Not OK, too low. Should be at least 100.

Ferritin OK 56.50 (13-150)

Not OK, too low. Should be about 100.

Serum Folate OK 9.70 (8.83-60.8)

Not OK, muct too low, should be at least mid-range.

I don't know much about Cushings, but I wouldn't have thought your cortisol was high enough to worry about that. However, there are a lot of other things that require your attention, and improving those might improve how you feel.

[HealthySam in reply to greygoose]

Hi thanks for your reply I see much of what Blue Horizon is saying is OK clearly is not! I take both T4 and T3 but self medicate T3 so I’m currently taking 25 T4 and 12.5 T3 split half morning half lunchtime (but at time of test was taking 25 T4 and 6.25 T3. Once a day am) The T4 is Almus brand from GP via Boots the T3 varies depending on what I can get hold of. I do supplement with liquid Vit D and K and Liquid B12 and occasionally liquid iron so will up all these.

What dose would you consider taking of T4 and T3 on these results? Am I still not really taking enough should I up my T4 too?

[greygoose in reply to HealthySam]

It's not about deciding in advance how much of each you should be taking in advance. It's about increasing slowly until you reach your sweet-spot - you need what you need, not what anyone else thinks you ought to need.

So, in your case, I would start with the T3, and increase by 5 mcg. Stick with that dose for six weeks, see how you feel and retest.

When you've got your FT3 to a decent level - i.e. at least over 50% through the range - then you can try increasing your levo by 25 mcg and see how that feels. But, never change both at the same time, or you won't know what's helped and what hasn't. Same with nutrients, only increase one at a time, and not at the same time as your thyroid hormone doses.

That's how I would do it, but others might do it differently.

[SlowDragon Administrator]

How much levothyroxine are you taking and which brand

Same question T3

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Did you split T3 day before test

Ft4 is below range

As Levo dose was 24 hours before test your results show you need 25mcg dose increase in Levo

Retest 6-8 weeks later

Cortisol is high because you are hypothyroid and under medicated. Cortisol levels should reduce as thyroid levels improve

Many people on levothyroxine plus small dose T3 find they need both Ft4 and Ft3 at least 60-70% through range

Meanwhile working on improving low vitamin D and low folate

Exactly what vitamin supplements are you taking

[HealthySam in reply to SlowDragon]

Hi testing was done fasted at 9am. I take both T4 and T3 but self medicate T3 so I’m currently taking 25 T4 and 12.5 T3 split half morning half lunchtime (but at time of test was taking 25 T4 and 6.25 T3. I take B12 and D regularly methylated B12 as also homozygous C677T MTFHR gene so aware have to avoid all supplements with folic acid.

I dropped doses down as felt a bit hyper or do I thought but perhaps was mistaken.

I see I should increase my T4 as well as my T3 so will increase this back up to 50 T4 and 25 T3 (split) I will also restart my supplements.

Thanks

[SlowDragon Administrator in reply to HealthySam]

I take both T4 and T3 but self medicate T3 so I’m currently taking 25 T4 and 12.5 T3 split half morning half lunchtime (but at time of test was taking 25 T4 and 6.25 T3. Once a day am)

So this dose Levo is far too low

How much levothyroxine were you taking BEFORE adding T3

What was highest dose levothyroxine you took

Typically dose levothyroxine is increased slowly upwards in 25mcg steps from standard STARTER dose of 50mcg …….

Guidelines on eventual dose when on JUST Levo is approximately 1.6mcg per kilo of your weight per day, so unless extremely petite likely at least 100mcg per day BEFORE adding T3

Aiming for Ft4 at least 70-80% through range on JUST Levo

If Ft3 remains low, once all four vitamins are optimal…..then is time to consider slowly adding T3

[SlowDragon Administrator in reply to HealthySam]

I see I should increase my T4 as well as my T3 so will increase this back up to 50 T4 and 25 T3 (split) I will also restart my supplements.

Only ever increase or decrease one thing at a time

First step …..ONLY increase levothyroxine by 25mcg

Retest in 6-8 weeks

Likely to need further increase in levothyroxine after next test result

How much vitamin D are you currently taking

You need daily vitamin B complex and increase dose vitamin D

mostly gluten and dairy free.

For gluten free to be effective you need to be absolutely strictly gluten free

[HealthySam in reply to SlowDragon]

Ok thanks. I will follow the increase in Levo first I take daily sprays of Vit D and stopped the B complex but will resume. I also take B12 spray. How much is the recommended B complex, B12 and Vit D please?

[SlowDragon Administrator in reply to HealthySam]

so if weigh 11 stone = 70 kilo

70kilo x 1.6mcg Levo = 112.5mcg as the likely daily dose of levothyroxine if ONLY taking levothyroxine

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Some people need a bit less than guidelines, some a bit more

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[HealthySam in reply to SlowDragon]

Thanks for all this info will have to copy out and digest it when my brain is functioning. I was on 100 T4 then lowered it to accommodate the T3 but think I’ve over compensated so will increase both.