# Enlarged thyroid coupled with Adrenal issues~ Please help my GP out~



## ~peaches~ (Jun 28, 2011)

Brief history: Diagnosed with Cushings Disease in 2009, three pituitary tumors removed in May 2010. I was on hydrocortisone for 3 months and slowly tapered off.

GP put me on Synthyroid 6 months after surgery due to my symptoms (labs were low/normal). I had a severe reaction, looking back it was Adrenal Insufficiency symptoms, unfortunately I didn't put two and two together at the time. I suggested Cytomel thinking I had a conversion problem. 2nd month on the Cytomel I recognized my Adrenal Insufficiency problems and quit the Cytomel and started on Hydrocortisone again. I got up to 15mg's daily on the hydrocortisone, as I began to wean off the hydro ( I was only on it 10 days) I started noticing a tightness in my throat and a dull headache.

My GP ran bloodwork:
Free T4- .78 (.46-1.42)
Free T3- 2.2 (2.5-3.9)
TSH- 2.29 (.340-5.60)
Thyroxine T4- 6.58 (4.87-11.72)
Ferritin-22.8 (11.0-306.8)
Iron- 51 (30-160)

Reverse T3 and T3 uptake is still pending

I have been doing some research and it suggest tapering off hydrocortisone can cause some autoimmune thyroidistis. I have also read I could have secondary hypothyroidism due to my pituitary surgery.

Has anyone here had experience with hydrocortisone and a enlarged thyroid? 
My GP is willing to send me for any test I need I am having a hard time pinpointing what labs I need at this point. Any suggestions?


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## lainey (Aug 26, 2010)

Okay, are you sure you don't need an endo for this? The pituitary tumors complicate things from the start, as your symptoms are likely not only thyroid in origin. That makes it difficult to comment, because the adrenal issues are truly a complicating factor in your labs, as is the medication you are taking for it.

You really should follow up on the adrenal insufficiency first, it may be that you need that low dose of hydrocortisone.

Okay, if you have central hypothyroidism due to the pituitary surgery, the first thing is that I would consider is that you treat to the free T4 and T3, because the TSH may not respond properly--the pituitary is what produces the TSH, and if yours is damaged, it cannot be relied upon to "respond" as it should to medication or the levels of thyroid hormone in your blood.

With the free T4 low in the range as it is, it is not surprising that the free T3 is below the range. You need one for the other.

Steroids (hydrocortisone) also tend to alter the thyroid numbers (ie, it tends to lower all of them and will make the reverse T3 high). You'll get a clearer picture of your numbers when the drugs have cleared your system.

I would start by looking at the adrenal/pituitary first and consider how the hydrocortisone affects the T4 and T3.

You could have antibodies testing for thyroid, to see if there is something autoimmune happening.

It's not impossible to have thyroiditis either alone or as part of this. Have you had a thyroid ultrasound?


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## ~peaches~ (Jun 28, 2011)

Thank you for your response.

I know I need an endo for this, unfortunately without insurance it is not affordable for me. I will be making an appointment with one very soon. I will be having an ultrsound tomorrow afternoon.
If I try to get off my hydrocortisone I have AI and my thyroid gets even more enlarged. So I am at a loss with this one.
I got some more labs back and it looks as if my ACTH is very low (sign of low adrenal function)

Aldosterone: 2.5 (4.0-31.0) supine less than or equal to 16.0 . I was upright.
Renin: 1.4 (supine 0.2-1.6) (upright 0.5-4.0)
ACTH 8 (6-58)
T3 Uptake 35 (28-41)
T3 reverse 244 (90-350)
Vit D 52 (15-75)
DHEA 1.790 (1.330-7.780)
Testosterone 26 (11-56)
Sex binding globulin 45 (30-135)
Free Testosterone 3.6 (1.3- 9.2)


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## lainey (Aug 26, 2010)

If you need the hydrocortisone because of the AI, there really isn't a way around it. Like anything, it would be determining the minimum dose needed to manage your symptoms.


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## ~peaches~ (Jun 28, 2011)

I guess what I am trying to establish is whether or not the hydrocrtisone has caused my thyroid to enlarge OR has the weaning off hydrocortisone unmasked something auto immune going on with my thyroid.


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## Andros (Aug 26, 2009)

~peaches~ said:


> Brief history: Diagnosed with Cushings Disease in 2009, three pituitary tumors removed in May 2010. I was on hydrocortisone for 3 months and slowly tapered off.
> 
> GP put me on Synthyroid 6 months after surgery due to my symptoms (labs were low/normal). I had a severe reaction, looking back it was Adrenal Insufficiency symptoms, unfortunately I didn't put two and two together at the time. I suggested Cytomel thinking I had a conversion problem. 2nd month on the Cytomel I recognized my Adrenal Insufficiency problems and quit the Cytomel and started on Hydrocortisone again. I got up to 15mg's daily on the hydrocortisone, as I began to wean off the hydro ( I was only on it 10 days) I started noticing a tightness in my throat and a dull headache.
> 
> ...


Goodness gracious! Bless your little heart. You have had some major challenges here.

When you were on the Cytomel, what was the dose and were you also on any T4 at that same time and if so, what was the dose of that?

Your ferritin is very low and low ferritin impedes the efficacy of thyroxine replacement. Ferritin should be 50 to 100; the closer to 100, the better. Please go to the link and read.

Ferritin http://www.thewayup.com/newsletters/081504.htm

I am glad you are having the ultra-sound tomorrow and I sure hope you let us know the outcome. Keeping my fingers crossed for you. It's a shame but sometimes more than one thing can be happening simultaneously and it is hard to figure out which came first; the cart or the horse.

Not too knowledgable about the adrenals.

I want to welcome you and even though I have limited knowledge, I plan on helping best I can and I know others here will as well.

Lainey always provides credible info.


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## lainey (Aug 26, 2010)

~peaches~ said:


> I guess what I am trying to establish is whether or not the hydrocrtisone has caused my thyroid to enlarge OR has the weaning off hydrocortisone unmasked something auto immune going on with my thyroid.


Honestly, I think both are likely. The way to find out if there is an autoimmune problem with the thyroid is to run the thyroid antibodies. That would give a clearer picture--maybe, because steroids do reduce inflammation.

I would say, if you were stable and choose to stay on a cortisone dose for the AI, you could then trial a low dose of T4 and see what impact it has if it turns out that there is a thyroid issue brewing. It will be important to measure the free T4 and T3 to see where you are, and factor in the effects of the hydrocortisone medication and pituitary issue when reading your labs.

This really is a complex issue--maybe your GP has an endo friend that could help them consult on this so that you can avoid having to pay a second doctor?


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## ~peaches~ (Jun 28, 2011)

Thank you all for the replies :hugs:

I finally got an appointment with one of the best endo's in Ga, unfortunately it's 6 months away. I am praying they will call me if they have a cancellation. I am in a bit of a tough spot to say the least.

I did see my low Ferritin (thank Andros). So I ordered what Dr.F in California suggest http://goodhormonehealth.com/Iron Deficiency and Fatigueaug06.pdf.
After reading the article I am leery about trying T4 since Iron helps with conversion. With mine being so low It might be why I had AI when I took Synthyroid.
Lainey I am defiantly going to get my GP to run a thyroid antibodies test.
My Gp told me it looks like my Pituitary is failing, which I understood those risk going into Pit surgery, but it is a complicated animal.
Thank you for all the replies.


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## Andros (Aug 26, 2009)

~peaches~ said:


> Thank you all for the replies :hugs:
> 
> I finally got an appointment with one of the best endo's in Ga, unfortunately it's 6 months away. I am praying they will call me if they have a cancellation. I am in a bit of a tough spot to say the least.
> 
> ...


A fellow Georgian!! We live in Henry Co.. South of the Perimeter.

Are you sure you do not have Addison's instead of Cushing's? I presume you were tested for Addison's? In other words, you know for a fact that the adrenals are functioning?

I was just thinking about that and thought I would toss it out there.

Smart to get on the cancellation list; good for you and I sure do hope this doctor can help you feel better. You have been through so much and you deserve quality of life!


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