simon dean

Hi,

The thing keeps going through my mind, how, if my TSH is elevated, but
my FT4 is within normal range (ie subclinical hypothyroidism as is
defined in many website) my question remains on how that can manifest
any symptoms. Logically I think "If my thyroid is able to compensate and
create enough T4, then why am I ill?".

Obviously Im still taking the thyroxine and hoping for the best, but I'm
still curious about other causes. I found an endocrinology book the
other day and I came across a section on cortisol.

Im not sure if I have this correct, but it seems to me that some people
could have say a cortisol deficiency, that then gives rise to an
overactive immune system. An excess would suppress the immune system
while reducing allergic reactions. I believe I have read that a cortisol
deficiency, could lead to an overactive immune system, giving rise to
thyroid antibodies, and this can be linked to subclinical
hypothyroidism, skin rashes (allergic reactions). I have read, only one
reference however, than when cortisol is given, symptoms of thyroid
problems clear up and the thyroid antibodies calm down.


(from http://www.emory.edu/WHSCL/grady/amreport/litsrch99/p000519b.html)
"Title: Addison's disease and corticosteroid-reversible hypothyroidism.
Source: Journal of Endocrinological Investigation. 10(5):523-6, 1987 Oct.

Abstract: We report the case of a 28-year-old man who presented with
idiopathic adrenal insufficiency and subclinical: hypothyroidism
do***ented by elevated basal thyrotropin level with abnormal response to
thyrotropin-releasing: hormone administration. Anti-thyroid antibodies
were present in high titer, supporting the diagnosis of Hashimoto's:
thyroiditis, and hence of autoimmune polyglandular syndrome type II. The
patient was not submitted to thyroxine: therapy, and during cortisol
replacement thyroid function improved, as judged by normalization of
basal and stimulated: thyrotropin and elevation of thyroid hormone
levels. Anti-thyroid antibodies titer significantly diminished, and a
short-time: withdrawal of corticosteroids was not followed by elevation
of thyrotropin hormone levels. Possible pathogenetic: mechanisms of
cortisone-induced remission of hypothyroidism due to chronic lymphocytic
thyroiditis are discussed."

And in relation to tiredness, "Physicians have long known that even a
subtle deficiency of cortisol can be associated with lethargy and fatigue."

Seems like this cortisol could play a big part, and could even cause
some of the symptoms of an underactive thyroid.

Any opinions?

Cheers
Simon