Reggie wrote:and intense fatigue and brain fog.
Some of this is adrenal, some is thyroid. I think I mentioned in a post to Mike, that low thyroid will hammer your adrenals. they work together to maintain metabolism. When one is down, the other works extra hard. One of the first things the adrenals can't make enough of is the Cortisol, but they crank out adrenalin and other things that add to the anxiety and depression, whereas Cortisol helps you deal with stress (unless it is in the "alarm" phase and abnormally high - you get panic - anxiety from that too).
What I am leading to here - your thyroid labs are in trouble, and that could be why your adrenals "couldn't take it anymore"
You have the fatigue symptoms, so your FT3 should be in the upper 1/3 of normal, and it is below the mid point of normal. I spent decades looking at descriptions of thyroid symptoms, thinking I found the answer, and my labs were always "within normal" but tending low. Now I am treating my thyroid - at 51 years of age I am tired of waiting to feel better. I am feeling better as I work up to a "replacement dose" on Armour's, gradually, up to 3 grains (60mg of Armour is a grain).
When the TSH is above normal, the saliva labs tend to be REALLY High. In other words, the Saliva test will show a high TSH, but when they get that high, it is somewhat exaggerated. But it is obviously higher than a normal TSH. A high TSH means the pituitary is begging for more thyroid hormone. And yours is begging, but it isn't as high as it looks - but that does confirm that you are hypo-thyroid. And the fact of a high TSH pretty much rules out a pituitary issue, you are barking out the orders for more, but the order isn't being filled.
In your Email you said that your Nov 2006 blood test TSH was .78 on a scale of .5-.55 That scale is different that what I am used to seeing - had to scratch my head there for a while. Usually they say a TSH over "3" is abnormal. But if your top of normal was .55 then .78 is significantly higher, and confirms that your body is asking for more T3 and not getting it. I would do a full replacement dose (working up to it GRADUALLY AND SPREAD IT OUT EVERY 4 HOURS)
If you took 1/2 a replacement dose, the body senses it in the blood and lowers it's TSH request to the thyroid. And you sort of end up where you started. This isn't a road you can walk 1/2 way. A lot of the patients that come to our adrenal-thyroid forum found us because they are on 1/3 of a replacement dose, the Dr wont' raise it, and they feel terrible.
You don't have antibodies (although this test didn't check for both of them, just the common one). And sometimes the saliva test misses the antibodies, I would ask for it on a blood test, both antibodies, just to rule out Hashimoto's (which I have, as does Marsha, Art Teacher). The reason it is important to rule out Hashimoto's , is that it is sort of reversible if you maintain a replacement dose of Armour's, the TSH gets lowered, and the antibody attack on the thyroid can be essentially halted. But if you don't know it's happening... I wondered for over a decade why my thyroid area often felt inflamed. It was under attack, still is, I can feel it as I type - I am just working up to the replacement dose of thyroid right now.
Did you know that Armour's thyroid has been on the market over 100 years? People were more likely to be accurately diagnosed with low thyroid in the 40s and 50's as the Dr's listened to symptoms like "fatigue - cold extremities - can't concentrate - hair falling out - nails getting thin & brittle" etc. Now they pretty much focus on labs, they used to focus on symptoms. the thyroid pioneer Broda Barnes preferred Armour's, it has T3 and T4 and is a natural product. Most MD's today want to prescribe synthetic T4 alone. But some people can't convert T4 to T3.
T4 is the "storage version" and has 4 iodine molecules. Your T4 is also low, and we like to see that at least at the middle of normal - but the T3 is the most important lab. Many Dr's are obsessed with TSH, but it MISSES so many patients (not you) who truly are hypothyroid.
In closing, your pituitary is working fine. You mentioned getting an ACTH check done (that is a pituitary hormone to tell adrenal cortex to make more Cortisol). There is a "stimulation test" to check that, and that would be to determine if you have Primary adrenal insufficiency (problem is with the adrenals themselves, or they have become fatigued due to prolonged stress - illness, mental, physical, whatever). Or due to low thyroid for too long.
Secondary AI is when the HPA axis is off, as we discussed. You had this happen after severe illness, but still I kind of suspect your pituitary is OK with that high TSH. Besides, there isn't much you can do for a pituitary but take the hormones that end up low (Adrenal, thyroid, and occasionally people need the other ones, testosterone, etc.)
If I had your symptoms and labs, I would start with the Cortef, little baby dose of 1/4 of a 10mg pill. Follow the links above, you do that for 3 days, this process is VERY SLOW and gradual. If you don't do it slow - it wont work and you will feel very strange. That is what happened to me 2 years ago before I got educated.
