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Thyroid  (Expert Forum)
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Thyroid and Adrenal Test Results
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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MedHelp Member's Question

Thyroid and Adrenal Test Results

by wonderme, Mar 28, 2006 12:00AM
I posted this below, but think it gets buried. Just got my test results back and of course everything is normal.



AM Cortisol 10.1 (Range 4.0-22.0)

FSH 2.8 (Range 1.5-9.1)

LH 1.5 (Range 0.5-16.9)

Progesterone 27.3 (Range 3.3-26) *This is a bit higher

Prolactin 7.3 (Range 3.0-30.0)

Testosterone 34 (Range 20-76)



Total T3 133 (Range 60-181)

Free T4 1.1 (Range 0.8-1.8)

TSH 1.58 (Range 0.4-5.5)

DHEA Sulfate 47 (Range 40-325)

Thy. Anti <35 (Range <35)



I do not have thyroid antibodies. Interestingly, my TSH has risen from 1.1 to 1.58, but my Free T4 remained the same.



I'm exhausted, but there's nothing wrong with me. I can't imangine how terrible everyone with out-of-range tests feels if I feel like this and I'm normal.



I read that cortisol should be in the 20's for women in the morning--even though I'm within range (at 10.1), could this be causing my fatigue? Also, my DHEA is in the low end of the range (I've seen other ranges for my age group that are 52-400 mcg/dl)--would this cause any of my symptoms?



Also to note, I have had no hair growing under my arms for several years.  One small patch of hair on my lower legs--rest of my legs no hair growth.  Also craving sweets and alcohol--read this was a symptom of adrenal dysfunction.



Any suggestions? I'd appreciate any advice.



Also, is taking some cortisone dangerous if you don't "need" it? I'm considering trying it to see if I can make myself feel better on my own. Don't want to hurt myself -- or in the slim chance I become pregnant, hurt the baby.



Thanks for everything.
Doctor's Answer

by Mark Lupo, M.D., Mar 28, 2006 12:00AM
Thyroid labs are completely normal.  



AM cortisol is probably normal but an ACTH stim test would be more definitive.  The lowish DHEA may be significant, but not enough data out there to be certain.  After the ACTH stim test may try 25-50mg of OTC DHEA / day under doctor supervision (watch out for acne & facial hair)



Member Comments (6)

by wonderme, Mar 28, 2006 12:00AM
Two other quick comments I forgot...



ACTH, Plasma    9   (Range 5-27 pg/ml)



Also, I don't know if this has any bearing on anything, but the weight I've gained (15+ lbs) primarily sits around my waist, with a little on my hips and upper thighs.



I am so certain that it has hit my mid-section b/c I always have to buy pants that fit my hips and thighs and wear a belt because the waist is always too big.  Now, everything is tight at the waist and I have lovely chub hanging over the sides.



Thanks again!

by wonderme, Mar 28, 2006 12:00AM
Kellie,



Thank you for your feedback.  Is it possible that low morning cortisol could create this fatigue?



Also, do you agree that my thyroid is functioning okay?  Just didn't know since the Free T4 is still at 1.1 (0.8-1.8) and Total T3 is in the middle of the range AND I still have so many symptoms...is it possible that I would just feel better with higher T4 and T3? Or since they are both "normal" is it unlikely to offer any relief?



What would be your next step if you had all these symptoms coupled with these test results?



Thank you again for your time, patience and kindness -- it is truly appreciated!



by wonderme, Mar 29, 2006 12:00AM
Thanks to Dr. Mark and Kellie for your feedback.



I just need clarification on a couple of things...



What is the difference in the ACTH Stim and the 4X Saliva Cortisol testing -- obviously different tests, but what do the results for each indicate?  I guess I thought they both had to do with cortisol levels, but is one advantageous over the other?



Secondly, am I right to understand that you feel it is more likely I may need DHEA supplementation than cortisol supplementation?



Also, are cortisol ranges similar to thyroid ranges in that some people may feel best at a certain level where it may be too much or too little for someone else?  Or, if you're in the range then you should feel okay and then it is not the source of the problem?  What about for DHEA?



I'm often tired in the morning and afternoon, but several times a week I wake up at 3 in the morning and can't get back to sleep until 5 or 6.  I go to bed by 10 and stay in bed til 7.  Last year my doc put me on Ambien for 7-10 days and it helped some while I was taking it, but even though I slept through the night, I was still tired in the morning.  Could this be suggestive that my cortisol levels fluctuate at the "wrong" times of the day?



Finally, can you advise the risks/safety of both cortisol supplementation and DHEA supplementation both for non-pregnant and pregnant women?  I've seen mixed reviews, at least for the DHEA and not a whole lot regarding use during pregnancy.



I know I ask a lot, but I soooo appreciate your help!  Thank you.

by Dixie1, Apr 05, 2006 12:00AM
To: wonderme
Hi Wonderme,



You do sound like you have adrenal fatigue, there are different stages. The 4x/day saliva test is well known to be the best test out there, many docs only do the blood and/or urine tests. I have just recently heard of a saliva test from Canary Club, which tests the full spectrum of cortisol, DHEA, estrogen, progesterone, testosterone, TSH, free T3, and free T4. You can get this test/take it without any prescription. CanaryClub.org/HomeLabTests/tabid/80/



Other tests: ZRT Labs... salivatest.com/ (can test just one thing if you want). HealthcheckUSA also another lab can get the saliva test, HealthcheckUSA.com



I would definitely get free T3 tested, don't let anyone no matter what their credentials tell you the test is outdated...bunch of bologna. Tests the amount of T3 in the blood, which is what the cells use. T4 gets converted to T3 in the liver. Even if you have what is considered 'normal' free T4 according to some range, this does not mean it is being converted to T3 enough. Get tested for ACTH, too. It is the pituitary hormone that stimulates the adrenals to make it's hormones. If low, need an ACTH stim test to see if the adrenals react to being stimulated or not, and find out what may be causing the ACTH to be low.



Adrenal fatigue can cause thyroid problems, and vice versa. Pituitary could be the problem, too. Also, cortisol levels need to be at the optimum levels for you to function well, so being at 10-11 will make you feel fatigued, etc. In addition, cortisol along with the adrenal cortex hormone aldosterone (get tested for this, too), are needed for T3 to pass through cell membranes. If these 2 adrenal hormones are low, especially cortisol, thyroid hormone medication won't do much good! Have heard if Ferritin is below 40's, will have problem with or increasing thyroid medication, too.



Make sure to be an advocate for yourself and remember doctors don't know everything. Some endo docs may be good at treating specific gland disorders, such as thyroid, but don't really know how to approach treated adrenal fatigue, or don't even test for it. It is just not taught in traditional medical schools. Without the adrenal hormones at higher/optimum levels, thyroid treatment will not work well!!



DHEA...have read many places, including highly informed physician websites, and talked with a couple very informed pharmacists, that women should never take above 10-12 mg/day. Not only can it be converted to too much testosterone causing hair loss, acne, and/or hair growth on your face, but higher levels of DHEA have known to cause heart palpitations. Some women don't do well on DHEA even in small dosages.



I HIGHLY recommend the book 'Adrenal Fatigue, the 21st Century Stress Syndrome", by Dr. James Wilson. Chock full of great info, as well as a thorough questionnaire to help figure out how severe your adrenal fatigue is. It has helped me tremendously. He mentions the use of adrenal cortex extracts, as well as in some cases the use of cortisol/hydrocortisone with adrenal fatigue. Supposedly, up to 20 mg/day will not shut down the adrenals, but may need much less than that. Have to back off of it after some point. Nutrition/supplements, etc are very important for the healing of the glands, which this book covers in great detail. My doctor has never even mentioned nutrition etc, and is just prescribing me thyroid and DHEA hormone replacements instead of trying to reverse the conditions if possible. No cortisol raising measures have been taken either, even though my cortisol is in the very low end of the range. No wonder I still feel terrible!



I am now going to see a Naturopathic doctor who is experienced in treating the adrenals and thyroid, and was highly recommended to me by several people. He is going to do the saliva test, plus test me for vitamin and mineral deficiency/excess, test for heavy metal toxicity, food sensitivity testing, etc. Also, candida can be a contributing cause to fatigue. I have it, and have continued to reduce the problem by eliminating all forms of sugar and empty carbs(white bread/pasta, etc.) from my diet. This will also greatly help adrenal fatigue. Need to stay away from sugar, alcohol, caffeine, chocolate with