Adrenal Tumor or just Hypothyroid?

[UmmYeahOk]

I will start by saying that I have Hashimotos, and despite being diagnosed a year ago, I still have symptoms, nothing has changed. Anyway, I'm on my third endo (surprise), but very first day, he decides to test my adrenal function without me even asking! (I've asked the previous two endos if they needed to be looked at after they decided that I was fine on my current synthoid dose, which they of course explained to me how those people with andrenal problems are way way sicker, so there's no way I could have an issue.) So here are the results:

ACTH, Plasma 8.4 pg/mL 7.2-63.3

ACTH reference interval for samples collected between 7 and 10 AM. (Blood was taken at 3pm)

Cortisol - PM 30.8 ug/dL H 2.3-11.9

DHEA-Sulfate 222.0 ug/dL 84.8-378.0

Aldosterone 2.0 ng/dL 0.0-30.0

Cortisol seems EXTREMELY high, but don't seem to be able to compare it with other people's high results. Is this "high" or "OMFG HIGH!!!"? Based off this result, he put me on 88mcg, which I was on 112, but he did not know I was self medicating. In case you're wondering, these were the results of me being on 112mcg:

TSH 0.018 uIU/mL L 0.400-4.000
Free T4 1.36 ng/dL 0.80-1.80
Free T3 3.3 pg/mL 2.0-4.4u

So, TSH alone, I look hyper, but I don't think the FT4 or FT3 look bad. I don't feel any different on either dose. Anyway, so, he tells me 88, and to see him in 3 months. So, I'm guessing there's no real threat, if he's making me wait that long without any other kind of medical intervention other than staying on the 88 the previous two "TSH is the gospel" endos prescribed. I also stopped taking my birth control, hoping that might lower it some. But I'm wonder if being hypo for 16 years might've raised my cortisol to that level. It came on real gradually. IMO, I've always had trouble sleeping. (If that's a symptom)

I will ask my doctor these questions when I see him, but I won't get to see him until mid July. Naturally my Internet research has made me a little impatient. I know that one test alone is not enough. Probably will need a 24 hour saliva test to be sure, I'm just wondering how to speed things along if he decides to wait and see if my 3pm cortisol level have lowered with the 88 dose. So should I ask for a saliva or CRH stim test while I'm there, or have him order it once he realizes that I'm not hyper? Or is it just that I've just been hypo for so long that my body is just really this stressed out?

[UmmYeahOk]

These are July's results, taken at 3 in the afternoon. I asked about a 24hr saliva, but he claimed that they weren't able to test that, but offered a 24hr urine, which I did. These are the results with me off birth control and me on 88mcg of synthroid:

Cortisol, F, ug/24hr, Urine
23 ug/24 hr 0-50

Cortisol, F, ug/L, Urine
9 ug/L

Renin Activity, Plasma
4.58 ng/mL/hr
Adult Normal Salt
Intake:
Upright 1.31 - 3.95
Supine 0.15 - 2.33

Sodium
136 mEq/L 136-145

T3, Free (FT3)
3.9 pg/mL
2.0-4.4

T4, Free
1.67 ng/dL 0.80-1.80

TSH
0.035 uIU/mL L 0.400-4.000

Aldosterone
12.4 ng/dL 0.0-30.0

Cort. Bind. Glob. (CBG)
3.1 mg/dL 1.7 - 3.1

Cortisol, Serum LCMS
8.1 ug/dL
8:00 AM 8.0 - 19
4:00 PM 4.0 - 11

Free Cortisol, Serum
0.21 ug/dL
8:00 AM: 0.2 - 1.8

Percent Free Cortisol, Serum
2.6 %
8:00 am: 2.3 - 9.5

Cortisol - PM
9.9 ug/dL
2.3-11.9

So cortisol supposedly looks fine. So does this test rule out such a problem? I brought up my issue about having borderline aldosterone, and he prescribed half a tablet of fludrocortisone (.5mcg). I was surprised that the test showed the level as being pretty good, but I had already gotten the prescription, and I've noticed an improvement. I'm not as sensitive to the light as much (photophobia). I still hafta wear a hat outside, but rarely ever indoors. Also, I'm hardly ever light headed anymore, which I didn't think was related, but I guess so.

My FT3 and FT4 is the highest it's ever been, so with the low TSH, my synthroid dose was lowered to 75.

[UmmYeahOk]

Heat - no
cold - no
infection - no
trauma - don't think so
exercise - don't think so
obesity - no
Pregnancy - no
physical and emotional stress - don't think so
illness - unless you consider hashimoto's
debilitating disease - I wouldn't consider it "debilitating."

I might've been a little stressed the day of the draw only because I was late for my appointment, running everywhere, impatient even if waiting might've been a result from me being late. I do remember feeling like I had to rush everywhere. Can't imagine that effecting the results that bad though. My pulse was 94/68, something endo #1 thought was fine/normal. But when it was taken, my pulse was very high, and I think waiting for the doctor to come might've been on purpose, as he mentioned tachycardia, but pulse dropped to a normal level when he checked (though pressure stayed the exact same) So even though I felt rushed everywhere, I actually did a lot of sitting and had to sit and wait about 5-10 minutes before the blood draw.

I was taking birth control, but can't imagine it elevating it that much. I stopped on May 4th though, in hopes that will bring it down come July.

I don't really have any symptoms of cushings other than being "wired but tired." Pretty much have to force me to function in the morning. Very difficult. By evening I'm much better. Last few nights though, around midnight - 1am, I lie in bed feeling like I could run a mile. If I have caffeine, its about half a glass of coke, and during midday/afternoon. For several months now I have been taking Benadryl to get to sleep. A few weeks ago I think I finally built up a tolerance to it, but still take it in order to keep me asleep. Oh, and if I forget to take it, I'm up till 4am until I decide to take it.

I do bruise easily, and my c-section scar is purple/brown, but its also only 22 months old, so I'm not sure if that's normal or not. Have nothing to compare it to. I have low muscle tone. I used to be underweight, but over time gained 20lbs (if I lost 10, Id be underweight again) but its all around my waist.

I don't know what's a result of being hypo, or possible cushings. I just know that I don't feel nearly as bad as the people on here do. My biggest complaint is mostly brain fog. It came along around 11 years ago. I feel like a total moron most days.

I guess I could ask about a 24 hour saliva if he doesn't order it on his own.

[Red_Star]

Labtest Online lists other causes for high cortisol other than Cushing's...

"Heat, cold, infection, trauma, exercise, obesity, and debilitating disease can influence cortisol concentrations. Pregnancy, physical and emotional stress, and illness can increase cortisol levels. Cortisol levels may also increase as a result of hyperthyroidism or obesity. A number of drugs can also increase levels, particularly oral contraceptives (birth control pills), hydrocortisone (the synthetic form of cortisol), and spironolactone.

Adults have slightly higher cortisol levels than children do.

Hypothyroidism may decrease cortisol levels. Drugs that may decrease levels include some steroid hormones.

Salivary cortisol testing is being used more frequently to help diagnose Cushing syndrome and stress-related disorders but still requires specialized expertise to perform."

[UmmYeahOk]

I have a prescription from my primary for cytomel. Only because my symptoms weren't going away, he didn't want to increase based off blood results because he assumed the endo I was visiting knew what they were doing. In just two weeks time, I went from a TSH of 0.45 (0.30-5.10) to a TSH 2.76 (0.45-4.50) Probably because the higher one was taken early in the morning. That result would've been enough for any of my endos to increase, but they didnt get the result, my primary did. This was when I finally was able to get FT3 and FT4 results since going with endo #2. With Free T4 at 1.20 (0.82-1.77) 40% and Free T3 at 2.8 (2.0-4.4) 33%, I then self medicated to 100 until I ran out, and upped it to 112 (88+44). I didn't use cytomel with the 112 due to the lack of testing.

Anyway, so I had listed cytomel as a prescription I was taking, and made absolutely sure he knew that I hadn't taken any in the last 3 weeks because I wanted to see what my tests results were without it. Because of the results, he told me not to take it in addition to going back to the 88 dose. From the symptoms I mentioned, it was he who decided to test the adrenals, mentioning that my symptoms sounded hyper. But I will let him know that I've had these problems for years before ever being diagnosed, thus, not drug induced. I had a cheat sheet made out of my test history, dose history, symptoms when they appeared, along with dates for everything. He found that very useful and asked to keep it. But, like I said, there were dates for everything. So any hyper symptom he might suspect existed years, even a decade before the introduction of synthroid or cytomel. My cheat sheet, however, is arranged by date, so he might've noticed that the dates where 100mcg and 112mcg were added, no such test results were bundled with it like all the other previous dose increases were. It's possible that his suspicion of self medication helped him see the results in a different light.

Anyway, I figured with my second visit I'm a clean slate, and he can rule out being hyper, adjusting my dosage to what he thinks is right, rather than an unknown. Thing is though, if I felt better on the 112, he probably would have kept me on it, however, I felt no difference, but again, wasnt taking my cytomel.

So you think my high cortisol is caused by being hypo, not something else? Or, at least "probably so?" What tests should I ask/not ask for?

[Barb135]

I don't understand why he didn't leave you at the 112 mcg (what med?).  Your FT4 is at 56% of the range; rule of thumb is mid range... Your FT3 is at 50%; rule of thumb is upper half to upper third of range, so you're actually a little lacking there.  Lowering your dose is going to set you back.  Looks like you might benefit from a small dose of T3 to bump up your FT3 level, which would probably alleviate your symptoms and possibly help drop your cortisol level, since the adrenals kick in to help take up slack when there isn't enough thyroid hormones, so your cortisol will most likely increase, rather than decrease.

When self medicating, it's always best to be forthcoming with that information, so the doctor can see what benefits (or not) your efforts are producing.