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Old 02-10-2006, 11:15 PM   #1
Sco24
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thyroid adrenal?

anybody know if u have hashimotot's u have a greater chance of adrenal problems? i've been dealing with dizzyness and thyroid problems for while now. started 2 weeks after ACL surgery.

scott
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Old 02-13-2006, 03:14 PM   #2
Divermon
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Re: thyroid adrenal?

Yes.

It is typical for hypothyroidism to go undiagnosed for years. During this time, the adreanal are overworked making up for the lack of sufficient thyroid hormone.

Now, for some reason, and I am less familiar with the mechanics of this point, the stress of going on thyroid medication can cause further exhaution of the adrenals.

One additional factor for you, is the surgery. The adrenals work overtime dealing with any kind of stress. Mental/emotional, allergies, surgery, over exersizing, just to name a few.
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Old 02-13-2006, 06:15 PM   #3
foxfire4321
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Re: thyroid adrenal?

There is a link between the adrenal and thyroid glands in that they are both part of the endrocine system, but there are distinct differences on how they fail. Many people (estimates are as high as 10% of women over 65) suffer from hypothyroidism (lack of thyroid hormone), most commonly caused by an autoimmune attack on the thyroid gland (Hashimoto's disease). This conidition causes a vast amount of symptoms and the onset is insidious (read as... hard to detect). The lowered thyroid hormone level causes your entire metabolism to slow down which in turn lowers your usage of cortisol (the main "stress" hormone of the adrenals). This typically isn't a problem; but your adrenal function should be tested before you start thyroid meication. If you are one of the small minority (something like 0.33% of hypothyroid patients) who also has adrenal failure (auotimmune attack on the adrenal glands, Addison's disease) the sudden jacking up of your metabolism by exogenous thyroid hormone can deplete your diminished cortisol reserves to dangerous levels (leading to an Addison Crises) through increased use.

Let me emphasize, it is a small percentage of people who suffer from both Hashimoto's and Addison's disease (a condition called Schmidt's disease or Polyglandular autoimmune syndrome type II), somewhere around 14-20 people per million of the general population in the US, while a significant number of people suffer solely from Hashimoto's disease (around 3 per 1000 according to the NIH with overt hypothyroidism). Your doctor will probably test your adrenal function prior to starting thyroid medicine, and either do routine follow-up tests every couple of years or test you for anti-adrenal cortex antibodies (around 1% of Hashimoto's patients have them, and 30% of those progress to Addison's).

This of course brings us to the topic of "adrenal fatigue" and subclinical Addison's disease. There is a body of research to support subclinical Addison's disease, which is where a patient has the autoreactive antibodies to their adrenal glands and they show evidence of damage through skewed biochemistry (i.e. plasma renin activity changes). A significant number of these people over time will continue to progress to Addison's disease and I would think that their doctor would monitor them closely. The "adrenal fatigue" syndrome is a nondistinct syndrome developed in the 80s or 90s to explain people who always "feel bad" but have no evidence of hormonal imbalance. It does not have a lot of support in the established medical community. The syndrome does not show up on normal adrenal function tests and as such has come under fire. I personally don't believe in "adrenal fatigue," but I have never claimed to know everything

There is a documented and significant rise in your chances to develop a second autoimmune disease once you have developed one. So if you have Hashimoto's disease than you are at higher risk to develop such things as Addison's disease (rare), pernicious anemia (fairly common, lack of ability to absorb vitamin B12), vitilogo (fairly common, loss of pigmentation), and diabetes (rare to develop type I later in life, but possible); BUT your chances are still pretty slim. As pertaining to your surgery one of the hallmarks of developing Addison's disease is hyperpigmentation and this is usually evident in recent surgery scars as the stress of the surgery is usually enough to deplete your cortisol levels.
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Old 02-14-2006, 05:49 PM   #4
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Re: thyroid adrenal?

Quote:
The "adrenal fatigue" syndrome is a nondistinct syndrome developed in the 80s or 90s to explain people who always "feel bad" but have no evidence of hormonal imbalance.
I would have worded that differently.... "but the particular cortisol tests used in these cases, fail to detect a hormonal imbalance."

This may simply be a self-confirming disbelief. Many Doctors, unfamiliar with this disorder, generally use a one-time serum draw, or a 24 hr. urine collection to test cortisol levels. It is not uncommon for someone with Adrenal Exhaustion to have near normal levels at certain points in the circadian rhythm, and very low levels, the rest of the day.

The above tests are not adequate to detect adrenal exhaustion.

If you tested me first thing in the morning, for example, I would appear somewhat normal. Any maybe the same at midnight. A 24 hour collection would average out to only being somewhat low. However, during most of the day, I have almost no cortisol at all.

So, we have differing views. But let's say for the moment that we can agree that, the tests are in fact showing something is not right with the cortisol supply...

What would you think would be the course of action? Is a small dose of Cortef, for example any possible value here?
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Last edited by Divermon; 02-14-2006 at 06:28 PM.
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Old 02-14-2006, 10:47 PM   #5
foxfire4321
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Re: thyroid adrenal?

One of the problems with the "adrenal fatigue" syndrome was that it was developed and popularized by Dr. E. Denis Wilson of Florida, the author of the "Wilson's Syndrome" undiagnosable (by all normally accepted tests) hypothyroidism theory. Please realize that Dr. Wilson's medical license was suspended by the state for malpractice. He refused to complete the mandated training required for reinstatement and instead turned to "education."

The way I look at it is that if you show no abnormalities on any of the tests of adrenal functions (ATCH stim, cortisol level, serum electrolytes, plasma renin level, etc.) than it is hard to prove there is a problem in the adrenals. If you have autoreactive antibodies it is possible to look at subclinical Addison's but absence the antibodies, or an adenoma or pituitary problem I would find it hard to make a case for a problem in the adrenal.

I would never take additional hormones simply because think you need them... you in effect are causing a hormone imbalance by your own actions.
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