Resolved question:
I was diagnosed with pcos a few years old patientago by my pcp. I have ovarian cysts, heavy regular periods, am extremely fatigued, hirsutism, anxious, my hair started falling out in clumps, have brain fog and just don't feel well. My Dr. recently had hormone testing. My tsh was at the high end of normal and t4 was a little low. My cortisol was 17.1 which he said was on the high end of normal. He prescribed compounded thyroid meds that I've been taking for about 3 weeks. My question is my testosterone was relatively low, so from what I have read in pcos excessive testosterone is what causes hirsutism. How can I have pcos with low testosterone? He was perplexed by this also. Said he was going to do some research and maybe send me to an endocrinologist. I have read that Cushing syndrome could cause these symptoms but my cortisol was not "that" high. So what could be causing all of these symptoms? Could hypothyroid be causing all of this or is there something else going on?
Submitted:
4 Days
Category:
Endocrinologist
Hello.
Thank you for your query at DoctorSpring.com.
To diagnose PCOS, you have to rule out Cushings, and Hypothyroidism.
Hypothyroidism can present with similar complaints, except for hirsutism.
You were diagnosed with PCOS few years old patientago and your tests now show low normal levels of Testosterone.
What all medication are you on?
I suggest you undergo tests to rule out Cushings (Dexamethasone suppression test) and then concentrate on diet and exercise to lose weight.
Also check your blood sugars.
After ruling out Cushings, you will need Metformin as a treatment for your PCOS.
Feel free to discuss further.
Thank you.
As of now I am on the compounded thyroid med which I believe is 1:4 t3/ t4, metformin 500mg qd., and he prescribed a compounded test. Cream, and a multivitamin daily. Is a blood drawn cortisol reliable for a true cortisol test? From what I read cortisol fluctuates throughout the day. I need to go to the GYN so I plan to ask her to follow up on a lot of this stuff because the thyroid meds, which I started about 3 weeks before the test. cream has helped with the fatigue and my hair has stopped falling out:) thank goodness. The hirtuism is what really throws me off! I don't get why that's happening? I currently weigh 145lbs and I'm 5'2". I go to the gym 5 days a week.
Hello.
Thank you for your response.
Cortisol needs to be tested early morning after a tablet of Dexamethasone 1mg taken at bedtime on the previous day. This is called the Dexamethasone suppression test and is used to diagnose or rule out Cushings.
Regarding your hirsutism, it is due to PCOS. Even though PCOS is associated with hyperandrogenism, blood Testosterone or other androgen levels can still be normal in some women. So that shouldn't be taken into consideration.
Let me know if I can assist you further.
Regards.