Brief Answer:
Adrenal and Thyroid tests

Detailed Answer:
Good day,
Noted your concern.
Cortisol follow a pattern of secretion and the levels are highest early in the morning and lowest in the late afternoon. This is the normal pattern. However, this normal pattern will change greatly in people who are stressed , late sleepers and night shift workers etc.

Aldosterone and Renin are hormones which change according to the posture of the patient. Lowest on lying down and highest on standing.

Hence when we interpret the values, we take all these factors in to consideration.
Again it is important what medicines patient use while doing these blood tests. Several drugs interfere with the results of cortisol, Aldosterone and Renin.Certain diet changes also can change the blood values of hormones..

Adrenal glands produce several hormones like epinephrine, norepinephrine, cortisol, aldosterone, sex steroids etc. These hormones are produced in the different layers of adrenal gland.

Based on the patient's symptoms and clinical signs, if the endocrinologist suspect adrenal disease, screening tests are ordered which has to be done at certain time of the day and there is a protocol for it. RANDOM HORMONE TESTS HAVE NO VALUE. Once screening tests are positive, doctors will order confirmatory tests. Once confirmatory tests are positive, doctors will order imaging ( XRAY, SCANS etc). This is quite complex and need an experienced endocrinologist to coordinate things.

Since you have fatigue, you have to do an 8 AM serum cortisol. If you have low cortisol, you may feel fatigued. Low aldosterone can cause low blood pressure, salt craving as well as fatigue. Low epinephrine and norepinephrine also will cause fatigue. Low adrenal sex steroids will cause lack of sex drive.

If you have high cortisol and Aldosterone, you may gain weight and develop high Blood pressure and fatigue again.

If you have high sex hormones, you may develop excess hair growth over body with high sex drive. If you have excess epinephrine or nor epinephrines, you may feel episodic palpitation, headache, anxiety and high blood pressure

Even though the TSH and Free T4 values are normal, a 3 cm nodule in thyroid certainly need a needle test.

Most of the things I described are complex and not easy to understand. Please feel free to ask further if you need to know about an individual hormone
Regards
Binu

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Brief Answer:
Thyroid nodule need follow up. If follow up is difficult, then surgery bett

Detailed Answer:
Thank you for the reply. Anxiety will increase the cortisol values. If you have lost weight, it can affect the cortisol values. You may need to do an 8 AM serum cortisol and some endocrinologist may also order for an ACTH test along with it. Based on the values, further tests need to be ordered ( if necessary). You should sleep well for 7-8 hours at night and try to go to bed at 10 PM at the latest few days prior to the tests. Otherwise it can adversely affect the cortisol test.

A 3.3 cm nodule is unlikely to regress on its own. If the needle test is negative and if it is not causing any pressure effect on the windpipe or food pipe in neck, not to worry. But it need a follow up ultrasound at 6 months. If there is a change in the character or size of nodule, a re biopsy would be required. If no change in an ultrasound, another ultrasound is needed in 1 year. This kind of follow up is done to monitor for development of malignancy. Some people find it difficult to go for such timely follow up and rather prefer to get the nodule removed. It is an individual choice.

Generally I advise surgery if biopsy is suspicious, if the nodule is pressing on adjacent structures, if the nodule is hyper functioning or if it is rapidly growing.

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Brief Answer:
Good decision

Detailed Answer:
Appreciate your decision. wish you good health.
Regards
Binu

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