Eric's Labs

[GettingAnswers]

Something else that is odd. My weight has always changed very gradually and is pretty consistent. I have gained about 10 pounds in the past 2 weeks (170 to 180). I haven't really changed anything other than stopping the brief trial of NDT (thyroid med). I don't know if anything in the labs points to anything or if it could be water, fat or what.....

 

[GettingAnswers]

January 2014 Testing Results

Cortisol results are in and they seem to look decent, but here we go

DHEAs 7.9 (2-23)
Cortisol AM 4.3 (3.7-9.5)
Cortisol Noon 2.6 (1.2-3.0)
Cortisol PM 1.4 (0.6-1.9)
Cortisol Night 0.4 (0.4-1.0)

I would have expected my night levels to be higher because I was wired that night I collected it.

So no one has to go back to see them, below are the most recent blood labs in case anything correlates with the cortisol results

Glucose 66 mg/dl (odd this low as I was not fasting...)
Potassium 4.5 (3.6-5.1) (has moved up since being low in December)
SHBG 21 (10-50)
Aldosterone 3 ng/dl (<=28) according to STTM this is low and could account for my dizziness, drops in BP, and weakness....
E2 23 (<39)
Vitamin B12 844 (181-1500)
Prolactin 20.41 (2-18) HIGH
DHEA-Sulfate 350 (45-345) HIGH (why is this always high??)
Magnesium, RBC 4.5 (4-6.4)
Folate, RBC 341 (>280)
TT 709 (250-1100)
FT 140.2 (35-155)
BioT 312.7 (110-575)
DHT 33 (16-79)
Iron Saturation 34.79 (15-55)
Iron, Total 121 (28-182)
Ferritin 108.7 (8-160)
Iron Binding Capacity 347.75 (261-478)
Transferrin 248 (180-390)
Vitamin D 25OH 62 (30-100)
Iodine, 24 hr Urine 778 (75-500) HIGH (odd it is high when I don't supplement except a small amount contained in Green Vibrance???)


Adrenals - My cortisol levels look OK, but my Aldosterone is low. Salivary DHEAs is normal, but serum is elevated.

Thyroids - One month ago things were screwy but I haven't had a followup to see where it is now.

If anyone has any thoughts - great! If not then I will keep this here for reference later. Have a great one all

 

[Nelson Vergel]

When aldosterone production falls too low, the kidneys are not able to regulate water and salt balance, leading to a drop in both blood volume and blood pressure. High sodium consumption may decrease aldosterone.

I would not worry about your prolactin, cortisol, DHEA.

Be aware that high doses of iodine can lead to a transient increase in TSH levels, which can be mistakenly interpreted as a sign of hypothyroidism.

Your high iodine and potential high sodium may indicate that your salt intake is high. Is this a possibility?

 

[GettingAnswers]

Nelson, thanks for the response. I would not say that my sodium is really high, but I do add about 1/4 teaspoon Himalayan salt to water twice a day. I have continued it because it seems to have helped with energy and blood pressure. The things I have read on STTM and Wilsons book seem to have made me think that increasing salt intake (not table salt) helps with low aldosterone levels....... I will try cutting that out to see if it helps. Other than that I tend to eat very clean whole foods without much salt.

I haven't supplemented with iodine so i don't think that was the cause of the TSH before.

Thanks Nelson.

Edit. I went back and read the page again on STTM. It says that too much sodium can cause aldosterone to fall, but then they say that adding 1/4 to 1/2 tsp of sea salt can help, but then they say that it may hurt and may be more beneficial to supplement potassium. Aaarrggg. Perhaps I will try and cut out the salt and increase potassium since my levels of K have been low to low normal.

 

[Vettester Chris]

IMO, your aldosterone needs further research. Your physician might want to consider an ACTH and the Renin enzyme assay. In the same fashion with low testosterone, or an under-active thyroid, hypoaldosteronism can be either primary or secondary. There's the other variables of sodium regulation and your iodine level, which again, my opinion, points to look that direction. Run it by your physician, see if it makes sense to checkout.

Your cortisol circadian profile goes from the low end of the range early, up towards the top at noon, above mid range on the PM, but down to the bottom of the low range at night. Various experts, like Dr. Michael Lam, look for the circadian rhythm to be in a normal pattern with their respective ranges. Adding up the values is known as the cortisol burden value, yours at 8.7 (5.9 - 15.4), it's a little over 29% of the range. It's not my place to say that's good or bad, just saying someone like Dr. Lam might be looking at the deviation of the noon and PM numbers, compared to the morning and night numbers. There are various stages and progressions with adrenal fatigue and issues, cortisol patterns being an indicator.

Stay on top of it and research as much as you can on all of this. Dr. Lam is highly regarded with STTM, and he has a TON of great information on his site, www.drlam.com. Heck, he might even comment on your situation if you contacted him.

 

[GettingAnswers]

Thanks Chris. I will see if I can wrap my head around all this!

I did find that the reference range I quoted was for laying down. Aldosterone range is 7-30 when standing or sitting. Considering I had just walked in and sat down when collected it should have been much higher than 3. Now to figure out how to fix it. Will try increasing potassium and slightly lowering sodium until my followup in two weeks. I also submitted a question on Dr. Land site. Thanks

 

[Vettester Chris]

Eric, here is your circadian profile. I've been meaning to get this put together for you since the last post, but just been busy ... In normal situations, the body makes "most" of the daily cortisol production between the hours of 4:00 AM and 8:00 AM, then it should respectfully have a sharp drop, following similar in the pattern of the Green and Blue lines. Dr. Lam could probably tell you the proper starting level in optimal or even semi-normal situations. Probably in the upper 1/3 of the range, yours is sitting just over 10%.

Do a little research on your end to see how this works, and also the correlation it has with the thyroid, specifically T3, and how it works with mitochondria at the cellular level. If Dr. Lam gets back to you, please let us know.

 

[GettingAnswers]

Thanks Chris. Looks like it could be optimized in some areas but by no means a train wreck. I will research how it all relates.

I left a message on Dr Lam site about my levels and specifically about my aldosterone and got back a boilerplate message that said lab values are not the only thing to consider and I may benefit from buying his book. It really looked like a standard letter that some assistant plugs in for responses.

 

[Vettester Chris]

Thanks Chris. Looks like it could be optimized in some areas but by no means a train wreck. I will research how it all relates.

I left a message on Dr Lam site about my levels and specifically about my aldosterone and got back a boilerplate message that said lab values are not the only thing to consider and I may benefit from buying his book. It really looked like a standard letter that some assistant plugs in for responses.

In similar fashion to testosterone serum levels, ranges can vary from 280 to 1000. So when a doctor says a guy at 330ng/dl isn't a "train wreck", well, I guess the patient can take what they want from it ... The difference in cortisol is the most IMPORTANT level (IMO) is the AM; being 3x greater than the closest lab range. Again, there's a reason for that being the case ... If you and your physician are content, then that's what matters.

 

[GettingAnswers]

Chris, I figured if I was in the lines that would be decent. However, if I understand what you are saying and studying the graph a little better, then my morning levels are pretty low and show a steady decline down to essentially nothing over the day. My pattern does not appear all that optimized. Could also explain why it seems that I am having a harder and harder time waking up and getting going in the mornings. I had assumed my levels were high because I am so wired in the evening, but is there a correlation with LOW levels and increased wired in the evening - i.e the body needs energy from somewhere and since there isnt enough cortisol then it pumps out adrenaline or something???

I have a bottle of Isocort from a year ago. Do you have any experience using that for boosting cortisol levels? I assume I could use a morning boost but I am not sure if there is a better way to go about it.

Another interesting tidbit - I recently got my 23andme results. Now that they can no longer provide the medical info, I am trying to plug the raw data into numerous other reporting sites. As it relates to things I am dealing with here, it appears I am homozygous for mutations in a gene responsible for Aldosterone-Renin function (my aldosterone is low), a MAO gene responsible for degradation of serotonin, dopamine, epinephrine and norepinephrine, a gene linked to Hashimotos Disease. If anyone has suggestions for using the 23andme results please chime in!!!!


Thanks again

 

[GettingAnswers]

Chris, please see my last post.

Chris or anyone - I don't know if coincidence but in the two weeks since I stopped the low dose of NDT, I have gained ten pounds, I am literally dragging ass in the mornings, and even my erections seem to have gone downhill. Thedaily cialis had things hanging better at all times and now it doesn't seem to work near as well.

I know I was only on it for a short time but could it have downregulated my own production in that time?

Thanks

 

[Vettester Chris]

Eric, the best I can tell you is get with your physician, and/or get a hold of a specialist like Dr. Lam. There are a lot of variables with your situation. As we've discussed and you alluded, I suspect you 'might' be dealing with an autoimmune issue / Addison's-like condition, but it's just all speculation from this standpoint. If your thyroid isn't converting T4 to T3 effectively, then taking NDT could be adverse as you've already experienced. Again, get with your physician immediately. If he's not the right one to help, then take the steps to get aligned with someone else.

Keep me posted, please!

 

[GettingAnswers]

Received results from Thyroid panel.

February 2014

TSH 1.17 (0.34-5.6)
Free T4 0.96 (0.6-2.0)
Free T3 2.9 (2.3-4.2)
Thyroid Peroxidase <10
Thyroglobulin <20
Reverse T3. 18 (7-24)

My TSH has obviously come down since testing in december when it was 4.29 and Free T4 has fallen some as well from 1.7. The hospital labs reported antibodies at 6, but it looks like this lab doesn't have that good of a detection limit.

I thought I should also note that I found a bottle of isocort that I had from last year. For the past week I have been taking one in the morning and a half at night to try and bring up my cortisol levels. I have felt much better. But, does anyone have suggestions for a better way to help bring up cortisol?

My doc wasn't worried too much about any of my labs. His comment on the iodine being elevated was that I either take in more than I need or I'm not using it properly. He recommended trying the iodine on the skin test before doing more bloodwork.

 

[GettingAnswers]

For some reason it wouldn't let me edit above. I have included Units.

Received results from Thyroid panel.

February 2014

TSH 1.17 (0.34-5.6) uIu/ml
Free T4 0.96 (0.6-2.0) ng/dl
Free T3 2.9 (2.3-4.2) pg/ml
Thyroid Peroxidase <10 iu/ml
Thyroglobulin <20 iu/ml
Reverse T3. 18 (7-24) ng/dl

My TSH has obviously come down since testing in december when it was 4.29 and Free T4 has fallen some as well from 1.7. The hospital labsreported antibodies at 6, but it looks like this lab doesn't have that good of a detection limit.

I thought I should also note that I found a bottle of isocort that I had from last year. For the past week I have been taking one in the morning and a half at night to try and bring up my cortisol levels. I have felt much better. But, does anyone have suggestions for a better way to help bring up cortisol?

My doc wasn't worried too much about any of my labs. His comment on the iodine being elevated was that I either take in more than I need or I'm not using it properly. He recommended trying the iodine on the skin test before doing more bloodwork.

 

[Vettester Chris]

Eric, you do keep it interesting with your labs!

Yes, something is happening, as you have went from elevated TSH to pretty darn good! Notice also that your FT4 has gone down substantially, as it appears to be converting nicely to T3. Anything new you're taking besides the isocort? It's all just speculation at this point, but at least it's going the right direction.

Your FT4 is now at 25% of the lab value, and your FT3 is: 31.5%. Your ratio on RT3:FT3 is 16:1. You would hope to see this 20:1 or better. This IMO indicates that you are experiencing some pooling with your FT3. It's not severe, and maybe with everything else it's on the way up. It would have been good to have compared this to the previous labs, but you can go forward. As I've mentioned in other posts, pooling takes place when areas like cortisol, iron, B12 and D3 (and others) are off.

On your Isocort, you could take it just like your circadian profile, where breaking up the dosage with the largest being in the morning, then taper it down at noon and night. Licorice Root is another option that can be taken similarly. Include plenty of Vitamin C, B12, D3, and chelated magnesium. If you continue this regiment, I would run labs in another 4 weeks and compare.

You ultimately want to get your FT4 and FT3 in the 50% to 80% area of the range values, and again with RT3 >20:1. At this point, you obviously need more thyroid hormone, but just keep in mind the pooling aspect and getting that area improved. Do some research on it and you can get more information on this. If your doctor wants to jump you back on NDT, I can only suggest just going REAL slow with it, and again run the same labs next month. If your RT3 improves, and everything is staying stable, you can maybe start looking upward and onward ...

And yes, I agree with your doctor that iodine could more than likely be a major culprit here, especially seeing the huge deviation of T4 to T3 conversion. Things are going in the right direction!

 

[GettingAnswers]

Thank you Chris.

My doc is happy with letting things go for now with the exception of strengthening the adrenals. I didn't change anything except
No longer on NDT
Taking isocort in the morning and a tiny dose at night to boost the lagging times.

Perhaps things are stabilizing finally. I am now six months off benzos and I have read dozens of personal accounts of them messing up almost every hormone pathway.

Thanks again for all the help.

 

[GettingAnswers]

Just a little update in case anyone has any pointers or thoughts....

Snoring. The past couple of weeks have driven people mad and my sleep has sucked. I have always sporadically snored some, but evidently this is window rattling all night long. My weight is consistent so I don't know.

Fatigue. Back to feeling drugged in the mornings. I hate that. I have alwaysbjumped out of bed but now it takes me 45 minutes to get going. Maybe tied to the snoring.

Erections. On the 5mg a day cialis before I was walking around ready at all hours. For the past weeks it takes five or six hours for the cialis to kick in and when it does it is nowhere near as effective. Perhaps because I am tired or something else.

In general not feeling near as great as I was. I thinkI may be getting labs done next week but in the meantime I am open to suggestions. Thanks

 

[GettingAnswers]

I have been dosing 25mg T Cyp 3x week (M, W, F) and HCG 250iu 2x week (T, Th). The following draw was a little over 24 hours after a T injection.

March 11, 2014 collection blood draw

Prolactin 14.7 (2.1-17.7)
Total Testosterone 1091 (240-900) HIGH
Free Testosterone 356.5 (21-135) HIGH
Testosterone Bioavailable 836 (48-317) HIGH
SHBG 16 (9-54)
DHT 85 (no range given)
Hematocrit 50 (37-48) HIGH
Hemoglobin 17.4 (12.5-17) HIGH
Estradiol 33 (<40) Not ultrasensitive

So, I am only injecting 75mg a week but my levels are high (Doc wants me to drop it some) and I certainly feel worse than when they were lower. See my previous post about some issues I am having. Granted the draw was 24 hours after an injection but since I do it 3x week this should be fairly consistent right?

What do you guys think I could drop the dose to to get to a good level? Any thoughts based on anything else? Thanks

As a summary though libido and erections not as good, fatigued, have gained 15 pounds in 2 months (not muscle), snoring alot more...

 

[Nelson Vergel]

The numbers look good. Yes, you could inject 50 mg twice a week and that may bring down to the 700's.

Is the Cialis giving you any sinus issue? That may be the reason you snore and are more tired in the mornings.

 

[GettingAnswers]

Nelson, I currently only inject 75mg a week, so how would going to 100 decrease my levels? Just curious in case I am missing something.

I do have a surge in stuffiness a few hours after taking it bit it seems to clear by bedtime but perhaps there is enough residual stuffiness to cause the snoring.

Also, the weight gain is troublesome but with my non sensitive estradiol only at 30 it doesn't seem like that is the issue.

Thank you very much