New member questions

[Snowgirl]

Hi, Chris,

I just got my aldosterone results back. I fasted salt 24 hours and it was the first week of my cycle. They insisted I lie down for 30 minutes to get the first number and then stand for 10 minutes to get the second.

Lying down 9.1 range 0-21
Upright 11 range 0-21

Sodium 138 range 135-146 (up from 134 a year ago)
Potassium 4.2 range 3.5-5.2

I was told by the assistant who gave me these results that they were all within range, but I gather from your comments in other posts that you probably don't agree. Any suggestions for how to explain to my doc why you think otherwise would be much appreciated.

Also, I've been having a bad fatigue episode for the last few days and had my thyroid re-tested:

TSH 1.530 range .465-4.68
Free T-4 1.01 range .59-2.19
Free T-3 2.69 range 2.77-5.27

They also tested for anti-TPO and TgAB antibodies, but those aren't back yet. Can you tell me what numbers would indicate a problem here?

Lastly, I'm curious if there is a philosophical post somewhere you can point me to regarding ranges, and why conventionally accepted "normal" ranges are so flawed.

Thanks so much for your comments.

[Chris Jackson]

The laying down I can't use, the upright is more useful and shows a problem being it didn't come up much and is at a level that is to low to be healthy. I look for around 20 for sitting.

Sodium is pretty low, potassium suggests possible low renin, low acth.

That assistant is an Einstein. NOT! Of course I don't agree. You can't convience most docs of much, they went to med school and spent years on the training, you didn't, so they thing they know more than you. Most docs are arrogant, simple minded and lack common sense. You need to find a doc, probably a DO that has common sense, knows the ranges are flawed and puts symptoms above all else.

Your TSH shows me you are untreated or undertreated, same with the frees. On the antibodies, any number of 5 or more is cause for concern. I consider 5 the early stage of Hashi's.

I don't know of a specific post I can point you too. I learned this stuff by going to the Chris Jackson school of medicine. Doc take the easy way and close their mind to obvious classic symptoms, just follow the flawed lab ranges.

You're welcome,
Chris

[Snowgirl]

Thanks, Chris. I really appreciate the perspective, and your willingness to share what you learned in the CJ School of Medicine

I am totally untreated at this point, as I've been trying to get all the tests done before I start. You were so right about how hard it is to wait, but I'm trying to be as thorough as possible.

I'm still a little confused about the DHEA piece, though. I know that DHEA and DHEA-S needs to be tested before cortisol is begun, but I'm not clear on replacement if it's low. Do you recommend DHEA supplementation, and if so, where in the treatment order do you deal with that?

Also, you said that sex hormones and GH should not be addressed until after adrenals and thyroid are handled. Do I want to have sex hormones and GH tested before I begin cortisol, or should I just wait until I'm stabilized on cortisol and Armour?

Thank you again for your time and generosity with what you've learned.

[Chris Jackson]

I don't recommend DHEA replacement for women. Women tend to get more testosterone than estrogen from it so it is common for them to get acne and unwanted hair growth, even a deeper voice. Since DHEA breaks down into sex hormones and you can't control how much of everything it's breaking down into (just as pregenolone), I don't recommend it for men either. If you want to try it, 5 mg is the most I recommmend really. My wife took 6 1/2 mg (25 mg cut into quarter) and started growing darker hair on her lip. She complained her nipples were way sensitive. libido was up there as expected, but after a month, I suggested she go try 3 mg, but she decided to stop altogether. DHEA is after cortisol, before thyroid. See sticky for successful HRT treatment.

I think before and after testing for GH and sex hormones should be done.

You're very welcome,
Chris

[Snowgirl]

You know, I've read that sticky like six times, but it's been slow to sink in because its taken me a while to get up to speed on what each of these hormones are and all the various components of the treatment are. So I'm sorry if I've been annoyingly redundant.

I am really looking forward to seeing your flow chart, since I think that will help my brain get a better handle on this.

Speaking of ranges, do you ever use labs to verify optimization (i.e. do you try to get your free t-3 into a certain range to show you're optimized on armour) or do you always go just by symptoms?

Lastly, since I already know my testosterone is way low, do I need SHBG?
Is there value in testing estrogen/testosterone etc. individually, or do LH/FSH provide enough info?

Thanks a million, Chris.

[Chris Jackson]

It's ok, I know there is a lot of info to take in. It would be easier to learn just one disease, but here many of us have to learn several.

I'm hoping the chart will be a benefit to you all.

I didn't use labs to help me optimze, just vitals, symptoms and how I felt.

SHBG is always good to have, but most women don't get it. LH and FSH have to be done with sex hormones.

You're welcome,
Chris

[Snowgirl]

Okay. I think I'm finally getting a grip on it. Thanks.

I had my stim test this morning and should have the results next week. The appointment made me even more grateful all your work here--though the endo who did the test was very nice, he told me my thyroid levels were fine and I should not go on thyroid and I should avoid cortisol at all costs. Thanks to you all, I knew better.

It did bring up two questions for me, though. My untreated TSH has swung from .39 to 2.66 to .84 to 1.53. You commented this is suggestive of Hashi's, and I am waiting for those test results. How is it that the endo can claim this is normal?

Also, he suggested that I try Provigil or Wellbutrin. I do not plan to take his advice, but I am curious if you know of anyone who had tried either of these and if there was any benefit from them.

Thanks again. Don't know what I would have done without you

[Chris Jackson]

I was put on several antidepressants including wellbutrin (SSRI I think) which didn't effect me but once every 10 days or so. Prozac (SSRI) was a nightmare for me. After 3 weeks I quite cold turkey though you are supposed to wean, but it was so bad I couldn't swallow anymore of it. I swore I'd never take another psych drug. HRT is the only thing that helped with depression.

You're very welcome,
Chris

[Snowgirl]

Thanks for sharing your experience. Since depression isn't really much of an issue for me except when I'm having an extreme episode, I can't really see the point of anti-depressants. My sense was the edno suggested them because he thought it was all in my head.

Anyway, I do have a couple of more questions about the stim test. Since the endo thought the only thing that mattered was whether my final stimulated cortisol was greater than 18, he didn't bother to request the baseline cortisol level from the lab. My doc is working on getting that info, but at the moment, all I have is the following:

30 min: 21.4 range 3.1-22.4
60 min: 26.2 range 3.1-22.4

1. I was up half the night before the test after getting some unexpected good news. I know that probably screwed up my starting level, but does it impact the stim function itself?

2. Can you tell anything from the size of the increase in the last half of the test? Does most of the increase happen in the first half, the second, is it equal, or does it vary so much from person to person you can't really say?

My Hashi's results also came back:

Thyroperox AB 1.3 range 0-8.9
Thryo AB SCRN <1.8 range 0-3.9

My doc is still suspicious I have an autoimmune thyroid condition, just not Hashi's in particular. I'm happy to report he is willing to perscribe Armour. He is hesitant to start me on cortisol at the moment, though if my full stim results fail to show at least a doubling, preferably a tripling, he will. He said that he has seen cases where supporting the thyroid alone increased pituitary and adrenal function, so he'd prefer to know if that might be the case for me before setting me on a path of lifelong cortisol dependence.

3. Since this flies directly in the face of everything I've read on this site, am I, in fact, doomed if I let him try this? Or is it possible that might actually work?

Thank you so much for your input.

[Chris Jackson]

You're doc messed up the stim. Not to useful. You really can't use the 30 to 60 minute. Did your base start at 19 or 2? Where is ACTH? Rhetorical questions. It depends on what your adrenals condition as to what that news may have done to them. If your base was very low and you actually tripled, your doc basically says your fine. Secondaries start low and double or more. See sticky on ACTH stim.

Weird ranges for you antibody tests, don't feel comfortable giving an opinion. If the unit is different that what is usually used, try to figure out the conversion.

Supporting the thyroid alone doesn't not increase pit and adrenal function.

Your endo doesn't not know enough about all this that I think he'll do you any good. How many times have I had to say that. I don't think I've seen more than a handful of endos diagnose secondary AI of the years I've been doing this by the way. The tests you've shown that indicate secondary is a possiblity are the DHEA, potassium and ACTH, so I am highly suspicous you are. If you are secondary AI with primary, that always happens with Hashi's, not non Hashi's. I've been looking for an exception for years and haven't seen one yet.

An osteopath I think is what you should look for now.

You're welcome,
Chris

[Snowgirl]

Sorry, I guess I didn't make it clear that the endo who did the stim is different than the internist who ordered it. I agree the endo is a waste of time, but my internist is the one who suggested both hypopit and an anti-immune thyroid problem, and he wanted the stim because he's concerned this has been going on long enough I may have become primary AI as well. Since the majority of what my internist says matches with what you guys say, I'm pretty sure I can work with him. The only oseopath covered by my insurance suggested I stop eating eggs and try acupuncture, so there's not much point in my switching to him.

To clarify:

If my interenst is able to get the stim test basline cortisol level from the lab, will the results still be valid despite the poor night's sleep I got the night before? (I know the baseline level will be off because of this; it's the stim part I'm curious about.)

If my Hashi's ranges are strange, what's a normal range?

Thanks so much.

[Chris Jackson]

If you always have a poor nights sleep, go ahead and get the test, otherwise reschedule. Ranges for TPO and Tga vary anymore, but for a long time was around <30. I use my own ranges of <5, but if you have even a few antibodies is a good idea to get retested in 6 months. Really, you aren't supposed to have antibodies, but most people have a couple.

You're welcome,
Chris

[Snowgirl]

Thanks again. I really appreciate the info.

[Chris Jackson]

You're welcome,
Chris

[Fitwolf]

Hi Snowgirl,

I'm also in Colorado and have been seeing an osteopath in Loveland... if you have a doc that you feel is really on top of this stuff would you mind sharing the name with me?

Thanks and good luck... I'm at the beginning of my journey - seems like perhaps we are in a similar spot.

Paige