Lastest thyroid labs and some others, very ill

[starangel777]

Hello Dr.

I am 31 years old and female. My latest labs for thyroid after being on Synthroid 137mcg for 2 years now (for hashimotos) are as follows:

TSH 0.25 ( 0.40-5.5)
Free T4 1.6 (0.8-1.8)
Free T3 302 (230-420)

ACTH 52 (5-27)
8am cortisol 27.7 (3.0-17.0)
DHEAS 679 (40-325)
Testosterone Total 51 (2-45)
Testosterone Free 13.8 (0.1-6.4)
IGF 127 (126-291)
Vitamin D, 25-OH Total 11(20-100)

I have been having horrible symptoms of weight gain, severe fatigue, acne, hair growth, muscle pain/aches, dizziness, headaches, etc.

What do you make of these labs, the endo is thinking cushings/pituitary problem. I had an MRI of the pituitary but it only revealed an empty sella.

Is my thyroid ok? Would I do better on a T3/T4 combo. The weight gain is horrible. I know you probably won't believe me but I am on a very strict carb controlled, low cal plan and in one day I can gain five pounds..but besides the weight I feel very ill.

I would love your input.

Thank you,

Marie

[starangel777]

Thanks Dr. Lupo, you have been VERY helpful.

I am on weekly dose of prescription Vitamin D (50,000IU) and hopefully it will help, as I have osteopenia now at 31. I will look into the antibodies you said.

Yes, the cushings is so difficult to diagnose, as some tests have been high, some low.

Thank you again!

Marie

[Mark Lupo, M.D.]

There is no data suggesting T4/T3 is better, but some paitents feel better with the combo.  The current thyroid labs are okay.

The high ACTH and cortisol need further evaluation -- ie, dexamethasone suppression test -- even with the empty sella on MRI.  These can both be elevated due to stress however -- the dex supp test helps sort this out.

The low Vit D needs to be addressed - check sprue antibodies (particularly with the history of hashi -- also autoimmune) and consider high dose weekly vitamin D treatment.  Make sure the calcium is okay as well -- probably already done.

The high DHEAS may be due to the high ACTH driving adrenal overproduction -- again, needs further eval as you have many symptoms suggestive of Cushings -- often a difficult thing to diagnose.