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SAI? AI? Hashis?

Hello all.

I am a diagnosed Hashimotos patient whose levels have stabled (with Synthroid) but unfortunately, the symptoms have not. My symptoms began after the birth of my child almost 2 years ago. I was pretty quickly diagnosed with Hashis and while the symptoms cleared a bit, they quickly came back with full vengeance. Debilitating exhaustion, muscle weakness, sensitivity to any stressors, pale skin, anxiety, and NO energy make up my symptoms.

My morning salivary cortisol test came back as ,161 (range of .272 - 1.348)
Morning serum ACTH came back as 8 (range of 9-27)

I just submitted a 24 hour urine test to my endo and we are doing the stim test next week. My question is, what do these results seem to say? And, can it be AI with normal sodium, potassium levels and no hyper pigmentation?


Ready for this nightmare to be over. 2 years ago I was a marathon-running 23 year old who had never had any health problems.
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COMMUNITY LEADER
Pigmentation only happens with primary (aka adrenal sourced) cases - than the pituitary gets all hyped up trying to signal the adrenal, the adrenal does not signal back, so the pituitary tries again - and so the ACTH causes the hyperpigmentation.

However, normal sodium and potassium (how normal - anything on the edges?) is a bit odd... do you have low BP?

Was the ACTH done properly? Chilled tube, spun right after the draw?  It can be low just for lab handling. Any serum cortisol testing? Saliva (free cortisol) can be impacted by many things - many medications and is subject to more lab error...

Has any other auto-immune testing been run?
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Avatar universal
The sodium and potassium are right in the middle. I am not sure how the ACTH was handled.

I have had one serum cortisol that was a 7 (range of 5 to 31)
If it is on the low end in the morning, doesn't that mean that it is going to go down during the rest of the day?

What medications can impact saliva test? The only medication I was on at the time was Synthroid.

I had a positive ANA test so they ran a full panel, and I as only prosucing antibodies to thyroid,
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Avatar universal
I was only producing*
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Avatar universal
Also, I have struggled with low blood pressure. It dropped very low during the birth of my daughter and I had to have two injections of epinephrine.
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Avatar universal
COMMUNITY LEADER
Did all this happen, as a coincidence, with the birth of your daughter? Then you need to look at Sheehan's Syndrome - which is a form of hypopituitary.

Cortisol varies by time of day - and it is possible to test low in the morning and test high at night - and have Cushing's syndrome. I had that with low BP - not the usual. That is a loss of diurnal rhythm.

Synthroid would not impact a saliva test. Are you gaining or losing weight?
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Avatar universal
Ok, so I just got my 24 hour urine results. I produced 11.1 ug of cortisol all day, so I don't believe it is Cushings.

Yes, this all came out of the blue after the birth of my daughter. I am not consistently losing weight but have lost 10 pounds more than my pre pregnancy weight which I find odd since I was only 135 lbs in the first place and am hypothyroid.
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Avatar universal
Ok, so I just got my 24 hour urine results. I produced 11.1 ug of cortisol all day, so I don't believe it is Cushings.

Yes, this all came out of the blue after the birth of my daughter. I am not consistently losing weight but have lost 10 pounds more than my pre pregnancy weight which I find odd since I was only 135 lbs in the first place and am hypothyroid.
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Avatar universal
sounds like your synthroid is not doing the job it should be doing.  you would probably do better on armour thyroid---or a T4/T3 combo.

if they want to test cortisol with blood tests, they need to test not just the serum cortisol, but also the free cortisol and the cortisol binding globulin.

if you are having cortisol problems you need cortisol before you can raise your thyroid levels--but our bodies were not meant to run on T4 meds only---it is a storage hormone.
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Avatar universal
COMMUNITY LEADER
I would go to a pituitary doc - and have them look at Sheehan's. It sounds like you may have had some pituitary damage during childbirth.
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