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    Old 03-30-2014, 11:35 PM   #1
    ops
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    New to Forum, Labs inside. Please Help

    Hello everyone,

    I will just get to point of what I know forsure now, these are two sets of labs one month apart. Recent March is to the right was follow up on some is what she told me.

    (Feb 28, 2014) 28 March 14
    cortisol 8AM 5.16 (L) (6.20-19.40) 3.84
    Insulin-Like Growth Factor Binding Protein three-7.5 (3.4-6.7) none
    Hemoglobin A1c 5.8(H)4.8-5.6
    Testosterone 279 (L) (348-1197) waiting
    Testosterone Free 6.2 (L) (8.7-25.1) waiting
    Insulin-Like Growth Factor one 153 (83-233) none
    Glucose 102 (H) (65-99) 92
    Urea Nitrogen 11 (6-20) 14
    Creatinine 1.2 (.7-1.2) 1.1
    Sodium 137 (136-145) 141
    Potassium 3.7 (3.5-5.1) 4.2
    Chloride 95 (L) (98-107) 97
    Carbon Dioxide 32 (22-32) 31
    Anion Gap 10 13
    Calcium 10 (8.4-10.2) 10
    Protein 7.6 (6.6-8.7) 7.5
    Albumin 4.5 (3.5-5.2) 4.5
    Bilirubin .4 (.0-1.2) .4
    Alkaline Phosphatase 98 (40-129) 88
    Aspartate Aminotransferase 41 (H) (0-40) 34
    Alanine Aminotransferase 66 (H) (0-41) 58 (H)
    Urea Nitrogen/Creatinine 9 (6-22) 13
    Osmolality Calculated 283 (L) (285-295) 292
    GFR Calculated Non-Black 70 (>=60) 85
    GFR Calculated Black 92 (>=60) 99
    Globulin 3.1 (1.9-3.7) 3.0
    Albumin/Blobulin 1.5 (1.0-2.5) 1.5
    Iron 135 (59-158)
    Iron Binding Capacity Total 337 (165-513)
    Iron Saturation 40.1 (20-45)
    Triiodothyronine 136.4 (80-200)
    Thyroxine Free 1.27 (4.5-11.7)
    TSH 2.82 (.27-4.20)
    Prolactin 10.9 (4-15.2)
    Vitamin B12 (Cobalamins) 1054 (H) (211-946)
    Folate 8.5 (6.0) Not sure the range don't say...
    WBC Blood 8.49 (4.80-10.8)
    RBC Blood 5.11 (4.60-6.20)
    Hemoglobin 15.1 ((14-18)
    Hemotocrit 42.9 (42-54)
    MCV Blood 84.1 (80-94)
    MCH Blood 29.6 ((28-32)
    MCHC Blood 35.2 (32.5-36.5)
    RDW CV Blood 13 (11.5-14.5)
    Platelets Blood 376 (130-400)
    MPV Blood 7.5 (7.2-11.1)
    Nuetrophils 58.3 (40-74)
    Lymphocytes 30.40 (19-48)
    Monocytes 7.20 (3.4-9)
    Eosinophils Blood 3.40 (3.4-9)
    Basophils Blood .70 (0-1.50)
    ABS Neutrophils 4.95 (1.92-8.0)
    ABS Monocytes .61 (.16-1.00)
    ABS Eosinophils .29 (0-.8)
    ABS Basophils .06 (0-.2)

    I'm 37 and horrible symptoms have started the last 2 years. I'm recently retired from the military after 15 years and was dx major depressive disorder and GAD. First it was weight gain in a hurry. I am 6'2 and weighed 175 my whole life, and currently I weigh 290. I sleep constantly was diagnosed with sleep apnea, and restless leg syndrome. Horrible back,neck,shoulder and hip pain. Tightness in forehead and pressure on my eyes, I constantly shake like my muscles are week in my legs and arms, dizzy when I stand up, I was high blood pressure but all of a sudden i'm normal, my body temp is always 97, blurry vision, short term memory loss, and inability to concentrate at all, socially i'm non existent to my family or my past friendships, personal hygiene is crap and it's so hard to shower as i'm out of breath with alot of sweating although I can walk a mile or so? shortness of breath for no reason and more I just can't think of any more. All this typing as been exhausting for me as when i do anything I get mentally exhausted, so I hope someone can give me some insight? Thanks

     
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    Old 03-31-2014, 04:21 PM   #2
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    Re: New to Forum Labs inside Please Help

    Anyone? I would appreciate any input?

     
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    Old 04-01-2014, 07:27 AM   #3
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    Re: New to Forum Labs inside Please Help

    I am not knowledgeable about a lot of these tests. But the thyroid and adrenal tests indicate that your thyroid and adrenals are producing sub-optimal levels of hormones.

    Although your TSH is in the normal range (2.82), that level can cause symptoms of hypothyroidism for many people. And TSH is produced by the pituitary, not the thyroid. Free T4 and free T3 levels are produced by the thyroid and are better indicators of thyroid function. And your free thyroxine (free T4) is far below range. This could very well be the cause of your symptoms, or at least some of them. Your doctor did not check free T3 but instead checked total T3 (Triiodothyronine). A free T3 test would tell how much of this T3 is available for the body to use. The thyroid converts T4 to T3 so I am somewhat surprised that your total T3 is in range. However, you may find that your free T3 is very low.

    Your low cortisol and testosterone levels are signs of a possible adrenal problem. Addison's is one that comes to mind but some of your symptoms don't fit but some do. It may be helpful to get an aldosterone test.

    There is a bit of "interplay" between the thyroid and adrenals, so if one is not working correctly, the other may very well suffer too. There are varying philosophies about which to treat first to see if the other one resolves. With your low free T4, an Rx for thyroid meds may be warranted and that may help "heal" the adrenal glands. But then again, treating the adrenals may help your thyroid. Has your doctor given you any input on these lab results? Some doctors (especially most endocrinologists) will only Rx thyroid meds if TSH is above range. So you will have to do some doctor shopping if your doctor treats by TSH alone.

    One other thing that stands out to me is the IGF-3 binding protein being high. But I don't know the significance of this.

     
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    Old 04-01-2014, 08:40 AM   #4
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    Re: New to Forum Labs inside Please Help

    Thanks so much for the reply, I've looked up my last three cortisol and testosterone levels as this is just getting tested with the testing.
    Jan 2014 cortisol 6.2 total testosterone 176 free 6.4
    Feb 2014 cortisol 5.7 total testosterone 279 free 6.2
    March 2014 cortisol 3.84 total testosterone 244 free 6.4

    All these levels were taken at 8AM, I have researched alot and it seems that everything i've seen it could be I don't fit because of a symptom that don't fit?
    I've not seen a endo yet but do have a appt in 2 days. My PA says she see's AI issues but most of what i've read low cortisol leads to weight loss? I'm hoping they do more than the 8am test to see what happens to the others, i do feel somewhat better past 8pm. I again thank you for your response was wondering if you have any advice of what to say to the endo in a couple days?

     
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    Old 04-01-2014, 08:42 AM   #5
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    Re: New to Forum Labs inside Please Help

    Thanks so much for the reply, I've looked up my last three cortisol and testosterone levels as this is just getting tested with the testing.
    Jan 2014 cortisol 6.2 total testosterone 176 free 6.4
    Feb 2014 cortisol 5.7 total testosterone 279 free 6.2
    March 2014 cortisol 3.84 total testosterone 244 free 6.4

    All these levels were taken at 8AM, I have researched alot and it seems that everything i've seen it could be I don't fit because of a symptom that don't fit?
    I've not seen a endo yet but do have a appt in 2 days. My PA says she see's AI issues but most of what i've read low cortisol leads to weight loss? I'm hoping they do more than the 8am test to see what happens to the others, i do feel somewhat better past 8pm. I again thank you for your response was wondering if you have any advice of what to say to the endo in a couple days?

    Last edited by ops; 04-01-2014 at 08:45 AM. Reason: sent twice

     
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    Old 04-01-2014, 09:10 AM   #6
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    Re: New to Forum Labs inside Please Help

    Yes, the weight issue (gain instead of loss) and blood sugar (slightly elevated versus low) are unusual with low cortisol. However, like you said, it would be good to get a cortisol level later in the day. Cortisol level should be highest in the a.m. and decrease throughout the day.

    Speaking of AI (autoimmune), I did not see thyroid antibody tests (anti-TPO and TgAb) in your list of labs. Those would indicate if you have autoimmune hypothyroidism or not. However, treatment is the same whether it's AI hypothyroidism or non-AI hypothyroidism (take thyroid meds).

    I don't have any specific suggestions for your appointment. Hope it goes well!

     
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    Old 04-01-2014, 11:05 AM   #7
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    Re: New to Forum Labs inside Please Help

    Also I reviewed my labs and the free t4 ranges I was wrong on must have looked at the wrong, I should have wrote (Thyroxine Free-1.27 ranges .93-1.70) so i'm assuming Hypothyroidism out as well. Do you know what higher levels of cortisol during the pm would indicate?

     
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    Old 04-01-2014, 05:32 PM   #8
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    Re: New to Forum Labs inside Please Help

    I should have realized the free T4 range was incorrect (my lab's lower value is .81). Prolonged levels of high cortisol are seen with Cushing's disease which has some of the same symptoms you are experiencing.

     
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    Old 04-17-2014, 08:07 AM   #9
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    Re: New to Forum Labs inside Please Help

    Please let us know what your endo had to say, and what additional testing was ordered.
    Thanks! And hoping for significant improvements in your health and wellness!

     
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    Old 05-12-2014, 08:23 PM   #10
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    Re: New to Forum, Labs inside. Please Help

    At minimum you have a testosterone, growth hormone, cortisol and thyroid deficiency.

    When replacing, you do them all simultaneously. This reduces the dose of each to reach optimal levels and and also reduces side efdects and cost.

     
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    Old 05-13-2014, 03:25 AM   #11
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    Re: New to Forum Labs inside Please Help

    From looking over your labs, I would say you probably have Addison's disease, which is adrenal insufficiency, and early hypothyroidism, with testosterone deficiency. The other possibility that should be checked out is a benign pituitary adenoma that is secreting FSH or LH , and "crowding out" production of ACTH which stimulates the adrenal glands to produce cortisol. These small tumors can cause headaches and visual disturbances and require an MRI to diagnose. Both the hypothyroidism and Addisons disease (primary adrenal failure) can be autoimmune in nature. I agree that anti-thyroid antibodies should be run, and that you can symptomatic with a TSH like yours, even though technically it falls in normal range. If you look at the AM cortisol, it has steadily declined since Jan. That alone makes one feel TERRIBLE, and you need to see an endo and get started on treatment while assessing whether this is primary insufficiency or secondary to pituitary insufficiency of ACTH, the hormone that stimulates the adrenals. Hypothyroidism can reduce testosterone production as well, and that may correct itself with treatment of thyroid.

     
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    Old 05-13-2014, 06:25 AM   #12
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    Re: New to Forum Labs inside Please Help

    If he had an elevated LH his testosterone would be higher.


    Quote:
    Originally Posted by ladybud View Post
    From looking over your labs, I would say you probably have Addison's disease, which is adrenal insufficiency, and early hypothyroidism, with testosterone deficiency. The other possibility that should be checked out is a benign pituitary adenoma that is secreting FSH or LH , and "crowding out" production of ACTH which stimulates the adrenal glands to produce cortisol. These small tumors can cause headaches and visual disturbances and require an MRI to diagnose. Both the hypothyroidism and Addisons disease (primary adrenal failure) can be autoimmune in nature. I agree that anti-thyroid antibodies should be run, and that you can symptomatic with a TSH like yours, even though technically it falls in normal range. If you look at the AM cortisol, it has steadily declined since Jan. That alone makes one feel TERRIBLE, and you need to see an endo and get started on treatment while assessing whether this is primary insufficiency or secondary to pituitary insufficiency of ACTH, the hormone that stimulates the adrenals. Hypothyroidism can reduce testosterone production as well, and that may correct itself with treatment of thyroid.

     
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    Old 05-13-2014, 10:11 AM   #13
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    Re: New to Forum Labs inside Please Help

    I have an update only on labs from endo, and honestly they didn't check anything new other than ACTH which sucks...The first appointment I had with the endo she looked through my labs and only commented on the low testosterone, nothing about cortisol other than it's lowish. She stated that all of my symptoms and low levels are due to my Major Depressive Disorder and Anxiety which I completely disagree.

    If I have Addison's why am I gaining weight at a rapid level nothing I do seems to slow it down, exercise, diet, nothing. She ran labs stating she didn't trust the military labs, BUT proscribed me Androgel 1.67 two pumps a day.

    Just gonna put a few results up as they didn't test for much,

    Glucose 106
    Cortisol 2.40 8AM only
    Testosterone 231 and this is 3 weeks on Androgel
    Free 42.6 ranges are in pg/ml not sure if that makes a differance

    ACTH 14 8am only
    TSH 2.71
    T4, Free 1.2
    ALT 66, This has been continuously high with no alcohol.
    Thanks for all the responses!

     
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    Old 05-13-2014, 10:13 AM   #14
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    Re: New to Forum Labs inside Please Help

    I have an update only on labs from endo, and honestly they didn't check anything new other than ACTH which sucks...The first appointment I had with the endo she looked through my labs and only commented on the low testosterone, nothing about cortisol other than it's lowish. She stated that all of my symptoms and low levels are due to my Major Depressive Disorder and Anxiety which I completely disagree.

    If I have Addison's why am I gaining weight at a rapid level nothing I do seems to slow it down, exercise, diet, nothing. She ran labs stating she didn't trust the military labs, BUT proscribed me Androgel 1.67 two pumps a day.

    Just gonna put a few results up as they didn't test for much,

    Glucose 106
    Cortisol 2.40 8AM only
    Testosterone 231 and this is 3 weeks on Androgel
    Free 42.6 ranges are in pg/ml not sure if that makes a differance

    ACTH 14 8am only
    TSH 2.71
    T4, Free 1.2
    ALT 66, This has been continuously high with no alcohol.
    Thanks for all the responses!

     
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    Old 05-13-2014, 02:43 PM   #15
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    Re: New to Forum Labs inside Please Help

    Your cortisol level is now even lower, which is clearly abnormal. The ACTH appears low normal, but since labs use different measurements and normal ranges, the ranges of your lab must be posted for proper interpretation. That would indicate there may be a pituitary problem, as ACTH should be high in Addison's disease. Your weight gain is most likely due to the hypothyroidism. Both hypothyroidism and adrenal insufficiency, regardless of whether it is primary or secondary to pituitary dysfunction, causes depression as a symptom. If this endo can't help you, I would seek a different one, perhaps at your local university hospital endo clinic. Your cortisol levels are getting really low, which could cause a total collapse and hospitalization if it doesn't get treated.

     
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