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Adrenal Insufficiency Testing?

Discussion in 'Adrenal Dysfunction' started by roxie60, Aug 5, 2013.

  1. roxie60

    roxie60 Senior Member

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    Central Illinois, USA
  2. roxie60

    roxie60 Senior Member

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  3. roxie60

    roxie60 Senior Member

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    Hopefully this works, my thyroid test results using Dr Rind's scale


    Thyroid Scale Diagram
    Input Labs -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10
    4.76 TSH 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.76 4.75 4.75 4.75 4.75 4.75
    0.90 FT4 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90 0.90
    290 FT3 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290 290
  4. roxie60

    roxie60 Senior Member

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    that didnt work so well, sorry too tired to fix
  5. roxie60

    roxie60 Senior Member

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    Just for reference I would say this entire day I have felt really ill, many symps, energy a 1 on an 1-10 scale. Yet my company expects me to function at a high level (my job can be very demanding mentally which inturn is physical) and I can hardly sit in front of this laptop for 15 mins without feeling worse. Many times hold my head in my hands.
  6. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

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    TSH: 4.67 = +5
    FT4: 0.90 = -3
    FT3: 290 = -2

    So your pituitary is pumping out a lot of TSH, but the thyroid is not producing much T4. Your cells are doing a good job of converting T4 to T3.
    roxie60 likes this.
  7. roxie60

    roxie60 Senior Member

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    Found another lithium B12 absorption discussion, surprise it is another PR thread :)

    http://forums.phoenixrising.me/index.php?threads/not-absorbing-b12.20441/
  8. roxie60

    roxie60 Senior Member

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    TSH is 4.76. So your take is there is nothing here that would explain extreme fatigue/low energy? I thought a TSH near 5 was negative in terms of health.
  9. roxie60

    roxie60 Senior Member

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    Based on Dr Rind's thyroid testing experience it would seem I am hypothyroid

    Some common results and interpretations:

    If the T4 is in the low (but still ‘normal’) range and the T3 is to the right of it in the low but normal range, it means that the T4 is converting to T3 at a high rate (more T3, less RT3). This is typically found when the thyroid gland is unable to keep up T4 production to meet the body’s needs. The body can compensate by increasing conversion of T4 to more T3. We see this in hypothyroidism. (e.g. TSH 5.5, FT4 0.85, FT3 294)

    http://www.drrind.com/therapies/thyroid-scale
  10. Ema

    Ema Senior Member

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    Welcome to the world of Addison's Disease! And hypothyroidism...congrats though because with proper treatment, you will be feeling much better soon.

    I still think you should have a stim test but 3.7 AM Cortisol is diagnostic all by itself.

    Ema
    roxie60 likes this.
  11. roxie60

    roxie60 Senior Member

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    I just hope my dr sees it that way and tells my company so i dont lose job. i am so dysfunctional right now it scares me. thanks for reply. So is TSH meaningless diagnostically speaking? is there a link i can capture info that indicates AD and hypo? so no AI or not enough info yet?
  12. roxie60

    roxie60 Senior Member

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    just so happens yesterday when had bld drawn for ACTH they did another cortisol should b interesting to compare this last (past Sat) to yesterday. I honestly feel like I'm dying but I have felt that way before and survived so hoping the same.
  13. roxie60

    roxie60 Senior Member

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    I have no idea how I'm going to be able to sit through that IME tomorrw
  14. roxie60

    roxie60 Senior Member

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    Thank you everyone for your responses and support.
  15. Ema

    Ema Senior Member

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    I hope so too.

    It is entirely possible to go into an adrenal crisis if you are under intense stress. Emergency personnel are ill-prepared to deal with this issue. If something were to happen, the best thing you can do is keep yelling "adrenal insufficiency" and that you need 100 mL of SoluCortef injected ASAP. If it makes you feel better, you can yell "suspected adrenal insufficiency". A crisis can be life threatening so do not hesitate to call for help if you experience symptoms.

    No, TSH isn't meaningless. It just isn't the whole story like endos want it to be. But yours is high by any standard and indicates hypothyroidism. Whether or not this is due to the AI remains to be seen. But you need to be on thyroid meds in my non-medical opinion. But you must resolve the AI first because thyroid meds can precipitate a crisis if you are not stable on steroid replacement first.

    I'm searching for the article that says that <6 is diagnostic all by itself. FWIW, the World Anti Doping Agency says this:

    Serum cortisol Diagnosis is confirmed if serum cortisol level measured between 8.00 am and 9.30 am after an overnight fast (basal cortisol) is less than 3 μg/dL. Values below 18 μg /dL in the presence of a markedly elevated ACTH and plasma renin concentrations are very suggestive of adrenal insufficiency and require further investigation by provocative testing (cosyntropin, CRH, insulin). Values above 18 μg /dL rule out adrenal insufficiency.​
    http://www.wada-ama.org/Documents/Science_Medicine/Medical_info_to_support_TUECs/WADA Medical info Adrenal insufficiency 3.1 EN.pdf

    I love that they include up to 18 ug/dl in the "grey" area. So many doctors would pass over those results as "normal" and clearly they are not.

    FWIW, I also think 3.5 is close enough to 3 to be diagnostic in my non-medical opinion. There's no question in my mind that you have AI.


    Ema
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  16. Ema

    Ema Senior Member

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  17. roxie60

    roxie60 Senior Member

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    Look forward to hearing my ACTH and renin results. Never had those tested before.

    I'm at 3.7 cortisol so that abstract would suggest I 'just' at the bottom. Well I can assure them I have reached bottom, I would actually have to go up some to get back to bottom.
  18. roxie60

    roxie60 Senior Member

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    Been in bed all day since early AM so that means once again probably not be able to sleep tonight and even more so worrying about getting up and not missing the IME meeting. Fortunately I only have to drive 1/2 mile to the hotel I have to meet the dr in.but it will be during rush hr. If the last few days are any indication I will not have the strenght to wash the clothes I want to wear (have been wearing cause they are comfortable) and may not have energy to shower. So not me, always took pride in my appearance, being prepared for any meetings, at this point I'm going to be lucky to get the forms filled out and copied tonight. Have to go, I have wanted to pay bills all night I abolutely have to tonight if I can find them all, paper everywhere.

    Ema I now need to find the ranges for ACTH and Renin (I found the Renin).
  19. Ema

    Ema Senior Member

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    The LabCorp range goes from 7-63 for ACTH.

    ACTH is a very fussy test and I'm a little concerned about the lab since you've had to go back so many times. It has to go immediately to a chilled tube and be spun down or it will degrade very quickly. So hopefully they did this!

    Ema
  20. Ema

    Ema Senior Member

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    Here is the one that says below 6 is definitive for adrenal insufficiency (panel 4 on page 6):

    (You have to convert units by dividing by 27)

    Attached Files:

    roxie60 likes this.

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