If you are going to do the stim test, make sure you don't do anything of the natropathic teas etc for at least 48 hours beforehand so it does not interfere with the testing.
Did the endo do any baseline testing - cortisol, acth, renin, aldosteron, dhea etc etc - how are your sodium and potassium and how is your BP?
Temp I associate with thyroid - so did they check that all out with antibodies on down?
With all the issues - did they check your pituitary? Have you seen a rheumy for any auto-immune issues?
thanks for the advice about stopping the herbal teas and such. yes they did test my blood acth. they did the full thyroid panel and apparently its really good. same with parathyroid and everything else. I have a copy of my bloodwork and went over it item by item with 3 docs. thyroid is fine. exercise lowers my body temp by 2 degrees even a 20 minute walk, therefore they are certain it's cortisol related/adrenal that's why the stim test. but she didn't do the renin and aldosterone or dhea. should I be asking for this? I won't be seeing her for weeks. here in Niagara Canada it's really long waits. I have been tested for rheumatoid factors and inflammation these were negative. how do they check the pituitary?
The renin, aldosterone and dhea sulftate are other adrenal tests that are usually wacky concurrently with cortisol so... a thorough lab testing would have covered this. Any urine or saliva testing?
Since it sounds to me, a layman, that you have several issues - they should have covered some pituitary as well - and might have - those tests usually end in H like TSH, ACTH (which by the way is super fussy - was it in a chilled tube and spun and frozen asap - if not it was lower for lab handling), LH, FSH, IGF1 or GH (IGF-1 better), just to cover you at least once. On thyroid did they just do TSH or do free T3 and free T4?
they only did TSH and yes the ACTH was specially handled I had to go to a lab out of town as my local lab doesnt do freezing and purple tubes apparently. To be honest I suspect that my thyroid was a bit low due to my overtraining with Tabata intervals and not enough rest/recovery, add in the non stop mega hot flashes and no sleep, it took its toll. then I started HRT and thats when the low body temp started and all the other symptoms as well. I am now cutting my dose of hrt in half to see what happens (so far no hot flashes but didn't sleep due to nightmares!) and may stop it altogether if I improve. I will insist on more complete testing next appointment. this is really terrible that doctors dont do a thorough job and wasted 5 months of my time and kept me suffering so long. I will also ask for a referral to a menopause clinic where the doc there does bio identical and will test and apparently treats thyroid based on how you feel not just labwork...
my BP has gone up 20 points actually it used to be around 110/70 now when i check randomly it ranges 150/80 down to 130/80 but then again I haven't worked out in a couple of months and I feel pretty stressed. the endo and the doc both did some tests on it with me laying down and getting up fast and sitting etc.. but I didnt ask what it was, but it did prompt the endo to order the acth stimulation test and acth morning blood test.
the blood test for acth results came back as 4.2 and the lab range said <10 so I assume that is a go od result? I am gonna try tapering off my HRT patch to half dose for a week and see if that helps, apparently estrogen binds to thyroid and can really mess with it in some people, and if mine was low to begin with, that might be the answer to the whole problem. funny how the doc never even thought of that, only the emergency doctor when I had a crisis said to me "if I were you I'd rip that thing off as soon as you get home". weird, and she was maybe a couple of years older than me but a real dynamo in action. I guess she's anti hormones but I wasn't functioning very well without them either...so hard to figure out!
Hormones are kinda necessary - so the right balance is needed and it is hard to get at times.
I have not heard of an ACTH range like that. I find that one strange - a low ACTH is not - IMHO - a goal one wants to get... so er, I don't know how to interpret that one.
I don't know about the estrogen binding thing but do work with your doc to get your dosages adjusted so all your hormones are in sync!
The HPA axis is the hypothalamic - pituitary - adrenal axis. In simple terms, this is the boss (hypothalamus), second in charge (pituitary gland) and one of the executives (adrenal glands) messaging each other to control stress response. So when a big spider is about to crawl up your leg, or something like that lol, you can run away super quick. I like this axis. :) The HPA axis does more than controls stress response though. Other "jobs" include regulating minerals and salts and blood pressure to name a few.
Various conditions cause HPA axis dysfunction and include, but not limited to, chronic stress, adrenal insufficiency, thyroid disease, Cushing's disease, diabetes, rheumatoid arthritis. Taking adrenal supplements can help with HPA axis dysfunction but in certain disease states you may need surgery or permanent replacement hormones.
Another "executive" is the thyroid gland. This axis is called the hypothalamic – pituitary – thyroid (HPT) axis. The HPT axis looks good in theory to make a diagnosis of thyroid disease but the thyroid stimulating hormone (TSH) is a pituitary hormone. In other words, you are taking the word of the second in charge that the executive is feeling great. In this axis, the second in charge isn't always right.
A more comprehensive thyroid panel - TSH, free T3, free T4, Reverse T3, thyroid antibodies - thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb).
A book that you may be interested in: "Why do i still have thyroid symptoms? when my lab tests are normal" by Dr Kharrazian.
Wow you really know how to explain things! I have decided to make an appt with my GP and tell her very nicely that I don't believe she was thorough enough with just testing the TSH, and that I want her to request the other thyroid tests (and I will tell her T4 T3 Free of both and reverse also, the works! apparently they dont test this routinely in Canada, no wonder so many of us are sick and tired! She has to complete my insurance forms anyway so we'll get to the bottom of it. I will say I have had a small burst of energy yesterday and today, maybe becuase I CUT my HRT patch in HALF to see if that was affecting my Thyroid. Guess what, I also woke up with a body temp of (97.7, this is more than one degree higher and pretty much normal) I think I wrecked myself doing too much high intensity cardio not eating enough AND when menopause hit my thyroid and adrenals were stressed, the HRT put me over the edge...Stay tuned.
No problem. :) Yeah the scientific versions can be a bit full on "what the?" type thing. :)
You can try a few adrenal home tests to try out below to see how you are going. I've had severe adrenal fatigue from severe vitamin B12 deficiency and again a few years later from a Hashimoto's thyroiditis flare up.
At my worst, my pupils fluctuated every second (maybe even quicker than that) and my white line test showed over a 2 inch white line on my belly. It took 18 months for the white line test to show a normal result. When you mess with the axis.... :)
From adrenal fatigue recovery...
"Adrenal Function Tests You Can Do at Home
ADRENAL FUNCTION TEST #1-Postural Hypotension:
Postural hypotension (also known as orthostatic hypotension) is a drop in blood pressure that occurs upon rising from a horizontal position. It is commonly expressed as a feeling of dizziness or lightheadedness, a "head rush", or "standing up too fast".
To do this test, you will need a blood pressure cuff. Lie down and rest for 5 minutes. Take a blood pressure reading while still horizontal. Then, stand up and take another reading.
Normally, your blood pressure should rise 10-20 points. If it drops, particularly by 10 points or more, hypoadrenia is indicated. Generally, the bigger the drop, the greater the adrenal insufficiency.
It should also be mentioned that low blood pressure in general is also an indicator of exhausted adrenals when present in conjunction with the other symptoms of adrenal gland fatigue.
ADRENAL FUNCTION TEST #2-Iris Contraction Test
For this test you will need a weak flashlight or penlight, and a mirror. In a dark bathroom or closet, wait a minute for your eyes to adjust to the dark. This will allow your pupils to dilate (open) fully. Then, shine the flashlight into your eyes, and watch the reaction of your pupils for at least 30 seconds.
The light should cause your iris to contract, making your pupils (the dark spot in the center of your eye) smaller. Normally, they should stay that way, but if you have adrenal gland fatigue, the iris will be weak and will not be able to hold the contraction, it will either waver between contracted and relaxed, or will contract initially, but then open up after 10-30 seconds.
As with the postural hypotension test, the degree to which you "fail" this test is an indicator of the degree of adrenal insufficiency you are experiencing.
ADRENAL FUNCTION TEST #3-Sergent's Adrenal White Line
With your fingernail or the dull end of a spoon, draw a line across your belly. In moderate to severe cases of adrenal fatigue, the line will stay white, and even get wider over the course of time, while a "normal" reaction would be for the line to almost immediately turn red.
This test has historically been used to indicate severe adrenal fatigue and Addison's Disease, milder cases of adrenal fatigue may not exhibit this sign."
I think that a morning temp of 97.7 is still too low and would be considered a symptom of low thyroid by quite a few doctors that use morning basil axillary temps to help diagnose thyroid problems.
Using only a TSH is totally unreliable. I had a doc once look at my thyroid test that was low T4 and low TSh---he should have realized something was wrong since, if they really worked, they should be opposite each other. He was obsessed with normalizing my TSh and lowered my thyroid meds 2 or 3 times until my hair was falling out---finally another doctor saw my test results and told me my thyroid was too low----It took about 2 years for my hair to fill back in.
I second what rumpled said about getting all your hormones in sync. make sure they get you into optimal ranges--not just "within range". I went to my doctor and told him my bones hurt--but they didn't think anything of of it because they have been used to me being in pain for so many years. My vit d had been tested and was "within range" so no one said anything about it. A few months back I looked at the test and realized that the bottom of the "range" was 30---and my levels were 33---no wonder my bones hurt. I've been on 10,000IUs of vit D for awhile and the bone pain has definitely improved----now if we can just figure out the muscle pain and the arthritis that started showing itself here and there since my early 20s----and it's not rheumatoid arthritis.