I have all the symptoms of hypothyroidism: gaining weight, losing hair, tired, cold, dry skin, etc. I have seen 3 endos and thyroid values are in the normal range (TSH 2.382; total T3 130; total T4 6.9). Thyroid peroxidase is 178.3 / thyroglobulin antibody 129.1 so am taking Armour Thyroid (1.5 grains) daily. This is having no effect on my symptoms. Interestingly, when I get extremely stressed (fight or flight) (only happened twice in my life), I start dropping weight & fluid & feel much better, despite eating & exercising the same. Last time this occurred was 2001 when I lost 18 lbs. When the stress leaves, the weight comes back, despite eating and exercising the same. I am now up to 146 lbs. and gaining. I do not eat enough to maintain my weight and I exercise and am generally very active.
ACTH stim test - I’ve read from reputable source: “. . . many patients with secondary adrenal insufficiency are missed because most doctors see doubling or more from a low base cortisol value with low ACTH being okay or even great, not recognizing this indicates low ACTH production.” I have also read regarding baseline values, “A healthy ACTH value should be just into the upper third of the range (assuming a range of 10-60).” My baseline ACTH was 7. My baseline cortisol was 16.7 and on the test, and a little more than doubled during the course of an hour. Doesn't this indicate a pituitary or hypothalamus problem?
DHEA is high, baseline 687. Endo did dexamethasone suppression test - pushed my ACTH to <5 and cortisol 1.0L, abnormally low according to the range. Put on .25 mg of Dexamethasone, but once DHEA was 1041, on Dexamethasone. Two endos told me to get off of it if it wasn’t helping prevent hair loss so I am not taking it now.
Should I see yet another endo? I know I've got a big problem, but no one seems to want to run it down. This problem has taken the joy out of life for me.
ACTH stim was completely normal -- not adrenal insufficiency in my mind, but discuss with your endo. And the dex supp test was normal -- so not Cushings.
The TSH is in the target range for hypothyroid treatment, so at this point, may need to consider that the symptoms may not be due to thyroid. The symptoms of hypothyroidism have many other causes. Once the endocrine work-up is complete (which it may be), then a general internal medicine re-evaluation may be necessary.
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