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Thyroid (Expert Forum)
Reference Ranges
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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Reference Ranges
by wonderme, Apr 06, 2006 12:00AM
Thank you for your previous responses. I wanted to post one more time w/ all relevant info for your comment. If you can reply to all questions that follow, I would really appreciate it.
I have been feeling fatigued for several years, I can't concentrate, I've started feeling dizzy...and many more symptoms.
I have had my TSH, Free T4 tested but they are "normal."
In addition, I had my AM cortisol, ACTH and DHEA tested:
AM Cortisol 10.1 (4-22)
ACTH 9 (5-27)
DHEA 47 (40-325)
I had my AM cortisol tested three years ago b/c of no hair growing under arms, forearms, knuckles, legs, and losing considerable hair on my head...at this time it was 18.8 on the same range.
Symptoms suggestive of adrenal problem:
- Still no hair growing under arms, forearms, knuckles, legs, and loss on scalp.
- Unrefreshed sleep, hard time getting out of bed in morning (I used to exercise then, can't get up now)
- Wake up several nights a week at about 2 or 3 and can't get back to sleep until 5 or 6.
- During period, goes for 3 days, stops 1 or 2 days, then starts again
- Three previous labwork showed low CO2 levels: 19 (21-33); 19 (21-33) and 18 (21-33)
- Sensitivity to bright light -- do a flashlight test and pupils constrict and dialate (don't stay constricted)
- The flu wipes me out -- I don't get out of bed for days, too tired
- Crave sweets and alchohol -- not a drinker and salt
- Have dark circles -- gotten worse
- Always have big reaction to bug bites -- swell with mosquito bite
THANK YOU!!
I have been feeling fatigued for several years, I can't concentrate, I've started feeling dizzy...and many more symptoms.
I have had my TSH, Free T4 tested but they are "normal."
In addition, I had my AM cortisol, ACTH and DHEA tested:
AM Cortisol 10.1 (4-22)
ACTH 9 (5-27)
DHEA 47 (40-325)
I had my AM cortisol tested three years ago b/c of no hair growing under arms, forearms, knuckles, legs, and losing considerable hair on my head...at this time it was 18.8 on the same range.
Symptoms suggestive of adrenal problem:
- Still no hair growing under arms, forearms, knuckles, legs, and loss on scalp.
- Unrefreshed sleep, hard time getting out of bed in morning (I used to exercise then, can't get up now)
- Wake up several nights a week at about 2 or 3 and can't get back to sleep until 5 or 6.
- During period, goes for 3 days, stops 1 or 2 days, then starts again
- Three previous labwork showed low CO2 levels: 19 (21-33); 19 (21-33) and 18 (21-33)
- Sensitivity to bright light -- do a flashlight test and pupils constrict and dialate (don't stay constricted)
- The flu wipes me out -- I don't get out of bed for days, too tired
- Crave sweets and alchohol -- not a drinker and salt
- Have dark circles -- gotten worse
- Always have big reaction to bug bites -- swell with mosquito bite
THANK YOU!!
Doctor's Answer
by Mark Lupo, M.D., Apr 06, 2006 12:00AM
, Apr 06, 2006 12:00AM
Would do an ACTH stim test with cortisol, DHEA and aldosterone levels at baseline, 30, 60 min -- this should address the adrenal issues.
The CO2 level is not specifically a problem.
Also test testosterone level. The lack of body hair in certain places is tough to pinpoint to a specific disease.
Consider testing for non-thyroid autoimmune disease such as ANA and sedimentation rate. And add thyroid antibodies to next labs.
If all normal then get a neurological consult.
The CO2 level is not specifically a problem.
Also test testosterone level. The lack of body hair in certain places is tough to pinpoint to a specific disease.
Consider testing for non-thyroid autoimmune disease such as ANA and sedimentation rate. And add thyroid antibodies to next labs.
If all normal then get a neurological consult.
I wrote a longer message back to you in the other section, please read it! We are very much alike, and no you are not 'normal'! These endo docs need to listen to our symptoms and realize we are all genetically different individuals. My doctor seems not to be able to understand why I really can't work. Imagine that! Hello!! Guess you have to have Addison's for most docs to think you are in dire straits.
Dixie
Dixie1
The ACTH stim test the doctor mentions above is what is used to diagnose Addison's Disease. I hope that comes out normal, meaning your adrenals aren't in a crisis state (yet). He still seems to be ignoring the issue of adrenal fatigue saying 'this should address the adrenal issue'. Also, a positive ANA result isn't just for non-thyroid autoimmune problems. It could be indicative of Hashimoto's thyroiditis, or just a regular thryoid problem, or even nothing. Around 5% of the population have elevated ANAs and have nothing wrong with them. The way the doctor stated that was misleading.
Thanks for the feedback...I feel like I'm going in circles.
I have had my antibodies tested and they came back <35 (Range <35) so that doesn't seem to be an issue.
Thinking I may need some cortisol -- what are your thoughts on the ranges? If you're in the "range" then you're okay? OR,could it just not be enough for you (as is suggested for thyroid) OR for you at that time?
I wonder b/c I'm so tired in the morning and during the day, sometimes better early evening, and often wake up in the middle of the night. Trying to get a saliva test to check the pattern...
Also, have you seen any mention of low CO2 levels? It has come back low on any bloodwork I've had done that they've checked it -- whether routine physical or when I feel terrible. There is a site www.digitalnaturopath.com that lists low CO2 as a risk factor for adrenal insufficiency. It discusses signs/symptoms, conditions, risk factors, etc. I, of cource, have virtually all of them except any diagnosis of a condition.
Anyway, what do you think about ranges for these things and about trying some hydrocortisone? THANKS!
Yes, it is the same with your adrenals as it is with your thyroid. Just because you are within 'normal' range doesn't mean that your reading is normal for you. I barely even function. I would find a naturopath that is experienced in diagnosing and treating adrenal fatigue for treatment. Most of mainstream medicine does not recognize it and people just get worse, and I for one don't want to end up with adrenal 'insufficiency', a.k.a. Addison's. We both definitely have risk factors.
Make sure to get tested for the other adrenal cortex hormones aldosterone, 'free' testosterone, estrogen, and progesterone, as well as GH(growth hormone from pituitary) also. An ACTH stim test, like the doc mentioned, is important to make sure you don't have Addison's...which your symptoms don't seem to warrant though. I can't emphasize more getting the book I mentioned, you will be so happy you did. The questionnaire itself is worth the price of the book!
As for supplementing with hydrocortisone, some people definitely need and benefit from it. Taking adrenal cortex extracts are always beneficial no matter what your level of adrenal fatigue. Some people take both. The book talks about all of this in great detail, and will help you approach a doctor about everything. Definitely need to work with a doctor so you can be tested and monitored for progress. Seek a naturopath or you won't ever be considered for taking cortisol/adrenal extracts. Naturopath will also do many other tests to see what nutrition supplements you need to take, and whether or not there are additional things contributing to your fatigue. I have read that everyone with adrenal fatigue has high copper in their system, and mercury can cause fatigue, so heavy metal test important.
I don't know about the CO2 levels and am so glad you mentioned them. I am going to check out the site you mentioned, and talk to my new doctor about it.
One thing I must mention...thank your lucky stars for having a supportive husband!! I am single, but do have a very supportive family and friends.
Thanks again...I posted a different message to you below too b/c I keep getting turned around where I'm looking for you.
Can you please remind me the name of the book? I've had a few suggested to me, but your situation seems so similar to mine that I think this would be the best starting point for me.
Where do you find a naturopath? Phone book -- I'll look there. I have so many doctors to choose from in my provider directory, but no naturopaths...and luckily I don't need a referral for a specialist. I feel like a dolt, but I've never done this before.
Also, what extracts are you referring to? Can you suggest some to try...what about vitamins and my note about sea salt? Thanks!
You, too, are very lucky to have supportive friends and family. I wish you the best.
The book is 'Adrenal Fatigue, the 21st Century Stress Syndrome' by Dr. James Wilson. As for salt, I would wait until you get tested for aldosterone, but if you crave salt that is an indication that it is probably low. Plus, do you have low blood pressure?
Extract I take has Siberian Ginseng(eleuthero) and Licorice Root in it. Put it in herbal tea, so alcohol used for extraction evaporates. I started on 2000 mg/dau of good quality Vit C. It has ratio of Vit C to bioflavinoids of 1:2. Starting taking good mixed tocopherol Vit E, 800 iu/day. Waiting for naturopath to test me before adding anything else. By the way, found out my CO2 was tested, and showed as 21. That is the very lowest score for 'normal'. Hmmmm.
I started on the above supplementation based on what the book recommends. There is lots more, but want to wait to get test results and find out what my new doc recommends. Pantothenic acid is highly indicated, something like 1200 mg/day. I may need somewhat less than than or more than that. Vit C and E aren't a problem to use in higher quantities in normal situations, so went ahead and dove in.
The book will explain everything, including what supplements, vitamins, herbs are needed/beneficial, and salt intake.
By the way, have you thought about making an appointment with a rheumatologist to rule out lupus or something else? I am going to be tested for lupus, RA, etc not only because of abnormal ANA test, but because DHEA is low. Supposedly low DHEA can be a sign of lupus and RA. Just found this out yesterday from reading a copy of notes from my last appt. My doctor's office was supposed to call me to tell me to see a rheumatologist, but never did! The doc should have told this directly to me anyway!! Maybe he didn't want to scare me though by saying I could have lupus, but at least he should have told me to see a rheumat. Talk about wanting to ring someone's neck!
If do have either, most autoimmune problems are caused from adrenal condition. Probably is reason for my probable Hashimoto's. However, want to be treated altogether for the reason for the adrenal problem in the first place, not treatment for the symptoms of the autoimmune