acne and Levo

[Thyroid2212]

My 18 year old daughter has secondary hypothyroidism, recent tests show her growth hormone is half the level it should be, the endocrinologist has increased Levo to 100mg and she is due a blood test in a couple of weeks. She isn’t feeling any better what so ever and is suffering with worse acne than usual. It’s really making her feel low and she wants to come off Levo to see if it clears her skin… looking for advice please 😣she takes microgyn pill also. Her legs ache like crazy and she has little energy.

[radd]

Thyroid2212,

Welcome to our forum & sorry to hear about your daughter.

If your daughter has Central Hypothyroidism & pituitary problems, it might indicate other hormonal issues related to the pituitary as well as low TSH and GH. Has she had a brain injury or being investigated for a pituitary tumour? Has she had other pituitary hormones measured? What have they said about her low GH?

A continued supply of GH after puberty is important for bone health & metabolism, and symptoms of low GH & hypothyroidism cross over so it can be difficult to identify what is what.

On this forum low thyroid hormone commonly causes elevated cortisol that leads to elevated insulin. Both encourage reduced SHBG that leads to higher levels levels of insulin resistance and free ‘active’ testosterone. Insulin resistance leads to weight gain which fuels further excess of testosterone being produced in the fat. Hypothyodism also leads to direct weight gain.

Elevated insulin may also enlarge the theca cells (ovary) that then make further testosterone and lead to ‘anovulation (when an egg doesn’t release from ovary during menstrual cycle). When we don’t ovulate we don’t make progesterone which upsets sex hormone balances further.

Therefore, it most likely isn't the Levothyroxine 'per se' that has caused the acne but a complex sequence of hormonal change resulting in elevated testosterone which is the classic cause. It is important your daughter continues to take her thyroid meds to prevent further hormonal imbalance.

Often the Pill is prescribed in response to a patients heavy/irregular periods but this may not be the right course of action and risks skewing further investigation for a GP unskilled in hormonal disturbance. Have you asked for a referral for further investigations?

If you post your daughters latest thyroid hormone results complete with ranges (numbers in brackets) members will comment. Also any iron & nutrient results, the important being Vit B12, folate, Vit D.

[Thyroid2212 in reply to radd]

That’s so informative thank you very much for your reply. I will get a copy of her results and post them. She banged the back of her head on a hard floor whilst doing a crab when she was around 12 and was diagnosed with under active thyroid at 14/15. The endocrinologist who we are now finally seeing has said he will check bloods at week 8 on the new Levo dosage and check if she needs growth hormones. Yes I believe all other hormones were tested when she had an insulin stress test. She did have to come off the pill for 6 weeks before the insulin stress test - this triggered her skin issues and they haven’t settled down since then. It’s all very complicated so I’m just trying to educate myself as much as possible so that I understand it best I can. She often feels exhausted and says her legs feel like lead - just hoping that eventually we get the right dosage and everything settles down 🤞🏻

[Jodypody]

Morning I had awful problems with Microgynon as did my sister I’m amazed it’s still in circulation

[Thyroid2212 in reply to Jodypody]

Hi there, thanks for your reply, she was on Lucette before that and had awful mood swings. This one did originally help with skin and heavy painful periods - would you recommend something different, wonder if worth asking gp to change it as it’s no longer helping with acne.

[caledoniancat]

Has your daughter been tested for adrenal issues? My own daughter was diagnosed as hypothyroid at 19yrs old and put on levo but became progressively more unwell. Aching legs and lack of energy were two of the many symptoms she had and got progressively worse before having an adrenal crisis (although we didn't know that's what it was at the time). She was admitted via A&E and subsequently properly diagnosed as having Addison's Disease. Her levothyroxine was stopped when she was admitted to hospital and instead she was put on daily hormones for Addison's (9yrs later and still no need for levo). The NICE guidelines do ask doctors to be vigilant for Addison's if a patient's health is deteriorating whilst being treated for hypothyroidism.

[Thyroid2212 in reply to caledoniancat]

Hi, thank you for your reply. No she hasn’t been tested for adrenal issues. Definitely sounds worth me asking the endocrinologist about that, thank you.

[slowtraveller in reply to Thyroid2212]

I’m currently going through the process of having my thyroid/adrenal/pituitary issues diagnosed, and the theory my endo is currently operating under is that I have a damaged pituitary gland (most likely from a concussion at 12 or a second one at 22 - I’m now 40). He thinks this has impacted both my thyroid hormone production and adrenal hormones, leading to central hypothyroidism and secondary adrenal insufficiency. I take thyroxine and hydrocortisone now, to supplement the hormones my body doesn’t make (as well as DHEA, which has been hugely helpful too). My endo told me that symptoms depend on which parts of the pituitary gland are damaged, but it can involve growth hormone, luteinising hormone, thyroid, acth and other sex hormones as well.

The other thing I learnt the hard way was that if someone has an underlying adrenal issue and is put on thyroid meds without adrenal support (ie corticosteroids or similar) they may get worse, or even suffer an adrenal crisis. It’s probably worth getting a cortisol blood test at the very least to make sure this isn’t the case.

I really feel for you both. Such a complicated set of symptoms, and not knowing how to move forward is frustrating and upsetting as an adult, I can’t imagine it at 18. She’s lucky to have you.

[Thyroid2212 in reply to slowtraveller]

Hi slowtraveller, thank you so much for your reply and kind words. I’ve taken all that info on board and will speak to endo at the next consultation. She had an mri to check the pituitary but nothing was picked up, but I’m pretty sure he said cortisol levels were fine and it was just growth hormones that are half the normal level. Thanks again for your help, and I hope you get sorted with your diagnosis.

[caledoniancat in reply to Thyroid2212]

Slowtraveller has given good insight. The following is also a quote from a research paper: "Patients with organic growth hormone deficiency (GHD) or with structural hypothalamic-pituitary abnormalities may have additional anterior pituitary hormone deficits, and are at risk of developing complete or partial corticotropin (ACTH) deficiency",. ACTH test would be advisable (good test for adrenal function).

[Thyroid2212 in reply to caledoniancat]

Blown away with with level of help here, thank you, I would never have discovered these things that we should be asking to have tested 🙌🏻

[Jamima]

Hi Thyroid2212. I’m sorry your daughter is going through this, must be particularly distressing when young. I too think I may have secondary hypo and a recent trial of levo was pretty disastrous, I had to stop. It’s really important for secondary hypo patients to have any low cortisol treated before commencing thyroid hormone therapy. I’d ask for those tests. Also, the type of birth control pill she should be on for acne is eloine, it used to be yaz or Yasmin but I think they’re now discontinued. I’ve used the hrt version Angeliq and it was great for water reduction, I didn’t have acne but it contains drospirenone as the progestin which reduces testosterone and many women find it useful for acne reduction. It sounds like your daughter needs to have full evaluation of pituitary hormones, but the change in pill might be a good place to give initial relief. Good luck.

[Thyroid2212]

Hi Jamima, thank you so much for your reply, and kind words. We will speak to gp about changing pill to Eloine definitely sounds like it could be more beneficial that the one she is currently on. I’m also going to get her last test results emailed over as I’m sure endo said her cortisol was fine - but I’m curious as to what they actually were now. Thanks again 😊

[caledoniancat in reply to Thyroid2212]

If the endo only tested cortisol at one point in the day e.g. first thing in the morning, that would likely not detect an issue, I think it is more usual to test at two different points of the day although the ACTH test is normally at three points in the day. Hope your daughter gets the answers and actions she needs to feel more like her normal self.

[Jamima in reply to Thyroid2212]

No problem- I hope you manage to untangle what can be very complicated. Good luck.

[Thyroid2212]

Thank you, yes it was only tested in the morning. So pleased I joined this forum 😊

[Cookerybookaddict86]

Hi Thyroid2212, I just spotted your post and wanted to reply as it really resonated with me.

I also have an 18 year old daughter with secondary hypothyroidism and acne. My daughter has a number of health issues and she's currently under the care of an endocrinologist, a gastroenterologist and a rheumatologist! However, the condition which causes her the most distress is her acne and we're currently at a loss as to what else we can do to treat it. Her skin has also worsened since starting Levo (she's currently on 75mcg) but it's hard to know whether this is just a co-incidence. Does your daughter suffer from gut issues as well? My daughter has a lot of digestive issues and we're sure that there may be some link to her acne which is very inflammatory. She's tried a dairy free diet which didn't seem to do much, although she probably didn't stick with it for long enough!

I'm sorry I can't offer any advice or suggestions but I just wanted to say I know how very hard this is to deal with. Good luck to you and your daughter.

[Thyroid2212 in reply to Cookerybookaddict86]

hey there, so sorry for delayed response I’m pretty new to this and didn’t see your message. Sorry to hear your daughter is going through very similar issues to mine, awful isn’t it 😣 Yes my daughter also suffers with gut issues, it’s so hard trying to find the right things to do to help when there’s so many different things going on. I’m really pleased to say her skin has settled down massively, it could be from seeing a dermatologist and getting obagi skin products that’s helped? Expensive but worth it if it’s that which has done the trick. I really didn’t want her going on roaccutane which the doctor suggested may be an option as she suffers with low moods/anxiety as it in and ive read some horror stories linked to that medication. If you want any details on the products she uses let me know 😊