It really depends on the degree of cortisol deficiency. Treatment can range from stress management to hydrocortisone med. First thing is to get some further testing done to confirm or rule out a cortisol deficiency.
Good. Remember to ask for the free T3 if you get approval for a Reverse T3. If you test for antibodies, TPO ab should be first, and if negative, then TG ab. I am not sure about the the possible effect of the scan on TSH. I do know that elevated iodine can cause TSH to rise. I think the key to diagnosing a thyroid issue at that time would be symptoms, that is why I asked about those. At this point your latest thyroid test results for Free T4 and Free T3 are at about 40% of their range, which is not too bad, but could be improved; however, it may be that the first thing needed is to determine your cortisol level and whether it is causing your symptoms. For example, check this list.
The symptoms of low cortisol, or hypoadrenalism, include:
Mental and psychological ailments such as depression
Faintness and dizziness
Weakness and fatigue
Heart palpitations
Emotional hypersensitivity
Inability to cope with stress
Social anxiety
Muscle weakness
Headache, scalp ache, or general body ache
Severe or dull lower back pain
Extremely sensitive skin
Nausea, diarrhea, and vomiting
Abdominal pain and hunger pain despite an empty stomach
Extreme craving for salty foods
Anxiety and jitters
Clumsiness and confusion
Motion sickness
Insomnia and dark circles under the eyes
Low bladder capacity and symptoms of IBS
Irregular or non-existent menstrual period
So it may be that you have to address any cortisol issue first and then see how you are feeling afterward.
Yes, I will definitely ask for the saliva cortisol and reverse t3. If my doctor won't order them I will order it myself. I'm at the point I'm desperate for answers and am not willing to be miserable on their clock. By what you say and what the link you posted says that could be my issue. My ferritin isn't 39 now, just to clarify, it's 141 per my last test. However, I agree, my iron was low when I tried the armour regardless of the infusion at that time because it takes awhile for the body to absorb it all. Thank you so much for all your help!!! I'm at my wits end and want so badly to feel better!
Before going further, I would like to go back and ask a few questions. When you were originally put on thyroid med, was it because of symptoms or just the high TSH level? If you had symptoms what were they?
I am suspicious that the reaction to the Armour Thyroid was the result of low cortisol or low ferritin, since you had only just started iron infusion due to low iron. Ferritin is considered as a precursor to iron levels, so your current level of 39 is far below recommended level of at least 70,and some say 100. So it appears you are going to need to supplement that daily with something good like Vitron C.
If you are going to try and get tested for Reverse T3, you might have to tell the doctor that, as shown in item c. on page 5 of the link, "RT3 is an excellent marker for reduced cellular T4 and T3 levels not detected by TSH or serum T4 and T3 levels". If you look at the diagram on page 7 of the link you can note the many things that can affect tissue thyroid hormone effects, which essentially powers our bodies. If you are able to get the RT3 test, you should also get a Free T3 from the same blood draw. That will enable a good calculation of Free T3 to RT3 ratio.
While at the doctor, if there is any way to get a diurnal saliva cortisol test taken at four times during the day, I highly recommend it. Diagnosis of cortisol is somewhat difficult. The saliva tests are for free cortisol, while the morning serum cortisol is total cortisol, taken only one time. The reason I am pushing this is your relatively low serum cortisol result plus the achiness you mentioned. Low cortisol can cause achiness. If the doctor refuses, could you handle getting a test kit from ZRT Lab?
Thank you so much for responding Gimel! Here are my recent labs with reference ranges:
January 3rd 2016 fasting thyroid test
Tsh 3.410 0.270-4.200uIU/mL
Ft4 1.24. 0.93-1.70 ng/dL
Ft3. 3.0. 2.0-4.4pg/mL
Ferritin 141 6-170ng/mL
I know this has come down a little more, but don't have the labs from the ER yet. This was December 27th 2016.
Cortisol 12.4ug/DL. 6.0-18.4ug/dL done at 8:05 am fasting
July 2016
B12 495pg/mL. > 246 ph/mL
Vitamin D. 55 ng/mL. 30-150ng/mL
I am planning to retest my own antibodies this Friday and will look to see if I can order a reverse T3 test as well. My iron infusion was done four days into taking armour thyroid. At the time, last week of September 2016, my ferritin was 39, but my full iron panel looked great. I will look those numbers up if needed, but I know my serum iron was in range and my saturation rate was great. However, my CBC ALWAYS makes me look iron deficient. I'm beginning to wonder if I have a blood disorder. I still have a high count of red blood cells that are tiny with low mov and mch, my hemoglobin finally went up last week. Very strange. Let me know what you think!
Wow you have really been through it. A couple of things come to mind. I would first like to see you get a more thorough panel of tests done. Specifically I suggest those listed in suggestion no. 2 on page 2 of this link.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
I would test for Free T4, Free T3, Reverse T3, TSH, and Thyroid antibodies (both TPO ab and TG ab) if not done previously. Also I would test for cortisol, Vitamin D, B12 and ferritin. If the doctor is willing to test for free cortisol with a saliva cortisol panel, rather than morning serum cortisol that would be even better. If the doctor is unwilling to do the saliva tests, then you could order it online and get a kit and send it and get results in a week or so. Cost is about $145 for a 4 test panel of saliva (free) cortisol.
The reason I include cortisol and ferritin is that low cortisol or ferritin can cause reactions like you mentioned when starting on Armour. And I assume that was before starting iron infusion.
For a little bit more clarity, please post the reference ranges for the recent Free T4 and Free T3 test results. Also when were they done? Also what time of day was the cortisol test done and what was the reference range shown for that time of day?