would adrenal affects thyroid stabilization

[bjlake3692]

My husband was diagonised in 98 w/ Graves and had surgery in 2000 to remove the thyroid.  Since then, the past 10 years have been terrible.  His quality of life has steady gone down hill.  He has been on high doses of T4 treatment with no relief, he complaines that after months of treatment with one type of medicine its like it just stops working altogether.  Two years ago finally switch to a T4/T3 treatment which seemed to be alot better then just T4 but then about 2 months ago, got really sick again and the blood test showed TSH at 44 and both the free T4 and free T3 below range.

His symtpoms are too long to list (and many of them overlap conditions it could be for ex. "butterfly like rash on his checks and nose), but from the very beginning he has demonstrated symptoms of Addisions (I have an aunt that has this condition so I'm very fimilar with it).  Long story short, in 2000 my husband had a one STIM test done the results were as followed
12:00 PM results were 19
1:00 PM results were 8
I know this is "not" normal (should of doubled not decreased in half) but since both were within the normal range we were told there was NO issue, but now I'm starting to wonder.  Having an aunt with addisions I understand the serious of adrenal but at the same time I know that if they are not messed up the last thing you want to do is mess with them so here are my questions
1.  are the results he got something to be concerned with, or atleast worth further investigating (his family has thyroid issues, Vit D deficencies, Adult Growth Hormone difencies, adrenal issues (non addisions) and celiacs)
2. Would the adrenals cause the TSH to bottom out like that after months on a given dose of thyroid treatment
3. Is there anything else you would suggest we look for, we can't seem to get a doctor to even check for anything else even with the family history

[bjlake3692]

I'm sorry don't mean to bother you but I really would appreciate it if you could explain the one hour STIM test to me.  Everything I read says the same thing..."If cortisol levels do not respond to the ACTH stimulation test, then it is more likely that the problem is based in the adrenal glands"  

I guess I don't understand how both an increase and a decrease on the one hour STIM test can both mean NORMAL.  If its just based on what the cortisol level is without the injection, why would they even bother to give the injection and retest.  I thought the purpose of the test was to see how the adrenal responded to the injection....and in this case they decreased.


We are scheduled to have an AM cortisol level done in January, but like I said I'm scared that if my husband has an adrenal issue and they do surgery we could have BIG issues.  

[bjlake3692]

So the decrease in okay since it was within normal range?  I always thought anything less than double was an indication that they weren't working properly.

Thanks for your reply its just so frustrating when the symptoms overlap and then we had so much trouble with getting the TSH regulated that its hard to even determine what are hypo symtpoms and which ones are not related to the thyroid.  I just wish we could figure out why we can't get the TSH regulated.

[Mark Lupo, M.D.]

The 2000 cortisol of 19 reflects normal adrenal status.
If you have these concerns currently still about adrenal, consult with the endocrinologist to re-evaluate.  With butterfly rash, also consider lupus.
TSH will not likely bottom out with adrenal issues.

[bjlake3692]

Forgot to mention why I'm especially concern.  They just found an cerebral aneursym (his father died of one at a young age).  We are under the impression they will be doing surgery on it-we see the surgeon on Friday.  I'm concern of having the surgery done when my husband has so many other issues that haven't been resolved.  It scares me to think of him going under with that low of a TSH or "undiagonized" adrenal issues.