Doctors Lounge - Endocrinology Answers
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Forum Name: Endocrinology Topics
|prayingtogetbetter - Sun Nov 11, 2007 11:31 pm|
I was diagnosed with Graves a few years back and had the radioactive iodine, now Im facing some scary symptoms and labs Im thinking. Please tell me what you think, and what testing you'd recommend to rule out further conditions. Im loosing hope. All is appreciated. Thank you.
ACTH= 19 (reference range <46, Unit pg/ml)
25- Hydroxy Vitamin= 15 L [8-38] (reference range >30, Unit ng/ml)
Vitamin D deficiency <10ng/ml
VItamin D Insufficiency 10-30 ng/ml
Vitamin D sufficiency >30ng/ml
Thyroid Auto Antibodies
Anti Thyroglobuli = <20 (reference range <40, unit IU/ml)
Thyroid Microplasma= 394 H (reference range <40, unit IU,ml)
Reverse T3= 458 H (reference range 90-350, unit pg/mL)
Ferritan= 38 [10-291] ng/ml
Iron and Iron Bindi
Iron= 136 [50-170] ug/ml
Iron Bind Capacit= 314 [ 261-478] ug/dl
Saturation = 43 H [21-42] %
Folate, Folic Acid = >24.00 H [5.4-24] ng/ml
Free T4= 1.6 [0.9-1.8] ng/dl
Glucose= 60 L [74-106] mg/dl
Total T3= 94 [60-181] ng/dl
TSH= 3.94 [0.3-5.5] UIU/ML
Vitamin B12= 427 [ 211-911] PG/ML
Sedimentation Rate= 0 [0-20] MM/HR
Insulin Level= 6.0 [3.0-28.0] UU/ML
My saliva testing is as follows:(Diagnose Techs Inc)
Note: I started my period Sep 8th, had testing done Sep28th, then started period again Oct1st.
My Testosterone- 13 Normal
My Estrone- 31 (says normal for age16-39 is 30-58pg/ml)
Estradiol- 19 ( in normal high range for Luteal)
Estriol-11 (Postmenopause-7-18, HRT Target Range 14-38, and cycling female 12-25)So, that's slightly low.
Progesterone 335 (HRT Target Range 100-300, Follicular 20-100, Luteal 65-500). Um, confused. Am I high or low for my cycle time?
FSH- 157 (Premenopausal-<125, Postmenopausal 90-500) that's high, Im no where near menopause, Im in my twenties.
LH-44 (Premeno- 8-30, HRT- 8-30, Postmen-NO HRT 25-200)- so thats high as well, for my age.
My cortisol at 7-8am is 9 (depressed)
at 11-noon- is 8 (normal)
at 4pm-5pm is 1 (very depressed)
at midnight is 3 (normal)
My DHEA is a 4 (normal)
|Dr. Chan Lowe - Thu Nov 15, 2007 12:51 am|
Your labs appear to be consistent with appropriately treated Grave's disease. The only lab that was really note worthy was the abnormally low afternoon cortisol level. However, with all the other cortisol levels normal it makes me suspicious that this particular value may be off.
I would recommend you follow up with your doctor. Labs themselves are not very helpful unless taken into context with the symptoms the patient is having. Your doctor can help you fit these labs with your symptoms.
|prayingtogetbetter - Thu Nov 15, 2007 9:17 am|
During the time of the cortisol drop, I feel dizzy, weak, tired, sometimes anxious with my thyroid feeling swelled...its weird. THe cortisol was also not that high to begin with in the morning either. So, its low, normal, low, normal...and thats how I feel all day.
My throat swells and feels funny. I feel anxious inside, and I cant walk around much longer than 15 minutes without getting dizzy.
I need to support that issue in order to ensure proper thyroid treatment right? Ive read about adrenal support before your thyroid meds will work well.
Would you recommend any further testing, to find out if the adrenal fatigue is caused by the pituitary gland? THen, I would have to be on cortisol for life, right?
I appreciate the help.
My doc has me on Adren-all vitamins, but if its my pituitary, HC is a must to feel better.
|prayingtogetbetter - Thu Nov 15, 2007 9:29 am|
Also, with those antibodies present, what do they mean?
Ive heard them abbreviated and named differently?
Does this mean that they are the only ones present?
Shouldn't I get further antibody tests to rule out other autoimmune diseases?
Isn't Hashi's a possibility?
What other antibody tests could I have?
I'm looking for a confirmed diagnosis...there is no such thing as too much testing, recommend all you can.
Thank you so much
|Dr. Chan Lowe - Fri Nov 23, 2007 2:09 pm|
Regarding your cortisol issue, with low normal levels and symptoms that may be consistent with low cortisol you may want to talk with your doctor about having a cortisol stimulation test done to see if your cortisol levels increase appropriately. You may have a partial deficit that is keeping you from getting enough cortisol to meet your needs.
Often, hashimoto's and grave's disease do run together. It is reasonable to have other antibodies tested for. Regardless of the underlying issue with the thyroid, the treatment is basically dictated by how much thyroid hormone is present in the blood. However, it would be good to know if there is hashimoto's antibodies present because in this disease the thyroid ultimately often burns out and the patient becomes hypothyroid. In pure Grave's disease, this really doesn't occur so thyroid ablation may ultimately be necessary.
|prayingtogetbetter - Sun Nov 25, 2007 4:51 pm|
What exactly is the cortisol stimulation test?
Is it the ACTH Stim test??
Also, which antibodies do I test for, what are they called for Graves? and Hashis?
Thank you for you're help.
|Dr. Chan Lowe - Sun Nov 25, 2007 10:48 pm|
You are correct that the cortisol stimulation test is the ACTH stim test.
There are many antibodies. Typically for Grave's disease, thyroid stimulating immunoglobulins (antibodies) are tested for. This is a generic test that looks at overall thyroid stimulating antibody production rather than looking for one specific antibody.
With hashimoto's disease, thyroid destructive antibodies are evaluated for. There are many of these, including thyroid peroxidase antibodies, antithryoglobulin antibodies and thyroid receptor blocking antibodies.
I hope this helps. Best wishes.
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