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04/26/2012 03:39 PM

Low Cortisol

MrsH2132012
 
Posts: 5
New Member

Ermm I am new here....for 9 months I have been suffering headaches and dizziness. I am 9 months postpartum, have postpartum thyroid problems and now dx low cortisol.

Here is my test results, after ACTH shot: 3/22/2012 22.4

after prolonged ACTH: 4/25/2012 2.1

My Endo put me on Cortef 10mg x2 from 3/23 to 3/26 and weened me off since ACTH responded.

Lab work on 4/13 showed cortisol was at a 3 at 8am, back on Cortef and sent to do an MRI and everything was good so she weened me off Cortef to the the proloned ACTH since the results were low I am back on the Cortef 10mg in AM and 5 in PM for 4 weeks then we are weening AGAIN to do more testing. She said she will have me do prolonged ACTH and other hormone tests then.

I just want the headaches and dizziness to go away!!

Thanks for reading and if you have any thoughts or Qs for me let me know

Smile

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04/29/2012 06:21 AM
ITeach91
ITeach91  
Posts: 1872
VIP Member

Yes, but if I were the endo I would have done the extended testing Before putting you back on Cortef. I would also ask you what your deliver was like - was there any odd occurrence during delivery that would have made your blood pressure nosedive?

Deb


04/30/2012 04:53 AM
fitdzin
fitdzinPosts: 21
New Member

Just wanted to add that during my delivery 14 weeks ago my BP nosedived too to 80/30. This ended with the emergency crew rushing in and one of them jabbing me with adrenaline. No one knew why this happened.....but maybe now we do. Sounds like we have this in common.

04/30/2012 06:19 AM
MrsH2132012
 
Posts: 5
New Member

Thanks for the replies

My delivery was great no BP issues but got PP thyroiditis

Could you tell me what the extended tests would be? I have been having a lot more head pressure

She told me we can do testing sooner than 4 weeks


04/30/2012 01:58 PM
ITeach91
ITeach91  
Posts: 1872
VIP Member

Thyroiditis is an autoimmune if I'm right. It's possible that the autoimmune is also affecting other endocrine glands -

Extended tests - I was talking about the ACTH stim test in which you receive three blood draws, 30 minutes apart, after being injected with ACTH. This tells what the reaction is. In a system where the adrenals are working and ACTH output is compromised, the shot would bring a rise in cortisol. If the adrenals are not working, no rise. It helps to figure out the cause of the adrenal insufficiency.

Deb


04/30/2012 02:34 PM
MrsH2132012
 
Posts: 5
New Member

Thanks Deb! The prolonged was 1 test before ACTH and after 60mins I don't know my start # but the 2.1 after worries me

They are sending me to a nueroligist, does that seem

Right?


04/30/2012 02:39 PM
MrsH2132012
 
Posts: 5
New Member

I read this article & wonder if I should talk to my endo about it

http://www.stopthethyroidmadness.com/t3-circadian-protocol- for-adrenals/

UK thyroid patient and author Paul Robinson discovered something quite fascinating—that poor adrenal function is probably related to poor adrenal tissue levels of T3. And one could bring back better function by a unique way of using T3-only…and even NDT if you prefer…in the early morning hours before you normally wake up. Note that this protocol will not work with hypopituitary or Addison's disease. The latter conditions would dictate the use of HC.  If you have Diabetes, you will need to be properly treated for that to make this work. 


05/02/2012 10:41 AM
Footprints11
Footprints11Posts: 391
Member

Mrs. H,

I apologize but I don't understand. On 3/22, you had an ACTH stimulation test done that showed......? 22.4 was for what? I'm guessing that your doc did initial testing of your hypothalamic-pituitary-adrenal axis (HPA) on that date and determined that you were "AI" or had adrenal insufficiency, somehow? It would be helpful if you could find out, and share, what your baseline ACTH and cortisol values were (before ACTH stimulation), and then what your cortisol levels were at 30 min and 60 min post injection. That would be very informative.

You were also diagnosed with thyroiditis....high TSH, low T3 and/or T4? I am not a doctor, but have been on thyroid replacement since high school for Hashimoto's hypothyroid/thyroiditis. T4 is the precursor hormone and floats around in your body (when you take it as synthroid etc) and in theory is converted as needed to the active form, T3. If you take T3 (like cytomel), it is active and short-lived. Only one doc ever prescribed T3 (and it was as a combo, synthroid plus cytomel), but the next doc said she doesn't prescribe T3 because it causes spikes of hormone that can cause heart racing and potentially cardiac problems (in an old woman like me, in my 40s heh). Anyway, that's some background about that.

You may want to research this since you've noticed postpartum thyroid/adrenal insufficiency: lymphocytic adenohypophysitis It's a peripartum problem affecting the pituitary gland, with those two problems predominating. May be worth having an MRI done. See if it sounds like a match.

Or Schmidt syndrome? I don't know much about this; just something I've been pondering myself. I have autoimmune problems, and my primary endocrine issues are hypothyroidism (I know that's autoimmune) and adrenal insufficiency (don't know cause).

Best wishes!


05/02/2012 02:01 PM
MrsH2132012
 
Posts: 5
New Member

Hi Footprints! Thank you for taking your time to reply

I hope I can explain better...sorry this is a bit overwhelming to me

On 3/22 I received a call that my cortisol test from 3pm on 3/16 was 4, the dr sent me to the Endo that day who sent me to get a corticotropin (ACTH) shot and took my blood after only. When the results came back my Cortisol level was a 22.4. So they weened me off Cortef since I responded to the shot. She asked me to go in for an MRI, everything looked good so she sent me to to the IV ACTH test they took my blood before but did not provide the results after the cortisol IV my level was 2.1

I have no base from before the tests Sad They did draw my ACTH on 4/13 but nothing else

Cortisol

3/22/2012 22.4 (after shot at 3pm)

4/25/2012 2.1 (60 mins after IV at 4:30pm)

ACTH range < 46- pg/mL

4/13/2012 15

My thyroid issue is postpartum here are my tests:

TSH range 0.10-5.50 uIU/mL

4/19/2010 1.59

10/25/2011 0.02

11/16/2011 <0.01

11/18/2011 <0.01

12/19/2011 1.36

1/20/2012 2.87

2/24/2012 3.54

4/13/2012 2.41

Free T4 range 0.8-1.7 ng/dL

10/25/2011 1.5

11/16/2011 1.6

11/18/2011 1.7

11/18/2011 1.7

12/19/2011 0.8

1/20/2012 0.8

2/24/2012 1.0

4/13/2012 0.9

I am not sure why they do not always do my Free T3 Sad

Triiodothyronine range 50-170 ng/dL

11/18/2011 216

2/24/2012 116

Would the HPA test be blood work? I do not see this in my chart. They also did:

3/22/2012 PROLACTIN

3/22/2012 FSH (FOLLICLE STIMULATING HORMONE)

3/22/2012 LH (LUTEINIZING HORMONE

3/22/2012 ESTRADIOL

Would these #s help?

I am currently on 25mcg of Levothroid (Levothyroxine, 10 & 5mg of Cortef (Hydrocortisone Oral) and now 10mg of Amitriptyline (for my headaches)

Hope that clears somethings up...even though I am still confused

I will look into Schmidt syndrome.....

Adrenal insufficiency after recurrent post-partum thyroiditis (post-partum Schmidt syndrome): a case report.

Mehta H, Badenhoop K, Walfish PG.

Source

Department of Internal Medicine, University of Toronto Medical School, Ontario, Canada.

Abstract

Polyglandular autoimmune syndrome (PGAS) type 2 (Schmidt syndrome) is characterized by the association of primary adrenocortical insufficiency with autoimmune thyroid disease, and/or insulin-dependent diabetes mellitus (IDDM). In this report we describe the occurrence of two episodes of post-partum thyroiditis (PPT) after a first and second pregnancy as well the development acutely of adrenal insufficiency after a second pregnancy. A family history of autoimmune thyroid disease and IDDM as well as positive antiadrenal and antithyroid antibodies and HLA typing is evidence for an underlying polyendocrine autoimmune syndrome. This case report provides further evidence that the immune system that is suppressed in pregnancy to tolerate the fetal allograft can rebound post-partum to unmask polyendocrine autoimmune disorders such as adrenalitis and PPT in susceptible women.

Post edited by: MrsH2132012, at: 05/02/2012 02:03 PM

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