Bloodwork for hypothryoidism, adrenals, perimenopause

[VitaminB12]

I'm due for some bloodwork re: hypothyroidism and overall general health (it's been 3 months). I am still concerned about my adrenal glands and possible perimenopause. I think the following tests are warranted: TSH, Free T4, Free T3, Antibodies, ferretin or iron panel, Vitamin B12, magnesium, potassium, sodium, and am cortisol.

Can a lab test one's iodine level? How frequently will a typical doctor test cortisol in a patient under chronic stress? How frequently will a typical doctor test female hormonal health in women aged 45 and up re:perimenopause? Should I consider having my Vitamin D level tested again even though I have to pay for it since I am taking a supplement? I also take a sublingual Vitamin B12 supplement.

Do you think I am missing anything important?

Please see below for relevant bloodwork results. Thanks. I live in Canada.

January 31, 2014 lab results
TSH 6.57 Reference range 0.35 – 5.00 miU/L
T4 Free 13 Reference range 12 – 22 pmol/L
Free T3 4.1 Reference range 2.6 – 5.7 pmol/L
Cortisol am 487 (walked 1/2 hour to lab) Reference range 170 – 540 nmol/L
Magnesium 0.82 Reference range 0.65 – 1.05 mmol/L
Sodium 141 Reference range 135 – 145 mmol/L
Potassium 4.2 Reference range 3.3 – 5.1 mmol/L
Chloride 102 Reference range 95 – 108 mmol/L

July 30, 2013 lab result
Vitamin D 92 Reference range > 50 nmol/L (paid for this test)

[VitaminB12]

I wrote, "I still get regular flare-ups from working even though I've been in a lighter job with the same employer since May 22, 2013, using my computer, cleaning ..."

I should have written, I still get regular flare-ups from working even though I've been in a lighter job with the same employer since May 22, 2013. I also still get regular flare-ups from using my personal computer, cleaning at home.

I have another question related to hypothyroidism and I may post it separately rather than with this thread.  

[VitaminB12]

Thanks for your detailed post. Please note the most recent test for thyroid antibodies was December 13, 2011 according to the lab requisitions I have on file. I don't have the results, but they must have been negative. I have been getting some nocturnal calf cramps again. I still suspect that there's more than just my thyroid out of whack. I still don't know why my thyroid is underactive. All I know is that when a ND (naturopathic doctor) prescribed medicaton in 2012 he flooded my system with iodine and that worsened my hypothyroidism. Yes, I am curious to see if the additional iron in my diet has positively affected my ferretin level and thyroid function. I still have the occupational tendinitis in both forearms (first noticed it in February 2013). I am currently going to a physio clinic for a 12 week, three days per week worker rehabilitation program which includes strengthening and work simulation activities (machine with attachments). I have had to request twice that the therapist address the education component that the WSIB (Workplace Safety Insurance Board) nurse consultant outlined to include managing flare-ups, pain and stress management, and body mechanics. I go back to the WSIB specialty clinic Hand & Wrist Program out of town on April 30 for a follow-up. I just completed week 6 of the program. I still get regular flare-ups from working even though I've been in a lighter job with the same employer since May 22, 2013, using my computer, cleaning ... I am doing regular duties at work with the only restriction being - heavy pushing/pulling as tolerated. I never took any time off even when the tendinitis was at its worst.

[Barb135]

It's been a while and my memory doesn't always serve me correctly, but weren't you already tested for thyroid antibodies, TPOab and TGab?  If so, they need not be tested again, unless they were negative and you want to see if they've ramped up since your last test.  However, even at that, testing them at 3 month intervals is sort of a waste of money, even if you don't have to pay for them.  If they were positive, they don't need to be tested again, because once you have Hashimoto's, you always have it, no matter what the antibody count is.

As I recall, you had increased your dietary iron by quite a bit; I'd say that a ferritin test would be sufficient, at this point.  If ferritin is low, then a full iron panel would be warranted.

It's reasonable to keep a close watch on vitamin B12, since, if I recall correctly, you were deficient in that as well and had increased your B12 food sources and started the supplement.

Your sodium, potassium and chloride were good on the last check, so probably no reason to worry about those.  Your magnesium was at 43% of the range last time, so probably not really needed again so soon.  You can't overdose on magnesium, so you can go ahead and supplement; it doesn't have to be tested every time you have blood work.

It's definitely time to get the thyroid hormones tested, as your FT4 was only at 10% of its range last time and your FT3 was at 48%.  Both are lower than the recommended mid range for FT4 and upper half to upper third for FT3.  Even your TSH was indicating hypo and you didn't want to take hormone supplements.  

From research I've done in the past about iodine testing, there is no lab (blood) test.  Thyroid size and function tests are, typically, the best tests to determine iodine sufficiency.  Aside from that, urine iodine loading is the best test and that's rarely done, because it's a 24 hr test and is quite complicated.  You can also do a skin patch test, in which you place iodine on your skin and see how quickly it disappears.  If the patch is still there after 24 hrs you're not deficient.  The problem is that no one knows exactly how much iodine is being applied to the skin, so basically, every one fails...lol

Your reproductive hormones don't look like peri-menopause, to me, but that's not my area of expertise.  There should be more than one reference range for those... or did you list the one that fits your category?

There is no set criteria for testing am cortisol.  No matter how much stress one is under, most doctors don't test, unless they feel strongly that there is an adrenal issue, such as Addison's or Cushings Disease, etc.  Cortisol should be highest in the morning, when one is preparing for the day and it gradually drops from there.  AM cortisol really tells very little, since you need to know what it's doing throughout the day, as well.   It's very important to note that when thyroid levels are low, as yours are, the adrenals kick in and try to take up the slack, so being hypo, would actually cause more stress than necessary on the adrenal glands; thyroid replacement hormones would allow them to return to normal function.  

Likewise, most doctors (in my experience) won't routinely, test reproductive hormones, simply for the sake of determining peri-menopause.  That's typically done when there are symptoms indicating an issue.  Peri-menopause is just that - a forerunner to actual menopause and since that's a natural phenomenon, there's usually not a good reason to keep close tabs.  Most of us know, when we get there and if we have issues, we're prescribed some type of hormone replacement.

With your vitamin D level at 92, I really can't see an issue.  Are you supplementing that?  If so, it's likely to still be up there.

In my opinion, the thyroid function tests (TSH, Free T3 and Free T4) and B12, would be the only "necessary" tests to do again, at this point.

[VitaminB12]

Sorry for the typo - correction below
Estradiol 281 Reference range Follicular 46 - 607 pmol/L

[VitaminB12]

Sorry, I forgot to include the following lab results from December 9, 2013
Please note my period started December 1, 2013. I was not told to have it done on any specific day of my cycle, but I read somewhere that these tests should be completed on day 3 and/or 20 to 22 of your cycle and day 1 is your first day of bleeding. Thanks.

LH 7 Reference range Follicular 2 - 13 IU/L
FSH 7 Reference range Follicular 4 - 13 IU/L
Estradiol 28 Reference range Follicular 46 - 607 pmol/L