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Adrenal issues with hashimotos?

I was diagnosed with Hashimotos a year ago. Put on Armour 30mg then bumped to 60mg, then I had to be taken down to 15mg because my body kept going into hyper state.

In April my primary did some blood tests and had me stop the Armour and sent me to an endocronologist.
TSH went from 5.85 to 1.55 in a month. Range 0.35-4.94
Thyroid Peroxidase Antibody 118.00    <9

I recently saw a rheumatologist, negative for lupus, sjogren's and ra.
He diagnosed Fibromyalgia and put me on 20mg of Cymbalta.

I'm wiped out all the time, belly bloat, diarrhea, tummy upset, my legs and feet hurt so bad I hate walking. The pain in my joints, hands is awful. I wake up sweating during the night.  I am gluten free, mostly dairy free(I use butter) watch my soy intake.
I've gained 40+lbs in a year.  I have water retention. My folate was very low at 4.4   Range 8.6-21, so I'm taking 1000mcg of folate acid.
Monocytes are still high MONO%           11.80 0.0-9.0
and neutrophils are still low. NEUT% 43.80 45.0-70.0

The endocrinologist ordered a 1mg dexamethasone AM cortisol test.
Result <0.5 Low  Range  4.3-22.4.
His nurse called today and said this test was good! And that I don't need any follow up since my labs are good.
Then added that I needed to be on 60mg of Armour. I can not do that, my body does not handle it.


Is that a normal AM cortisol?? Is it normal with the hashimoto's? I have other auto immune malfunctions.
3 Responses
Avatar universal
When you say you went hyper, what do you mean?    Was that based on test results  or that you had hyper symptoms?  If test results, please post all your thyroid related test results from before and after starting on the med, along with their reference ranges shown on the lab report.  If due to symptoms,  please describe them for us.  
1 Comments
Symptoms were
Racing heart, anxiety, very hot feeling, agitation, couldn't sleep, very restless legs.

Dr did labs and here is the results, so he said I went hyper and lowered my armour to 15mg.

August of 2018
TSH  0.01   L    range .50-6.00
T4Free   2.1 H   range 0.8-1.5
TPOab   132 H   range  0-34
TGab      1.5  H   range  0.0-0.9
T3Free   5.2 H    range  2.0-4.4
Avatar universal
Those labs certainly are hyper, but could not be caused solely by taking only 60 mg of Armour, since serum thyroid levels are the sum of both natural thyroid hormone and any thyroid medication.   The output of natural thyroid is dependent on the amount of stimulation the thyroid gland gets from TSH.   A TSH of .01 would not  stimulate any production of  natural thyroid hormone, and as I said the 60 mg of Armour is not  enough to account for those FT4 and FT3 levels.    So I would look for other causes.

Your TPO ab and TG ab indicate Hashimoto's Thyroiditis.  With Hashi's people often go through a hyper phase, and then as destruction of the gland continues, they end up hypothyroid.    There is also the possibility tht the Hashi's has caused nodules on your thyroid gland that leak hormone faster than normal, which could account for the levels you have.    This leads me to ask for your lab results at the time you were diagnosed hypo and started on the 30 mg of Armour.

There is also much more to  discuss regarding cortisol, Vitamin D, B12 and ferritin, but let's look first at your test results and reference ranges that resulted in the hypothyroid diagnosis.  
1 Comments
This was my first visit with this doctor, this is how he diagnosed Hashimoto's along with symptoms. Eyebrow missing outer part, fatigue, headaches, body temp of 97.2 or below, low bp, weight gain, dry eyes, cold all the time, pain in my feet, muscle cramps, tummy upset, grouchy, etc.
May 1, 2018  
Vit D 25.4       L         Range 30-100
Iodine  30.9  L                       40.-92
T3Free  2.9                              2.0-4.4
T4Free  1.3                              0.8-1.5
TPO       65                              0-34
Thyroxine Binding  14       13-39
TSH   1.35                                .50-6.00

Then the labs posted in the other post,
We moved and the new CNP ordered on March 11, 2019

T3Free   2.88                  Range 2.18-3.98
T4Free    0.82                              0.76-1.46
TSH         5.81                              0.35-3.74
She then had me stop the 15mg of Armour.
Avatar universal
When attempting to diagnose for possible hypothyroidism, the most important indicator is symptoms.    An individual symptom  is considered non-specific since it can have several causes.   Having multiple symptoms that are often related to hypothyroidism, like you have, is strong evidence of hypothyroidism.  TSH is useful as a diagnostic only when at extreme levels.   Your TSH is high enough currently to also indicate hypothyroidism.  Your previous tests for TPO ab and TG ab were positive for Hashi's.  Even though your FT4  and FT3 were within range, that does not preclude hypothyroidism.  The reason for that being the ranges are far too broad and skewed to the low end due to the erroneous assumptions used to establish the ranges.     Your FT4 of .6 is only at 9% of its range , which is too low, and your FT3 is at 39% of its range.   Since you were only taking 15 mg of Armour, which contains only about 2 mcg of T3, I expect that the FT3 being higher in range than FT4 is an indication that your body is converting extra T4 to T3 in an attempt to maintain thyroid function as best possible.  

So there is strong evidence that you are hypothyroid and in need of thyroid med  adequate to raise your FT4 and FT3 levels enough to relieve all those hypo symptoms.   I cannot account for why your levels went out of range with the relatively small dose of Armour, unless the Hashi's had affected your thyroid gland enough that it was leaking thyroid hormone faster than normal.   So you need to check this out before proceeding with thyroid medication.  

So the first thing I suggest is to get an ultrasound test for your thyroid gland to determine the general condition.   You also should get a test for cortisol level.  The last one you had was for the possibility of Cushings, which was negative.  That test would not show if you were normally low in cortisol.    In addition, you need to supplement with D3 to get your Vitamin D to above 50 ng/mL.  Also you need to test for B12 and ferritin, since hypo patients are so frequently deficient in those.  B12 should be in the upper part of its range, and ferritin should be at least 100.  

If you want to confirm what I have said, click on my name and then scroll down to my Journal and read at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective.   If you have trouble getting these tests from your doctor, give him a copy of the Overview and maybe that will help persuade him of the need.
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