hashimoto's, weight gain, and high corsisol in 24 hr urine lab test

[audrey214]

I switched endo's this year after my TSH was 5.9 and I gained 30 lb. The new endo suggested armour. I am on 60 mg and 3 months later my TSH is 1.5. My fasting blood work was normal(electrolytes,BUNS, and serum insulin all within mid-range) and glucose is 84.  However, my free cortisol was 64.8 High (range: 4.0-50.0)during a 24 hr urine collection. He just ordered 1 mg of dexamethasone to take at 11 pm followed by bloodwork the following morn at 8 am to check cortisol and ACTH. I have been under huge amounts of stress (mother recently died after long stays in nursing homes & hospital)coupled with an unruly young adult son, and a not so happy marriage. I really do not feel the 30 lb weight gain coincides with my diet. I truly do not feel what I eat could account for such a large weight gain. I have gone from a size 12 to a size 16, and look like I am 7 months pregnant. My hair is looking sgraggly and my nails are frail.I have been weaning off .25 climara patch and 100 mg progesterone since Dec 05.  My gyn switched me to 0.3/1.5 PREMPRO, and I am down to taking 1 tab every 10 days.I plan to take 1 tab every 2 wks, then 1 tab a month for a few mo, etc.until I am noticing no more flushes and RX is finished.  I am 57 years old.  What do you think about my stiuation--I look and feel so dumpy.  I saw a therapist for a few months and she felt I am not depressed&worked through the many family problems effectively.  I am a ret'd teacher since 1998 (have narcolepsy, but provigil is working well these past few years.I took real estate classes in 03 & passed but need to take state exam.

[Mark Lupo, M.D.]

sounds like the thyroid is reasonably treated - follow-up on the overnight dex suppression which will likely be normal and consider asking the endo to add a 30mg afternoon armour dose but would need to watch for signs/symptoms of hyperthyroid.

[audrey214]

I have a printout of my labwork from the new endo & he only tested my TSH, fasting results 1.5 with a range of .4-5.5. My electrolyte panel was unremarkable & basically middle of range in all areas. My BUN/creatine ratio were all good-mid range.  My fasting glucose was 84 with a range of 65-99..  My free cortisol was 64.8(range 4-50), creatine in the 24 hr urine was 1.04 (range .63-2.5) My potassium during the 24 hr urine was 100 (range 22-160).  He did not order any other thyroid tests-just the TSH after he switched me to Armour.  My old endo kept reducing my synthroid from ................112mg to 100mg & then she lowerecd me to .88mg because she couldn't rationalize keeping my synthroid any higher because of my labwork. i didn't notice any weight gain until she lowered me to .88mg & I told her everytime I stepped on the scale I was gaining a lb or 2.  She said quitting smoking would cause that and being on HRT (had been on lowest patch of 0.25 estradial was the equivalent--can't think of the brand and 100 mg prometrium--now on lowest strength prempro--1 tab every 10 days-very few hot flashes. Almost done with HRT.  My new endo said some people do better on armour & gave me a script for 60 mg & I took it from Feb to present date-had labwork & 24 hr urine test down the end of April, 06.  He only checked my TSH & nothing else. Receptionist said he felt my level of armour was doing the job, but wants further cortisol testing-am doing this labwork tomorrow or Wed

[GravesLady]

There could be many reasons you are feeling they way you do.  For examples, it takes time to heal, maybe you are not at the level that makes you feel your best - one level dose not fit all.  Some people do not do well or feel well taking Armour, perhaps you are one of them, yet others swear by it. Thyroid symptoms share some of the same symptoms with many other health conditions, so maybe something else is going on.
Until you get stress out of your life, most of it anyway,  you will not heal.  Stress is not good nor healthy, expecially for autoimmune thyroid or any other autoimmune disorders or health issues.  Stress can make a person gain weight or make it hard to lose no mattew where your levels are, suppressed or not or what meds you are taking, Armour or not. And if the weight is all or mostly in the middle stomach area it is stress related and a sign for future heart problems as well, which is the leading cause in women death today. Do some stress relief therapy.  Yoga is very good, running, laughing (go see funny movies or read funny books).  I avoid sad dramas and movies on TV and watch mostly funny sit-coms because its better for stress to laugh than to be sad.  A nice long hot candle light aroma bath every night or at least once a week, eating properly, getting sufficient rest, and getting good recreational exercise and any other diversions will also help to lessen the stress loads on your body and mind.  Buy yourself a pretty new outfit, change make-up, get a new hair style, go to a hair and beauty salon, spa,  treat yourself to somthing wonderful, will help with your feeling dumpy. You are a beautiful women so be good to yourelf, you deserve it.
I don't think there is an easy and fast solution and what works for one may not work for another and that goes for meds and levels - we are not all alike.

[audrey214]

THANKS FORUM M.D.-ML, KELLIEK, AND GRAVESLADY FOR YOUR COMMENTS.  I WILL LET YOU KNOW HOW THE LABWORK GOES & ASK ABOUT POSSIBLY ADDING THE 30 MG ARMOUR IN THE PM.  I WAS GLAD TO HEAR THAT THE MD FELT THE SERMUM CORTISOL/ACTH LABWORK WILL PROBABLY BE NORMAL. I AGREE STRESS CAN PLAY HAVOC WITH ONE'S BODY. I WILL TRY TO KEEP THOSE STRESS BUSTERS IN ACTION, AND HOPE MY WEIGHT GOES DOWN AND I BEGIN TO FEEL BETTER. LIKE I SAID BEFORE THIS HAS BEEN THE WORST YEAR OF MY LIFE---IT WAS JUST LIKE MURPHY'S LAW ---IF ANYTHING COULD GO WRONG IT DID. I DO TEND TO LOOK AT THE CUP AS BEING HALF FULL, AND KEEP THINKING TOMORROW WILL BE BETTER. I WILL COME BACK TO THE SITE TO REPORT MY LAB RESULTS. THANKS AGAIN FOR ALL OF YOUR REPONSES TO MY QUESTIONS.

[rwr]

You mentioned that only TSH is being tested.  What about your T3 levels.  Maybe you need cytomel as well to help alleviate some of your problems.  I was just diagnosed with hypo at an elevated TSH of 19.5 and I just had tests for T3 as well as T4 and I also had the cortisol test.  Although I don't suspect having it, Crone's (spelling?) disease plays havoc on cortisol levels as well.  You might ask about need for addressing T3.

[rwr]

Ooops...I meant cushing's instead of Crohn's

[byegonebooks]

Hi

I have high cortisol along with Hashimotos. High cortisol as well as low cortisol wrecks havoc with thyroid hormones.  High cortisol creates thyroid resistance, estrogen dominence and insulin resistance. I gave up on mainstream docs several years ago since I was misdiagnosed for 25 years and they ran my health into the ground. I now see a holistic MD who understands the whole endocrine system. I take biotics research ADHS to normalize the cortisol levels and natural progesterone to keep the estrogen under control as I am always hot. You are on a rather low dose of Armour and will most likely need more. The lab results are almost useless. The ARmour will build up in your blood and will not get into your cells and lab tests are simply blood tests. They do not tell what is in your cells. Ideally you want your Free T3 to be in the upper third of the range and FT4 to be past the middle to upper range. TSH when on Armour is almost useless as it disrupts the negative feedback between the pituary and thyroid. A normal thyroid needs between 3-5 grains of Armour.