help with low cortisol

[B12life]

I had a blood test at 10 am.

6.03 UG/DL

Reference Range: 6.70-22.60 UG/DL

Thyroid seems normal

T4 FREE: 1.02 NG/DL Reference Range: 0.60-1.12 NG/DL

TSH: TSH: 1.634 UIU/ML Reference Range: 0.270-4.200 UIU/ML

TTG-A: 0.5 U/ML Reference Range: 0.5-14.9 U/ML

SYMPTOMS

I have been fealing like death for a few months now:

tired despite 9 hours sleep, weak/muscle loss, brain fog, malaise, hypoglycemia.

Wake up tired and get more and more tired throughout the day. totally worthless by 3pm on.

This is impacting my job and am normally very very active.

QUESTIONS

Is this test and symptoms enough to warrant treatment?

Should other tests be done?

[SlowDragon Ambassador]

Looking at other posts you have PA?

How often do you get B12 injection

You’re not on any replacement thyroid hormones?

Are you taking any other vitamin supplements

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

VERY important to test TSH, Ft4 and Ft3 together

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

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[B12life in reply to SlowDragon]

I had high TPO antibodies a few years ago, but was told that because the iron panel was normal, then everything is good.

I keep up on b12 by injecting daily. No choice there. I also take 50mg P5P b6, a b multi, vit D, k2, C, magnesium.

This is the panel done last week.

Vit D, was good.

WBC

3.8 10E3/UL

Reference Range: 4.3-10.8 10E3/UL

- low neutrophils

CORTISOL

6.03 UG/DL

Reference Range: 6.70-22.60 UG/DL

T4 FREE: 1.02 NG/DL Reference Range: 0.60-1.12 NG/DL

TSH: TSH: 1.634 UIU/ML Reference Range: 0.270-4.200 UIU/ML

TTG-A: 0.5 U/ML Reference Range: 0.5-14.9 U/ML

IRON

IRON SAT: 66% (60 % is the high) , iron serum, transferrin and tibc are normal

LOW CORTISOL IN MORNING WHEN IT SHOULD STILL BE HIGH

Low cortisol 6.03 UG/DL. - Reference Range: 6.70-22.60 UG/DL.

IRON, SERUM

187 UG/DL

Reference Range: 50-212 UG/DL

TRANSFERRIN

203 MG/DL

Reference Range: 203-362 MG/DL

TIBC

284 UG/DL

Reference Range: 284-507 UG/DL

IRON SATURATION

66 %

Reference Range: 25-60 %

[SlowDragon Ambassador in reply to B12life]

So iron saturation is too high

TIBC low also says iron is too high

webmd.com/a-to-z-guides/wha...

Are you taking any iron supplements, if you are stop and retest in 2-3 months

[B12life in reply to SlowDragon]

I will see if I can gat another panel with these things all tested together, and before 9 while fasting.

[humanbean]

I had a blood test at 10 am.

6.03 UG/DL Reference Range: 6.70-22.60 UG/DL Under range

I'm assuming that the result above is your cortisol result from a blood test?

T4 FREE: 1.02 NG/DL Reference Range: 0.60-1.12 NG/DL 81% through the range

TSH: TSH: 1.634 UIU/ML Reference Range: 0.270-4.200 UIU/ML 35% through the range

TTG-A: 0.5 U/ML Reference Range: 0.5-14.9 U/ML Bottom of range

Your cortisol result being under range makes me think that you should have a test done for Adrenal Insufficiency (AI). I don't know if doctors would agree - I'm not a doctor.

Adrenal Insufficiency comes in several forms - Primary, Secondary, and Tertiary, and they are each described here :

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

I see you are from the United States. In the UK the usual first test for Adrenal Insufficiency is the Short Synacthen Test (also known as the ACTH Stimulation Test) :

en.wikipedia.org/wiki/ACTH_...

This test is also described here in the Endocrine Bible on pages 68 - 70 :

imperialendo.co.uk/Bible202...

There may be different methods of diagnosis in the USA.

...

Your thyroid function test results don't include a Free T3 , which is common but annoying. T3 is the active thyroid hormone which controls the metabolism of cells all over the body. It is low Free T3 that gives people symptoms of hypothyroidism (underactive thyroid) and high Free T3 that gives people symptoms of hyperthyroidism (overactive thyroid).

Your Free T4 is actually rather good at 81% through the range, and if your conversion from T4 to T3 is good you might not have a thyroid problem at all - but there is no Free T3 result to see how good conversion from T4 to T3 is. Your TSH looks like you would expect from someone with a healthy thyroid who is not treated for any form of thyroid disease.

The TTG-A result looks like a negative result for a coeliac test to me, but I'm no expert on coeliac testing. To the best of my knowledge the coeliac test is only accurate if you have been eating plenty of gluten before the test for several weeks. If you had stopped eating gluten for several weeks before the test then it would most likely come back "negative" whether you had coeliac disease or not.

labtestsonline.org.uk/tests...

...

I have been feeling like death for a few months now:

tired despite 9 hours sleep, weak/muscle loss, brain fog, malaise, hypoglycemia.

Wake up tired and get more and more tired throughout the day. totally worthless by 3pm on.

The symptoms you describe could be caused by low cortisol. But if that is ruled out then it is worth getting some nutrients tested too.

If you haven't had any tests of any nutrients recently I would strongly recommend that you get an iron panel and a Full Blood Count tested to check for iron deficiency and anaemia.

Other useful nutrient tests are vitamin B12, Folate, Vitamin D.

If you have recent results for these then you could post them with their reference ranges and ask for feedback.

An iron panel varies in the tests that get done, but they often consist of :

Ferritin, Serum Iron, Transferrin Saturation, Total Iron Binding Capacity. It helps in interpretation of the results if a CRP test is done as well.