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Old 04-17-2008, 03:01 PM   #1
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New Lab tests----Low cortisol Please help

Last Nov. I had labs done. I was taking 1 grain Armour (60 mcg) + 12 1/2 mcg Levoxyl.

TSH.........................0.881....... ...............Range .3 - 4
Free T4....................0.8............... ..........Range 0.6 - 1.2
Free T3...................2.73............... .........Range 2.77 - 5.27


Levoxyl was discontinued and I worked up to 82 mcg Armour only.
Had labs done middle of Feb. and labs were:

TSH.........................0.842....... ................Range 0.35 - 5.5
Free T4....................0.89 .......................Range 0.61 - 1.76
Free T3....................2.5 ........................Range 2.3 - 4.2

I increased up to 90 mcg (1 1/2 gr.) Armour and just had more labs:

TSH.......................0.10.......... .................Range .3 - 4
Free T4..................0.9................. ...........Range 0.6 -1.2
Free T3..................3.01................ ..........Range 2.77 - 5.27

I have been going to my gp for the above treatment but she is sending
me back to Dr. A to read and treat my ultrasound reports.
Now she is saying my TSH is suppressed and wants to decrease. And
I have felt better than I have in a long time. I go to Dr. A in a week
to read my ultrasound and I am supposed to take my labs to him
and I know he will cut them in half. He would not increase my labs
to more than 45 mcg Armour + 12 1/2 Levoxyl with a TSH of 1.35 and
frees at the bottom of range.

About a yr. ago same gp checked my TSI antibodies and they were 87 %.
I think they are falsely suppressing my TSH. I can't find a dr. that will
agree with this, they just focus on the TSH.

Also, since I have been on the increased meds, my bp has been lower, but I
am still sleepy all the time.

Last edited by SHMILY; 06-09-2008 at 02:40 PM. Reason: 90 mcg Armour=1 1/2 gr. I had put 1/2 gr.

 
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Old 04-17-2008, 04:33 PM   #2
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Re: New Lab tests----Low cortisol Please help

You mention low cortisol in the title, but there is nothing about it in your post? Did you miss that info? I know I have done that on occasion. Or posted on the wrong thread. The way the hypoT mind wanders.

TSH.......................0.10.......... .................Range .3 - 4
Free T4..................0.9................. ...........Range 0.6 -1.2 = 50% Right at the bottom of optimal.
Free T3..................3.01................ ..........Range 2.77 - 5.27 = 9.6% Whoa! Way too low. You may need more than the Armour. I would suspect high cortisol or high levels of RT3 with this ratio. Have they ruled out Cushings?

MG
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Old 04-18-2008, 07:29 AM   #3
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Re: New Lab tests----Low cortisol Please help

MKG....

My gp ran cortisol tests because she suspected I might have Cushings because of the hump on my back and my appearance. She ordered a 24 hr urine, Cortisol serum or plasma, where that draw blood at 10 PM & 8 AM, and ACTH test. Her nurse called me and said everything was normal. Then I noticed a call on my caller ID the next day. I returned the call and she said my cortisol was low. I couldn't read the tests but here is what it says:

ACTH.A.............................13 pg/ml.......................Range 6 -58

24 hr. urine (Catecholamine Fract, Plasma
Epinephrine........................[A] <10 pg/ml ..........Range 10 - 200
Norepinephrine.......................... ....393 pg/ml..........Range 80-520


Cortisol, Serum or Plasma (Cortisol A)...........5.8 ug/dl........no range
REFERENCE INTERVAL: Cortisol
0800 hrs: 6-23 ug/dl
2000 hrs: 0-9 ug/dl
8 hrs post 1 mg dexamethasone given at midnight: 0-5 ug/dl 30-60
min post 25 units Cosyntropin I.V. greater than 20 ug/dl [I DON'T
UNDERSTAND THIS BECAUSE I WAS'T GIVEN ANYTHING BEFORE OR
DURING THIS TEST.]

Then on the next pg. it has
Tests: Cortisol, Serum or Plasma [Cortisol.A]..........16.1 ug/dL...no range


I'm confused. Do these tests look like I have high or low cortisol or is it normal?

Sorry this is so long.

 
Old 04-18-2008, 07:38 AM   #4
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Re: New Lab tests----Low cortisol Please help

Cortisol, Serum or Plasma (Cortisol A)...........5.8 ug/dl........no range
REFERENCE INTERVAL: Cortisol
0800 hrs: 6-23 ug/dl
2000 hrs: 0-9 ug/dl

Well this is low if it was your 8 am result. There should be a time listing on this sheet stating what time. I think you said they did it at 8 am and you were suprised. 5.8 at 8 am is low but 5.8 at 10 pm is fine right around 60&#37;. You want to be at a minimum of 14 in range at 8 am to be considered normal... it looks like you are at 16 which is right where you need to be. SO.. cortisol doesn't look like your answer. Your ACTH is a bit low, but that may just be where your body is happy. Aldosterone levels would be the last check in this area. Your cortisol is not high enough to cause the T4 to T3 discrepancy. You need T3 supplementation and need to check your RT3 levels for sure.

MG
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Last edited by mkgbrook; 04-18-2008 at 07:39 AM.

 
Old 04-18-2008, 07:41 AM   #5
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Re: New Lab tests----Low cortisol Please help

Shmily-

I realize they ordered an 8 am and a 10 pm serum cortisol, correct? Then apparently one of those results is am and the other pm. The question is, which is which??? If the 5.8 is am, then it is a little low, which probably needs to be addressed with a stim. test. If the 16.1 is the am, then you seem fine in that dept. So finding the timeline of those tests is important.

The catecholamines look fine. I had an almost zero on my epinephrine, and researched forever, and couldn't find any significance to it being low in urine.

I hope you come closer to an answer with each round of testing!

 
Old 04-18-2008, 11:52 AM   #6
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Re: New Lab tests----Low cortisol Please help

Mkg & Sue............Thanks for your help. I can't find anywhere on the report where it tells which result is am or pm. Were they susposed to give me dexamethasone at any time during the test??? I was wondering why it stated on the test " 8 hrs post 1 mg dexamethasone given at midnight; 0-5ug/dL 30 - 60 min post 25 units Cosyntropin I.V.; greater than 20 ug/dL."

Dr. A did a test on me and I am wondering if it is the same as a RT3. It was called Thyrel [TRH Med]. He drew blood and then gave me an injection, then drew blood at 30 min intervals. It was normal.

Since I have TSI antibodies that are falsely suppressing my TSH, how will I ever be able to take enough med. to be at a good level to feel good? I know I need a lot more T3 and that will push my TSH to 00.000.

 
Old 04-18-2008, 12:26 PM   #7
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Re: New Lab tests----Low cortisol Please help

I think the lab sheet is just covering all bases on ranges for whatever reason the cortisol was drawn:

-if they were checking for cushing's, they would be administering the
dexamethasone to see what the cortisol levels were doing.

-if they were checking for addison's, they would administer the cortrosyn
and then see what the cortisol was doing.

And of course, the 8 am and 10 pm have different normal ranges.

The TRH test Dr. A did on you was testing your pituitary's ability to respond for a need to increase thyroxine in the body. It's very rarely done, but I had one done by Dr. A also, and my TSH rose within 30 minutes up to 47! That was showing that my pit. was working, but it also showed that I was very near hypo. That was three years ago, but I never did get to feeling hypo, just hyper, up until my TT.

 
Old 04-18-2008, 02:57 PM   #8
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Re: New Lab tests----Low cortisol Please help

If I remember correctly, when Dr. A did the TRH on me my TSH rose to 5.??
Anyway he said it was normal. And he wouldn't increase my meds. even though my TSH was 1.37 and my free T's were at the bottom. I have finally worked up to 1 1/2 grains [nearly double what he had me on] on my Armour and have been feelling better, not hyper, bp is better, not as short of breath, resting pulse in the 50's and 60's. I feel like I need another increase now because I get really sleepy middle of day and early at night. I'm so disappointed that my TSH is ..10 and I will have heck getting anyone to give me another increase. They will probably even cut me back. No one will take into consideration that my TSI's are probably falsely lowering my TSH. Can't they see that I need more T3????

I go to Dr. A. Wednesday, 1st time in a yr. I guess he's been wondering who's prescribing my Armour. I would have to call his office about 3 times every month to get only 1 month's Rx, so I just got my gp to do it. She was good enough to write the prescription for 1 1/2 gr of Armour and let me work up to that amount, but she probably won't renew it because of low TSH.

Dr. A. might dismiss me when I take him all my labs for the yr. and have to tell him my gp increased my meds because my FT3 fell under the Range and my FT4 just barely in. He wouldn't even acknowledge that the TSI antibodies were a problem.

I got another ultrasound last week and instead of 4 nodules, it showed I had numerous tiny nodules and 1 solid 1.5 cm nodule. Gp said I need to go back to endo so that is why. Maybe I can ask him for a reference for a top surgeon before he dismisses me.

So all the cortisol tests my gp ran on me tells me nothing I guess? She was testing me for Cushings.

Hope you are doing better. Have you been able to increase your meds yet?
Are you glad you had the TT? I look for your posts every day. Thank you for your help.

Last edited by SHMILY; 04-18-2008 at 02:59 PM.

 
Old 04-18-2008, 05:11 PM   #9
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Re: New Lab tests----Low cortisol Please help

If I was you, I'd ask for lab orders for a 24-hour urine and hold on to it until you feel like you are in a "high"--more energetic at night, etc.. That's how most Cushing's people have to do it. I know there are many that have to do 24-urines many times before they catch that high level.

I know what you mean about Dr. A gonna probably make you decrease. I don't know what to tell you, as I'm not sure of who will treat by symptoms in Houston. Just when you've worked so hard to get where you're at, and know you need to work higher!

I'm glad I had the TT, as, even though I'm not feeling near optimal at all, at least I feel level. I hated those wild swings! I was three weeks into syn. 112 but began to feel really hotter, so I backed down to 100. I get cold hands and feet, and I LIKE that! I haven't had that in probably 20 years. During the winters, I'd be at my daughters' softball games in February with a coat, but slip on shoes with no socks. People used to ask me if my feet weren't freezing, and they weren't. This season, I wore socks because my feet were actually cold! It was nice. Keep us posted on what Dr. A says.

 
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