20 year old with thyroid and potential sex hormone issues

[buckcheds]

TSH - 0.43
T4 Free - 10.5 (10.5-20 pmol/L)
T3 Free - 7.3 (3.5 - 6.5 pmol/L)

FSH - 2.7 IU/L
LH - 6.1 IU/L
Prolactin 6.3 ug/L

AM Cortisol - 351 nmol/L

Estradiol - 383 pmol/L
Testosterone - 1.2 nmol/L

She's on dessicated thyroid at 60mg per day. She started that about 2 years ago, had significant reduction in hypothyroid symptoms, energy was up etc.

The past 4-5 months though she's had a significant decline in energy and well being. She hasn't had her period in 4+ months and has little to no sex drive and had acne issues. She's also had general exercise intolerance and an inability to make progress in the gym despite regular training.

She started accutane in mid august, which has reduced the acne significantly but exacerbated the fatigue and depression symptoms.

Any idea whats going on based on the numbers? Thyroid looks a little bit hyper if anything, maybe an issue with T3 binding to receptors?

Any help you can offer would be greatly appreciated.

[thisAngelBites]

It would help if you could post the reference ranges for the rest of the blood work. We also need to know her height and weight.

Can you say which day of her cycle these bloods were drawn? FSH looks like it might be low, but I don't know until I have the ref range and the cycle day. Also, has her doc checked her ovaries to see if she has any cysts (in other words, ruled out PCOS)?

Do you know her cholesterol levels from before she started the accutane?

I would say you definitely need to know her ferritin level if you don't already. It would also be helpful to have a salivary adrenal profile (which measure the cortisol output at four times in the day), as many people who optimise thyroid find they are fine for awhile and then relapse, and it's often due to not enough cortisol.

Accutane causes fatigue pretty commonly. I'm not sure of the mechanism but would be surprised if it caused a low grade, chronic vit a toxicity and that results in sleepiness. For myself, I wouldn't take it unless I were already healthy and fine to start with as the side effects are not good. I hope a doc is monitoring her use.

[Bonaparte]

What is her Accutane dose?
That alone could be causing all of her issues.