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24 hour cortisol saliva test, other labs
Anyone want to help interpret these, any recommendations ? Feel worse than ever. Doctors order these tests and then there doesn't seem to be any urgency getting me back in to see them or adjusting my meds. Dying here. MORE labs tomorrow. 8 years of this. Never well. Was sold 2 bottles of supplements, cost almost $100, cannot afford it.One is called Adren-All, which I'm supposed to take with lunch. What is "lunch" ? No appetite, yet gained 25 lbs. in 2 months. This is a combination of vitamins I'm already taking anyway plus some bovine extract, ginseng, rhodiola, Schizandra, and Licorice. I've been given similar things in the past, never did much for me. Other one is called Digest which is a bunch of enzymes because apparently I'm not absorbing fats properly and am passing too much fiber. Supposed to take one with meals. Not sleeping at all, so exhausted, wake up every night at 3AM. I'm sure if I tallied up all the money I've spent on "supplements" over the last 8 years, not to mention co-pays, I'd have enough money for a fancy trip to Paris and Rome or something. Instead, I have no life whatsoever and am flat broke. Everything hurts.
May 1, 2013
50 mcg levothyroxine 30 mcg Cytomel (before rT3, I was on 150 mcg T4 and 30 mcg Cytomel. FT4 was mid-range and FT3 was near the top of the range)
TSH ultra-sensitive .02 (L) .350 - 5.000 (what's ultra-sensitive about that range ?)
FREE T3 3.10 1.50 - 5.00
FREE T4 .80 .50 - 1.55
Dr. did not order T4 Direct Dialysis as is usual since I am on HRT. He did not order rT3 to compare to previous tests. Last it was measured, at this same dose of thyroid meds, the ratio was 10 but Dr. did not seem interested. However, these labs were done through Lab Corps. All my other tests were done at Quest. Doctor insisted. I don't know how to compare them, really. Usual disclaimer that new reagent is returning 10% higher FT4 values.
DHEA-SULFATE 390 350 - 43000
Cortisol serum 24.60 (H) 8 - 22.0 (AM draw)
Free testosterone .4 (L) .8 - 1.4
24 hour saliva test, adrenals
8AM 21.9 13.0 - 24.0
NOON 4.7 5.0 - 8.0
4 PM 3.3 4.0 - 7.0
MIDNIGHT 3.1 1.0 - 3.0
CORTISOL SUM 33.0 23.0 - 42.0
DHEA-S Average 1.94 2.00 - 10.00
FREE Testosterone was low, estrogen and progesterone were OK but were cut in half because my breasts hurt, which was a first for me. Sex-binding hormones were very high and I am a fast metabolizer. I have CC MTHFR 1298, so high risk, but homoncysteine isn't too bad, it's 11 and optimum is <11. Test high for hs-CRP at 3.1, optimum is 2.9, so some sort of inflammation.
All tests were done before taking any medication.
Thanks for any help.
May 1, 2013
50 mcg levothyroxine 30 mcg Cytomel (before rT3, I was on 150 mcg T4 and 30 mcg Cytomel. FT4 was mid-range and FT3 was near the top of the range)
TSH ultra-sensitive .02 (L) .350 - 5.000 (what's ultra-sensitive about that range ?)
FREE T3 3.10 1.50 - 5.00
FREE T4 .80 .50 - 1.55
Dr. did not order T4 Direct Dialysis as is usual since I am on HRT. He did not order rT3 to compare to previous tests. Last it was measured, at this same dose of thyroid meds, the ratio was 10 but Dr. did not seem interested. However, these labs were done through Lab Corps. All my other tests were done at Quest. Doctor insisted. I don't know how to compare them, really. Usual disclaimer that new reagent is returning 10% higher FT4 values.
DHEA-SULFATE 390 350 - 43000
Cortisol serum 24.60 (H) 8 - 22.0 (AM draw)
Free testosterone .4 (L) .8 - 1.4
24 hour saliva test, adrenals
8AM 21.9 13.0 - 24.0
NOON 4.7 5.0 - 8.0
4 PM 3.3 4.0 - 7.0
MIDNIGHT 3.1 1.0 - 3.0
CORTISOL SUM 33.0 23.0 - 42.0
DHEA-S Average 1.94 2.00 - 10.00
FREE Testosterone was low, estrogen and progesterone were OK but were cut in half because my breasts hurt, which was a first for me. Sex-binding hormones were very high and I am a fast metabolizer. I have CC MTHFR 1298, so high risk, but homoncysteine isn't too bad, it's 11 and optimum is <11. Test high for hs-CRP at 3.1, optimum is 2.9, so some sort of inflammation.
All tests were done before taking any medication.
Thanks for any help.
Very sorry to hear that you're feeling poorly. Sigh indeed. Thanks for all the good information. SHBG is high out of range. Homocysteine is 11 which is either low mid-risk or high low-risk, depending, as it's right on the line. But it's certainly not 6. Will investigate. Hope we both feel better soon.
XO
XO
A great book i've read is "The H Factor Solution: Homocysteine, the Best Single Indicator of Whether You Are Likely to Live Long or Die Young" by James Braly MD and Patrick Holford.
This is an excerpt from the book: "Probably two out of 10 people reading this book will have a super healthy H score below 6 and two in ten will have an extremely unhealthy H score above 15."
Overall, your 24 hour cortisol levels are looking good. I'm not sure you will feel that much of an improvement on adrenal support but you could give it a try. The main issues look to be with low cellular free T3. The reasons for low cellular T3 are quite a few but include high SHBG which can bind excessive amounts of thyroid hormone leaving less free thyroid hormones available to enter the cells.
Hypothyroidism is one reason for poor digestion, fat malabsorption and higher cholesterol. Slower metabolism can slow the production of stomach acid (an essential part of digestion but also stomach acid stimulates the pancreas to produce digestive enzymes) and can slow liver function which increases cholesterol levels. Just to add, cholesterol is a healing substance and responds to arterial inflammation and forms plaque as a healing agent on the artery lining.
I did read that DHEA concentrations are found to be significantly decreased in various cancers, inflammatory diseases, type 2 diabetes mellitus, and cardiovascular disorders.
I'm not feeling that great. Thyroid dramas *sigh* :)
This is an excerpt from the book: "Probably two out of 10 people reading this book will have a super healthy H score below 6 and two in ten will have an extremely unhealthy H score above 15."
Overall, your 24 hour cortisol levels are looking good. I'm not sure you will feel that much of an improvement on adrenal support but you could give it a try. The main issues look to be with low cellular free T3. The reasons for low cellular T3 are quite a few but include high SHBG which can bind excessive amounts of thyroid hormone leaving less free thyroid hormones available to enter the cells.
Hypothyroidism is one reason for poor digestion, fat malabsorption and higher cholesterol. Slower metabolism can slow the production of stomach acid (an essential part of digestion but also stomach acid stimulates the pancreas to produce digestive enzymes) and can slow liver function which increases cholesterol levels. Just to add, cholesterol is a healing substance and responds to arterial inflammation and forms plaque as a healing agent on the artery lining.
I did read that DHEA concentrations are found to be significantly decreased in various cancers, inflammatory diseases, type 2 diabetes mellitus, and cardiovascular disorders.
I'm not feeling that great. Thyroid dramas *sigh* :)
I forgot to say...I think the low DHEA is a big clue. In serum tests, its way below normal. T4 was raised to 75 mcg. I'll be interested if the FT3 goes up along with it. If it doesn't, it will point to a conversion problem. And seems clear to me that this has GOT to be central hypothyroidism, with those low levels.
Thanks for responding. I think, for instance for homocysteine, that it depends on the individual lab, right ? In this case my homocysteine is 11. The lab lists the ranges as >13 high, intermediate risk as 11 - 13, and optimum as < 11. So I'm not sure what optimum under 6 would mean in this context. So confused.
And I'm sorry but I don't understand how the range you gave for the 24 hour saliva test relates to what I seem to have had done......are you talking about the summary ? I guess so. So mine is 33 which is just slightly low. The doc said it was too low in the afternoon and that's when she wants me to take the adrenal supplement. I guess what I'm asking is that you see no need for a course of corticosteroids ? It just doesn't make sense that my FT3 and FT4 are so low. Obviously don't care about TSH. I went off T4 for 3 months, rT3 dropped low out of range as I increased T3. Blood tests during that time (having not taken meds for 32 hours) gave results of FT4 below normal and FT3 at the very bottom of the range, which I'm assuming is my "normal" sans medication. Rather frightening. During this time, edema went away but ears started ringing like crazy which made it hard to sleep. Foot spasms mostly ceased. No further charley horse.
The worst is that as soon as I reintroduced a small amount of T4 (had been on 150 mcg, reintroduced 50 mcg) and gradually lowered T3 back to my standard dose of 30 mcg, within 2 weeks severe edema returned, wose than before. Ankles looked like an elephant's. Then I gained 15 lbs. in a month, verified at the doctor's office, and a further 11 lbs. the next month. My waist swelled 4" and I had GERD-like symptoms. Fell horrible, as none of this has gone away. My cholesterol went up 40 points and my blood pressure zoomed up too. And my hair and skin got super-dry and the hair started falling out again. SO, I was pretty much back to the condition I was in before I went on thyroid meds in the first place, yet I was now on the same dose I started with back in 2009. Exhausted. Depressed. Anxious.
I led you astray about the fiber. It wasn't that there was too much fiber, it was that things that should have been digested were not. She mentioned meat fibers and something else. And yes, there's some malabsorption of fats. On the other hand, had ELIZA testing for food allergies and don't have any....just as the regular allergy tests said.
I'm blaming the elevated hs-CRP on the elevation of cholesterol due to being undermedicated. I had a dye-enhanced stress test 2 years ago just to prove to endos that, by taking T3, I was NOT putting myself at risk of heart attack as they all told me I was going to do. Passed perfect. And my HDL is stratospherically high.
And like your Mom, I only take phyto-based HRT. I just don't know. Everything hurts.
Hope YOU are doing well. Thanks again.
And I'm sorry but I don't understand how the range you gave for the 24 hour saliva test relates to what I seem to have had done......are you talking about the summary ? I guess so. So mine is 33 which is just slightly low. The doc said it was too low in the afternoon and that's when she wants me to take the adrenal supplement. I guess what I'm asking is that you see no need for a course of corticosteroids ? It just doesn't make sense that my FT3 and FT4 are so low. Obviously don't care about TSH. I went off T4 for 3 months, rT3 dropped low out of range as I increased T3. Blood tests during that time (having not taken meds for 32 hours) gave results of FT4 below normal and FT3 at the very bottom of the range, which I'm assuming is my "normal" sans medication. Rather frightening. During this time, edema went away but ears started ringing like crazy which made it hard to sleep. Foot spasms mostly ceased. No further charley horse.
The worst is that as soon as I reintroduced a small amount of T4 (had been on 150 mcg, reintroduced 50 mcg) and gradually lowered T3 back to my standard dose of 30 mcg, within 2 weeks severe edema returned, wose than before. Ankles looked like an elephant's. Then I gained 15 lbs. in a month, verified at the doctor's office, and a further 11 lbs. the next month. My waist swelled 4" and I had GERD-like symptoms. Fell horrible, as none of this has gone away. My cholesterol went up 40 points and my blood pressure zoomed up too. And my hair and skin got super-dry and the hair started falling out again. SO, I was pretty much back to the condition I was in before I went on thyroid meds in the first place, yet I was now on the same dose I started with back in 2009. Exhausted. Depressed. Anxious.
I led you astray about the fiber. It wasn't that there was too much fiber, it was that things that should have been digested were not. She mentioned meat fibers and something else. And yes, there's some malabsorption of fats. On the other hand, had ELIZA testing for food allergies and don't have any....just as the regular allergy tests said.
I'm blaming the elevated hs-CRP on the elevation of cholesterol due to being undermedicated. I had a dye-enhanced stress test 2 years ago just to prove to endos that, by taking T3, I was NOT putting myself at risk of heart attack as they all told me I was going to do. Passed perfect. And my HDL is stratospherically high.
And like your Mom, I only take phyto-based HRT. I just don't know. Everything hurts.
Hope YOU are doing well. Thanks again.
Optimal homocysteine is under 6 umol/L. Total 24 hour saliva cortisol - normal is 23-42 nM with the ideal being 34-36 nM.
Fiber is not absorbed by the body so the only way to be passing too much fibre is eating too much fibre. Any condition that affects lipase (pancreatic enzyme), bile (digestive fluid created in the liver and held in the gallbladder), or the duodenum (the first section of the small intestine) will affect fat absorption.
High sensitivity CRP (hs-CRP) is an index of inflammation that is now believed to promote all stages of atherosclerosis including plaque rupture. Risk of heart disease and stroke; hs-CRP: low risk: less than 1.0 mg/L, average risk: 1.0 to 3.0 mg/L, high risk: above 3.0 mg/L.
HRT has been shown to increase levels of hs-CRP. The HRT synthetic drug Prempro has been shown in large clinical trials to increase the risk of heart disease, stroke, blood clots, and breast cancer. My mother decided to use a phytoestrogen product instead called Phytolife (soy product) with excellent results.
Factors which increase SHBG and lower free testosterone include oral estrogens (including oral contraceptives, HRT tablets), thyroxine tablets, increasing age, alcohol, smoking, some anticonvulsants (eg: phenytoin), pregnancy, reduced liver function.
Fiber is not absorbed by the body so the only way to be passing too much fibre is eating too much fibre. Any condition that affects lipase (pancreatic enzyme), bile (digestive fluid created in the liver and held in the gallbladder), or the duodenum (the first section of the small intestine) will affect fat absorption.
High sensitivity CRP (hs-CRP) is an index of inflammation that is now believed to promote all stages of atherosclerosis including plaque rupture. Risk of heart disease and stroke; hs-CRP: low risk: less than 1.0 mg/L, average risk: 1.0 to 3.0 mg/L, high risk: above 3.0 mg/L.
HRT has been shown to increase levels of hs-CRP. The HRT synthetic drug Prempro has been shown in large clinical trials to increase the risk of heart disease, stroke, blood clots, and breast cancer. My mother decided to use a phytoestrogen product instead called Phytolife (soy product) with excellent results.
Factors which increase SHBG and lower free testosterone include oral estrogens (including oral contraceptives, HRT tablets), thyroxine tablets, increasing age, alcohol, smoking, some anticonvulsants (eg: phenytoin), pregnancy, reduced liver function.
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