Hi doctor,
I am suffering with hypothyroidism and polycystic ovaries. Over last three years, I have gained 15 kg of weight. I am taking T4 150 mg, Glucophage 850 mg and Yasmin. I think I have Cushing's syndrome. My cortisol level in blood is 34 in the morning but in 24 hour urine test it is in normal level. Also my ACTH is 63.4 whereas the upper limit is 64. I am eating healthy diet and I exercise every day. Over three years now, but I cannot find a solution for this problem. I visited an endocrinologist and also a dietitian but of no use. I also have acne. If I do not take birth control pills then I will not get my periods. I am very tired all day and I even feel very difficult to move. I have anxiety too. Please help.
Hi,
Welcome to icliniq.com.
There may be three possibilities. Either your polycystic ovarian syndrome and hypothyroidism are two separate disorders or it may be a pituitary or autoimmune disease which affects many organs.
If any problem in the above tests then pituitary is affected and the treatment differs.
Revert back with the test reports to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
In my MRI brain and pituitary, nothing was found abnormal. I also had my kidney ultrasound which looks normal. I did blood tests for autoimmune disease and they were negative. My recent prolactin level was 28, which is above the limit. What else should I do?
Hi,
Welcome back to icliniq.com.
Please do the above tests and also consult your gynecologist regarding side effects of oral birth control pills.
Revert back with the blood report to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
I got some tests done. My MRI, nerves and adrenal are normal. I did cortisol test after tablet Dexamethasone 1 mg. The value went from 34 mg/dL in the morning to 3.4 mg/L and ACTH from 63.4 pg/mL to 5.7 pg/mL. Other values are FT4 1.98 ng/dL, GH 4.4 ng/mL, SM-C 104 ng/mL, anti-TPO 9 IU/mL, anti-TG 40 IU/mL and creatinine 0.60 mg/dL. GnRH and TRH are yet to be done. From the results, what is your opinion about my condition? Is it Cushing's syndrome? Should I take Signifor or Metyrapone?
Hi,
Welcome back to icliniq.com.
I went through the reports (attachment removed to protect patient identity) posted by you.
Your reports are fine and definitely you do not have Cushing's. Moreover, your BMI (body mass Index) is 25 which is quite normal (high normal). So, I do not think you have any disease that is causing you unusual weight gain.
Otherwise, you do not have any endocrinological problem. One more advise is to get tested for diabetes.
Revert back with TSH report to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
My main problem is that I am keep gaining weight. I was 55 kg and now I am 75 kg. I put on 8 kg in a month when the doctor changed the T4 dose from 75 mg to 50 mg. Gained 5 kg in two weeks when the doctor changed T4 from 150 mg to 100 mg. I exercise every day and my diet includes healthy foods such as salads, fruits, vegetables, turkey and chicken. Definitely there is something wrong. Should I control cortisol levels with pills? My TSH level is 1.98.
Hi,
Welcome back to icliniq.com.
Your TSH is in normal range. So, the decision to reduce your thyroid medication dose is right.
For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
Even I have tried this before. I have stopped Yasmin twice for 6 months and nothing happened. I cannot lose weight and I cannot reduce T4 dose because I will gain even more weight. My morning cortisol is 34 and prolactin is 28. Should I use Metyrapone or something else to control cortisol and to lose weight? Nothing happened with exercise and healthy meals for about three years and three months now. I have consulted many doctors and I have done many tests but there is no solution to my problem. Can you please help me? Any ideas or suggestions of what I may have. My diabetes test in also negative.
Hi,
Welcome back to icliniq.com.
There are two issues here. Weight gain and high cortisol.
High cortisol and weight gain could be due to Yasmin intake. As you are saying that weight gain is happening even after stopping Yasmin for six months, we need to consider other causes of weight gain.
Revert back with the scan report to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
My MRI nerves, adrenal, brain and pituitary were normal. Also my kidneys are normal in ultrasound. I have done free cortisol test in urine for 24 hours one month back with the same tablet and it was 60 mg/24 hours, hv = 1230 mL and cortisol in blood was 21.04 mg/dL. The problem is not only increasing weight, I also have anxiety and headache every day. Periods problem and acne trouble too. I feel tired the whole day.
Hi,
Welcome back to icliniq.com.
The normal range for urinary free cortisol is 3.5 - 45 ug/24 hour while you have 60. This could be taken as suggestive of Cushing's but a normal Dexamethasone suppression test goes against Cushing's. So, there is a dilemma here.
That too a normal MRI brain, pituitary and adrenal scans supports the diagnosis as not Cushing's.
There are two options for you. One wait for 6-8 weeks and get the tests re-done that is urinary free cortisol and Dexamethasone suppression test or get started on treatment with Ketoconazole or Metyrapone.
One thing you need to understand is if started on treatment with Ketoconazole or Metyrapone may cause reduced efficacy of Yasmin. Among the two option I recommend the first one.
Revert back with the investigation report to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
I have read that only 50% of pituitary tumors only seen in MRI. I have reduced the efficacy of Yasmin. My periods is irregular now. With these pills, will I lose weight, anxiety, headaches and tiredness?
Hi,
Welcome back to icliniq.com.
Yes, not all tumors will be seen in MRI. But, next time when you go for scan ask for pituitary scan and not just MRI brain. Also get it in a MRI of 3 Tesla strength.
After the start of medication, your weight gain will slow down. But I do not think you will loss weight.
For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
I have done three separate MRIs for brain, pituitary and adrenal gland. Well, If I continue exercising and eat healthy along with prescribed medicine, will I lose weight?
Hi,
Welcome back to icliniq.com.
Yes, you will lose weight. Please follow my advice for better outcome.
You should avoid non-vegetarian food including chicken. Eat more of fruits and vegetables.
For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
I read that Metyrapone is 75% effective and Mifepristone 60%. What dosage do you suggest for me? Regarding an alternative of Yasmin, should I go for anything seasonale?
Hi,
Welcome back to icliniq.com.
For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
Hi doctor,
I had few tests yesterday. My 24 hour cortisol in urine is 72.1 mcg/g CR; previously it was 60 mcg/g CR. Early morning cortisol is 40.5 mg/dL while previous one was 38 mg/dL. ACTH is 80.8 pg/ml and last one was 63.4 pg/mL. After this I had high dose suppression test with Dexamethasone 8 mg and here are the results. Cortisol 2.5 mg/dL and ACTH 1.9 pg/mL. I read that if the disease is Cushing, suppression will be more than 60%. What does it mean?
Hi,
Welcome to icliniq.com.
If you have done the test while on Yasmin, then this test does not hold any significance.
For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician
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