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Free Cortisol / ACTH Blood Test?

I'm a 31yo female, had a TT in April due to a obstructive nodules and an enlarged thyroid. I have a number of symptoms including extreme fatigue and weakness, muscle weakness and pain, joint swelling and pain, problems sleeping (probably only average about 3-4 hours a night, I tend to wake up after the first few hours and then wake up every 20 minutes or so), complete exhaustion even if I DO get a decent night of sleep, weight gain, GERD, fluid retention, brain fog, confusion, memory loss/problems, heavy and painful periods, anxiety/depression/irritability/mood swings, nausea, vertigo, easy bruising, migraines, stiffness, lower back pain and back aches, complete loss of my ability to handle stress, and very frequent urination (usually between 13-17 times a day, sometimes at night I'm up 3-4 times, and it's usually more frequent if I'm sitting for work or laying down sleeping). Symptoms have been persistent and getting worse for about two years. Obviously hypothyroid from the lack of a thyroid, but the meds (112mg Levothyroxine) keep me in "range." I'm starting to really suspect some sort of adrenal issue.

Here are some of my labs, done last week:

Free T3  -  2.9 (Range 2.9 - 4.2)      
Free T4 - 1.12 (Range 0.76 - 1.46)
TSH - 1.910 (Range 0.358 - 3.740)
Ferritin - 7 (Range 8 - 252 ng/mL)
C-Reactive Protein - 14.1 (Range 0.0 -2.9mg/L)
Vit D - 37.50 (Range 30 - 100 ng/mL)
Vit B12 - 404 (Range 193 - 986)
ACTH, Plasma - 12 (Range 6-50pg/mL)
Free Cortisol, Serum (Tested @ 10AM) - 0.96 (Range: 0.07 - 0.93 mcg/dL 8:00-10:00AM, 0.04 - 0.45 mcg/dL 4:00-6:00PM)

Had a whole bunch done but those were the ones I thought were most significant. Doctor called and said other than being slightly anemic and needing an OTC iron supplement, everything looked okay. I've heard from people on these boards that my T3, vit D and vit B12 are too low and I'm definitely going to work to improve those. But should I be pursuing the adrenal route?
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9197017 tn?1429016816
Hi there,
It's generally accepted that saliva cortisol tests are the most informative. The test should take 4 samples (at least): 7am, noon-ish, dinner time, bed time.

A functional medicine practitioner would tell you that what the ranges labs deem as "normal" are much too broad. Better to be in the middle of a lab's "normal" range.

I'm not a medical professional. Just sharing my opinions as someone who's done a lot of research for my symptoms. My opinions:
Looks like your ferritin is extremely low.
Vit D - aim for 50-80
C-Reactive Protein measures inflammation--looks like yours is high

Good luck!
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Avatar universal
I'm not sure. He said my cortisol was elevated, but as it was just a blood test and only hits that specific moment in time on that particular day, it wasn't diagnostic. He said he would do the dexamethasone test instead of the 24 hour urine test (I suspect he thinks it'll be difficult for me because I pee anywhere from 15-20 times a day lol) but if this comes back normal I'm going to press him to do the urine test in a few weeks anyways. I have a lot of symptoms consistent with high cortisol and/or Cushing's (fatigue, anxiety, depression, fat pads over my collar bones, belly fat, weight gain, easy bruising, excessive sweating and being hot a lot, brain fog, fluid retention, facial flushing, high BP, weakness, pain and stiffness, the pattern of my sleep problems, mood issues, inability to deal with stress, etc.). Hopefully something comes up, two+ years living like this and it only getting worse is a real drag.
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Avatar universal
That is normally for high cortisol. What is she thinking?

If you have low cortisol you sodium typically sits low and potassium goes higher or goes low too... Mine is very bottom of range (and I take salt tabs daily, salt for etc.) as the disorder is salt wasting.
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Avatar universal
Having a dexamethasone suppression test this Friday, hopefully that'll tell me something.
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Avatar universal
Sorry, replied but just made it as a separate comment, not a reply, arghhh!
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Avatar universal
I didn't realize she was going to do a cortisol test, it was just done among about a million other blood tests lol, It was fasting though, yes.

Potassium, serum - 4.2 (range 3.5-5.1 mmol/L)
Sodium, serum - 141 (range 136 - 145mmol/L)

Doc's sending me to see an Endocrinologist tomorrow (don't have high hopes but I figure at this point I've already met my deductible so what can it hurt). Hopefully he can figure out what's going on. Feeling worse and worse by the day :(
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Avatar universal
Were you fasting? It is better to do cortisol closer to 8 than 10...

It looks normal to me and ACTH is in normal ranges (and usually drops from bad lab handling).

Do you have abnormal sodium and potassium? That would point to an adrenal issue.  
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