Help with test results *frustrated*

I'm at the end of my rope. For 6 years, since I was 27, I've been suffering from every symptom possible of hypothyroidism and secondary Addison's disease (the main symptom being that I'm so tired I can barely function). I just got my test results back from my endo, and essentially, everything is "fine", except she encourages me to start taking B12 (which I've done before, with no change in symptoms).

I can't make heads or tails of these test results, can someone help me out? Blood drawn at 11am

Test Name                             Result                 Units                             Ref. Range

T. Protein                                 8.1                       g/dL                               6.3-8.4
Albumin                                   4.7                       g/dL                                3.5-5.0
Total Bili                                   .5                        mg/dL                              .2-1.3
Alk Phos                                  92                         U/L                                  23-159
AST                                          25                        U/L                                  11-43
ALT                                           32                        U/L                                   9-52
Sodium                                      143                     mmol/L                               134-144
Potassium                                 4.0                      mmol/L                              3.5-5.3
Chloride                                     103                      mmol/L                             98-107
CO2                                           25.9                     mmol/L                              22.0-30.0
Glucose                                       76                      mg/dL                                 74-100
Calcium                                     9.6                         mg/dL                                8.5-10.5
BUN                                          17                          mg/dL                                6-22
Creatinine                                    .8                        mg/dL                                  .1-1.2
GFR                                            82                         mL/min per 1.73                  >60
Iron                                              88                        ug/dL                                   37-170
TIBC                                            302                       ug/dL                                   265-497
% Saturation                                29                           %                                       20-55
WBC                                          2.8L                        10^3/uL                                3.8-10.6
RBC                                          4.17                          10^6/uL                              3.8-5.1
HGB                                         14.1                           g/dL                                    11.5-15.5
HCT                                            41.9                           %                                       37.0-47.0
MCV                                          100.3 H                      fL                                         78.0-100.0
MCH                                            33.7 H                      pg                                         27.0-31.0
MCHC                                          33.6                        g/dL                                       32.0-36.0
RDW                                           12.4                         %                                          11.5-15.5
PLT                                            196                          10^3/uL                                   130-400
MPV                                          10.1                          fL                                            7.4-10.4
NEU %                                        60.6                        %                                             40.0-74.0
LYMPH %                                     25.4                      %                                             14.0-46.0
MONO %                                       9.7                       %                                            4.0-13.0
EOS %                                         2.8                        %                                             0.0-7.0
BASO %                                       1.5                         %                                              0.0-3.0
NEU #                                            1.7 L                     10^3/uL                                    1.8-7.8
LYMPH #                                       .7                          10^3/uL                                     .7-4.5
MONO #                                        .3                         10^3/uL                                        .1-1.0
EOS #                                          .1                        10^3/uL                                          0.0-.4
BASO #                                        .0                         10^3/uL                                        0.0-.2
ESR, Westergren                         18                          mm/hr                                         0-20
VitD                                           43.8                         ng/ml                                       31.0-100.0
Cortisol                                      6.40 L                       ug/dL                                        7.8-19.8
Free T4                                       1.1                          ng/dL                                         .7-1.8
TSH                                           .85                           MIU/mL                                       .5-6.0
FT3                                             296                        pg/dL                                          200-490
Rheumatoid Factor                      <6.3                        IU/mL                                          0.0-12.0
Vitamin B12                                351                          pg/mL                                         230-1050
Sjogren's SS-A                            <1.0 NEG                 AI                                               <1.0 NEG
Sjogren's SS-B                            <1.0 NEG                 AI                                               <1.0 NEG
Ceruloplasmin                                 31                        mg/dL                                        18-53
Thyroglobulin                                <20                        IU/mL                                           <20
Thyroid Peroxidase Ab                    18                          IU/mL                                          <35


The next day, I had more blood drawn at 11:30am for a stimulation test, and had these results:

WBC                                               3.1 L                          10^3/uL                                  3.8-10.6  
Cortisol                                            10.72                       ug/dL                                       7.8-19.80
Cortisol (1 hour)                                29.89 H                     ug/dL                                     7.8-19.8
ACTH, Plasma                                 34 H                          pg/mL                                    5-27
Gastric Parietal Cell Ab                     <=20.0                       Unit                                       <=20.0
Intrinsic Factor Blocking Ab             Negative


Now, I can see that most of the numbers fall into the range specified. But no one can tell me that I'm FINE and there's NOTHING WRONG WITH ME. I'm a 33 year old female, and I should NOT be this tired all the time.
      

[cmjones311]

Ugh. This looked fine when I posted it, but now you can't even read it, let alone figure out what it says. Is there anything I can do to make the format better?

[cmjones311]

Let's see if this posts correctly:

Test Name        Result      Units    Ref. Range


T. Protein            8.1         g/dL       6.3-8.4
Albumin             4.7          g/dL       3.5-5.0
Total Bili              .5         mg/dL      .2-1.3
Alk Phos              92           U/L       23-159
AST                    25           U/L         11-43
ALT                     32           U/L         9-52
Sodium              143       mmol/L    134-144
Potassium           4.0       mmol/L     3.5-5.3
Chloride              103      mmol/L      98-107
CO2                   25.9      mmol/L    22.0-30.0
Glucose               76        mg/dL        74-100
Calcium              9.6        mg/dL      8.5-10.5
BUN                    17         mg/dL        6-22
Creatinine           .8          mg/dL       .1-1.2
GFR                  82   mL/min per 1.73   >60
Iron                   88           ug/dL       37-170
TIBC                 302          ug/dL       265-497
% Saturation      29             %           20-55
WBC                 2.8L       10^3/uL     3.8-10.6
RBC                 4.17        10^6/uL     3.8-5.1
HGB                 14.1           g/dL       11.5-15.5
HCT                  41.9            %         37.0-47.0
MCV              100.3 H          fL          78.0-100.0
MCH               33.7 H          pg          27.0-31.0
MCHC               33.6          g/dL        32.0-36.0
RDW                 12.4          %           11.5-15.5
PLT                    196      10^3/uL       130-400
MPV                  10.1         fL              7.4-10.4
NEU %              60.6       %                40.0-74.0
LYMPH %           25.4       %                14.0-46.0
MONO %            9.7         %                4.0-13.0
EOS %               2.8        %                 0.0-7.0
BASO %             1.5       %                  0.0-3.0
NEU #               1.7 L   10^3/uL           1.8-7.8
LYMPH #             .7       10^3/uL           .7-4.5
MONO #             .3     10^3/uL              .1-1.0
EOS #               .1    10^3/uL                 0.0-.4
BASO #              .0     10^3/uL               0.0-.2
ESR, Westergren 18      mm/hr                 0-20
VitD                  43.8     ng/ml             31.0-100.0
Cortisol             6.40 L    ug/dL              7.8-19.8
Free T4               1.1      ng/dL                .7-1.8
TSH                   .85     MIU/mL                .5-6.0
FT3                    296     pg/dL                200-490
Rheum. Factor   <6.3    IU/mL                0.0-12.0
Vitamin B12        351    pg/mL               230-1050
Ceruloplasmin       31     mg/dL                 18-53
Thyroglobulin      <20  IU/mL                    <20
Thyroid Perox Ab   18    IU/mL                  <35

Sjogren's SS-A <1.0 NEG                                                
Sjogren's SS-B  <1.0 NEG


The next day, I had more blood drawn at 11:30am for a stimulation test, and had these results:



WBC                 3.1 L        10^3/uL    3.8-10.6  
Cortisol            10.72       ug/dL        7.8-19.80
Cortisol (1hr)   29.89 H     ug/dL        7.8-19.8
ACTH, Plasma    34 H         pg/mL         5-27


Intrinsic Factor Blocking Ab             Negative

[rumpled]

The elevated cortisol is troubling but ah - your doctor - why did they do the tests at 11:30? That is not a diagnostic time... Cortisol and the hormone testing my doc insists on 8am fasting...

Cortisol can vary at time of day and at that time of day it should actually be going down, not rising - which should be a clue to the doctor. Your diurnal or circadian rhythm is off. Have you looked at the symptoms of Cushing's syndrome to see if they fit? You may have the episodic or cyclical type.

[Red_Star]

Okay well i'll go through the list..my answer may be as long as your question lol.  

Your vitamin B12 levels are too low. (Japan and Europe changed their lowest acceptable B12 serum to 500 or 550 pg/mL).  Labs elevated with B12 deficiency - MCV and MCH.  Sublingual (under the tongue) B12 is highly recommended. Vitamin B12 deficiency is commonly seen with hypothyroidism due to insufficient stomach acid.  Optimal vitamin B12 serum is over 800pg/mL. Low white blood cells can be due to vitamin B12 deficiency so correcting B12 deficiency may correct your low WBC.

***

The body does not reliably begin storing vitamin D in fat and muscle tissue until blood levels get above 50 ng/ml.  Vitamin D council recommends 80ng/mL.

***

TSH is not reliable as there are too many variables to consider.  Your TSH result may be artificially low if you are deficient in cortisol. This explains hypo symptoms with TSH heading into hyper range.  

Optimal thyroid levels:

TSH: 1.3 - 1.8
Free T4: 1.2 - 1.3
Free T3: 320 - 330

Your low cortisol has no doubt artificially lowered your TSH into hyperthyroid range. Your FT3 and FT4 are in "normal" range but at the lower end of normal.

"If the T4 is in the low (but still ‘normal’) range and the T3 is to the right of it in the low but normal range, it means that the T4 is converting to T3 at a high rate (more T3, less RT3). This is typically found when the thyroid gland is unable to keep up T4 production to meet the body’s needs. The body can compensate by increasing conversion of T4 to more T3. We see this in hypothyroidism. (e.g. TSH 5.5, FT4 0.85, FT3 294)" - Dr Rind - Thyroid Scale Overview


***

Primary adrenal insufficiency:

The ACTH stimulation test does not double the low base cortisol level.  ACTH plasma will be at the top of the range or above range. Sometimes in Addison's disease, ACTH will be very high into the 1000's.

Secondary adrenal insufficiency:

The low base cortisol can double, triple, quadruple. The serum ACTH will usually be in the bottom half of the range to the very bottom, but not usually below the range.

Your labs are conflicting.  Your cortisol triples from the base line indicating secondary adrenal insufficiency. The ACTH test however is high indicating primary adrenal insufficiency.  Not sure about the pg/mL range. Could be too low maybe.  I found an article by Chris Jackson on interpreting the ACTH stimulation test. He doesn't mention reference ranges when talking about the secondary ACTH plasma test but he does mention a 5 - 27 range. Hmmm :)

"Again, I like to see it in the upper third of the range (assuming a range of 10 – 60 as they almost always were until a couple of years ago), but now many different ranges are popping up and most are flawed to the lower end of the range ie. 5 – 27 which is the range where most secondaries test at in the serum acth test. Further proof that the labs get their ranges from the sick people who are given the test."

[AngieBud]

Red_Star is very bright & right on.  So, I won't reiterate what she analyzed.  I just want you to know that this IS NOT IN YOUR HEAD & you are right...there has to be some Dx to explain your fatigue & symptoms.  DO NOT GIVE UP looking for the answers.  

I started getting sick around 28 (like you 6 years ago) & now I'm 39 years old.  After many doctors, even Mayo Clinic, and multiple tests, procedures, surgeries, diagnoses (Fibromyalgia, CFS, Depression, Interstitial Cystitis of the bladder, migraines, hypoglycemia, PCOS & MANY MORE) - I finally got the diagnosis of SECONDARY ADRENAL INSUFFICIENCY in May 2010 after I started passing out from severe hypoglycemia & ended up in the hospital.  My family doctor figured it out; not an endocrinologist!

And, many of the symptoms of secondary mimic or co-exist (differential Dx or co-morbidity) with the diseases I listed.  I am still not at 100% functioning on everything but at least I know now.  I'm on steroids (prednisone) daily & have to stress dose often because I get sick easily & have lots of stress.  I'm hoping to decrease my steroid intake & lose some of the weight I've gained.

Anyhow, my point is...keep trying, don't give up & surround yourself with people that make you happy & understand &support you.  This website along with mdjunction are wonderful places to get support from others who understand you because they are in the same boat.  I wish you well & hope you find some answers so your healing can begin.  How are you ever supposed to lead a normal life or be happy if you can't fix what's wrong since you don't even really know the problem.  Doctors give up way too easily & rely too much on numbers/lab values instead of true clinical symptoms & the patient's own words/feelings.

Keep in touch!  Good luck!

Angela

[cmjones311]

Thank you all for your information.

I'm sorry if I sound dense (we'll blame it on brain fog!), but redstar, I'm so confused at what you said! lol

Do my test results indicate that something is wrong that the doctor is not looking at? And if so, what should I tell her when I go back in a few weeks?

[Red_Star]

Oh i can relate to the brain fog lol! I had severe vitamin B12 deficiency myself.  

Well this is the short version of my long answer:

Vitamin B12 deficiency needs correcting.
Vitamin D still a bit low.
Hypothyroidism is present (but easily missed).
Secondary adrenal insufficiency is likely.

Your adrenal stimulation test results are not healthy. A healthy person should see the cortisol level double from a baseline of 20-30 ug/dl within 60 minutes. Your base cortisol level is 10ug/dL and triples.  I personally would get a second opinion from another doctor.

[wada01]

I can completely relate.  I have been going through the same exact symptoms for years; however they have become god awful since about 28, 29 years old.  I'm now a 35 year old female.  I'm on lexapro, wellbuetrin and adderall (adderrall) xr 30 mgs per day (adderall (adderrall) alone should be wiping out fatigue but it doesn't).   I'm soo tired of this.  Doctors think its in my head and I'm starting to wonder myself.  Any suggestions?????

[rumpled]

Depression and fatigue are often side effects of hormonal issues - so your docs are treating symptoms without doing testing.
Perhaps you should insist on some tests - but sadly the meds can interfere with the tests. So your tests may come off weird just do to the *treatment*.

[AnnNoniMoss]

I found that Wellbutrin helped my thyroid medicine work better.  I've read that dopamine helps your body to use thyroid hormone.
I used to chew nicotine gum, but stopped when I realized it was masking my thyroid symptoms and skewing my test results.  I felt really fatigued for a while afterward.  Since nicotine causes an increase in dopamine, it makes sense to me now!
...  On a different topic...
Has anyone looked into Polyglandular Autoimmune Syndrome?  It's listed on the Johns Hopkins Autoimmune Disease Research site.