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Old 02-11-2005, 06:51 AM   #1
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Question OK veterans: What do these tests mean?

Ok, I went for my first endo appt this week, and he collected a few samples in his office and then had me do a few tests yesterday AM (he said fasting, early AM tests were best)
Anyway, I am kind of confused as to what some of these tests are! If you know, please let me know!
Little background - My gen. Prac. ran thyroid tests and found my TSH, FT3 and FT4 to be in the normal range - but very low normal. Thinking they may be surpressed and caused by another issue, he ran a TRH test. This test came back less than 0.5 indicating a possible problem with my hypothalamus.
I had my first meeting with my endo this last wednesday, and he was of course less than impressive. He proceded to tell me that the TRH test was interesting, but really didn't mean much because a hypothalamic dysfunction is rare. So he decided to run the following tests:
TSH
FT3
FT4
(the above three are being run for the 3rd time, even though the results from the last 2 times have not varied by more than .5 or so!!!)

Total Testosterone
Free Testosterone
Prolactin
Somatomedin-C (IGF-I)
LH, FSH (intact)
Estradiol
DHEA - sulfate
17-Hydroxyprogesterone
Cortisol
ACTH
24 Urine measuring Free Cortisol

I know what some of these are, but the ones with the question mark by them are the ones I have no clue about. Also, why would he run these test inparticular? What do they look at?
I was really frustrated with him, because he pretty much wrote my infertility/miscarriage off to PCOS, even though I have had 2 dr's tell me I don't have it. I told his intern that, and he disagreed with me, then I told the endo that and he argued with me some more. I guess it is possible I have PCOS, but I don't want my symptoms to be wrote off like that...especially since the symptoms I have aren't specifice to PCOS...I also notice now that he didn't take a anthibody test... grrrrrrrr Is that something to push for?
ANYWAY,
If anyone can offer any guidance to why he took these tests, and what soem of those big words mean!!

LM

Last edited by gracesufficient; 02-11-2005 at 06:51 AM.

 
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Old 02-11-2005, 07:08 AM   #2
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Re: OK veterans: What do these tests mean?

Total Testosterone
Free Testosterone
Prolactin
Somatomedin-C (IGF-I)
LH, FSH (intact)
Estradiol
DHEA - sulfate
17-Hydroxyprogesterone
Cortisol
ACTH
24 Urine measuring Free Cortisol

OK...He is obviously looking at thyroid function, adrenal issues and sex hormones. Usually when you are Hypo, many of your other hormones will be out of wack. Prolactin will usually be very high. Prolactin is responsible for milk production in women for breastfeeding. When hypo, that number is high in both men and women usually. Testosterone is obviously the main male growth/reproductory hormone. When hypo with adrenal issue, testosterone can be low. Test can also be very low when "going through changes" - sometimes its your age, gender, stress, etc.

Cortisol is the anti-adrenal. If you are totally stressed out, cortisol will be high because cortisol helps burn off excess adrenaline. Its the body's natural calming system. If cortisol is too high, it could indicate Cushing's Disease or other problems with the adrenal glands...possibly an adrenal tumor....but that number will usually turn up VERY high if that is the case. You would have to be under a horrific deal of stress to get your cortisol level above the range normally unless there is an underlying adrenal problem.

ACTH is another adrenal component - its a hormone secreted by the pituitary that stimulates cortisol production. You doctor is obviously concerned with your adrenal glands by the tests he ordered. He might be ruling out adrenal tumor or adrenal fatigue. The symptoms of adrenal trouble and thyroid trouble often mimick each other and go hand in hand. DHEA is another adrenal component as well. I've had all these tests too.

Estradiol tests adrenal and ovaries for estrogen and can rule out or help diagnose ovarian tumor.

IGF-I is a human growth factor, called Insulin-like Growth Factor....it has to do with sex hormones, adrenals and metabolism as well.

Last edited by nastyhashi; 02-11-2005 at 07:10 AM.

 
Old 02-11-2005, 07:10 AM   #3
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Re: OK veterans: What do these tests mean?

In my opinion, if he is trying to find the reason behind miscarriages and/or infertility trouble, he is giving you the correct tests to start. You are very lucky to have a thorough doctor. These tests should reveal a great deal of information about what is going on inside you with regard to your reproductive system and hormonal levels.

 
Old 02-11-2005, 07:50 AM   #4
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Re: OK veterans: What do these tests mean?

Quote:
Originally Posted by nastyhashi
In my opinion, if he is trying to find the reason behind miscarriages and/or infertility trouble, he is giving you the correct tests to start. You are very lucky to have a thorough doctor. These tests should reveal a great deal of information about what is going on inside you with regard to your reproductive system and hormonal levels.
Thank you so much for all the info!!!!
It is comforting to know that these tests will be very informative - I didn't know what to think because when we were there, he doesn't have the best bed-side manner, and we left feeling pretty confused (it was a long 2hour drive home!!!) So, it is great to know what some of these tests mean.
Also, I was mainly referred for my low thyroid levels, and very low TRH level... so the infertility is kind of a "back burner" problem - until we get my body straightened out we aren't really "worried" about getting pg (and luckily I am young -24 - so we have lots of time!) Anyway, are the tests he run going to also help investigate the low thyroid levels and the low TRH (ie: pituitary/hypothalamas dysfunction)? That is the real reason I was referred to him, so I am a little worried since you said some of the tests are looking at infertility, that my insurance won't cover them.... hmmm...

LM

 
Old 02-11-2005, 08:18 AM   #5
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Re: OK veterans: What do these tests mean?

Its alll interconnected. Thyroid runs virtually everything. For instance and this is not medically backed and may not be perfectly correct:

Your thyroid disfunction makes your cholesterol go up. Cholesterol is a chemical that is used tohelp make other hormones. More cholesterol = more prolactin, more prolactin = more estrogen....see where Im going with this....its all connected. My example might not be medically correct, but there is for sure a connected process to almost everything and it all connects or correlated with the thyroid.

Your doc is correct that hypothalamus issues are very rare. Your TRH supression test does not tell all that much, your doctor is correct there as well. Now the pituitary can be a cause for concern because pituitary tumors are quite common in comparison to hypothalamus problems. Perhaps an MRI of your pituitary might be helpful.

Next, you will certainly want the Free T3, Free T4, Total T3, Total T4 and TSH and Antibodies tests done all at the same time so you at least have a benchmark.

As for the connection between it all....the hypothalamus produces TRH, which sends a signla to the pituitary to produce TSH (the chemical that turns on or off the release of thyroid hormone). More common than not, the pituitary sends incorrect signals to the thyroid telling the thyroid to produce more or less hormone....in these instances, a usually benign pituitary tumor can be the culprit. This problem should easily be viewed on a contrast MRI.

 
Old 02-11-2005, 08:42 AM   #6
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Re: OK veterans: What do these tests mean?

Keep this Doc for now, he is running all the right tests, I should be so lucky to have one this concerned and up to date. Good luck to you.

 
Old 02-11-2005, 09:14 AM   #7
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Re: OK veterans: What do these tests mean?

I agree, this doc is looking in the right places. The pituitary is a biggie when it comes to reproductive health; it makes a few other hormones, like Luteinizing hormone or LH - which regulates testosterone in men and estrogen in women and Follicle-stimulating hormone or FSH which promotes sperm production in men and stimulates the ovaries to enable ovulation in women. LH and FSH work together to cause normal function of the ovaries and testes. He's testing Prolactin as well, which stimulates milk production from the breasts after childbirth to enable nursing and can affect sex hormone levels from the ovaries in women and the testes in men.

I think you're in good hands LM

Nat
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Old 02-11-2005, 10:23 AM   #8
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Re: OK veterans: What do these tests mean?

Thanks so much for your encouragement!
I was pretty freaked out when we drove home - kind of like "I waited for this!!" But I know he is running good tests.
I should have mentioned this in my original post - but I did have an MRI. IT was a basic head one, not the pituitary one with the injection, but there was no visible tumor. (praise the Lord)! So we have ruled that out.
Is there another major cause that would lead to pituitary dysfunction? or supression of all the hormones?
Thanks again!!
LM

 
Old 02-11-2005, 02:06 PM   #9
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Re: OK veterans: What do these tests mean?

Not many others...either thyroid is shot, pituitary has a small tumor on it or soemthing wacky with your hypothalamus.....of course when dealing with the human body anything can happen but the odds are extremely rare that the problem would not link back to one of those mentioned above. More than likely, its your thyroid throwing other things off. As for your MRI, unless they specifically looked for the pituitary, I don't think it would show up well enough. We're talking about something the size of a pea near your brain stem behind your jaw and a tumor on that pea can be very, very small.

 
Old 02-11-2005, 03:52 PM   #10
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Re: OK veterans: What do these tests mean?

Quote:
Originally Posted by nastyhashi
As for your MRI, unless they specifically looked for the pituitary, I don't think it would show up well enough. We're talking about something the size of a pea near your brain stem behind your jaw and a tumor on that pea can be very, very small.

That is kind of what I thought. The dr. just ordered the basic brain one, even though I think we specifically talked about the pitituary one.
I have heard that if you have a significant head injury, it can damage your hypothalamus or pituitary... I wonder how common this is. I had a significant head injury about 9 years ago, but the symptoms just totally flared after my miscarriage last year.

 
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