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First time being on Cortef...

Here are my thyroid and cortisol results...

Free triiodothyronine 4.5 RANGE 3.5-6.5
Senstitve TSH 1.37 RANGE 0.35-5.00
Free T4 16 RANGE 9-23

ANTI -PO 48 HI RANGE <35
ANTI-TG <20 RANGE <40

ANTINUCLEAR ANTIBODY POSITIVE
TITRE 1:320 HI
ANA PATTERN Speckled and homogeneous pattern


6:00-8:00am    10   depressed   range:13-24 nM
11:00-noon        15 elevated        range: 5-10 nM
4:00-5:00pm      13 elevated        range 3-8 nM
10:00-midnight    8  elevated       range  1-4 nM

Cortisol Burden  46      range   23-42

Elevated  DHEA


I was also tested tested for adrenal tumors and they were all in range and normal..

creatine    11.4  range   5.0-16.0
normetanephrines    0.9   range   <3.4
Metanephrines   0.6  range   <1.5
urine ph  1.9

Catecholamines   urine
epinephrine     23    range    <120
norepinephrine   151  range  <575
dopamine    1736    <3200

Long story short, I am on 5mcg Cytomel split up(have tried natural thyroid before and stopped taking it)   Doctor wants to put me 10mg of Cortef split up and 50mg of progesterone at night(calming effect and I'm also trying to get off birth control). The cytomel helps with my body temp but not much with all other symptoms such as fatigue, brain fog, weakness.  Are there any side effects to taking cortef???  My test results show I have high cortisol at night but honestly I always feel like high cortisol cycles throughout the day, depending how stressed I am.  Will it lower the high cortisol and will it shut down my adrenals a bit?? How do they know this is not affected by my pituitary gland? thanks.
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Avatar universal
Fasting, 8am. It is a regular blood test but unless the lab knows  how to do it correctly (chilled EDTA tube, spun immediately, frozen promptly after spin) the test can appear lower than it actually is if the tech does not know how to do it or the tube it put in the bin to wait for processing or *coagulation*...

A proper pituitary MRI is with a without contrast - and dynamic... you doc is not doing you any favors... Pays to go to an experienced place too. There is some skill involved to get the contrast in while the images are taken. Then the radiologist and surgeon can see the uptake - smaller tumors are seen that way.

Good about the bones!
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Avatar universal
Finally! I got my doctor to give me an ACTH test but he didn't say much about it. When is the best time to take it? What is the process? Do I need to fast? Will it be uncomfortable. I also got a head MRI to check for pituitary tumors but it wasn't ordered with any kind of injection or dye. Should I ask for that? thanks.

To rumpled: Yes I think I have already done a bone density test and it came back fine.
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Avatar universal
The bone scan is easy, you lay on an open table while a little scanner angles over you making a zzzzz zzzzz sound...  bone scans are called DEXA usually.

Usually they cannot due to the magnet according to a post in the brain community...
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Avatar universal
I did get a bone density scan a year ago for my whole body but it wasn't called a DEXA as far as I know.  

Even with the newer MRIs they are still scary lol.  I wonder if they can administer general anesthetics.
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Avatar universal
Sorry to be the bearer of bad news - but better than getting more sick... the cortef would have ironically added to your fatigue.

The newer 3T machines have a larger opening. Ask your doc for a sedative before the MRI and have someone drive you there. Just get a good, dynamic MRI.

Have you had a DEXA scan ever?
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Avatar universal
Thanks Rumpled...sigh...its just so frustrating and you hope that this little cortef pill will help.  I might have to go and get a second opinion.  Man, I don't like MRIs.  The last time I went in one I had to get out half way through.
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Avatar universal
How has the doc looked for tumors? It can be very difficult to look for tumors. I had one of my hide for 12 years, while the other changed sizes. MRIs slice in 3mm so pit tumors can fall between the slices, the radiologist can miss it etc. My adrenal imaging was read as normal and they were 3 to 4 times the size of normal (and scans afterward said they were normal too!) and this happened to other people too.

It takes lab testing to find the source and really good imaging and surgeons need to look at the scans. They can typically find more than the radiologists as these lesions are tiny... and they know what to look for.

Cortef does not block cortisol at all - it is a cortisol replacement. It would add to the cortisol. I take cortef to replace my cortisol.
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Avatar universal
from what I have read..people do use Cortef to sort of block cortisol too, no?
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Avatar universal
Well thats the problem..I don't seem to have anything that is causing the rise of cortisol...no tumors and such..
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Avatar universal
Why oh why is he putting you on cortef when you have elevated cortisol readings??? Do you want to throw fuel on to fire?

Were they saliva tests - and you were on birth control pills? Saliva is free cortisol. The estrogen in the birth control binds free cortisol - making the tests appear lower than they are...

There are a lot of side effects to cortef. If you don't need it and you take it - it will actually raise your inflammatory markers, not lower them. Your tests already read as Cushing's and to take corticosteroids on top of that is rather strange since Cushing's is too much cortisol aka the equivalent of corticosteroids.

Fatigue is a huge part of Cushing's. Your adrenals are wired but tired - the resolution is to find the source of the cortisol and remove it.
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Avatar universal
forgot to add I will be tapering off antidepressants slowly and hope it won't affect how the Cortef works.
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