Lab results..

My Endo told me this test was normal, but if you look at my AM level it is below Normal range..

Is this normal?

ACTH it is written just like this *7.8..... my level )
expected values
10-60 (am draw )
then along side this he hand wrote " PM Level ok*

Also have my Cortisol levels as well...

My cortisol is 10.2... with the ref ranges of
AM ( 4.2-22.4 )
PM (3.1-16.7)

Just a small background on me.. I was DX'd with Hashimoto, and I also have PCOS/IR. I am on meds for both. Anyway, I was FINE, until I had my SON.. I had a section after a failed 21 hr labor, and I bled out, and needed a tranfusion of 2 units of blood * Anyway, all I know is after having him I fell apart.. Extreme Fatigue, Hair Loss ( Loads of it ) Also dry, brittle hair that breaks, I am getting all these dry brown patches of skin, I have dark circles under my eyes, Dizzy spells, Joint pains in my elbows. I have blurry vision along with watery eyes. The list if things wrong with me is endless... I just fell apart after having him.. I was fine Up until then *sigh*..

Now the Syntroid I take is NOT doing anything for me, as far as helping with symptoms, it did when I first started taking it, for about 2 months I felt great, then I started too plummit.. it has been 2 months since I have felt good..

I just wonder if there is something MORE going on with me , then just my Thyroid...So thought I would get your thoughts on my ACTH levels.. Can anyone here Please help me too understand these results :D

I can't believe your doc, doesn't seem alarmed, but really should be in my opinion. In 3 years I've seen a couple dozen people fall below range (very uncommon) on the acth serum test. I look for acth, if healthy, to be in the top third of the range. Most with secondary adrenal insufficiency are in the bottom third. Almost all with secondary fall within range on that test.

Your morning cortisol is very low, upper 20's is what I look for in healthy women. 15 is the most common number reported. You definately need the acth stimulation test, all pituitary hormones tested (LH, FSH, prolactin, TSH (with free T3 and free T4 and antibody tests), igf-1 and possibly vasopressin). All who test low pituitary should get an MRI, with and without contrast of their pituitary (newer machines give better pics, look around) to see if a pituitary tumor could be the cause (many docs fail to do this for some reason). If no tumor, some other possible causes are radiation, head trauma, major blood loss (Sheehan's). That you say your problems happened after you bled out, I think Sheehan's syndrome (hypopit caused by blood loss) is likely what you have. The loss of blood can damage the pituitary. Don't assume this could be the cause before an MRI is done. Sheehan's is treated the same as non-Sheehan's, just treat the hormones that are low period.

Synthroid (T4) does not convert to T3 in most people and the T3 is what makes you feel bad or good depending on the level in your body. Investigate the benefits of Armour Thyroid (has T4, T3, T2, T1 and calcitonin). I've seen no one on Armour say they wanted to switch back to synthroid, but there is a stampede of people on synthroid trying to find a doc to prescribe them Armour. Low cortisol has to be treated first though, so get the acth stim test.

Those with low acth, on the stim cortisol will usually double or more from a low base cortisol number. For example, your 10 if stims to 20 or higher (I've seen tripling and more, even decupling base 2 stimmed to 20), that shows your adrenals can work, just not getting the acth signal. If your adrenals were the problem, then your 10 won't double, but might only go up a little or not at all.

An osteopath is who I usually recommend, they tend to be better with hormone problems (know ranges are flawed) than most docs, especially endocrinologists.

Good luck

Thank you so much! I have had every test listed, and my FSH/LH are off, but the others are within normal range ( as far as refrences ranges go )... I did place a call into my Endo about this, about the ACTH, and asked if they could test me a bit Further since my level was so low! She is going too call me back, and we will go from there.

Last Night I spent time in the ER due too High Blood Pressure, that they think the Synthroid caused ( they just upped my dose too 75mcgs ) 2 weeks ago..I really feel something else is WAY OFF with me, cause even after 4 months of treatment on Synthroid I feel No different then when I walked into his office..

I really appreciate the time you took too reply toome! So Thank you so much!

Missy

I agree w/Hormone Man. You need to be evaluated for Sheehan's Syndrome -- hypopituitarism following postpartum hemorrhage.

Best wishes.

The ranges are skewed because the labs get their ranges from sick people who are tested. Labs do not test healthy people to see what healthy ranges are. I have seen a few blood cortisol ranges go as high as 24 to 25

In Cushing's I've seen blood cortisol 40 and higher. In no way is her numbers matching with Cushing's.

I recommend the book Safe Uses of Cortisol to understand what normal cortisol levels are.

You're welcome Missy.

That her problems happened after the blood loss, Sheehan's would be a high probability. If she had high cortisol in PCOS before the blood loss, a damaged pituitary can supercede that.

In the morning her ACTH would go up if her cortisol fell low from a very high level at say midnight. Cyclical Cushing's I know all about, doesn't fit here.

Instead of giving me a so called education, it would be more tactful to tell Missy that she should have her cortisol tested several times throughout the day, either blood or saliva as well as a 24 hour urine. Then it should be easy to tell if looked like Cushing's or not, then go on to the dex suppession or acth stim test.