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Forum Name: Endocrinology Topics

Question: Immune responses Thyroid or Adrenal


 endoweird - Tue Oct 27, 2009 2:49 am

30 year old female, smoker, coffee drinker 8-12 cups per day with subclinical hypothyroidism.
I have had many tests run to try determine the cause of my symptoms, my doctor is uncertain of the cause and wants to put me on Eltroxin. If i do have adrenal problems will the Eltroxin make it worse and if it does make it worse will it make the Mitral valve prolapse worse? And if this is not adrenal what is likely?

My symptoms - kidney pain,headache,allergic reactions (first hands swelling now dry eye and cobblestone appearance in my eyelids,slow weight loss, infections (flu, tooth abscess - won't heal, kidney infection, bladder infection.
My test results blood taken at 7:00am, fasting, day seven of my cycle:
S-Sodium: 140 mmol/L
S-Potassium: 4.7 mmol/L
S-Chloride: 105 mmol/L
S-Tot. Co2 (bicarbonate): 26 mmol/L
S-Urea 5.2 mmol/L
S-Creatinine 86 umol/L
Egfr > 60 mL/min.
S-Bilirubin (total) 11 umol/L
S-Bilirubin (conjugated) 1 umol/L
S-Alkaline Phosphatase 47 IU/L
S-g-Glutamyl Transferase 13 IU/L
S-ALT (GPT) 12 IU/L
S-AST (GOT) 18 IU/L
S-Lactate Dehydrogenase 137 IU/L
S- Total Protein 77 g/L
S- Albumin 42 g/L
S- Calcium Total 2.34 mmol/L
S- Magnesium: 0.9 mmol/L
S- Cholesterol: 6.73 mmol/L
S- LDL Cholesterol: 5.35 mmol/L
S- HDL Cholesterol: 1.09 mmol/L
S-Uric Acid: 0.33 mmol/L
P-Glucose fasting: 3.8 mmol/L
S-C-Reactive Protein: 5 mg/L
Rheumatoid Factor: 10 IU/mL

Endocrinology
S-Iron: 21.4 umol/L
S-Transferrin 30 umol/L
S- % Saturation: 0.357 %
S- Ferritin: 52 ng/mL
S- Thyrotropin: 2.76 uIU/mL
S- FT4: 17 pmol/L
Thyroglobulin Ab: 3.13 IU/mL
Thyroid antimicrosomal Ab: 214.96 IU/mL
S-17b-Oestradiol: 224 pmol/L
S-Follitropin (FSH): 9 U/L Day 7 of my cycle
S-Lutropin: (LH) 14.1 U/L Day 7 of my cycle
S-Prolactin: 23.7 ng/mL
S-Immunoglobulin E: 51.1 KIU/l
S-Growth Hormone: 0.49 uIU/mL
S-PTH (Intact): 22.1 pg/ml
ACTH: 7.3 pg/ml
Anti-Nuclear Factor: Negative

Haematology
ESR: 8 mm/hr
Erythocyte Count: 4.57 x10^12 L
Haemoglobin: 13.8 g/dL
Haematocrit: 0.4 L/L
MCV: 86.2 fL
MCH: 30.1 pg
MCHC: 34.9 g/dL
RDW: 12.8 %
Platelets: 295 x10^9 L
Leucocyte Count: 7.10 x10^9 L
Neutrophils: 44.4% 3.15 x10^9 L
Lymphocytes: 46.2% 3.28 x10^9 L
Monocytes: 5.7% 0.40 x10^9 L
Eosinophils: 2.6% 0.18 x10^9 L
Basophils: 1.1% 0.08 x10^9 L
 Dr.M.Aroon kamath - Tue Oct 27, 2009 8:35 pm

User avatar Hi,
It is never a good idea to 'diagnose' a condition by looking at a set of lab results or to suggest 'treatment' without examining a patient.
Having said that, i will try to answer in a rather general way about the queries you have raised.
In analyzing for example the thyroid functions, one has to consider the following...
- what is the normal range? The American Association of Clinical Endocrinologists(AACE),issues guidelines periodically.

Many will take a TSH level between 3.0 and 5.0 uU/ml as the normal range.
If one goes by some epidemiological studies,a high thyroid stimulating hormone concentration (>2 mU/l) has been shown to be associated with an increased risk of future hypothyroidism- your test value falls above this range.However, there is no proof as yet that thyroxin is needed in this situation to 'prevent' future risk of Hypothyroidism!
Now, coming to the question of thyroxin vs adrenals, adrenal cortical insufficiency may co-exist with hypothyroidism.In some settings (such as in Hashimoto's disease and combined TSH & ACTH deficiency in hypopituitarism etc), thyroxin administration in this set up has been reported to worsen the adrenal cortical insufficiency.
As far as the worsening of mitral valve prolapse is concerned, theoratically, the answer is -'possible'--- Perhaps, depending upon which degree of mitral valve prolapse one has.
I hope this will somewhat clarify your doubts.
Best wishes!

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