Hi Ema, wow, thanks for your insights. I have elevated EBV and HHV-6 titers, and it looks like I most likely have Lyme Disease. I guess those could easily be the 'underlying causes' of the HPA/O axis dysfunction... :-/
Yes, absolutely. Lyme in particular is known for dyregulating the endocrine system.
When you say most likely you have Lyme, what do you mean in particular?
I'm attaching my two saliva cortisol tests- the first from February, the second from May. In March/April I began taking some adrenal supplements ("Adrenal Rebuilder"), rhodiola rosea, some other stuff, and I started the methylation protocol. Maybe those contributed to the improved results...
The results actually look pretty similar to me. Both sets are too low in the morning and midday and then too high at night. Are you having trouble sleeping? I suspect yes, given the time stamp of 255AM!
I think that boosting the levels in the AM with Isocort or HC might be something to consider. If your doctor is running these panels, hopefully s/he is up on treatment beyond adrenal supplements. I think there is a place for rhodiola etc but your below range morning levels may need more help especially if Lyme and other infections are involved. These will cause you to burn through cortisol like nobody's business.
The methylation protocol definitely has the potential to improve the endocrine system as well.
Here are some thyroid results from January:
Free T4: 1.21 ng/dL (ref 0.82-1.77)
Free T3: 3.2 pg/mL (ref 2.0-4.4)
Looks ok, doesn't it? I also had thyroid antibody tests and they were negative.
They could be a smidge higher (most people feel best with FT4 about 1.4 and FT3 at the top third of the range) but don't look too bad at all. I wonder what they look like now? Also, I wonder what your RT3 would look like?
That's great that your antibody tests were negative and that your doctor ran them. It sounds like you are working with someone who is at least somewhat on the ball.
My last iron panel was done in November:
TIBC: 316 ug/dL (ref 250-450)
UIBC: 233 ug/dL (ref 150-375)
Iron, Serum: 83 ug/dL (ref 35-155)
Iron Saturation: 26% (ref 15-55)
Ferritin, Serum: 45 ng/mL (ref 13-150)
Those seem to be ok. Although a lot could have changed in 8 months, I suppose.
Yes, they could definitely have changed. But again, they are a bit low but not dreadful. I personally shoot for serum iron of 100-110 and ferritin 70-90. Your TIBC is above the bottom of the range which indicates that you can safely supplement and store iron. It also doesn't look like you have anemia of chronic disease which is great. But I would consider trying iron bis-glycinate (which is a non-toxic form) to see if bumping those levels up a bit would help increase energy etc.
I had the sex hormones tested because a few months ago I suddenly developed signs of PCOS (irregular periods, hair growth, etc). That actually coincided with a major relapse (Lyme?)... Hopefully this will get figured out one day.. :-/ I wonder what the doc(s) will suggest based on these results.
In PCOS, often times the LH is higher than the FSH. So with that not being the case nor your testosterone being high, I would lean away from thinking PCOS.
What has helped me the most is treating from three fronts...I treat the endocrine abnormalities that I have with replacement hormones, support the balancing of the endocrine system with the methylation protocol and attack the infections directly with antivirals and antibiotics. I have seen quite a bit of improvement with this plan but it is taking time for sure!
If I were you, I would want to get an ACTH stim test - preferably the low dose version. Your low AM cortisol is worrisome to me still. If it is negative (as it may very well be because the stim test is not perfect and misses about half of those with secondary adrenal insufficiency), then at least you will know. And if you fail the stim, your treatment options will be significantly easier to get in terms of endocrinologists acknowledging your disease.
After the stim test, I would want to start on some sort of adrenal program, most likely involving the use of low dose hydrocortisone or Isocort and possibly trying some melatonin at night. I think the morning levels are beyond what you can reasonably expect an herbal formula to correct though something like rhodiola certainly won't hurt.
I would also get the Day 21 sex hormone labs to finish fleshing out that picture. If those are low, then I would consider supplementing with bioidentical hormones.
I would keep up with the methylation protocol.
And I would try to get on an appropriate protocol for lowering the infectious load in your body. I have had a lot of success with Nexavir personally but there are many threads about antivirals and antibiotics on the boards.
If you have Lyme, it is important to get on a good antibiotic profile that will attack all 3 forms the bacteria can take. For me, this takes the form of cefuroxime, azithromycin and Flagyl. I also am taking Famvir now for the viral infections.
I would finally also consider a stool analysis like the CDSA or the Organic Acids test from Metametrix to assess gut function. I would also think about incorporating a lot of probiotics into your regimen especially if antibiotics are to become a part of your course of treatment.
Hope that helps and is not too overwhelming. Your results are not dreadful but I definitely think that there is room for improvement and that you are on the right track!
PS: Any idea why the DHEA-S would be high? Also, what would elevated prolactin suggest?
It's not uncommon for DHEA-S to go high right before it starts to plummet in earlier stages of HPA axis dysregulation. I would guess that is what is happening here as your cortisol results are not completely flat-lined yet.
The elevated prolactin could really be nothing more than stress from the needle stick. I would not fuss about it unless it goes up (prolactinomas generally produce prolactin levels many many times above the top of the range) upon retest.
I will go back through my notes though and see if I have saved anything else on prolactin. If I find anything, I will add it to the thread.
