Concerned about cortisol levels

I was diagnosed with hypothyroidism in March. My TSH was 280 with almost no symptoms other than a little tired. I was started on Levothyroxine 50 mcg and have gradually increased to 75 mcg. My last blood test for TSH on April 29th was 25. We are going gradually with med increase as I am very sensitive. I was feeling a little better till this week esp this weekend. I feel so exhausted,dizzy,and have no appetite. I had a AM Cortisol done on April 7th-21.6 (5-31) I also had an MRI in March which showed mild enlargement of pituitary but no tumors.  Should I be concerned that my weakness is adrenal related or from recent levothyroxine increase?

[rumpled]

TSH is a pituitary test... cortisol is not.  An enlarged pituitary can mean there is a tumor sometimes - how was the MRI done - was it done with and without contrast and was it done dynamically - as in did they take images while contrast was being injected? That is a proper pituitary MRI. A newer MRI machine - A 3 tesla may also help...

A single cortisol test (what time) without the ACTH is not very helpful... is is not diagnostic. Cortisol normally goes up and down. It could be higher at other times. Have they fully investigated the pituitary and the thyroid - as in ultrasound, antibody tests, other thyroid tests that actually test the thyroid and pituitary tests?

[dani35]

I had the MRI done with contrast and they took images as it was injected. The radiologist,my endo and ent checked the results and said there is no tumor.   I had an 8 AM cortisol done and the results were 21.6. My endo said that result was fine.   I have had a thyroid ultrasound,thyroid antibodies, t3,t4, and TSH done.  I had some blood work this morning and the dr feels all lab work is fine and TSH has continued to come down.  The drs feel that I am improving and that the thyroid is my only problem at this point based on labs.

[rumpled]

Did you get a copy of the lab work?
I have known of  *normal* scans that have later been found not to be when looked at by a surgeon.

I take T4 and t3 all the time - no issue...

[dani35]

I have copies of my lab work. I do not have copy of MRI. My internist,endo,radiologist,and ENT checked it and confirmed that there was no tumor.  Should I still concerned?  My endo feels that my TSH continues to decrease so it will just take time to feel better.  But should I still be concerned about adrenals with normal lab ranges?

[rumpled]

Well... I have had good and bad luck with doctors... I had one of my tumors hide for 12 years... I was told I was ok when I was not. My TSH was bouncing and I got every color medication - it did not help - they removed my thyroid and my problem was really pituitary...

So, every case is very unique so you have to know your own body to some extent - and you have to know in your heart if you feel that all is well or not and go on that.

[dani35]

Just wanted to update my situation.  I saw the endo again last week and told her about my continued weakness.  She ordered labs- Cortisol,ACTH,glucose,prolactin and TSH. All were normal and TSH down to 16.  Still high TSH but improving.  She also had me have a repeat MRI of the pituitary with contrast. Thank goodness the results were normal- Pituitary no longer enlarged.  I still feel weak and dizzy at times but endo feels this is all due to thyroid.  I thank you for your advice.

[rumpled]

Does your doctor test any other pituitary function other than TSH? Since your TSH is high, maybe other pituitary function should be tested for baseline at least?

Is the MRI going to be a proper pituitary MRI - dynamic? That is a technique where the inject the contrast while you are in the machine so they record the uptake. That can record the smaller lesions. A place trained in pituitary tumors will know how.

[dani35]

What other pituitary function should she be testing? I am not sure what I should be asking for.  My TSH has been coming down steadily since Feb. I am very sensitive to meds so my endo has me taking it down slowly.    I had the MRI of the pituitary with contrast done last week. They injected the contrast while I was in the machine.

[rumpled]

She did cortisol so she should at least do the pituitary hormone with it - ACTH (albeit a fussy test). The others can be with symptoms but normally LH, FSH, prolactin, GH or IGF-1... there are others but need to show symptoms ADH (you are not complaining of drinking/peeing) etc.

Has your doctor tested your cortisol at different times of the day? Sodium and K normal?

[dani35]

I had cortisol,ACTH,prolactin,LH,FSH, and all electrolytes tested.  All came back normal range.  I have had AM cortisol tested three times since being diagnosed and has always been normal.  Are there any other tests that should be done?