High ACTH

I got the following blood results recently I am HypoThyroid I take 100Mcg Levothyroxine

ACTH - 88.00 pg/mL ( Normal Range 7.2 - 63.3)
TSH - 2.660 uIU/mL ( Range 0.450 - 4.500)
T4, Free 1.59 ng/dL ( Range 0.82 - 1.77)
Thyroxie(T4) 11.3 ( Range 4.5 - 12.0)
Cortisol- AM 19.5 ug/dL ( Range 6.2 - 19.4)

What can we conclude from this ,do I have adrenal insufficiency ?

[Pmak]

I appreciate if some one can help me. Thanks

[rumpled]

You have elevated ACTH and your cortisol is on the high side - it is more likely that you have elevated cortisol than low cortisol from this testing. What time was the cortisol test done?

High cortisol tends to suppress the thyroid as well. Another clue.

A lot of the symptoms overlap.

[Pmak]

Thanks for the response rumpled.  You are the only one seem to be active here.

Well, the testing was done at morning 9:00 AM fasting for 10 hours.

Cortisol is mild high, but one more thing is when I take thyroid medication in the morning before breakfast I get a headache ( on the sides I think its pituatory gland place).

[rumpled]

I am the community leader - others are active though.

I usually try to test closer to 8am. Fasting is great.

I have not heard of headaches specifically related to just taking the medication - can you ask for a different brand?

Cortisol testing takes time - one test does not tell the story so you have to test more than once and you have to test different ways - ie blood, urine and saliva.

[Pmak]

Reg. my headache, Could there be a tumor in pituitary gland, what they call cushing's disease ?

[rumpled]

Pituitary tumors do cause headaches. Some docs do deny this though - oddly.

Your doc also runs lousy thyroid tests - did not mention that before - but he only runs the standard panel which does not tell much at all - so no free T3, just free T4 - so you don't know what the thyroid is doing totally. Have you had any antibody testing - hashimoto's? This guy acts like T3 is not important but that is what the body uses... so you don't know. But to his credit at least he ran the ACTH and cortisol together but no other hormones effected by cortisol or any other adrenal hormones...

[Pmak]

Extremely sorry I just overlooked, yes my doc has done the T3.

T3 Uptake  32 % ( 24 - 39)
Free Thyroxine Index 3.6 ( 1.2 - 4.9)
Triiodothyronine 111 ng/dL ( 71 - 180 )
Thyroxine Binding Glubulin 19 ug/mL ( 13-39)

No Antibody testing.  My gut feeling if this headache goes all will be normal.

[rumpled]

Any other adrenal tests - like renin, aldosterone, or dhea sulfate?
The T3 looks decent. Your TSH is higher on the new, accepted scale of .3 to 3.0.

Is the doctor going to run any other cortisol tests?

[Pmak]

No, he is running any cortisol tests. He increased the dosage of Thyroid to 112Mcg. And for headache he prescribed "INDERAL".

[rumpled]

But you had a high ACTH test! He should at least follow up with a few more tests... sheez....

[Pmak]

Thanks, I am not even sure what question I need to ask when I visit the doctor he just looks at the lab tests and increases or decreases the dosage of thyroid. What should I do ?

Find a different doctor ?

Doctors nowadays are not trying to find the root cause.

[rumpled]

I say that over and over - they never look for a source - just toss a pill at everything.
You may have to find several docs - as in it may take a while to find the right doc... ack...

The guidelines say at least 3 tests... dang it.