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Ask the Medical Expert Archives 2000-2004

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Hypothyroidism
September 2001

Q. I am a 38-year-old female with a history of hypothyroidism for 5 years. After a work-up with an Endocrinologist for severely suppressed TSH levels while on Synthroid, a 24-hour free cortisol urine test (lab values 20-100) showed values of 121. A pituitary MRI was negative. A repeat 24-hour urine showed a cortisol level of 22. How do you know which test is correct? Should re-testing be done and is there still a concern for Cushing's? Also, does Cushing's present with chronic yeast infections? I understand that Cushing's is difficult to diagnose, however, with two such different lab values where do you go from here? Thank you!

A. It sounds like testing is being done to determine whether any problem exists in addition to the known hypothyroidism. The pituitary gland, located in the brain, is a vital organ that sends control signals to many other target organs, including the thyroid, adrenals (the site of cortisone production), and the gonads. It is unclear whether you have excess cortisol as one test was normal and one was high. Additional tests could include cortisol levels in the bloodstream, ACTH measurement (the signal hormone released from the pituitary), dexamethasone suppression test to check pituitary function, and a CT scan of the adrenal glands if there is suspicion for problems there. Your doctor can select which tests are appropriate in your situation.

HELPFUL WEBSITES:

http://the-thyroid-society.org/faq/

http://www.pituitary.org/PituitaryDisorders.htm

http://www.aafp.org/afp/980215ap/adlin.html

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