HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Having Severe Fatigue, Acne And Constipation. Test Results Show Tsh .3 T4 1.4 T3 3.9 Ferritin 45. Meaning?

Posted on Mon, 17 Jun 2013

Question: severe fatigue, acne, constipation, takes 36 hours to recover from physical activity. ekg wnl, vit b 12 575 vit d 49 cortisol 26 tsh .3 t4 1.4 t3 3.9 ferritin 45 autoimmune testing negative, fasting sugar 97 2 h pp 75g glucose 73, estradiol 31, serotonin saliva wnl, progesterone saliva low, testosterone saliva high, dhea saliva wnl, dhea serum wnl,

Answered by Dr. Om Lakhani (1 hour later)

Hi XXXXXXX

Can you please add the units for all the tests you mentioned. Units of testing differ from place to place. Even better would be upload a picture of the reports if available. However I am taking interpretation on usual units which we use.

Morning cortisol is higher than normal. However, just a simple cortisol would be inadequate to make an interpretation. We need to get done one of the following tests to rule out what is known as Cushing's syndrome

1. 1mg Dexamethasone supression test or
2. 24 hrs urine free cortisol
3. Late night salivary cortisol.

This will rule out for us Cushing's syndrome.

As far as your thyroid tests are concerned , I am unable to make out if your TSH is 0.3 or is it 3 ? Also are T4 and T3, free t4 and free T3 or total T4 and T3. It would be useful if you could send the tests with proper units.

Your post prandial sugar is less that your fasting which suggests an early Beta cell dysfunction that is precursor of Diabetes. I would advice you to get done HBa1c to see if we are in a prediabetic range.

If you can send us the reports properly we would be able to help you better.

Regards
Dr. Om Lakhani, MD

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Om Lakhani (36 minutes later)

cortisol serum 0800 was 26 mcg/dl,
TSH 0.3 mcu/ML;
free t4 1.4 NG/DL;
free T3 3.9 PG/ml;
local endocrine here did dexamethasone suppression test and result wnl 1.0 ug/dl so he dismissed me as it ruled out a tumor and he doesn't believe in insulin or thyroid resistance.
I am wondering about insulin and thyroid resistance related to elevated cortisol. I am a nurse but work in labor and delivery. I feel like my symptoms are hypothyroid plus occasional episodes of hypoglycemia symptoms;
hgba1c 5.4 % normal range 4.8-5.9%;
24 hour saliva cortisol
0600 5.6 ng/ml normal range 7-10,
1100 5.9 ng/ml normal range midday 3-6.0,
1620(4:20pm) level 4.1ng/ml normal range evening 2-4,
2205(10:05pm) level 4.6ng/ml with night normal range <1.5.
I have terrible insomnia and the window of the day that I feel the best is for 1 to 2 hours between 1400-1600 (2-4pm) in the afternoon.
Please let me know of any other labs or testing I might consider.
Thank you.

Answered by Dr. Om Lakhani (28 minutes later)

Hi XXXXXXX

Thanks for the reports. For your investigations I would say the following

1. Thyroid function is normal. Thyroid hormone resistance leads to Increase TSH with Increase T3 and T4 and not the kind of pattern you have.
2. HbA1c is also fine. I don't see any reason for any problems there
3. If Dexamethasone supression tests was okay, I wouldn't go much in line with Cushing's. However the night time salivary cortisol is a little high. Now as far as cortisols are concerned , in your case salivary cortisol wouldn't give us much of an idea since you are a nurse, and I belive you may be working in night time shifts. In such cases cortisol and salivary cortisols can get screwed up. Just to complete the list, you may go for a 24 hr urinary cortisol. That would rule out Cushing's .

The reason for slightly elevated cortisol would be your sleep pattern. However, just plain cortisol value does not carry any significance.

I would just advice you to take Vitamin D supplementation. You can get done a 24 hr urinary cortisol and revert back.

Regards
Dr. Om Lakhani.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Om Lakhani (1 hour later)

I regularly monitor my Vitamin D level every 4-6 months and do supplement to maintain levels between 50-60 ng/ml as I have chronic muscle pain and learned I am better served by 50ng/ml cutoff than the routine 30 most physicians use.
I actually changed jobs in 2010 when my serum cortisol was high normal range of 17mcg/dl. I work 0645-1915 and regularly go to bed by 2200 whether working or off. I do work 2 or 3 days for 12 hour shifts then 2 days off. Would this mess with my cortisol the same as if I rotated from day to night schedules?

I work 12 hour 0645-1915 2 or 3 days on then 2 days off. I keep the same bedtime whether working or off. Can these 12 hr shifts effect my cortisol the same as if I was flipping day to night shifts?

Answered by Dr. Om Lakhani (13 hours later)

Hi XXXXXXX

If you keep the bedtime as the same, it shouldn't effect the cortisol levels. Any any circumstance a simple cortisol level should be interpreted with due caution and doesn't carry much meaning in terms of diagnosis. A 24 hr urinary cortisol or a suppression test would be more meaningful. Keeping the Vitamin D in 50 ng/ml is good enough, you can continue with that.

Regards
Dr. Om Lakhani.

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar