Brief Answer: Adrenal fatigue. Check TSH, MRI and CT Adrenals. Detailed Answer: Hello, Welcome to XXXXXXX Thanks for your query. I have gone through your query and understand your concern. Pulsating pupil is common in Adrenal dysfunction or fatigue or exhaustion. What the symptom you are experiencing is similar to Pupilary response test done for Adrenal fatigue. As you are adrenals are insufficient to produce stress hormones like adrenaline and noradrenaline. Your pupils find difficult to constrict on immediate exposure to bright light ( Stress to eye). This results in Pulsation of pupils. As for as your tiredness is concerned, you need to recheck the Thyroid profile ( TSH, T4 and T3). Check for any increase in TSH level. You may need to increase the dose of Levothyroxine. But tiredness could also be due to Adrenal fatigue or Adrenal insufficiency. Your adrenal cortical insufficiency may be due the sudden withdrawal of long term intake of steroids. My advise is to consult an endocrinologist and do the following investigations 1. CT and MRI for Adrenals. 2. ACTH Stimulation test. 3. Thyroid profile 4. CRH Stimulation Test 5. Serum Electrolyes 6. Ultrasound of the abdomen 7. Tuberculin test to rule out Adrenal Tuberculosis. 8. MRI and CT to rule out Pitutary gland Pathology. Hope this helps. Please reply for further queries. Wishing you good health. Regards, Dr.Manjeth XXXXXXX G

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