Hashimoto's, low AM cortisol, high PM cortisol

Posted by jessindy @jessindy, Nov 22, 2022

I am Active Duty military, have always been active and relatively healthy. I am a 39 year old female. Only surgeries are a C-section and a few sinus surgeries to remove polyps and tonsils.
I had post partum thyroiditis and eventually ended up with a hashimoto's diagnosis. Over the last year, even with normal lab values, we have been increasing my dose of synthroid because I am still very symptomatic.
I finally asked to go to an Endocrinologist because my weight gain was getting out of control. I had low AM cortisol and low AM ACTH. I have all the symptoms of Cushing's (weight gain, moon face, Buffalo hump, and the overlapping symptoms with hypothyroidism of fatigue, sleep issues, depression, anxiety, etc). I have high PM salivary cortisol.
I had a ACTH stim test that was normal.
I had a pituitary MRI that was normal.
I had an adrenal CT that was normal.
Less than a year ago I developed masses in my thyroid that showed up 18 months after my previous US, the largest was 9mm so didn't meet criteria to biopsy. I also had a 1cm mass outside of my thyroid that wasn't involving my parathyroid. All thyroid and parathyroid labs are normal while I'm on 150mcg of synthroid. Repeat US 4 months later didn't show the masses had grown.
Around the same time I had an incidental finding of spots on my lungs that they think are most likely histoplasmosis, because I grew up in the Midwest. They didn't even recommend repeat imaging.
I also have hypermobility that is significant enough that physical therapists have suggested that I may have Ehlers Danlos syndrome, but I have never been diagnosed.
I also had high free and bioavailable testosterone, but normal total testosterone.
I am hoping someone can suggest other tests or conditions I need to be researching. I can't find any information on having low AM cortisol and the HIGH PM cortisol. And if I don't have a pituitary or adrenal tumor, what else could it be? I have considered maybe it is coming from a lung or thyroid tumor but none of my doctors seem concerned about the masses.
I am scheduled for a 24hr urine cortisol and a dexamethasone suppression test. I already have low AM cortisol so I don't understand what thet dex test will show.
Other labs I have had checked that are normal: LH, FSH, prolactin, aldosterone, renin, thyroid, parathyroid, cbc, cmp, lipids, A1C.

Interested in more discussions like this? Go to the Diabetes & Endocrine System Support Group.

Welcome, @jessindy. I moved your post to the Diabetes & Endocrine System group here: https://connect.mayoclinic.org/group/diabetes-and-endocrine-problems/

Here you will meet other members who have experience with Hashimoto's, thyroiditis and other endocrine related conditions.

To connect with other members with EDS, see these related discussions:
- Ehlers Danlos Syndrome (EDS) & HSD, calling all types! https://connect.mayoclinic.org/discussion/edshsd-calling-all-types/
- Ehlers Danlos Syndrome, MCAS, POTS, and MALS https://connect.mayoclinic.org/discussion/ehlers-danlos-syndrome-mcas-pots-and-mals/

You may also wish to follow the EDS expert blog here:
- Ehlers-Danlos Syndrome https://connect.mayoclinic.org/blog/ehlers-danlos-syndrome/

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As a longstanding patient with hypothyroidism I can offer only suggestions from that perspective. My understanding is that one's thyroid medication(s) are unable to work effectively if vitamin B-12, vitamin D, folate and iron ferritin levels are not in optimal ranges. Thyroid self help groups I've read recommend that one check these levels on at least a yearly basis. One's healthcare providers can advise on how best to optimize any suboptimal lab values so that one doesn't go masking a underlying diagnosis by self supplementation. If you haven't checked these labs in the past year, it might be worth your while to do so.

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