See an endo or accept diagnosis?

[Jenipeni]

I’m sorry this is not specifically a thyroid question but relevant as you are an endocrinologist – I hope you don’t mind…

Because I recovered from TT (for obstructive multinodular goitre, 27yo) much slower than expected (7 weeks before I could go back to work just a 4 hours shift and even then it was a struggle) I had other tests run.  

Testosterone - 4.0 (0.5 - 2.6)
24hr Urinary Free Cortisol - 182 (<160)

23/1/07
FSH – 7 (Follicular phase 1- 6)
LH – 15 (Follicular phase 1 - 10)
E2 – 428 (Follicular phase <575)
Progesterone – 3.2 (Follicular phase 1.0 - 7.0)

14/3/07
FSH – 4
LH – 9
E2 – 120

I had a abdo/pelvis CT scan to check for any abnormalities of ovaries or adrenals.   Adrenals appear normal, ovaries mildly enlarged. Right ovary having a bipolar length of 3.5cm and the left 3.7cm.  Fibroid uterus.

All points to PCOS, but my question is; should I have more tests for Cushing’s considering the ^^cortisol and the following symptoms/history;

- a definite hump on the top of my back/neck
- an area of skin (6 x 7cm) that is hyperpigmented on chest
- hirsutism
- ex-smoker (4 years since I quit, smoked heavily for 5 years)
- regular menstruation (BCP for 7 years)
- chronic dermatitis on palms of hands and thin skin (10 years+, poor healing++)
- no libido
- big stretch marks on abdomen, upper thighs and legs (have gone white now but red to begin with – some years ago)
- BMI = 33
- long history (5yrs+) of fatigue even though normal thyroid labs before TT

A gynaecologist who didn’t even ask where I was in my cycle when bloods were drawn says it is definitely PCOS, but will only treat the hirsutism by changing my BCP to Cyproterone acetate and ethinyloestradiol (not TTC yet).  Should I just accept this diagnosis and that my other symptoms are not related?  Or should I see an endocrinologist?
It’s now 21 weeks since my TT and I feel about 95% of my old self before TT, yay!
TSH=0.44 (0.50 – 4.00)
FT4= 13.5 (10.0 – 19.0)

[Mark Lupo, M.D.]

yes, would see an endo to make sure you don't have cushings, but the UFC of 182 is only borderline high so this is most likely PCOS - most endos treat this as well.

[Jenipeni]

Oops sorry I forgot to add - the tests run on the 14/3/07 for FSH, LH and E2 were taken during menstruation.  

Thanks in advance I sincerly appreciate your wisdom and guidance.
Jen

[jd2]

hi jenipeni,
i also had dermatitis on my hand (for 5 years after i spilled my chemistry experiment on my hand - learnt my lesson now and always use gloves)
anyways, i went to heaps of doctors and dermatologists coz it wasnt getting better and really hurt. eventually i found one doctor who told me to use emulsifying ointment (50% in water) - can get from chemists - as soap, and to try not to let ANY chemicals touch my hand - so in the shower i wear a vinyl glove (or any type of plastic glove), with a cotton glove inside, with emulsifying ointment on the dermatitis underneath.
im happy to say that my dermatitis has gone!! i even have a fingerprint on the finger it was on now. but i still have to be very careful with what i come into contact with.
my aunt also had dermatitis and found that if she didnt eat any dairy products it went away. i think a lot of people with thyroid problems also have a gluten intolerance, and lots of people with gluten intolerance also have lactose intolerance (dairy) - so it could also be worth trying that!
i know this doesnt solve your main problem, but hopefully it might help the dermatitis (although the dermatitis could be caused by something else -but the emulsifying ointment will still help it a lot)

[Jenipeni]

Hi!
Thanks very much for sharing your experience!  At home I don't use soap at all and I always wear gloves to do the dishes or housework.  I think I've tried just about every over the counter cream/preparation and soap alternative - I used to work at a chemist.  
Very interesting about the gluten and dairy stuff - I am highly suspicious, especially of dairy myself, but I love it soooo much!  You've prompted me to eliminate it from my diet for a fortnight or so and then bring it back and see if there's a reaction - I wouldn't be surprised because as a child I'd get sick after a big glass of milk.  But first we'll have to use up what's already here...
A few months ago we started buying a high quality Low GI bread - it's wholemeal and wholegrain, it's really heavy and much less refined than regular bread.  Anyway I've had the biggest improvement in the past 10 years since BUT I've also been using a zinc supplement and a fish oil supplement in that time.  So it's possibly a combined effect - zinc is good for healing and fish oils are great for dry skin.  
I believe what you are saying about the emulsifying ointment - there was a couple of times that my hands were so bad I had to have time off work and have my hands 'wet wrapped' - layers and layers of bandages wet with cream/ointment.  We used emulsifying ointment then.  On a day to day basis I find it too heavy/greasy.  

Wow - you must have been doing a serious chemistry experiment!  
Thanks again, - Lets hope our dermatitis goes away and stays away!!!  
Cheers!
Jenipeni

[jd2]

oh i forgot to mention also - a big problem with my dermatitis turned out to be the washing powder i was washing my clothes in (and my boyfriends at the time - i refused to touch him till he changed his washing powder!!)
im not sure what country you're in, but im in australia and now i use lux (soap flakes) with water softener (i think the water softener is from woolies) - and the dermatitis improved majorly (i also rinse twice). i used to use omo sensitive (bad) and my boyfriend used cold power (even worse!). recently i went to america (not sure if you're there or here?) and found it difficult to find lux/soap flakes - although i wasnt in a major city. i used some environmentally friendly brand that was made from coconut oil or something - and it was ok - but i only used it twice, which is probably not enough to know (although cold power will do it to me straight away!).
anyways, not sure if it will help you, but i know that i thought anything was worth a try!
hope you get better soon!
ps. the chemistry experiment wasn't that serious - just making oil of cloves (or what was sposed to be oil of cloves!) - i was just unco coz i was undiagnosed hypothyroid!!

[Jenipeni]

OH WOW!!! I'm in Australia too - A smallish town in country Victoria (I won't go into further detail than that because its small if you don't mind!)!  We have done the same thing trying different washing detergents and found (as you have) not all are alike. My hubby gets some dry skin too and he was also getting really itchy before we started experimenting.  We have been happy with "Earth Choice Laundry Liquid" you can get it from Coles and Woolies and the great thing is it is Phosphate Free so it's okay to use the washing water on the garden (grey water)!!!! Yay!!!  It's also pretty cheap too - some of these so called "Sensitive" washes are way expensive aren't they?  I've never used Lux flakes - but if ever I can't get my usual I'll look out for it!

Another thing I do is use a measuring cup (the kitchen kind) with the laundry liquid - cause I have a tendency to be a bit heavy handed!!!  So we only use 50ml per wash (full load) our skin stays happy and it's probably more ecconomical $$ and enviro too!  

And.. Another thing I notice a big difference from is drinking enough water - if I don't drink enough the dermatitis gets way worse!  
What state are you in?  I'm guessing you're not in Vic 'cause we call Woolies Safeway here. How long hypothyroid?  
I had TT (30th Nov 06) for obstructive multinodular goitre which had been observed for 10 years as it grew and grew... I'm 28...anyway...
I'm so glad to have made a smart Aussie friend who understands thyroid AND dermatitis!!  ;-D
Cheers!
Jen

[jd2]

hi jen!
i live in sydney, near the beach - but also won't say more here!!
victoria is really nice - i've been to melbourne and ballarat!
yay someone on here that's close to my age too -  im 25. i cant believe you had 10 years of thyroid problems!!! you poor thing!!!!
i'm sure ive been hypo since i had glandular fever when i was 19, but looking back im pretty sure the hashimotos started at 15.
was undiagnosed till a year ago, went through 5 years (plus the last one) of hell - which im sure you understand. (if you ever hear of anyone with chronic fatigue tell them to get their thyroid tested!!!)
finally i seem to be very close to the right dosage of oroxine (yayayayay), and im even able to run and surf a bit now! i've only found the right dose by adjusting it myself though - my first 3 doctors wanted me to take 4 times the amount im taking now!!
i also measure my washing powder :) - i think my family has always done it - probably for $$ reasons!!
anyways, that was really sweet - but i dont really understand thyroid that much (although dermatitis is maybe a different story.... think ive had it all!!) - i just write stuff that i've been through coz i wouldnt want anyone to suffer like i have!!
think i might've written a bit much... so better go
oh yeah i didnt know that about drinking water and dermatitis - i'll make sure i remember it next time i get it!
jd

[idesofmarch]

I suggest a 24 hour urine test for cortisol in your system. You have some Cushings symptoms.

[Jenipeni]

I already had the 24hr urine test for cortisol - see results in original post, result was elevated. Thanks