# Lab results and more tests



## TickledPinkTwice (Jul 28, 2011)

Hi guys! It has been awhile since I have been on here. Still really struggling with Thyroid and with newer symptoms. I finally got a referral to an Endocrinologist. He suggested some labs, I got these results and now found out that I have to have additional testing. I have Hashimotos and he was thinking perhaps Addison's Disease as well. Well now, they are also thinking maybe a pituitary problem. Has anyone ever had a low TSH AND Low FT4 and Low T3 and Low Cortisol levels? I will get the actual results shortly. I have never heard of having all low levels. They mentioned Central Hypothyroidism but with antibodies?Experiences or input would be appreciated. Thanks!
ETA I am on 100MCG of Synthroid every other day and 112MCG the other days. They are keeping my dose the same but ordering and ACTH infusion test and a Pituitary MRI
TSH .07 range .4-4.5
FT4 .90 range .8-1.8
T3 83 range 80-180

A few older lab results for comparison
all reference ranges are the same from this lab.
2/26/11
FT4-2.1 ranges .8-1.8
TSH-4.87 ranges .4-4.5

8/21/10
FT4-1.3
TSH-1.44

6/4/2010
FT4- .9
TSH- 9.88

4/1/2010
FT4- .8
TSH- 41.69

10/7/2009
FT4- 1.1
TSH- 8.66


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## Octavia (Aug 1, 2011)

Wow - you have a great doctor! So many don't want to do the extra "digging" to see what the problem is.

What are your newer symptoms?


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## TickledPinkTwice (Jul 28, 2011)

Octavia said:


> Wow - you have a great doctor! So many don't want to do the extra "digging" to see what the problem is.
> 
> What are your newer symptoms?


I know I really really like him! Of course the usual, I am horribely tired, cold....etc but I have had some dizziness,syncope, headaches and a very strong craving for pure salt( I dump salt in my hand). My heart seems to be fine so we went back to my Thyroid.haha And although my blood pressure is very low, it doesn't seem to be a result of Postural Hypotension either.


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## TickledPinkTwice (Jul 28, 2011)

I added a few other of the lab results that I have, the one of February last year both the FT4 and TSH were high. What is wrong with me?lol


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## TickledPinkTwice (Jul 28, 2011)

Does anyone have any experience? My MRI is tomorrow. I am just so tired of all these symptoms, especially being exhausted. It is ridiculous, how tired I always am:sad0049:


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## Octavia (Aug 1, 2011)

We're not ignoring you...

I do not have experience with what you're describing, and your situation does seem like a unique challenge.

I find myself wondering what kind of anemia you have and how bad it is, as that can make you feel pretty fatigued. I'm also wondering if you have absorption issues, given that you have been dealing with colonic inertia and gastroparesis. If you have absorption issue, you may be quite undernourished, no matter how well you eat. (That can also lead to the anemia.)


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## TickledPinkTwice (Jul 28, 2011)

Oh I know, I just wanted to bump back up to the top. As far as I know just Iron Deficient Anemia, but it appears to be under control. Absorption issues were also something that Endo mentioned. Thanks for the response


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## Octavia (Aug 1, 2011)

A good friend of mine has pernicious anemia in addition to thyroid issues. It makes her feel like she's moving in quicksand and very tired. She gets B12 shots on a regular basis, and they help a lot.

Perhaps in addition to the hormone testing, you could request some nutritional labs, such as Vitamin D, Iron, Vitamin B12...I'm sure there are others, but I don't have first-hand knowledge.


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## Octavia (Aug 1, 2011)

One more thought...I am not very familiar with "Central Hypothyroidism" but I did some reading on it. It does seem to match the labwork you've posted...the recent stuff, anyway.


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## TickledPinkTwice (Jul 28, 2011)

I don't know much about Central Hypothyroidism either. I had my MRI on Friday and I haven't spoken to the doctor but the report stated no evidence of any microadenomas but "There
is an unusual linear area of more intense enhancement along the mid 
portion of the pituitary gland. This is oriented vertically and seen 
on the sagittal image #6. With more T2-weighting, this region does 
show increased signal intensity compared to the remainder of the 
pituitary gland. Its underlying etiology/significance unclear." I will be asking about that. My ACTH Stimulation test was yesterday so no results on that either. I will say when they injected me, I had issues breathing and my chest felt hot. It was not pleasant but it went away. I will update you when I get more results. I am just so incredibely tired of feeling this way and of being tired. I have 3 year old twins and a full time job, I don't have room in my schedule to constantly be exhausted:sad0049:


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## TickledPinkTwice (Jul 28, 2011)

I haven't read the report or heard from the doctor but I do have my numbers.
My ACTH was 32.9
Cortisol level at 0 min was 5
Cortisol level at 30 minutues was 19
Cortisol level at 60 minutes was 25

I don't have my Aldosterone results yet.

This is the note beside my 60 minutes result:
A normal serum cortisol response to 25 units (250 ug) of ACTH (Cortrosyn) stimulation is a rise of at least 7 mcg/dl from the baseline and a peak of 20 mcg/dl. The peak value is the most informative. These criteria do not apply if the baseline cortisol is >20 mcg/dl, as the patient may already be maximally stimulated by endogenous ACTH. With acute ACTH or CRF deficiency, the serum cortisol response to stress is low, but the response to ACTH stimulation is normal. In these situations, consider other tests to evaluate adrenal function

Some more information I have found:
Interpretation for secondary adrenal insufficiency 
ACTH will be low- Usually below 35, but most people with secondary fall within the range limit. Although uncommon, values for ACTH can reach into the low 40s.
Talking about secondary adrenal insufficiency
typically serum cortisol levels will double or triple from baseline. The lower the baseline cortisol, the more likely it is that the patient's cortisol will increase by a large amount

So somethings are saying normal and other things are pointing towards secondary adrenal insufficiency, especially with the mri results. Uhhh I hate waiting.

In healthy adrenals, the cortisol level should double within 60 minutes. For example, if the cortisol level was a 25 before the stim (base level), then after the stim should reach at least 50.
In primary adrenal insufficiency, the base level usually starts at least a little lower, like 15 (can be much lower) which is the most common number I see and acth stim might raise cortisol level to 20, which would not be doubling and thus support the diagnosis of primary adrenal insufficiency.

In secondary adrenal insufficiency, the base cortisol can double from a low base value and I've seen tripling, quadrupling, quintupling (5 stimming to 25, 6 stimming to 30), sextupling (4 stimming to 24, 5 stimming to 30), septupling (0.7 stimming to 4.9) and decupling (2 stimming to 20, 2.7 stimming to 27.6) and recently a stim that almost tridecupled (1.25 - 16 went up 12.8 times) and a stim that quadecupled (went up 14 times 1.7 stimming to 24, after 1 1/2 hours reached 27.5 for sexdecupling). These examples illustrate how extreme secondaries stims can be. Most secondaries only double or triple and usually start with a base cortisol value of at least 10. The base cortisol can be very low because of the bodies lack of natural acth. When the synthetic acth is given in the stim test, the patients adrenals go hog wild because they can work, just not getting enough ACTH from the pituitary gland.
Insecondaries, serum ACTH will usually be in the bottom half of the range to the very bottom, but not usually below the range (98% of secondaries are in range on the serum acth). I have seen a few secondaries (going by stims doubling or more from low base number to indicate they are secondary) whose serum acth was just above the middle of the range or as high as the 40′s. Again, I like to see it in the upper third of the range (assuming a range of 10 - 60 as they almost always were until a couple of years ago), but now many different ranges are popping up and most are flawed to the lower end of the range ie. 5 - 27 which is the range where most secondaries test at in the serum acth test. Further proof that the labs get their ranges from the sick people who are given the test. In my opinion, acth ranges have become even more flawed compared to what they were before. If I were to draw up a healthy range for the serum acth, I think a range of 48-55 would likely be closer to healthy range.


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