Possible Hypo secondary to RA

[Connie43]

Hi,

I am new to this board.  I was dx 2 years ago with Rheumatoid Arthritis and after several failed drugs I have kept it controlled with Enbrel and Methotrexate.  About 4 months ago I went to see my Gyno (who is a seriously great doctor) and because I was having some problems he ran a bunch of blood tests (18 tubes).  The end result being that he said my adrenal gland was not working, I am estrogen high and TSH was borderline high and T4 or T3 (I cannot remember numbers) was extremely low, I am also ANA positive which I aleady knew from my rhuematologist.  At the time he was suggesting I start thyroid meds but I was still weaning off of prednisone (the heroine of choice for people with RA) and I was worried that the prednisone was screwing with my levels.  We agreed to wait three months and retest.  I am going back to the doctor in two weeks and I am now a little scared.  I have had for over a year now a hoarse voice (I sound very deep and raspy), fatigue is horrible but I also have an autoimmune disease, weight gain, no drive, depression (but I have a painful disease), memory issues and memory fog.  

My questions to you are what questions should I ask?  I learned from my first year with RA that you need to be informed as a patient and really know your body and your disease.  Is it possible my voice is related to my thyroid?  I went to an ENT about 8 months ago and he put the scope thru my nose and down my throat and saw nothing but some inflammation which he wrote off as RA and said it could be reflux and gave me an rx for nexium... and still hoarse voice with some difficulty swallowing sometimes.  Any help or info you could give would be greatly appreciated.

Thank you,
Connie

[AR-10]

The lab results help, but the lab range varies from lab to lab with the tests. The TSH is easy to understand, and it is a little high, but not bad.

The other test results need to be veiwed in relation to the lab ranges for the tests. Your Free T4 looks really low, and your reverse T3 looks really high, but without the ranges on the report it's all a guess.

It sounds like the doctor knows what he is doing. I don't know that much about adrenal treatment. The treatment you describe sounds about right.

We have an Adrenal Insufficiency board you could go to and get some better information.  

http://www.medhelp.org/forums/show/306

Do you have the lab limits for the tests?

[Connie43]

I found my lab results:

FT3 = 1.2
FT4 = 0.2
Reverse T3 = 239
TSH = 2.28

I don't know if this helps

[Connie43]

I understand that prednisone messes with everything, I hate that drug. But, I have been off of it now going on 5 months.  As for my adrenal fatigue, the doctor made dietary suggestions (small meals 5-6 times per day with protein in afternoon and before bed), supplements (vitamin B, DHEA and vitamin D) and he also has me on some bio identical hormone cream (progesterone) to try and kick start it.  Are there other treatments that I should know about?  Sorry, just trying to understand all of this.

Thanks

[AR-10]

1) Prednisone will screw with your thyroid levels.

2) If you have adrenal issues they need to be treated first. Your adrenal glands can influence your thyroid, so treating the adrenals may rectify the thyroid situation. Also, treating the thyroid when you have adrenal problems can make all the symptoms worse.

Treat the adrenals first.