Re: I have my labs from the adrenal crisis, comments please

[Guest guest]

Here is the entire lab report, I am wondering about the note on CKD?

It's LONG! But, here goes:

CBC with differential/Platelet

Test Result Reference

WBC 18.2 4.0-10.5 High

RBC 5.01 3.80-5.10

Hemoglobin 16.8 11.5-15.0 HIGH

Hematocrit 49.8 34.0-44.0 HIGH

MCV 99 80-98 HIGH

MCH 33.5 27.0-34.0

MCHC 33.7 32.0-36.0

RDW 13.6 11.7-15.0

Platelets 581 140-415 HIGH

Neutrophils 50 40-74

Lymps 43 14-46

Monocytes 6 4-13

Eos 1 0-7

Basos 0 0-3

Neutrophils Absolute 9.1 1.8-7.8 HIGH

Lymphs Absolute 7.8 0.7-4.5 HIGH

Monocytes Absolute 1.1 0.1-1.0 HIGH

Eos Absolute 0.2 0.0-0.4

Baso Absolute 0.0 0.0-0.2

Comp. Metabolic Panel (14)

Glucose, Serum 93 65-99

BUN 12 5-26

Creatinine Serum 0.9 0.5-1.5

Glom Filt Rate, Est 60 60.0-128.0

Note: Persistant reduction for 3 months or more in an eGFR ,60

min/1.73 m2 defines CKD. Patients with eGFR values ./=60 min/1.73 m2

may also have CKD if evidence of persistent proteinuria is present.

Additional information may be found at www.kdoqi.org

BUN/Creatine Ratio 13 8-27

Sodium Serum 145 135-148

Potassium serum 4.5 3.5-5.5

Chloride serum 102 96-109

Carbon Dixide total 22 20-32

Calcium serum 10.6 8.5-10.6 Borderline

Protein total serum 7.4 6.0-8.5

Albumin serum 4.8 3.5-5.5

Globulin total 2.6 1.5-4.5

A/G Ratio 1.8 1.1-2.5

Bilirubin total 0.2 0.1-1.2

Alkaline Phosphatase serum 57 25-150

AST (SGOT) 21 0-40

ALT (SGPT) 22 0-40

Lipid panel with LDL/HDL Ratio

Cholesterol, total 186 100-199

Triglycerides 295 0-149 HIGH

HDL Cholesterol 53 40-59

VLDL Cholesterol 59 5-40 HIGH

LDL Cholesterol Calc 74 0-99

LDL/NDL Ratio 1.4 0.0-3.2

TSH 0.642 0.350-5.500

Thoroxine (T4) 8.1 4.5-12.0

Lipase serum 43 0-59

Cortisol 0.9 3.1-22.4 AM READING RATIO LOW

That's it.

[Guest guest]

What hormone meds are you taking and how much?

It may be that the excess steroid (how much, for how long were you on

the excess, how long was the taper?) has shut down your acth

production. One month on the excess is plenty long enought to put

ACTH to sleep. You need acth serum tested to see what it is doing.

Chris

>

> I wanted to see if you guy's might can give me any insite on the

> labs, please.

>

> I am going to post all the flagged items, he did a lot of test!

>

> Cortisol=0.9L Ref: 3.1-22.4 (it was bottomed out!)

>

> WBC=18.2 Ref: 4.0-10.5

> Hemoglobin=16.8 Ref: 11.5-15.0

> Hematocrit=49.8 Ref: 34.0-44.0

> Platelets=581 Ref: 140-415

> Neutrophils Absolute=9.1 REf: 1.8-7.8

> Lymps Absolute=7.8 Ref: 0.7-4.5

> Monocytes Absolute=1.1 Ref: 0.1-1.0

> Triglycerides=295 Ref: 0-149

> VLDL Cholesterol Cal=59 Ref: 5-40

> And Thyroid;

> TSH=0.642 Ref: 0.350-5.500

> T4 Thoraxine=8.1 Ref: 4.5-12.0

> Lipase Serium=43 Ref: 0-59 (better)

> Labcorp/Louisville, KY

>

> Note: My platelets have been high since my spleenectomy, so this is

> normal for me.

>

> Any comments?

> Judy

>

> Summary below on labs and treatment on Grave's and TED

>

> Ref: T3Free 2.3-4.2 pg/dl

> T4F- 0.54-1.61 NG/DL

> TSH- 0.4-5.5

> TSI-<130%

> Severe TED, Bilateral Orbital Decompression 4-25-05

> Total Thyroidectomy July 21, 2005

> Second Orbital Decompression 12-15-05

> 12-01-05 labs:T4F-1.62

> TSH-0.00

> Dxed with Steroid Induced Cushing's Syndrome 02-27-06

> Feb 27, 2006 Labs

> TSH-0.01

> T4F-1.38

> March 14, 2006 Radiation Treatments on Eyes for TED

>

[Guest guest]

I was started on 60 mg of prednisone in January 2005 for treatment of

Thyroid Eye Disease. The swelling was pushing my eyeballs out of the

sockets. This was to try and avoid orbital decompression surgery. I

was to take it for 10 days and start tapering but as I tried to go

down, the swelling would come back even worse. This continued and I

started loosing my vision in the left eye and I continued on 60 mg

until April 25th, when I had the surgery on my eyes. Then, once more

I tried to taper off, the swelling came back worse and because of the

prednisone symptoms, my Endo wanted me off it but the Opth said until

my thyroid levels stabilized, she wouldn't do anything else. SOOOOO,

they removed my thyroid in July of 2005 while still on 60 mg pred. I

once again try to taper off, and once again it comes back even worse

with vision loss again! In the meantime, I loose my job AND insurance

in August, and was increased on the prednisone to 80 mg!!! On

December 15th, I had ANOTHER Orbital Decompresson SUrgery, and they

removed everything possible to make more room for the swelling. Until

the TED goes into remission, the swelling will not go down. THen

Cushing's Syndrome enters the picture full blown with all it has to

offer! We start tapering the last week in December per my Opth by 10

mg every 5th day. By the time I got to 40 mg, I was a walking dead

person, unable to function. It amazes me how these doctors do not

communicate with each other! Anyway, I called my Endo and told him

what was happening, and he had me stay on 40 mg for 4 weeks to

stabilize, then we did 40-35-40-35 for 2 weeks, then 35 for 2 weeks,

then 35-30 for 2 weeks and so on. When I got to the 15-10-15-10

alternating dose for 2 weeks, the problems REALLY started to get bad

by the day until I went into the adrenal crisis, and I am not out of

it yet! I am on 20 AM and 20 PM today and tomorrow, but the pain and

symptoms, dizzy, nausea but no vomiting yet have returned. So, in

total I was on Prednisone and still am for almost 16 months. Mostly

on 60 to 80 for over a year! And the fun just keeps on coming!

Judy

[Guest guest]

How much pred were you on the day of the crisis and the days before,

just want to be straight here as you say you got down to no less than

10 mg a day.

From what you have wrote, doesn't sound like you had tapered all the

way off the pred. You have been on the supra doses of pred way long

enough, your acth and adrenals have been shut down real good and there

is a better than even chance they probably won't come back I'm afraid

(steroid induced secondary adrenal insufficiency). Not saying not to

try, but be prepared.

Chris

>

>

> I was started on 60 mg of prednisone in January 2005 for treatment of

> Thyroid Eye Disease. The swelling was pushing my eyeballs out of the

> sockets. This was to try and avoid orbital decompression surgery. I

> was to take it for 10 days and start tapering but as I tried to go

> down, the swelling would come back even worse. This continued and I

> started loosing my vision in the left eye and I continued on 60 mg

> until April 25th, when I had the surgery on my eyes. Then, once more

> I tried to taper off, the swelling came back worse and because of the

> prednisone symptoms, my Endo wanted me off it but the Opth said until

> my thyroid levels stabilized, she wouldn't do anything else. SOOOOO,

> they removed my thyroid in July of 2005 while still on 60 mg pred. I

> once again try to taper off, and once again it comes back even worse

> with vision loss again! In the meantime, I loose my job AND insurance

> in August, and was increased on the prednisone to 80 mg!!! On

> December 15th, I had ANOTHER Orbital Decompresson SUrgery, and they

> removed everything possible to make more room for the swelling. Until

> the TED goes into remission, the swelling will not go down. THen

> Cushing's Syndrome enters the picture full blown with all it has to

> offer! We start tapering the last week in December per my Opth by 10

> mg every 5th day. By the time I got to 40 mg, I was a walking dead

> person, unable to function. It amazes me how these doctors do not

> communicate with each other! Anyway, I called my Endo and told him

> what was happening, and he had me stay on 40 mg for 4 weeks to

> stabilize, then we did 40-35-40-35 for 2 weeks, then 35 for 2 weeks,

> then 35-30 for 2 weeks and so on. When I got to the 15-10-15-10

> alternating dose for 2 weeks, the problems REALLY started to get bad

> by the day until I went into the adrenal crisis, and I am not out of

> it yet! I am on 20 AM and 20 PM today and tomorrow, but the pain and

> symptoms, dizzy, nausea but no vomiting yet have returned. So, in

> total I was on Prednisone and still am for almost 16 months. Mostly

> on 60 to 80 for over a year! And the fun just keeps on coming!

> Judy

>

[Guest guest]

Judy,

I know it's a big request and you're not seeing very well, but do you

think you could resend the values you were high on with the units they

used to measure them? Like ug/dL, for example. If you don't want to

type it all in, you could scan it in and just email it to me

personally. I promise to keep everything confidential. I want to

look into this some more when I have the time.

Thanks,

Jen

>

> Here is the entire lab report, I am wondering about the note on CKD?

> It's LONG! But, here goes:

> CBC with differential/Platelet

> Test Result Reference

>

> WBC 18.2 4.0-10.5 High

> RBC 5.01 3.80-5.10

> Hemoglobin 16.8 11.5-15.0 HIGH

> Hematocrit 49.8 34.0-44.0 HIGH

>

[Guest guest]

Well, I have the buffalo hump, central obesity, terrible purple stiae

under arms, breast, upper theighs, abdomen and butt, Masculine build,

hair loss, skin like spider webs, High BP, which is now on a roller

coaster ride up and down, red face, cushing's face...chipmunk cheeks,

muscle wasting and weakness, easy bruising, very slow wound healing. I

posted photo album with before and after photos on this site. A mess!

[Guest guest]

CBC with differential/Platelet

Test Result Reference

WBC 18.2 x10E3/uL 4.0-10.5 High

RBC 5.01 x10E6/ul 3.80-5.10

Hemoglobin 16.8 g/dl 11.5-15.0 HIGH

Hematocrit 49.8 % 34.0-44.0 HIGH

MCV 99 fl 80-98 HIGH

MCH 33.5 pg 27.0-34.0

MCHC 33.7 g/dl 32.0-36.0

RDW 13.6 % 11.7-15.0

Platelets 581 x10E3/ul 140-415 HIGH

Neutrophils 50 % 40-74

Lymps 43 % 14-46

Monocytes 6 % 4-13

Eos 1 % 0-7

Basos 0 % 0-3

Neutrophils Absolute 9.1 x10E3/ul 1.8-7.8 HIGH

Lymphs Absolute 7.8 x10E3/ul 0.7-4.5 HIGH

Monocytes Absolute 1.1 x10E3/ul 0.1-1.0 HIGH

Eos Absolute 0.2 x10E3/ul 0.0-0.4

Baso Absolute 0.0 x10E3/ul 0.0-0.2

Comp. Metabolic Panel (14)

Glucose, Serum 93 mg/dl 65-99

BUN 12 mg/dl 5-26

Creatinine Serum 0.9 mg/dl 0.5-1.5

Glom Filt Rate, Est 60 60.0-128.0

Note: Persistant reduction for 3 months or more in an eGFR ,60

min/1.73 m2 defines CKD. Patients with eGFR values ./=60 min/1.73 m2

may also have CKD if evidence of persistent proteinuria is present.

Additional information may be found at www.kdoqi.org

BUN/Creatine Ratio 13 8-27

Sodium Serum 145 mmol/L 135-148

Potassium serum 4.5 mmol/L 3.5-5.5

Chloride serum 102 mmol/L 96-109

Carbon Dixide total 22 mmol/L 20-32

Calcium serum 10.6 mg/dl 8.5-10.6 Borderline

Protein total serum 7.4 g/dl 6.0-8.5

Albumin serum 4.8 g/dl 3.5-5.5

Globulin total 2.6 g/dl 1.5-4.5

A/G Ratio 1.8 1.1-2.5

Bilirubin total 0.2 mg/dl 0.1-1.2

Alkaline Phosphatase serum 57 IU/L 25-150

AST (SGOT) 21 IU/L 0-40

ALT (SGPT) 22 IU/L 0-40

Lipid panel with LDL/HDL Ratio

Cholesterol, total 186 mg/dl 100-199

Triglycerides 295 mg/dl 0-149 HIGH

HDL Cholesterol 53 mg/dl 40-59

VLDL Cholesterol 59 mg/dl 5-40 HIGH

LDL Cholesterol Calc 74 mg/dl 0-99

LDL/NDL Ratio 1.4 ratio units 0.0-3.2

TSH 0.642 uIU/mL 0.350-5.500

Thoroxine (T4) 8.1 ug/dl 4.5-12.0

Lipase serum 43 U/L 0-59

Cortisol 0.9 ug/dl 3.1-22.4 AM READING RATIO LOW

[Guest guest]

>

> Judy what thyroid are you on and for how long? Alot of the changes

may

> be thyroid as it can really make a huge difference in your looks as

well

> as the Cushings. I wonder if getting yo on full replacement with

Armour

> if it would help alot 0f your symptoms as well as maybe slow the

TED

> symptoms .

>

> --

> Artistic Grooming * Hurricane, WV

> My Ebay Jewelry Store

http://stores.ebay.com/valeriescrystalcreations

> The BEST thyroid website! http://www.stopthethyroidmadness.com

> http://health.groups.yahoo.com/group/NaturalThyroidHormonesADRENALS/

>

, I am on Synthoid 150 mg and have been since thyroidectomy in

July 05. I am going to request my Endo put me on Armor as I see that

may help me! Thanks!

[Guest guest]

> >

> >

> > I was started on 60 mg of prednisone in January 2005 for

treatment of

> > Thyroid Eye Disease. The swelling was pushing my eyeballs out of

the

> > sockets. This was to try and avoid orbital decompression surgery.

I

> > was to take it for 10 days and start tapering but as I tried to

go

> > down, the swelling would come back even worse. This continued and

I

> > started loosing my vision in the left eye and I continued on 60

mg

> > until April 25th, when I had the surgery on my eyes. Then, once

more

> > I tried to taper off, the swelling came back worse and because of

the

> > prednisone symptoms, my Endo wanted me off it but the Opth said

until

> > my thyroid levels stabilized, she wouldn't do anything else.

SOOOOO,

> > they removed my thyroid in July of 2005 while still on 60 mg

pred. I

> > once again try to taper off, and once again it comes back even

worse

> > with vision loss again! In the meantime, I loose my job AND

insurance

> > in August, and was increased on the prednisone to 80 mg!!! On

> > December 15th, I had ANOTHER Orbital Decompresson SUrgery, and

they

> > removed everything possible to make more room for the swelling.

Until

> > the TED goes into remission, the swelling will not go down. THen

> > Cushing's Syndrome enters the picture full blown with all it has

to

> > offer! We start tapering the last week in December per my Opth by

10

> > mg every 5th day. By the time I got to 40 mg, I was a walking

dead

> > person, unable to function. It amazes me how these doctors do not

> > communicate with each other! Anyway, I called my Endo and told

him

> > what was happening, and he had me stay on 40 mg for 4 weeks to

> > stabilize, then we did 40-35-40-35 for 2 weeks, then 35 for 2

weeks,

> > then 35-30 for 2 weeks and so on. When I got to the 15-10-15-10

> > alternating dose for 2 weeks, the problems REALLY started to get

bad

> > by the day until I went into the adrenal crisis, and I am not out

of

> > it yet! I am on 20 AM and 20 PM today and tomorrow, but the pain

and

> > symptoms, dizzy, nausea but no vomiting yet have returned. So, in

> > total I was on Prednisone and still am for almost 16 months.

Mostly

> > on 60 to 80 for over a year! And the fun just keeps on coming!

> > Judy

> >

>

[Guest guest]

Your are first I've heard of having an adrenal crisis on 15 mg of

pred. The only thing I can think of is maybe you tapered to fast and

or your cells are desensitized because of being on so much pred.

Being on megadoses, it can be very hard to come down. This can happen

with other hormone therapies as well.

Also I meant to mention that cortisol tests don't mean much when on

prednisone because tests don't pick it up very well since pred

molecular structure is different than natural cortisol.

Chris

> > >

> > >

> > > I was started on 60 mg of prednisone in January 2005 for

> treatment of

> > > Thyroid Eye Disease. The swelling was pushing my eyeballs out of

> the

> > > sockets. This was to try and avoid orbital decompression surgery.

> I

> > > was to take it for 10 days and start tapering but as I tried to

> go

> > > down, the swelling would come back even worse. This continued and

> I

> > > started loosing my vision in the left eye and I continued on 60

> mg

> > > until April 25th, when I had the surgery on my eyes. Then, once

> more

> > > I tried to taper off, the swelling came back worse and because of

> the

> > > prednisone symptoms, my Endo wanted me off it but the Opth said

> until

> > > my thyroid levels stabilized, she wouldn't do anything else.

> SOOOOO,

> > > they removed my thyroid in July of 2005 while still on 60 mg

> pred. I

> > > once again try to taper off, and once again it comes back even

> worse

> > > with vision loss again! In the meantime, I loose my job AND

> insurance

> > > in August, and was increased on the prednisone to 80 mg!!! On

> > > December 15th, I had ANOTHER Orbital Decompresson SUrgery, and

> they

> > > removed everything possible to make more room for the swelling.

> Until

> > > the TED goes into remission, the swelling will not go down. THen

> > > Cushing's Syndrome enters the picture full blown with all it has

> to

> > > offer! We start tapering the last week in December per my Opth by

> 10

> > > mg every 5th day. By the time I got to 40 mg, I was a walking

> dead

> > > person, unable to function. It amazes me how these doctors do not

> > > communicate with each other! Anyway, I called my Endo and told

> him

> > > what was happening, and he had me stay on 40 mg for 4 weeks to

> > > stabilize, then we did 40-35-40-35 for 2 weeks, then 35 for 2

> weeks,

> > > then 35-30 for 2 weeks and so on. When I got to the 15-10-15-10

> > > alternating dose for 2 weeks, the problems REALLY started to get

> bad

> > > by the day until I went into the adrenal crisis, and I am not out

> of

> > > it yet! I am on 20 AM and 20 PM today and tomorrow, but the pain

> and

> > > symptoms, dizzy, nausea but no vomiting yet have returned. So, in

> > > total I was on Prednisone and still am for almost 16 months.

> Mostly

> > > on 60 to 80 for over a year! And the fun just keeps on coming!

> > > Judy

> > >

> >

>

[Guest guest]

Judy, are you from Louisville? I am. Have you had luck finding a

good endocrinologist in this area? I have not..........they are all

too caught up with their lab values to listen to symptoms.

Amy

>

> > Labcorp/Louisville, KY

>

>

[Guest guest]

I am in Nashville, TN. We at least have plenty of doctors, Vanderbilt,

etc. here I see my Endo tomorrow, thank goodness. But, I am getting

weary of him at the present. Tomorrow will tell the tale!

> >

>

[Guest guest]

I fully intend to discuss Armor with my Endo tomorrow at our

appointment. Something has to give!

[Guest guest]

Judy,

These labs are really concerning me. I'm no doctor, but having those

high readings on the white blood cells especially with being on such a

high dose of pred is not normal at all. You might have something else

going on with your immune system -- possibly something in the bone

marrow that needs attention. I really have no idea how having no

spleen might play into it, but I think you really need to find a good

immunologist. What did your doctor say about these results when they

came in?

Jen

>

> CBC with differential/Platelet

> Test Result Reference

>

> WBC 18.2 x10E3/uL 4.0-10.5 High

> RBC 5.01 x10E6/ul 3.80-5.10

> Hemoglobin 16.8 g/dl 11.5-15.0 HIGH

> Hematocrit 49.8 % 34.0-44.0 HIGH

> MCV 99 fl 80-98 HIGH

>

> Platelets 581 x10E3/ul 140-415 HIGH

>

> Neutrophils Absolute 9.1 x10E3/ul 1.8-7.8 HIGH

> Lymphs Absolute 7.8 x10E3/ul 0.7-4.5 HIGH

> Monocytes Absolute 1.1 x10E3/ul 0.1-1.0 HIGH

>

> Glucose, Serum 93 mg/dl 65-99

> BUN 12 mg/dl 5-26

> Creatinine Serum 0.9 mg/dl 0.5-1.5

> Glom Filt Rate, Est 60 60.0-128.0

>

> Note: Persistant reduction for 3 months or more in an eGFR ,60

> min/1.73 m2 defines CKD. Patients with eGFR values ./=60 min/1.73 m2

> may also have CKD if evidence of persistent proteinuria is present.

> Additional information may be found at www.kdoqi.org

>

>

>

[Guest guest]

Since pred has such a different chemical structure from cortisol I

don't believe it will show up on a blood test. A dose that high will

certainly shut down the adrenals, so the low cortisol isn't all that

surprising.

Jen

> >

> > How much pred were you on the day of the crisis and the days before,

> > just want to be straight here as you say you got down to no less

> than

> > 10 mg a day.

> >

> CHRIS:

> I was on 10 in the morning and 5 in the afternoon, total 15 per day.

> That is what makes me SO ANGRY! I ahd called my Endo's office on

> Monday with my symptoms, and all he said was to stay on the 15 mg per

> day and no more 10 mg alternating until I came back in to his office

> next week, then on Thursday, it hit full blown! And my GP got me

> through it! I am about ready to tell my ENDO to jump where the sun

> don't shine!

> Judy

> >

> >

>

[Guest guest]

Vanderbilt has an excellent immunology department. Please try and get

a referral to see somebody there. We've also got great people here at

Duke if you're willing to travel a bit.

Jen

>

> I am in Nashville, TN. We at least have plenty of doctors, Vanderbilt,

> etc. here I see my Endo tomorrow, thank goodness. But, I am getting

> weary of him at the present. Tomorrow will tell the tale!

> > >

> >

>

[Guest guest]

That is what he explained to me today,my adrenals are dead right now

and it will take 1 to 2 years for them to wake up...IF THEY WAKE UP.

The cortisol test was of no use in my situation while I am on

Prednisone.

Thanks!

Judy...I am still learning!

[Guest guest]

My Endo seems to think that the prednisone is keeping my WBC high in

addition to the staph infection I am currently fighting and taking

antibiotics for. He explained prednisone will make the WBC stay high in

it's own self. I see the Urologist tomorrow on the blood in my urine,

don't know if maybe something is going on there. In my urine test, it

did not show any infection. I'll be interested to find out and will

keep you posted!

Thanks for your help!

Judy

[Guest guest]

> ,

It was for severe thyroid eye disease, to keep the swelling off my

optic nerve, as it was causing me vision and color loss. Every time we

would taper, the swelling came back even worse, so it's been a long

road on pred! Now that I have had 2 decompression surgeries and

radiation treatments, I am hoping the eye swelling will continue to go

down and I will be able to get off the Pred. I am having a really hard

time coming down from it. It is so hard on your body!

Judy

[Guest guest]

>

> That's what I've heard. So you are hyperthyroid, then? I guess I

thought

> the swelling was from the pred.

>

> Best,

>

> Handcrafted Jewelry ~ http://www.ChestnutHillDesigns.com

> Curly Horse Rescue ~ http://www.CurlyRescue.com

>

> ~Age is a case of mind over matter. If you don't mind then it

really doesn't

> matter.~

> Re: I have my labs from

the

> adrenal crisis, comments please

>

>

> >

> > > ,

> > It was for severe thyroid eye disease, to keep the swelling off my

> > optic nerve, as it was causing me vision and color loss. Every

time we

> > would taper, the swelling came back even worse, so it's been a

long

> > road on pred! Now that I have had 2 decompression surgeries and

> > radiation treatments, I am hoping the eye swelling will continue

to go

> > down and I will be able to get off the Pred. I am having a really

hard

> > time coming down from it. It is so hard on your body!

> > Judy

> >

> >

> >

> >

> >

> >

> >