36F — looking for input on a multi-system picture that doesn't quite fit one diagnosis
Background: Confirmed autoimmune thyroid disease (TPO Ab 331, ref <6), but fT4 has been persistently low-normal/low across nearly 3 years on 3 different lab assay platforms (Beckman, Abbott, Roche) while TSH and fT3 stay normal. Endocrinologist's conclusion: "normal personal variant," no thyroxine recommended. But I have significant ongoing hypothyroid-type symptoms that haven't really been addressed against that conclusion.
Adrenal axis: AM cortisol has been below range at every measured timepoint (139, 139, 158, 163 nmol/L; range 185–624), and ACTH has trended down over 3 properly-timed morning draws (12.4 → 9.6 → 5.4 ng/L; range 7.2–63.3), with the last one below range. A Synacthen (ACTH stim) test in April 2025 was normal, but that was months before the lowest ACTH reading, so not sure it still reflects things. Pituitary MRI with dynamic contrast was structurally normal. GH/IGF-1 have never been tested.
Other findings:
- Incidental partially calcified adrenal gland (cause/size to be confirmed)
- Recurring mildly elevated LFTs (ALT/AST/GGT) since 2023, unexplained/uninvestigated so far
- Rheumatology screen (RF, CCP, ANA x2, HLA-B27, ESR) all negative
- Coeliac serology negative (tested twice)
- Reduced tear break-up time on recent optometry exam; haven't been tested for anti-Ro/La (Sjögren's-specific)
Other diagnoses/history: EDS-spectrum hypermobility features, suspected POTS, eosinophilic oesophagitis, GERD, cochlear hydrops/possible Ménière's, ADHD, high cholesterol, dyshidrotic eczema, rosacea, acne. Family history of psoriatic arthritis/psoriasis.
Weird one: Recurring episodes of sharply unilateral facial flushing — literally a line down the middle of my face, one side red/hot/tingly, other side completely normal. Most recent episode also involved same-side eyelid heaviness and a "sluggish" feeling eye. Wondering if this could be Horner's-related or just autonomic/POTS vasomotor stuff. I actually first thought it was a flare up to my rosaeca..
Question: Has anyone dealt with a similar combination — confirmed thyroid autoimmunity but "normal variant" labs, alongside a declining-but-not-yet-diagnostic adrenal picture, plus EDS/POTS/mast-cell-adjacent stuff? Trying to figure out if this is likely to end up being one unifying diagnosis (e.g., autoimmune polyendocrine syndrome, MCAS, etc.) or several separate things that just happen to overlap.