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Thyroid and Adrenal Function
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Thyroid and Adrenal Function

Good afternoon.  I posted a week or so ago and had so many helpful responses.  Thank you!

I have an appointment with my doctor in a couple of weeks, but spoke to her last week because I didn't want to wait to have tests done (we are trying to get pregnant and want to rule out hypothyroidism for the safety of the baby).

My doctor was very receptive to my concerns and is sending me for TSH, Free T3, Free T4, thyroid antibodies, estrogen, testosterone, and more.  She also mentioned having my adrenal function tested...I have looked into this and it appears to often (although not always) have a connection to thyroid function.

My questions are:  

1.  Can you please tell me exactly what adrenal tests I should have?  (I want to make sure I have the most reliable before I go.)

2.  How often do you see these two issues together -- thyroid issues turn to adrenal issues or adrenal issues turn to thyroid issues?

3.  Can someone suggest typical reference ranges or if "this" is high, then "the other" should be low.

I'm concerned to get the correct tests and then ultimately to have them read correctly.  Everything I read suggests that many doctors are not knowledgable on interpreting these thyroid and adrenal tests, but my doctor is great and will listen to me and research it more in depth if I ask her to.

Just want to head in the right direction.

Thanks again.
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Adrenal testing is more complex than thyroid testing -- if the concern is adrenal underactivity (this is the association with thyroid typically) then an ACTH stimulation test is recommended -- a cortisol response greater than 17 is normal.
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This is a great web site:
http://labtestsonline.org/understanding/conditions2/endocrine_table.html
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Thank you for all of your help.  The adrenal tests my doctor has ordered are ACTH, cortisol and DHEA.  

You hit my concern on the head -- from the info I've seen, this may only pick up something if it is a severe problem -- like all the thyroid tests I've had (or not had)...as it seems cortisol can ebb and flow throughout the day.

I'm going to try this and see where we end up.

Did I see there are home saliva tests you can do throughout the day and send in to a lab?  Is this a good route to take if all my tests are normal?

Can anyone recommend where to get a good one?

Also, my doc is testing TSH, Free T4, TOTAL T3, thyroid antibodies, prolactin, estrogen, testosterone and a few others.  I asked her for the Free T3, but the lab has Total T3 -- I'm not on any medication so is the TOTAL T3 okay?  Or, do I need to tell her to get me the Free T3?

Thank you to everyone for your continued help and support.
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Kellie,

Thanks -- you've been a great help and source of info.

I called again and asked my doc for the Free T3 -- okay.  Checked with the lab -- okay.  Went for the blood test yesterday, different person who told me after that it was only Total T3, couldn't find the Free T3 paperwork...UGH!

Now what?  Are these tests totally useless now?

I had TSH, Free T4, Total T3, thyroid antibodies, and adrenal (cortisol, DHEA, ACTH, extrogen, testosterone, prolactin...).

Can there be any correlation with the TSH, Free T4 and Total T3?  Mind you, I am NOT on any medication (including no birth control pills).

Also, if I need to have the Free T3, I think I read that the tests should all be from the same sample, so do I have to retest all of them?

Thanks for your continued help!

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Hi.  Just got my test results back and of course everything is normal.

AM Cortisol        10.1       (Range 4.0-22.0)
FSH                 2.8        (Range 1.5-9.1)
LH                  1.5        (Range 0.5-16.9)
Progesteron        27.3      (Range 3.3-26) *This is a bit higher
Prolactin           7.3        (Range 3.0-30.0)
Testosteron         34          (Range 20-76)

T3, Total           133         (Range 60-181)
Free T4             1.1          (Range 0.8-1.8)
TSH                  1.58        (Range 0.4-5.5)
DHEA Sulfate     47          (Range 40-325)
Thy. Anti           <35        (Range <35)

So I do not have thyroid antibodies.  Interestingly, my TSH has risen from 1.1 to 1.58, but my Free T4 remained the same.

I'm exhausted, but yet there's nothing wrong with me -- I can't imangine how terrible everyone with out of range test results feels if I feel like this when I'm normal.

Any suggestions?  I'd appreciate any advice.

Also, is taking some cortisone dangerous if you don't "need" it?  I'm considering trying it to see if I can make myself feel better on my own.  Don't want to hurt myself -- or in the slim chance I become pregnant, hurt the baby.

Thanks for everything.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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