I am new to this board but was advised that due to my lab results I should maybe inquire here about the possibility of adrenal issues and/or hyperparathyroidism. This is my life for the past few months:

Hip pain started 11 months ago now.
I started on Thyroid meds in Nov.

Results:
11/19
TSH 1.12 (.34-5.6)
FT3 2.6 (2.3-4.2)
FT4 .68 (.58-1.64)

01/08
TSH 0.03 (.34-5.6)
FT3 3.7 (2.3-4.2) (75%)
FT4 1.02 (.58-1.64) (41%)
TPOab was 24 (0-9) and TGab 16 (<4)

One hypoechoic thyroid nodule 4x4x6m

Vitamin D 21 (32-100) Put on supplements again!
Vitamin D 35 (32-100) I take 50,000IU/week
PTH 27 (12-88)
Calcium 10 (8.5-10.5)
Ionized Calcium 1.35 H (1.17-1.32) NO calcium supplements taken

At my latest Endo visit:
TSH 0.02 (.34-5.6)
FT4 .84 (.58-1.64) 27%
FT3 3.5 (2.3-4.2) 63%

Changed to 50mcg Synthroid and 5mcg Cytomel

3/19
Calcium 10.3 (8.5-10.3)
Potassium 4.1 (3.6-5.1)
Creatinine .7 (.5-1.5)
Chloride 104 (101-111)

04/03
Calcium 5 (8.5-10.2) GEEZ! Maybe a lab error since Ca is ALWAYS at he high end but then the electrolytes went whacky! Doc sent me to the ER!

04/04 (At the ER)
Sodium 137 (135-145) low normal
Chloride 97 (97-108) low normal
Potassium 3.3 (3.5-5.2) LOW
Glucose 117 (60-99) HIGH
Blood Pressure 172/97 (eventually came down)
Calcium 9.7 (8.5-10.2)

B12 324 (211-911) Now 424 with supplements
Folate 16.6 (>5.4)
Ferritin 30

I am not dehydrated and I eat a lot of bananas, avocado, salads etc. and I drink water! No diuretics! Hope this helps!

The only thing I can think that might be contributing is that I am writing final exams and feel the stress! Who wouldn't after being away from school for 30 years! (Doing great though...) I just wish my body would cooperate.

I have two thoughts...
#1 Hyperparathyroid because Calcium tends to be above 10 more than not.
#2 Something with the adrenals and I had no testing for that. Just started on thyroid meds.

Thank you! Hoppy

I woke up this morning to the WORST cramp in my calf that I have had in a LONG time. Finally got it to dissipate but it is still sore!

You know my take on this from the thyroid board. ;) I hope the vets here get back to you with their wisdom soon. Rumpled and many other gooduns roam this board.

MG

Have you had a dexa scan? Have you had your alkaline phosphatase tested? Does it show you have bone turnover? I am hypoparathyroid so I have had a few of these issues but on the opposite side.... there are endos that specialize in the parathyroid and bone or you need to see a good one that will scan you as well as check all this out. But to be hyperparathyroid, your PTH #s have to be above 88, I think.

I look at your TSH jumping all over and I have to think... pituitary. Mine did that and my docs kept adjusting my meds to the TSH and I got every color (dose) and I felt like crud and it turned out I had two lesions on my pit. They were not TSH secreting ones but the pressure put on my pit wreaked havoc with my hormones.

Are you taking a good D3? Check the label on your D and make sure it is D3 - take at least 1000iu a day or more.

Thanks Rumpled. My alkaline Phosphatase is 52 (38-126). I am on Rx 50,000IU Vitamin D once a week. I haven't had a DEXA scan yet but have asked for one as I failed the drug store wrist one. (I don't think that traveling test is reliable but who knows). My doctor did agree to the DEXA scan so I will ask again as it was forgotten with the calcium debacle. I have had horrible diarrhea and pressure in the chest for the past two days....not sure what is up. My doc is checking my calcium again at the end of the week. I am really feeling like a hypochondriac but I have to keep pushing until I start to feel better. Hoppy

I hope you get a good DEXA with wrist, spine and hip checked (I think those are the three points). My one doc did a whole body check.
Calcium being off is not a good thing - you really need to keep on top of it so don't think you are a hypochondriac.

I went and had another calcium test this morning! I saw the doctor requested that if it is elevated, an intact PTH be done. I also had an 8am cortisol test. This cortisol test was a surprise. I actually went yesterday for the blood draw but didn't know the doctor had requested the 8am cortisol. The tech said that even though it was noon it would be ok to do the test. I told her I would return and have it done at 8am. Why wouldn't they know that it could make a difference with the result? I didn't see ACTH on the form. (Is it done with morning cortisol or does it have to be written separately?).

ACTH is a fasting blood serum test that is pulled at 8 am like the cortisol. See about getting the salive cortisol rhythm test to go with the blood ones. A DHEA sulfate would be good to add as well.

MG

I got hold of the lab. They couldn't tell me the exact numbers but said all was "normal" with the cortisol and the calcium so they didn't bother to send out the blood for PTH. I won't know the exact numbers until Monday but I do believe I am at a dead end again!

How can calcium be too high, then way too low....then normal?:confused: And why do I feel like I have been put through the wringer?:confused::confused:

I got my lab results.
Cortisol 8am 22.1 (4.3-22.4)
Calcium 10.3 (8.5-10.3)

The cortisol is "normal" but it sure is close to the top. The calcium is "normal" but, again, it sure is close to the top!!!

My FT4 and FT3 are also out of sync. I won't post the values again but FT4 was 41% and FT3 was 75% on 01/08. On 3/12, FT4 was 27% and FT3 was 63%. I take 50mcg Synthroid and 5mcg Cytomel.

MG, Can you help at all? I saw what you posted earlier and this looks like the opposite. I believe you said if if FT3 is higher, to look for low cortisol?

I hope, again, that although calcium is high "normal", my doctor will agree that humans do not like to live with calcium in the 10's.

Does anyone know what the causes might be for "artificially" lowering the calcium? I think I read that low Vitamin D is one reason (and mine is low but I am taking 50,000IU weekly). Is there ANYTHING else I can look for or ask about? Any help would be most appreciated. Hoppy

You are on Ft4 and Ft3 supplmentation. How were your levels before the Ft3 was added? Alright you do have an FT3 to FT4 imbalance. This can be due to high cortisol.. or poor ACTH/pituitary function.. or iodine/selenium/B12 imbalance. Your blood cortisol at 8 am is on the high side.. how is it the rest of the day. You need a saliva test/urine test to see what things are doing cyclically. Now your ACTH levels when tested may be revealling. If you have high cortisol you treat the ACTH levels.. you do not add more cortisol. If ACTH and cortisol are fine.. you need to look to your iodine/selenium/B12 balance. I question whether T3 supplementation is needed at your level. You definitely need more T4 supplementation. The urine test maybe the cotisol rhythm of choice. Selenium and iodine can be tested in the urine as well. Something is off and now we just need to keep poking about til we uncover it.

You need more meds either way.. your imbalance is ~34%. Optimal levels are when FTs are with in 5-10% of each other and in the 50-80% range of normal where your symptoms are negligible. So IMO you are undermedicated in the T4 range. You should get a boost to 75 mcgs and maybe cut back the cytomel to 2.5 instead. Because you are on the T3 supplement your TSH will be suppressed and the Ft3 levels will rise. How much T3 you need is another individual niche. What you need, you and your MD will need to figure out. You may need an FT3 and Ft4 level in the 60% range. I can not tell you what is optimal for you.. your body and blood will though. Investigate the pituiitary gland.. because something is up for it to be that low when your FTs are that low. Also get that PTH as well. YTou should also look into the aldosterone, progesterone, and testosterone levels. Something is going on and i can not put my finger on what.. so i recommend the shot gun analysis route and see what hits. Keep up with it.. something is going to come out of this.

MG

Thank you, MG

Before I started any meds, my TSH was 1.51, FT4 .97 (.61-1.76) (31%) and FT3 2.5 (2.3-4.2) (10%). My FT4 flops all over and a month later it was .59 (.58-1.64)(.9%) and FT3 was 3.2 (2.3-4.2) (47%). Started meds and FT4 increased but FT3 dropped. Increased meds and FT4 dropped to .68 (.58-1.64) (9%) and FT3 2.6 (2.3-4.2) (15%). ALL OVER THE MAP! Doctor decreased meds due to low TSH.

Latest TSH .02
FT4 .84 (.58-1.64) 27%
FT3 3.5 (2.3-4.2) 63%

Now latest tests show hypokalemic. Potassium 3.3 (3.5-4.2)

Calcium back up to 10.3 (8.5-10.3)
8am cortisol 22.1 (4.3-22.4) Normal but where is optimal?
Sodium 137 (135-145)
Chloride 98 (97-108)

I seem to be at the VERY bottom or the VERY top for a lot of tests and they contradict each other! There must be a solution.

One word is coming to mind and the only thing that is fitting the fluxing you are having:
hypoaldostronism. Look into it a bit. Also make sure they test ou for AI attack of the adrenal glands. The lab code is ACA. With Hashimoto's it is possible you are in the early stages of a new spin off AI and symptoms haven't gelled one way or the other yet.

Hope this helps.
MG

You are a sweetheart! I will do my best! I'll let you know! Hoppy;)

Well, I went to the doctor with a whole list of requests. She basically told me not to worry! She said cortisol came back great so that rules out anything adrenal. So no ACTH, no DHEA and no further blood tests even though potassium was low 3.3 (3.5-5.2). I also asked about the wide berth between the FT3/FT4. She said it is not an issue because the Cytomel raises the FT3 and that causes the production of FT4 to be suppressed. She said not so much FT4 is needed as it converts to FT3 and since that is good, there is no problem. She upped the Lexapro from 10mg to 20mg. I asked again about the calcium being 10.3 and she said a lot of people have calcium in the 10's and not to worry about that either.

It was only two weeks since my last visit and I gained another two pounds. Doesn't sound like much but it is two pounds EVERY visit....making 20 pounds so far! :(:( SO....I asked if maybe I am a hypochondriac. She said maybe I am dwelling on things???

I did manage to get a DEXA scan arranged and I did that today too as they had an opening. They only wanted to do the spine and hips but I mentioned to the tech that my Vitamin D has been lower than range and calcium is at the very top of range and "could it be hyperparathyroid"? She was great! She said she would do the radius scan as well and she would "figure out something" to tell the insurance. (I know they use that for hPTH). Now if that comes back normal....I will officially diagnose myself as crazy! :jester::jester: Hoppy

Did you ask her about running the aldosterone test? I would think that she wouldn't have an issue with it. optimal cortisol. Well each person once again is an individual. The best place to look is to your parents and siblings and figure out where they lie.. the statistical normal curve generation was based on a bulk study where 85% of the normal resided in the 40-60% range however.

8am cortisol 22.1 (4.3-22.4) - [22.1-4.3]/[22.4-4.3]*100 = 98.34% This is high in my opinion. Depending on your rhythm test.. how the cortisol falls through out the day.. you could stay elevated.

The smelly ofal about a low Ft4 being OKAY would have got this womans ears burned and on serious lecture. If you were to get pregnant NOW, the increased chance of complications is not a pretty picture. Also, while T4 is not as active as T3 it is EXTREMELY important for cognitive function. This is a well KNOWN metabolic fact if one is willing to look. Is your MD an Endo? I think you have a decent MD, but they may not be up to handling the added complications of possible adrenal/pituitary dysfunction.

Being unwilling to check for autoimmune attack of the adrenals and the other important adrenal hormones is a red flag in my opinion. Ask for a T4 boost as well to get the Ft4 levels in line with the Ft3. One can not exist on T3 alone. If we could.. we wouldn't retain balanced levels of T4 and T3 when no disfunction of the thyroid and adrenals are evident.

MG