adrenal and thyroid tests

[alizarin]

Hello - I'm hoping you can help me.  I recently saw a doctor who, on the basis of my symptoms and a Thyroflex reading, gave me a diagnosis of Adrenal Exhaustion and Hypothyroidism.  She prescribed DHEA (100mgs) and Hysone (hydrocortisone) 12mg, to be joined after 3 weeks by Thyroid Extract.  She also sent me for blood tests but advised me to take the medication immediately, which I have been doing.

I've now had my blood tests back and am confused by them (being very new to all this despite having symptoms for several years).  I have tried to speak to my doctor on the telephone but to date she has not rung me back, nor can I get an appointment for another 2 months.  The blood tests seem to me to indicate that I don't have a thyroid disorder and I'm unsure whether to continue taking the medication.  Maybe you could comment on my levels?  They are:

serum cortisol AM 828 (range 138 - 650)
urinary free cortisol (24 hour collection) 231 (range 70 - 430)
free testosterone 0.4 (range 0.1 - 13.5)
DHEAS roche method 2.1 (range 2.0 - 11.00)
Reverse T3 - 445 pmol/L (range 140 - 540)
Free T3 3.3 (range 2.5 - 6.0)
FT4 13 (range 8 - 22)

Any light you can shed on these mysterious numbers would be greatly appreciated.  Many thanks,
Alizarin

[laura1967]

I have an internal medicine dr, endocrinologist and a naturopathic dr.
I want to get better so I wanted to cover all my bases...lol....:)  :)

[alizarin]

Hello again Laura
Your reply is helpful - thank you.
I will research the adaptocrine - I'm finding the HC helpful (apart from the insomnia) but I'm wary of staying on it too long.
And no, she hasn't prescribed any testosterone, probably because she wrote the prescription before the tests were done.
She didn't test for hashimoto's - not sure why not.
I'm thinking I'll see how I go on what I've been given for a while, but research endocrinologists here, and maybe find a good natural practitioner.  Have you found it best to have one of each, or are you only seeing your natural practitioner?

[laura1967]

Nothing to apologize for.....asking questions is how we learn. :)
Our high cortisol levels put stress on the adrenals and can cause exhaustion. That is why my natural practitioner prefers adaptogens so it covers over and under cortisol levels. The product she put me on is made by Apex Energetics Nutritional Complexes and is called Adaptocrine (k-2) for adrenal support. Made in California. Try finding it on the web. I have done further testing for cushings but have not had MRI of putuitary or adrenals yet....too expensive.  Maybe you are on too high of a dosage of HC. It should only be used temporarily anyway to give your adrenals a break and time to heal.
Definately ask her about some bio-identical testosterone cream...that will help with your energy level. Were you tested for hashimotos thyroid autoimmune disease? That could cause early onset of hypothyroid symptoms. Let me know with any other questions.

[alizarin]

Dear Stella and Laura

Thank you both for replying to my post.

My symptoms were what took me to the doctor in the first place - intensifying exhaustion so that I was barely able to function; feeling that I was in the beginning stages of 'flu all the time; mental fog; insomnia... I found this particular doctor on the internet.  she received rave reviews but I find her a bad communicator - didn't explain much, is too busy to speak on the phone and discuss my test results and I can't get another appointment for 2 months.  Hence the confusion!  The endocrinological world here is very conservative, so finding someone else 'sympathetic' seems to be hard.

The only thing which came back out of 'normal' range on my blood tests was the AM cortisol 828 when the range is 138 - 650, but I don't know what this means. The adaptogen adrenal support - can I ask what that is, and where it can be obtained (I'm in Australia, not America, so many of the preparations and terms seem to be subtly different). Is it what stella suggests as 'natural' adrenal support?

I think I'll take the advice of both of you and get a saliva testing done, though I'll regret having to stop using the HC because it's actually helped a lot (other than the fact that I now wake between 4 and 5 every morning and can't get back to sleep - not sure whether that's the HC or something else).

Oh, and I checked the dosage of my HDEA and found it was 20 mg and not 100!  Obviously the mental fog hasn't dissipated quite yet.

Laura - your HC levels are high in the morning  like mine - what does this mean?  Is it a symptom of adrenal exhaustion or what?  Please forgive my lack of knowledge - this is all very new and somewhat confusing.

Thankyou both very much.

[laura1967]

Starting you on 100mg of DHEA is way too high....holy cow. You are in the low normal range, but probably should have been put on 25mgs per day. Women can usually get away with 10mgs to boost your levels. Low dhea is from your adrenals. Your cortisol is high in the am....mine is too. My saliva adrenal panel showed high normals the rest of the day. You really need a saliva panel with the blood panel to show true results. You look like you could use an adaptogen adrenal support....if high it will lower....if low it will boost.
As far as the computerized testing....if she is using a machine, you may not get a true reading because of the electricity running through the unit can alter results. Ask her to do hands on kinesiology. Or find someone that does, then you will get truer answers.
How come she didn't add some testosterone to you?
I agree with Stella that your dr needs to address adrenal issues first then you can see what is going on with the thyroid when she runs the correct tests which include a TSH.
Also as Stella asked....what are your main symptoms and complaints?

[stella5349]

HGH was just a stab idea  - thinking you may be heading into an anti aging therapy with Human Growth Hormones in addition to what you are recieving. That is why I asked your age too. Along with a possible menopause issue.

Your doctor is following protocal in (BIO IDENTICAL) hormones and looking at the adrenals as a starting tool to start repairing things.

Unfortunately - I am baffled that the TSH was not ran - I know - with the protacol of testing your doctor does - TSH is not really practiced as reliable testing for thyroid function. I do believe to a point the TSH testing IS a baseline to see a problem with thyroid symptoms. I do not believe however we all fit in a range.

BUT it should be done to watch increases and decreases in the pitutary telling the thyroid to make hormones.

Yes the Free's - in my opinion - decide whether the patient is symptom free or need more/ or go on -  replacement meds. But TSH should be there too. The other odd thing is the Reverse T3 that was done. Ironically that shows "pooling" of thyroid hormones - so your body is storing that for some reason which again can be associated with the adrenal issues.

Here's what I think - consider calling your doctor and see if you can get off the HC. Ask to have a 24 saliva test on a "dry" test = meaning = no HC for 3 days prior to the test. ZRT labs is where to get the test and I am sure your doctor knows of this.

Ask to have a full panel ran on FSH - LS - TSH and Free's - cortisol - and DHEA. There is a group of testing that can be circled on the sheet to send to the labs. Circle the complete testing profile. This results take about a month to get back. If your office does on have it handy - you can get it on your own.

In the meantime after the saliva test - ask / try natural adrenal support instead of HC - Acetyl-L Carnitine and L-Tyrosine along with Adrenal Support and Sea salt may be good for you -

I do not suggest iodine or kelp in addition to that either. Without a TSH lab number you can not tweek supplements into your diet - not knowing where you are at.

Are you symptomatic - ? What is going on symptom wise with you? Meno too?

[alizarin]

Hello Stella
Thanks for responding to my post.
My doctor didn't order a TSH test, so I have no results for that.
I'm 50.
No, I'm not confusing Thyroflex as a medicine and test - it was a computer based reflex test which, she said, confirmed I had a very underactive thyroid, though the blood tests seem not to confirm that, hence my confusion.
As for the cortisol levels, they seemed to be way too high, rather than nicely high, and as far as I understand it (which isn't very far at all), low testosterone and DHEA are correlated with adrenal exhastion.
And I'd had (the doctor said) insufficient hydrocortisone before the tests for it to show - 3 days at about 3 mg daily.
HGH - what's that?

[stella5349]

I do not see a TSH - but looking at the RT3 - this is pooling T3 hormones. Stored within the body.

Both your T3 and T4 Frees are on the low end which indicates some issues with conversion levels (could be due again to the pooling)

I have never seen a AM serum cortisol referenced that way I had mine and I was a 9 in the AM and ranges were 8-23.

I was low in the AM

The higher you are the better is what I understand with that so I will make a patient assumption you are not in adrenal exhaustion. and decreases through the day.

Did you not have a saliva test?

I think the TSH test results were missed in your post. I never heard of anyone not getting a TSH along with other thyroid testings.

Did you take your HC prior to testing with the DHEA and cortisol reading. Has there been a discussion on HGH a possibility as treatment?

It sounds as through you are confusing Thyroflex as medicine. Here is what I came up with on Thyroflex:

Thyroflex Testing- a specialized testing device for assessing thyroid function and thyroid medication efficacy.

Sounds as through it is a basic check of the reflex in the Achilles reflex time which estimates low thyroid function. Checking the Achilles reflex is still accepted and used by mainstream medicine today as an indicator of thyroid function.

I also assume your doctor has had you keep a journal on your basel temp and symptoms.

Mostly likely if you doctor is praciticing this way you are on a natural T3 T4 combo med either - Nature-Throid from Western Research, or Armour.

I would also assume you are on a low dose due the the HC (maybe 1/4 to 1/2 grain) to see if symptoms get better.

How old are you?