Adrenal insufficiency/hypothyroid symptoms

I've been seeing a gp at my practice for a few months now with hypothyroid symptoms. I have had all the bloods done, all normal (b12, vit d, ferritin etc all well within normal range)

tsh 2.65 (0.35 - 4.5)

FT4 12 (12 - 22)

FT3 3.9 (3.1 - 6.9)

I asked to be referred to an endo as gp is only willing to refer to cfs clinic but the endo refused the referral because bloods are within range. They simply suggested a 9am cortisol test to check for addison's, wanting the result to be over 400. I had the result today (saw a different gp as well) and it's only 359 so he is writing back to the endo. In the meantime I have to do a 24hr urine test and also have tsh and FT4 tested again, plus a coeliac screen.

I was wondering if anyone has hypothyroidism AND adrenal insufficiency - can they go hand in hand? And is it possible to have adrenal insufficiency and still gain weight, as I have gained a stone in recent months despite following slimming world. Every link I've seen suggests weight loss as a given. It's all so confusing, I just want to feel better :(

9 Replies

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  • What is normal for your Ferritin - B12 etc. ??? In range maybe - but that does not mean normal. B12 should be more than 500 - Ferritin around 80/90 and so on. Nothing works well when these important nutrients are below par.....

  • I don't have a copy of the exact numbers but they were all well within range. I will ask for a print out when I go back for my next blood test in Thursday.

  • Rayjay, hypothyroidism and adrenal insufficiency can be related especially if pituitary dysfunction means there is lack of stimulus to the thyroid gland (secondary hypothyroidism) and lack of stimulus to the adrenal glands.

    Manufacturers of Levothyroxine suggest adrenal issues in long term undiagnosed hypothyroid patients should be addressed before prescribing thyroid hormone replacement.

    It's possible your weight gain is related to hypothyroidism as your FT4 is bottom of the range although TSH 2.65 isn't elevated, typical results for secondary hypothyroidism. Your thyroid gland is probably healthy but unable to produce sufficient thyroid hormone due to lack of TSH stimulus.

    Lack of pituitary stimulus to the adrenal glands may also mean the adrenals are unable to stimulate sufficient ACTH.

    endocrinology.org/policy/do...

  • When I mentioned secondary hypothyroidism to the gp I saw today I was told it was not possible because the tsh level is too high. He has at least said he will write to the endo again given my low end ft4 and cortisol below 400. Just feel like I'm going round in circles at the moment without getting any closer to some actual help! In fact I get more helpful advice and information on here than through the gp surgery!

  • Rayjay, Perhaps you should direct your GP to the NICE Clinical Knowledge Summaries:

    In secondary hypothyroidism (pituitary or hypothalamic disease), the TSH level is low or 'normal' and FT4 is low. See Scenario: Suspected secondary hypothyroidism for advice on management.

    cks.nice.org.uk/hypothyroid...

  • I would have expected it to be investigated further, given that I had a placental abruption with my youngest son and required a blood transfusion, but he dismissed it as apparently I would have needed more units of blood for it to have an affect on my pituitary! I will show the gp the guideline above at my next appointment in a couple of weeks tho, thanks :)

  • There are different levels of central hypothyroidism (secondary hypothyroidism) it's not all or nothing on the TSH front. It may be that the pituitary is producing some but not all the TSH it should be given your Ft3 and Ft4 levels.

  • You are low in range for both Ft3 and FT4 which can suggest central hypothyroidism. People generally feel well when FT3 is high in range. The adrenals and thyroid are linked in the endocrine system so if you've been hypothyroid for a few years your adrenals will have been taking up the slack which can then in turn cause adrenal insufficiency. I would insist on seeing an endocrinologist. But maybe ask for the list of recommended doctors from Louise Warvill as they vary so very much. Also ask the doctor for a thyroid specialist not a diabeties specialist. You can normally find this info on the web about the endos. My first Endo was terrible and my second one was amazing.

    Good luck.

  • Thank you. I did ask to see an endo but they refused to see me. I am hoping they may change their minds as the serum cortisol was lower than they recommended but I guess that will depend on the urine test results. I do have the list from Louise but going private would be a last resort as I can't afford it so would need to borrow the money :(

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