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Hi peeps,

I've been suffering from several hormone imbalances for 3.5 years now and I am, as many of you, getting more and more frustrated by not getting nowhere. I hope to find some words of advise regarding my complex condition and I will do my best to keep it short and focus on the main points.

- 28 years old, female, 160cm, 65kg, German (no native speaker, please excuse my English :))

- drugs and supplements I have been taking but didn't lead to any long-term improvement which is why I stopped taking them after some time: levothyroxine, metformin, birth control, minerals and vitamins (highly dosed)

My current condition involves:

- low t4 and t3 levels

- low-to-medium cortisol and DHEA levels (after episodes of elevated cortisol in the past 3 years)

- insulin resistance and high blood sugar levels

- hypoadrenalism (I understand that it's no diagnosis for real, yet I have obvious symptoms of adrenal depletion)

- in general, typical symptoms like tiredness, muscle weakness, hirsutism, weight gain, inability to lose weight, cravings for salt / sugar to feel a short boost of energy, hypoglycemia, dry skin, slow metabolism, impaired digestion, etc.

- AGS, Diabetes and adrenal insufficiency have been ruled out at least

- no thyroidal antibodies atm (but in 2013, which led to the diagnosis Hashimoto's)

- currently on birth control to suppress PCOS symptoms like irregular periods and hair loss, with limited improvement of hirsutism

- currently no other drugs or thyroid treatment

The complexity leaves my doctors stumped, just like me.

I don't know where to start, as I have tried so much and each of my conditions would require different treatment - natural progesterone, thyroid hormone replacement (natural desiccated maybe?), pregnenolone.

However, I am aware that hormones shouldn't be played with wherefore I am extremely careful in taking next steps. Everything is so deeply intertwined and I am afraid to do more harm than good by e.g. start taking synthetic cortisone. Attempts to stay off birth control for a year have resulted in elevated androgenes and PCOS symptoms.

Any experiences from people who have been suffering from these multiple conditions? Any advise on what to treat first? Are natural hormones required or will synthetic ones do? Is there a key origin point that needs to be addressed in order to trigger overall recovery, e.g. adequate treatment of the Thyroid or Adrenals will lead to improvement of the other conditions?

Also, please let me know if there are other highly-frequented boards hosting discussions about hormonal imbalances. I am pretty keen on sharing knowledge and experiences.

Best wishes,
Linda

PS: I can upload several blood tests if required (hypothyroidism, PCOS, insulin resistance and low cortisol are pretty obvious though).
 

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Welcome to the board!

Can you please post a few thyroid labs to include ranges and what drugs or supplements you were taking at time of lab draw.

As far as cortisol - 4 point saliva testing is what most here have experience with. When you state your cortisol is "low" what do you mean by that? How are they testing your cortisol? Single blood draw or 4 point saliva?
 

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Hi Lovlkn,

thanks for the welcome. I am happy to provide some lab test results and szintigraphy images (done in 2013 and 2016).

As can be seen in the attachment, my first doctor (GP) gave me Levothyroxine + iodine because in 2008 he diagnosed slight hypothyroidism. No inflammation though. I was feeling fit and well enough to do sports regularly, apart from my struggling with generalised anxiety disorder. No other hypo symptoms at this time, hair was ok, PCOS was not strong, normal weight and weight loss was possible.

In 2013 I went to see a new doctor when my metabolism crashed (looking back I am sure I went through an episode of adrenal crisis and hashimoto's) as a consequence of ultra-low carb dieting, exercising heavily and going off birth control. This is when I was diagnosed with elevated thyroid antibodies, high CRP indicating my body was in an inflamed state and furthermore the slight hypothyroid and PCOS symptoms became more severe including dry skin, slow metabolism, impaired digestion, weight gain, thinned hair and hair loss, damageable fingernails, exhaustion etc.

So the new doc put me on Levothyroxine in varying dosages and full/split doses. There were around 5 weeks between each blood test performed. Felt an initial boost for the first 2 weeks of treatment, but the symptoms became worse again and continued to do so even though t3 and t4 were stable while treated. After 9 months my thyroid levels plummeted all of a sudden, which is why I stopped taking LT from July 2014.

So much for the thyroid. In terms of cortisol, only serum blood tests have been made repeatedly in the mornings. From 2013 to 2016 I have experienced medium levels of cortisol overall:

2013: can't find the test but I remember cortisol was around 300 nmol/l

02/2014: 192 nmol/l

02/2014: 412 nmol/l

No reference range given but this site indicates the levels were fine.

06/2016: 8.1 µg/dl (5.0-25.00), ACTH 19 ng/l (< 46)

The low levels of cortisol and ACTH in June 2016 had then led to an ACTH stimulation test:

Cortisol in µg/dl: 13.3 (0 minutes), 20.7 (30 minutes), 27.3 (60 minutes)

Reference range: Cortisol is supposed to be higher than > 25 at the end of the testing. Alternatively, a delta of at least 10 is required to prove adrenal gland function/stimulation.

Since the ACTH test was not too bad, no further measures have been taken. However, as my cortisol is low end reference level and I am suffering from nausea, muscle weakness and fainting since 2016 I suspect my adrenals are weakened.

I have been researching a lot about 24h cortisol saliva testing but I am not sure about the benefits. Do you think it is required to give better insights?

There are two possible outcomes if I were to do a saliva test now:

1. normal-ranged cortisol levels, meaning my symptoms could only be attributed to my thyroid - or

2. low or high cortisol levels, maybe following a non-circadian trend, indicating I should get treatment for my adrenals.

Nevertheless I am not sure if this would be beneficial in order to lead the way to adequate treatment. But I am willing to learn!
 

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24/6/2016 - labs, were you taking any thyroid hormone at that time?

All your thyroid labs have you in a hypo state. It looks to me like your conversion of levothyroxine is not sufficient but overall you are low in thyroid hormones even taking levothyroxine.

The 24/6/2016 is the only lab where your FT-3 is in a good range, FT-4 is still on the low side.

I don't have any experience with PCOS so am unable to comment. Cortisol and thyroid do impact eachother but I am not expert in that either.
 

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No, I did not take any thyroid hormone anytime in 2016. In summer I used to spend lots of time outside in the sun and was taking 200µg iodine every morning, so I assume sufficient vitamin D levels and especially iodine had a supportive effect on t4-t3 conversion.

The odd fact is that I was not feeling any better despite having good t3 levels. I was quite fatigued and too weakened to do even the lightest workout. If I did any sports like 15mins of jogging and 30mins bodyweight exercises, it would leave me sore for about a week and enforced a state of exhaustion for days. Also, no weight loss happening despite healthy and normal-low caloric diet. That is why I went to have my cortisol checked and got the ACTH stimulation test done.

I agree that my lab results indicate a hypo state for years. Due to my current symptomes I personally do not want to rule out weakened adrenals and of course I do see the connection between thyroid / adrenals / sex hormones. You may know the struggle of finding docs who are willing to treat hypos with t3 or NDTs.

What does your intuition say about treatment options? I considered searching a doctor to prescribe armour and start off 1/2 grain. Also, microdosing hydrocortisone (1-2mg a day) could be an option.
 

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Do not start hydrocortisone until you have done an adrenal saliva test and a doctor prescribes it. High and low cortisol symptoms can mimic each other and until you know what you have for sure, you could be making yourself even worse. Blood cortisol is not a great test because it checks one moment in time, whereas saliva checks levels at 4 points throughout the day so you can see your pattern.
 

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Hi, Linda,

do you mind if i ask whether you were diagnosed with Pcos before or after the Thyroid diagnosis ?

the reason i ask is i was diagnosed with Pcos many many years ago (probably 2005).

While trying to conceive baby number 2 in 2010, i was put on hormone treatment, a large cyst appeared on the ovary, forward a few months, i ended up with an ovarian torsion in 2011 ( the pain was horrendous- not nice at all) and ended up having an emergency left ovary removal. I went on to have 2 more babies (3 total) after the left ovary was gone, and i still believe that that one ovary was causing most of my PCOS. I still have Pcos symptoms, difficulty to loose weight ( i am overweight 1m63 and about 86 kilos), the hirsutism never really improved , i still have very heavy periods (the gynea actually did a DNC procedure last year to clear my womb out), which in turn has brought issues with Aneamia, fatigue and depression.

I also have PMS symptoms, hot flashes, mood swings.

then earlier this year, i went to the gp complaining of insomnia, ,pressure in my neck, and bloods and ultrasound was requested . the bloods came back in range ( although very close to bottom range), but the ultrasound revealed nodules on the thyroid. i am scheduled for surgery in about 3 weeks time, still to decide what to do, although leaning at the moment towards Total Thyroidectomy)

i still personally believe there is a link between the ovary hormones and the thyroid hormones . but it is hard to know, maybe my original pcos/ pms symptoms where the thyroid acting up all along ..(that is just an opinion). i never saw an endocrinologist for pcos, i only started to see the endo when they noticed the nodules on the thyroid. i wish i had the info i have now about the thyroid , when i was first diagnosed with pcos.

pcos seems to run in my family, my sister also has pcos, and we suspect my mother had it too, although not confirmed .

thyroid issues also run in my family, my mother had a Total Thyroidectomy about 15 years ago.

i know our stories are different but i think there is common ground in a some of our issues , so i felt i should share with you.

all the best

cascais

for reference my latest bloods are :

tsh 0.77 (range 0.27.4.20)

free t4 12.16 (range 12.00 -22.00)

tpo antibodies <4.0 (range 0.0 to 25.0)
 
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