# Thyroid/Adrenal Lab results



## Arctice (Jun 12, 2013)

I have been struggling with symptoms of thyroid disorders for a long time without being sure of what my actual problem is. I've had a few tests done when I could afford it, so these results are somewhat spread out. I'm not sure how I should interpret these results and I hope someone can shed a light on what seems to be the problem! 
I'm currently dealing with some major issues and I'll list them here in case it's any help. Feeling fatigued and a lack of energy during the day, I usually feel somewhat better around night time and have a very big difficulty falling asleep at night. Conversely getting out of bed in the morning is very hard for me as well. I've been suffering from diffuse hair loss(my whole hair line is thinning including the sides and the back). Also bouts of depression, low motivation, lowered libido, panic attacks and racing heart. It's becoming a big problem in my life and I really want to get this solved!

This is my first test from April 2012:
TSH: 6.80 (0.4-4.50) Out of range
T4: 1.4 (0.8-1.8)

My more thorough second test was in November 2012:
TSH 2.100 : (0.450-4.500)
T4,Free(Direct) 1.65 : (0.82-1.77)
T3,Free 4.0 : (2.0-4.4)
Reverse T3 36.5 : (9.2-24.1) (HIGH)
FT3/RT3 Ratio 11 : (20+) (LOW) 
(TPO) Ab <6 : (0-34)
Antithyroglobulin Ab <20 : (0-40)

My latest test was an adrenal test June 2013:
* DHEA SULFATE *
DHEA-S 8AM 3.20 ng/ml (2.80-12.70)
DHEA-S 8PM 3.10 ng/ml (2.70-9.00)
DHEA-S 12AM 3.00 ng/ml (1.80-8.10)

* CORTISOL PANEL *
Cortisol 8 AM 3.03 ng/ml (3.50-6.50) (LOW)
Cortisol 12 PM 1.71 ng/ml (1.40-2.80) 
Cortisol 4 PM 1.32 ng/ml (0.80-2.40) 
Cortisol 8 PM 0.86 ng/ml (0.60-1.60) 
Cortisol 12 AM 1.07 ng/ml (0.30-1.20) 
Cortisol 4 AM 2.03 ng/ml (0.30-1.70) (HIGH)

Testosterone 354 :	(348-1197) ng/dL
Free Testosterone(Direct) 10.4 : (9.3-26.5) pg/mL

Any help is very much appreciated!


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## bigfoot (May 13, 2011)

I'm a little confused about the Cortisol panel results. I see you being low at 8 a.m. on one day, but then high at 8 a.m. the next day? (If you could clarify, that would be great.)

I see several things going on here looking at everything overall. First being your TSH is obviously leaning towards the hypothyroid side of things. The upper end of the TSH range as recommended by the AACE a few years ago should be 3.0, not 4.5. (But most labs are severely out of date with their ranges anyway.) I can tell you that when I was diagnosed with hypothyroidism via a TSH of 6.9 or so, I was a total non-functioning mess. Physically, mentally, and emotionally. Folks here encourage others to shoot for a TSH of 1.0 or less, and Free T3 and Free T4 in the upper 75% of the range. That is easier said than done, works well as a long-term goal, and you may actually need less/more depending on your signs & symptoms.

Which brings me to the next problem -- your Reverse T3 is high. Not sky-high, but high nonetheless. (For perspective, mine was up over 500, no wonder I felt crummy.) Your Reverse T3 is the inactive form of T3, and it fools your cells into taking it onboard, thus displacing spots for actual active T3 to attach. So you wind up with labs that look like yours; a very decent-looking Free T3 level on paper, and if a doctor never looked beyond that, he/she would totally miss the Reverse T3 problem.

The fact you can hardly get out of bed, feel poorly during the day, then perk up in the evening is likely partly attributable to adrenals. (In addition to thyroid and whatever else.) Your Cortisol and DHEA-S seem to be on the lower end. Plus, cortisol and thyroid are closely linked, as are the sex hormones. If you're male, you may wish to look into getting testosterone, free testosterone, SHBG, and estrogen tested. (Low testosterone can do a number on you.) In fact, same goes for if you're female, although I probably missed a few other hormones there. Thankfully, your TPO antibodies and Thyroglobulin antibodies look pretty good, as does your Free T4. Did they test TSI and TRAb, in relation to the thyroid, looking for Graves' disease?

So... where to go from here? The goofy cortisol levels and elevated Reverse T3 could be indicative of inflammation, stress, illness, and so forth. I would get checked for subtle things like Lyme disease, H. Pylori, Mono/EBV, liver disease, etc. There could be a low-level infection or virus taxing your body. I would also address your diet and consider getting tested for Celiac and gluten sensitivity (not one in the same). Going gluten-free can help things along, as can eating fewer processed foods, sugars, drinking more water, less coffee/soda, less fast food. Check out the Paleo diet, although it's more a lifestyle than anything.

Barring all of that, addressing your thyroid with thyroid medication (and you absolutely want to take some T3, since your Reverse T3 is high), and taking some sort of steroid like hydrocortisone or prednisone to help your adrenals along. But that (steroids) would be worst-case scenario, if you couldn't get your adrenals and cortisol levels in-line by more gentle means.

In any case, you want a doctor who is skilled with hormones looking at all of this. Beware the doctors who will just get you "in range" and leave you there. You need to optimize everything.

hugs6


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## Arctice (Jun 12, 2013)

Ah, my apologies on the Cortisol mix-up. That was supposed to be 4AM that was high, not 8AM. Thank you for reminding me about testosterone, and as I did have that tested, I added it to the original post: It seems to be on the low side but still in range. 
Great informative post, thank you for that! I did not get tested for those antibodies no, I wasn't aware that they were separate from the hashimoto's AB. Would that be a good thing to get tested for in consideration to my results? 
Also regarding "There could be a low-level infection or virus taxing your body", would this be applicable considering I've been dealing with this for at least 4 years now?


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## bigfoot (May 13, 2011)

Ouch, your Total Testosterone is on the low side, as is your Free Testosterone. Yes, your Total T. is still "in range", but just about dragging on the bottom. While you'll see the ranges go from 200 or 300 up to 1200, sitting at 354 ng/dL is probably not a pleasant place to be. (Seen mine as low as 200-220.) I think something from at least 500+ is a better spot. I'm surprised they didn't draw SHBG, too. And Estradiol (E2) is important here as well, since excess estrogen could be robbing you of testosterone. Low testosterone can be causing or adding to the anxiety, fatigue, and about a million other things. Crucial to find out the "why" you have lower testosterone, *before* any treatment, if you can.

As far as testing TSI and TRAb, if you have insurance, it sure wouldn't hurt to find out. And likely you have either/or low Vitamin D-25 and B-25, and your lipid panel is probably wacky, too. You asked about whether a virus could be sapping your energy and causing many other things; absolutely. Things like Lyme disease have a habit of slipping under the radar and being in the background wreaking havoc. Just one more thing to rule in or out. A sleep study might even be beneficial, too. All things to consider -- basing this on personal experience as having dealt with fatigue and other health issues for the last 5+ years.

My hope is that you have insurance and a good doctor who can listen to you, pursue these leads with you, all without causing you to go bankrupt. Something else to think about is seeing a doc (or having a consult with one) who specializes or is interested in chronic fatigue. Mine happens to be an infectious disease doc, but I'm sure there are other specialities out there.

More than likely, it isn't any *one* thing going one, but a combination of a few things. IMHO, you are hitting on the right stuff, and just need to figure out what needs treatment, what will improve by way of treating something else, and what isn't a huge problem at the moment. If you walked into many doctors' offices with this list of issues, you'd walk out with blood pressure meds, anti-anxiety meds, anti-depression meds, cholesterol meds, and so forth. Better to get at the root of the problems, instead of just treating every sign & symptom. But I get the impression you already know that!

Anything else, just ask away...


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## Arctice (Jun 12, 2013)

Unfortunately I'm a poor college student with no health insurance and no doctor. I've been ordering these tests myself online whenever I've had the funds to do so, which is why there are time lapses between my tests. Thank you for warnings regarding the negligence of some doctors, and yes I'm aware that the standard medical procedure for these problems are rarely a good solution. 

If you feel comfortable answering, what do you think I should take as my next step? (Any specific tests I should take and/or problems I should rule out first?)
And thank you for all the help so far, it has been very useful!


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## Andros (Aug 26, 2009)

Arctice said:


> I have been struggling with symptoms of thyroid disorders for a long time without being sure of what my actual problem is. I've had a few tests done when I could afford it, so these results are somewhat spread out. I'm not sure how I should interpret these results and I hope someone can shed a light on what seems to be the problem!
> I'm currently dealing with some major issues and I'll list them here in case it's any help. Feeling fatigued and a lack of energy during the day, I usually feel somewhat better around night time and have a very big difficulty falling asleep at night. Conversely getting out of bed in the morning is very hard for me as well. I've been suffering from diffuse hair loss(my whole hair line is thinning including the sides and the back). Also bouts of depression, low motivation, lowered libido, panic attacks and racing heart. It's becoming a big problem in my life and I really want to get this solved!
> 
> This is my first test from April 2012:
> ...




Consider hyper. Your labs are unusual in that the FREES are rather high, the TSH is elevated (by some standards anyway) and some of your clinical symptoms suggest it.

I hate to suggest more tests re the financial situation. Trab is the least expensive test and if you have Trab, you have TSI.

Here is info....

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583


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## bigfoot (May 13, 2011)

Ugh, sorry to hear about the lack of insurance and a good doctor. That definitely makes things rough. I think Andros has a really good suggestion in ruling out being hyperthyroid. That would be my next step, too. If that turns out to be a non-issue, you can focus more closely on hypothyroidism and hypogonadism. Convincing a doc to test for TSI and/or TRAb is usually downright difficult, anyway. (Still haven't done it here.) They would likely see your more recent TSH being 2.1, along with your in-range FT3 and FT4, and never even consider hyperthyroidism as a possible culprit in all of this.


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## Arctice (Jun 12, 2013)

So I'm bumping this thread as I finally had the test done for TSI as well as Lyme's and both came back negative. While I was at it I also had my Vitamin levels done and my Vitamin A and Calcium levels came back as high. I'm not sure what I should look for as I feel like I've covered all the basic tests. Any guidance is much appreciated.

Recent test results:
Vitamin A, E, D, B12, Beta Carotene
Carotene, Beta : 37 : 3-91 ug/dL
Vitamin A : 91 (high) : 18-77 ug/dL
Vitamin E(Alpha Tocopherol) : 12.4 : 4.6-17.8 mg/L
Vitamin D, 25-Hydroxy : 36.4 : 30.0-100.0 ng/mL
Vitamin B12 : 647 : 211-946 pg/mL
General Health Screen
Glucose : 89 : 65-99 mg/dL
Uric Acid : 6.9 : 3.7-8.6 mg/dL
BUN : 14 : 6-20 mg/dL
Creatinine : 1.00 : 0.76-1.27 mg/dL
eGFR If NonAfricn Am : 106 : >59 mL/min/1.73
BUN/Creatinine Ratio : 14 : 8-19
Sodium : 138 : 134-144 mmol/L
Potassium : 4.8: 3.5-5.2 mmol/L
Chloride : 99 : 97-108 mmol/L
Calcium : 10.2 : (High) 8.7-10.1 mg/dL
Phosphorus : 3.6 : 2.5-4.5 mg/dL
Protein, Total : 7.4 : 6.0-8.5 g/dL
Albumin : 5.2 : 3.5-5.5 g/dL
Globulin, Total : 2.2 : 1.5-4.5 g/dL
A/G Ratio : 2.4 : 1.1-2.5
Bilirubin, Total : 0.5 : 0.0-1.2 mg/dL
Alkaline Phosphatase, S : 84 : 44-102 IU/L
LDH : 146 : 0-225 IU/L
AST (SGOT) : 20 : 0-40 IU/L
ALT (SGPT) : 24 : 0-44 IU/L
GGT : 13 : 0-65 IU/L
Iron : 98 : 40-155 ug/dL
Cholesterol, Total : 183 : 100-189 mg/dL
Triglycerides : 72 : 0-114 mg/dL
HDL Cholesterol : 55 : >39 mg/dL
VLDL Cholesterol Cal : 14 : 5-40 mg/dL
LDL Cholesterol Calc : 114 : 0-119 mg/dL
T. Chol/HDL Ratio : 3.3 : 0.0-5.0 ratio units

Thyroid and Lyme's
Thyroid Stim Immunoglobulin : 20 : 0-139%
Lyme IgG/IgM Ab : <0.91 : (Negative) 0.00-0.90
Lyme Disease Ab, Quant, IgM : <0.91 : (Negative) 0.00-0.90


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## StormFinch (Nov 16, 2012)

Not sure about your Lymes as I've never dealt with them, but your TSI is 20. A person without an autoimmune condition would have 0. Truthfully, I'm not even sure why they include a range, other than the fact that some people who were subclinical were included in their sampling.


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## Arctice (Jun 12, 2013)

Interesting, so although it's a low amount, it would indicate that I have something to do with an autoimmune disorder? The other anti-bodies I tested didn't give me a specific result;
(TPO) Ab <6 : (0-34)
Antithyroglobulin Ab <20 : (0-40)

Although it's indeterminable whether they are 0 or not, could the same be said about these antibodies if they were above 0; as in it would imply an autoimmune condition?

Also is the autoimmune condition likely be graves disease in my case?


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