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DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64415
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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My daughter who is 23 years was born at 25 weeks gestation

Resolved Question:

Hi, my daughter who is 23 years was born at 25 weeks gestation and hasn't felt well for a number of years. She is an accountant and works hard. She has hypothyroidism diagnosed at 6 years and pernicious anaemia .
About 2 years ago she had what they thought was post viral fatigue. she recovered after about 3 months. Her cortisol levels were high and she put on a large amount of weight very quickly. Since then she has fluctuations in her cortisol levels...see latest blood results.
Her symptoms are
Weight gain
Fluctuating cortisol level
Acid stomach
Swollen upper eye lid
Painful behind the eyeballs (she ices them as they hurt her)
She takes 150 thyroxine
And b12 injections 3 months
She has recently had a full blood test done. Renal and liver function were fine, immunoglobulins were fine, and creating kinase was normal. Ck and serum calcium were also normal. Crp and esr are normal as well as fasting sugar.
Free t3 5.2 (2.8-7.1)
Free t4 22.0 (12.5-20.5) Hi
Tsh 3.93 (0.60-4.20)
TPO 1069 (0-75) HI
Ferritin 62 (13-150)
B12 573 (197-771)
Cortisol 718 (172-497) Hi
Electrophoresis alpha 1- 3.5 (2.1-3.5). ....... Is she borderline???
Electrophoresis alpha 2 7.2 (5.1-8.5)
Beta globulin 1. 5.1 (3.4-5.2)....borderline?
I have been looking on the Internet at different medical conditions, and I did wonder if she could have cushings?
katies cortisol level was 501 in 2011, 802 in Feb 2014 (felt very ill) and later in Feb when it was down to 26 and now it is high again and she feels unwell.
Are there any more tests you think katie should have to rule things out? I can get them done privately.
I hate seeing my daughter like this. She is feeling extremely down with her weight gain and how she is feeling. She is normally an outgoing person, but is feeling low.
I look forward to receiving your suggestions......
Submitted: 1 year ago.
Category: Medical
Expert:  DrRussMD replied 1 year ago.
HelloThe solution is simple here.She is hypothyroid.Simple as that.3.93 on a TSH would be hypo for someone NOT on medication.Optimal for treatment is .8 to 1.She needs her thyroid medication increase, TSH in 8 weeks, and increased again if needed.The spot cortisol is not useful.She needs, first, a 24 hour urine for free cortisol.If this is high she needs further investigation, yes for cushings.She should be seeing an endocrinologist.Please click a positive rating.Come back if needed.
Customer: replied 1 year ago.
Many thanks for your reply. Would increasing the dose make her t4 even higher? Also when my daughter increased her dose from 125 to 150 she suffered from bad acid in the stomach...and still suffers. Are her painful, swollen eyes the cause of being under medicated?
Expert:  DrRussMD replied 1 year ago.
It should not affect the T4 and the free T4 should be used.The dose can be increased at a smaller increment.If the TSH stays hi and the T4 goes up, then pituitary secretion [benign tumor] needs to be considered, which can also raise cortisol. please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
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Customer: replied 1 year ago.
Many thanks ūüėä
Expert:  DrRussMD replied 1 year ago.
anytimeany questions I am board certified in integrative medicine, internal medicine, trained in functional medicine and homeopathy, etc. I am here daily: use my request link as needed and “for Dr. Thomas” in the question title. Give that link to friends, family, associates, etc. Find me as needed for correct, safe and accurate answers.