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Thyroid (Expert Forum)
Lastest thyroid labs and some others, very ill
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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Lastest thyroid labs and some others, very ill
by starangel777, Jun 12, 2007 12:00AM
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
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
Doctor's Answer
by Mark Lupo, M.D., Jun 12, 2007 12:00AM
, Jun 12, 2007 12:00AM
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.
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.
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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