Help with Diagnosis

[researching]

Hello everyone,


I'm new around here, trying to get some advice if you'd be so kind.


I'll try and sum up a brief history:


I'm male, 40y; a few years ago I was diagnosed with sub-clinical hypothyroidism, I was on low dose synthetic T4 for years (hearth couldn't tolerate higher than 50mcg) without improvement, so researching I found out I have a T4 to T3 conversion problem and tried natural desiccated hormone to see if that was better, but it had an extremely negative effect (made more hypo) so I stopped after a month or so. When I did that I immediately started to feel better, so I stayed without thyroid medication for a month, planning on testing my hormone levels without medication, but now I'm spiraling downwards feeling worse and worse everyday.


At the same time (off medication) I did an adrenal test, since it seems to be one of the causes why thyroid hormones sometimes don't work, and I tested other hormones to try and find the root of the problems.


I've got the results and there are plenty of imbalances, but I've been at three doctors (one of which holds the chair of endocrinology at a renowned hospital) and all of them say it's nothing to worry about, just some minor imbalances that wouldn't cause my symptoms, which I refuse to believe.


Most of my symptoms are: hypercholesterolemia, shortness of breath, irascibility, mood swings, depression, fear, constant fatigue and tiredness from anything, stress, complete lack of concentration, lack of strength, high libido but erectile dysfunction, palpitations and ectopic heartbeats, swelling of the neck, insomnia, anxiety.


I'm thinking now of cholesterol to hormone conversion problems since I have extremely high levels of one and very low levels of the other. I haven't been able to find a doctor who is wanting to find the root of the problem, they will just prescribe meds to treat symptoms so I do the research and treatment myself, but I'm a bit lost and with my mental state it's very hard to make some progress, so any and all input would be greatly appreciated.


Here are links to blood test and adrenal test.
BloodAnalysis_Oct2014.pdf
CortisolLevels-chart.pdf


Thanks in advance!

 

[Gene Devine]

I have asked Chris to jump in here and help you; he's our resident expert on Thyroid.

 

[Vettester Chris]

High cortisol can inhibit and interfere with conversion of T4 to T3. With FT3 being at 27% of the reference range, the demand for more thyroid hormone is being prompted to the pituitary through the feedback loop, which is elevating your TSH just enough to continue producing more thyroid hormone. It's kind of a viscous circle.

Adding any NDT or T4 at this point is just adding fuel to the fire. If anything had to be added it would be Cytomel (T3), which could at least work to signal TSH that thyroid levels have increased, which should lower TSH and subdue thyroid hormone production. Not that I am suggesting you start this treatment, but just giving you a general idea of why FT4 is and continues to top out like it is.

My immediate suggestion is that you get with a specialist to address your cortisol profile and accumulated burden. I didn't see an ACTH lab (maybe overlooked). With what I see, I am concerned there could be a possible pituitary issue. I don't want to cause an over reaction, but I would presume that a physician would be on the lookout for something like Cushing's if this persists (?). The elevated cortisol throughout the daytime is either being prompted by the pituitary, or the adrenals (primary), or some other form of stress that has a strong demand on the adrenals. I don't think it should be shrugged off by a medical professional, but that's just my take ...

If you can also get a Reverse T3 lab and aldosterone, it would be helpful. As your program progresses you will want to get your Vitamin D increased (probably doubled), but that's a secondary item at this point.

 

[researching]

Hi Chris, thanks a lot for your answer and thanks Gene for making it possible!


Chris, I do have results which confirmed high RT3 ratio, these are from May 2014, here I had just dropped from 50mcg to 25mcg T4/day:


TSH: 1,63 mU/L (0.35 - 5.5)
T4: 11,2 μg/dL (4.5 - 11.5)
FT4: 1,40 ng/dL (0.8 - 1.8)
T3: 1,2 μg/L (0.6 - 1.9)
FT3: 4,1 ng/L (2.3 - 4.2)
RT3: 0,26 ng/mL (0.1 - 0.35)


I've just checked Cushing's symptoms and I'm missing most of the characteristic ones, for example all in the mnemonic. I'll keep it in mind though.


I will re-test next Monday, my idea is to check the hypothalamic-adrenal axis as well as my testicles, please, let me know any other tests I can include to help with diagnosis.


I'd like to check cholesterol-hormone metabolism but I'm not sure how to do that yet, that's why I'm checking pregnenolone since it seems to be the first step in the chain.


For now this would be the list:


FT3/FT4
Pregnenolone
ACTH
cortisol/DHEA (blood since now I have only saliva)
free testosterone
LH
FSH
albumin
prolactin
PSA


I'll also include aldosterone also as you suggest.

Before I start treating symptoms I'd like to try and find the root of the problem, but of course it's not an easy task, especially when one doesn't have the proper knowledge.

If it's not too much too ask, could you answer this questions:


What could you tell me about my almost non existent levels of DHEA?
Also, aren't my testosterone levels extremely low?


Could adrenals be causing all these hormonal disorders?
Could these problems be caused by malfunctioning testicles?


I'd also love to find an specialist but it's proven to be a very difficult task, I'll keep looking but meanwhile I'm trying to find out everything I can for myself since I'm feeling worse everyday. I'm learning what I can along the way but it's not easy so any and all input is greatly appreciated.


Thanks again for your kind help!

 

[Vettester Chris]

Thanks for finding the RT3 information. Correct, you're seeing a little more RT3 conversion than would be desired. No doubt the stress load on the adrenals is probably contributing to this.

On the subject of Cushing's .. Notice that I said that I hoped that a physician would be on the lookout for Cushing's if "this persists"; meaning one should keep an eye out for Cushing's symptoms if the elevated cortisol goes untreated. Cushing's is a reactive condition as you probably know, stemmed from hypercorticism and/or extensive glucocorticoid administration.

I agree with your quest to find the "root" of this. IMO, that starts with the other labs, and it probably doesn't rule out an MRI and other exams. For forum discussion, this is some of quick talking points on where to look ... However, some of these conditions can be quite complicated, which is why (in my opinion) you need to continue finding that "right" physician. Take a look through Dr. Lam's site as a possible resource http://www.drlam.com/index.php. It might be worth it to reach out to him as well.

You asked about DHEA ... It's not uncommon for cortisol and DHEA to have an inverse relation, and more so when stress and other factors put a high demand for cortisol. I believe you are in the Maladapted Phase I area with your Cortisol / DHEA Correlation, based on your noon and early PM readings. You can do a little research on that to get more information.

Yes, I do agree you have low testosterone. There's a lot to chew with what you've provided, so I've kind of kept it focused on my end with the adrenal and thyroid part of it. You have the correct labs with LH & FSH to also see how the pituitary is working on that end. I suspect that your LH will be somewhat suppressed (secondary), but let's see the labs and there will be no speculation.

 

[researching]

Hi Chris,


Thank you very much, your input is extremely helpful.


Sorry I missread about Cushing's, and no, I didn't had much information about it, so thanks for the warning!


Also, big thanks to pointing me to "Maladapted Phase I", the charts look exactly as mine and I didn't knew the name of this condition, so it's helping a lot on the research.


I realize I may be giving an image of knowing much by naming specific terms, but I don't, I just have a lot of information from the web, and as a wise man once said, "information isn't knowledge". I'm actually pretty lost and my symptoms prevent me from being as effective as I'd like on this research, so your help is greatly appreciated.


I've been reading about adrenals and the "Pregnenolone Steal" and it seems to make a lot of sense with what's going on with me, do you think that and/or hypothyroidism could be the cause of my low testosterone or are my levels too low for that to be the cause?


Also, you say "an MRI and other exams", could you tell me which other exams/tests would you recommend?

Thanks again!

 

[Vettester Chris]

Your research on pregnenolone is accurate, as it is the precursor for all hormones downstream. I'm sure at some point it would be a good idea to supplement this hormone, as many of do just that on HRT. However, I would suspect your situation could be other factors as I noted above. As I see it, most of the preg steal variables tend to be more lifestyle related. Either way, you can and should look at your LS patterns with diet, sleep, exercise, etc.

The exams would be at the liberty of your physician, ranging from BW of course, MRI, X-Rays, who knows biopsy if warranted.

 

[researching]

Hi again Chris,

I've got the results from the tests we talked about, I took them to a new endo and she said all is peachy.

Could you please tell me what do you think?


FT4 18.76 pmol/l (12.0-22.0)
FT3 4.12 pmol/l (3.1-6.8)

DHEA-S 8.55 umol/l (4.34-12.2)
Cortisol 506.9 nmol/l (morning 171-536; afternoon 64-327)
ACTH 21.87 pg/ml (7.2-63.3)

Albumin 47.43 g/l (35-52)
Prolactin 14.72 ng/ml (4.04-15.2)

free Testosteron 0,109 nmol/l (0,057-0,178)
LH 4.16 mIU/ml (1,7-8.6)
FSH 3.31 mIU/ml (1-12.4)

Aldosteron * ng/l (20-220)
*not ready yet (14 days)

I couldn't check pregnenolone, the test doesn't exist where I live.

Thanks!

 

[researching]

I've just got the aldosterone result, it came much quicker than anticipated:

Aldosterone 130 ng/l (11.7-236)


I'd truly appreciate your input if you'd be so kind, thanks.

 

[Vettester Chris]

I don't see anything in the Aldosterone or ACTH that is standing out, but a medical specialist in this field might have a different viewpoint, or they might see something that warrants further testing in that department.

Your FT4 is still up in the 68% area of reference range, FT3 is at 27% .. As before, the reserves are elevated and converting to T3/FT3. Nothing "peachy" about that as your endo might think. Selenium and kelp (iodine) can help with the conversion process, but as stated before this is most likely due to your cortisol profile.

As I stated above, this stuff can sometimes be quick to identify and fix, and sometimes it can be quite complicated. I still believe you need to find a physician that knows how to specifically identify and treat adrenal conditions. Even if all is checking out with the pituitary, there could be a primary condition directly (or indirectly) related with your adrenal glands. He/she will be able to factor in your complete profile, including blood work, lifestyle, stress load, family history, ... Basically a litany of collaborated details to assess your situation.

Your current physician/endo says everything is "peachy". What that means is there's a number between 1 and 50, and you are somewhere in between that, so she is telling you to move on. I know, I had one of those endos many years ago. You have two choices ... 1) Run with it and adapt. 2) Invest in finding a new medical partner that pays attention to how you're feeling, and one that really knows how to interpret the numbers, and that person your partner.

I think I gave you the link to Dr. Lam's site. Here's a few other links with good information from STTM.com ..
http://www.stopthethyroidmadness.com/adrenal-wisdom/
http://www.stopthethyroidmadness.com/how-to-find-a-good-doc/

 

[researching]

Hi Chris,


Thank a lot for your answer.


Yes, every endo I've seen until now only worries about results being within range (or near) and they say I should see a psychiatrist about my symptoms, which I know is not the case. I went to Dr.Lams site but they only take patients from the US, I'm foreigner and there's no info on "good" doctors here on STTM or available on the web. This is quite a 'backward' country. I've been trying to find one for a long time, but it's a very difficult task, that's why I try to do what I can for myself in the meantime.


One thing that might be relevant:
If you look at the test with the current ranges (very broad) all is "in", but, if you use internationally accepted ranges then you see a different picture. Doctors here say "you can't do that" but I still haven't got a convincing answer on why not since they are international units.

Could you tell me what do you think about this?


Also, I couldn't find a range for free Testosterone that comes close to the one I have, I don't know if this is because the assay here is different or because I'm far off the range.

FT4 18.76 pmol/l (12.0 to 22.0) - MERCK 10-18 ↗ FT3 4.12 pmol/l (3.1 to 6.8) - MERCK 3.1-7.7 ↘

Cortisol 506.9 nmol/l AM 7h-10h (171-536) ↗; MERCK AM 251–552 nmol/l ↗

DHEA-S 8.55 umol/l (4.34 to 12.2) MERCK 3.5–14.9 μmol/L Optimal(LEF.org)9.5-13.5 ↘

ACTH 21.87 pg/ml (7.2 to 63.3) MERCK 9-52 pg/ml

free Testosterone 0,109 nmol/l 0,31-1,04 nmol/l - ????? ↘↘

FSH 3.31 mIU/ml (1-12.4) - MERCK 5-15 mIU/mL ↘↘

LH 4.16 mIU/ml (1,7-8.6) - MERCK 3-15mIU/mL ↘

Aldosterone 130 ng/l (11.7-236) – MERCK 70-200 standing-20-50 supine (I was sitting)

Prolactin 14.72ng/ml (4.04 to 15.2) MERCK max 13.5 ↗↗

Albumin 47.43 g/l (35-52) - MERCK 35–55 g/l

http://www.merckmanuals.com/profess...oratory_values/blood_tests_normal_values.html

If these were correct and considering my testosterone readings from last time (and my symptoms) it could point to secondary hypogonadism, right?

 

[researching]

OK, today I went to the lab and spoke with their doctor, she confirmed that the range in my test was for females 20to40 years old, their range for males is 0,31-1,04 nmol/l (they didn't have ranges for different ages, just this one) which confirms my free testosterone is well below range in both tests.

I'll correct the files and the posts now.

 

[researching]

Still haven't been able to find a doctor that takes an interest.

I can barely think these days, but I keep wondering this:

Shouldn't my LH and FSH be much higher given my testosterone levels?
Doesn't that together with high prolactin point to secondary hypogonadism?


Thanks