BellaOnline Forums Health and Fitness Thyroid Health Low Cortisol - Low dose ACTH test

cybercat,

Some Dr.s who treat central hypothyroidism don't put much stock in what the TSH level says because with this type hypothyroidism, TSH is often not reliable. In your son's case however, they may be expecting improvement over time in his pituitary function, so makes sense to retest his TSH.

I see they retested free T4 which is usually in a range of about 0.7 to 1.9 ng/dl and his result looks good. I wonder if they would also test free T3 just as a precaution if you ask that it be ordered? I mention this because in uncommon cases, T4 doesn't convert into enough T3 in the body which is called "impaired conversion". While this isn't likely, it would eliminate another possible cause of unrelieved symptoms.

Other than this, thorough blood testing for anything else that might be causing fatigue would be important. Tests for types of anemia (including low B-12) and for sex and other adrenal and pituitary related hormone imbalances, including growth hormone and the ACTH hormone itself might be needed. They likely have already been testing these I've listed and sometimes restesting is where problems are found over time.

I wish I had more to offer. Maybe other members will have comments to add. I do wish you the best and send positive hopes and prayers your way.

I wanted to post the link to my article that gives a basic run down about Central Hypothyroidism, for readers who may read this thread and want a general understanding of it.

"Basics about Central Hypothyroidism"
Here> http://www.bellaonline.com/articles/art24276.asp

Jim thanks for your comment and the link to your article.

I don't think they actually tested him for anemia. They tested him for the others and they all were in the normal range, however they were in the low range on all of them. I might ask to have these rerun when we see them in Feb.

I called an expressed my concern to the nurse once again about his symptoms and they decide to increase his dose and he will have another round of blood work done in Feb before our visit.

As you mentioned they can't look at the TSH so I was told they are actually looking at the free T4 - however that number hasn't moved in one direction or another since he was first tested back in Feb 08, and his dose has been increased 3x's.

I honestly never realized how complicated this all is - I thought you just take a pill and all is good. I guess it will be once they find the right amount. I think I am going to ask to check the cortisol again as I just have a "gut" feeling this is becoming more of an issue even if previous numbers fell in the normal range.

If any of you can think of any questions I might ask I would appreciate it - I am new at all of this and not sure if I am asking the right questions or asking for the right tests.

I appreciate this board in allowing me to get "educated" on all of this.

Jim you wouldn't happen to have an idea where the numbers should fall with someone with central hypo?

As far as treated hypothyroidism, the FT4 and FT3 should be optimized the same for all types. The TSH is what will look different in the case of Central Hypothyroidism.
Most patients feel better symptom relief at mid range and above on these, on up to higher-normal but the tweaking part of it is an individualized thing for each patient and based on symptom relief (or should be). In other words once mid range is achieved on the FT4 & FT3, the upper normal from there varies among patients. Some can stay at mid and feel great while others need to be in the upper 3/4 of normal or even at close to borderline-high.
Armour patients (combo T4 & T3) are a different story because even well treated, T4 will stay lowish, so tweaking the T3 is more important for them.
That dose increase they are planning, sounds like it may hold promise of better symptom relief for him. It sounds like you are working very well with his doctor and asking all the right questions. I believe he'll see better days ahead!