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Old 11-08-2008, 08:46 AM   #1
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High ACTH caused by thyroid medication?

I am wondering if thyroid medication can cause elevated ACTH. I once heard taking thyroid medication has a similar effect on the body like taking amphetamines so I began to wonder if thyroid med's can cause elevated stress markers? My ACTH fasting blood test is 10 times higher than the normal range. The ACTH test has been high for a couple of years. I do not fit the typical Cushings Syndrome profile. Could some possible causes for elevated ACTH be ACTH secreting ectopic tumor like in lung, pancreas or adrenals, adrenal stress, hypothalamus/pituitary/adrenal feedback loop not responding appropriately, receptor defect, polymorphism enzyme defect, can be caused by a virus, Epstein Barr Virus causing Adrenocortical Insufficiency, inflammatory cytokines, etc? How do you test for tumors in the body that are causing elevated ACTH? CT Scan of lung or pancreas or adrenals? Thanks -

 
Old 11-08-2008, 12:51 PM   #2
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Re: High ACTH caused by thyroid medication?

ACTH is the pituitary hormone that triggers the adrenal glands to produce cortisol and aldosterone. It is not effected by thyroid hormones in the manner that you are suggesting.

High ACTH has three main sources. Hyperpituitarism, hypoadrenalism, and in rarer cases pituitary tumors. NOW if it was a pit tumor you are talking HIGH HIGH levels of ACTH and as a result you would be experiencing Cushing symptoms. How high is your ACTH. My ACTH was 2-3 x the normal upper limit. It was due to low adrenal function. Now a Tumor would have been more suspect if my levels had be 10-100 times the normal limit. In any case to rule out a tumor you will need an MRI. In the mean time you need extensive ADRENAL testing. I am leaning toward hypoadrenals, because it is a common side effect of prolonged hypothyroidism or under treated hypothyroidism.

MG
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Old 11-10-2008, 07:43 AM   #3
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Re: High ACTH caused by thyroid medication?

Dear MG, Thank you for your insightful reply. My ACTH was 300 and on retest 290 which is 10 times higher than normal range. Yes I have had an MRI (with & without contrast specifically looking at pituitary) and no pituitary abnormality was found. I have also read on the internet that 50% of MRI's may not reveal a pituitary tumor but I am not sure this is accurate information. I have followed my cortisol levels (saliva, blood and urine for a number of years) to test adrenal status. What extensive adrenal testing lab do you recommend or use? For a couple of years, my cortisol has been high 1st thing in the morning but now my cortisol is low mid day and in late afternoon indicating adrenal fatigue. I am now currently supporting adrenals with various formulas and taking a hypothalamus/pituitary glandular to see if this will help to lower ACTH. In the past I have also taken various adrenal formulas as needed based on lab tests. Over the past 2 years, I have had high morning cortisol therefore not Addison’s Disease and high ACTH 131 (3 X normal range) which led me to believe pseudo cushings as my body type didn’t fit typical cushings picture. Other organic acid markers and neurotransmitter testing revealed an over firing of the sympathetic nervous system and excessive catecholamines which I am now using various supplements/herbs to lower. My TSH is .1 which currently indicates more potential hyperthyroid range. I am waiting on test results for Fee T3 and Free T4 to more accurately give the whole picture. T4 and T3 within range. I have also heard numerous clinicians imply that thyroid medication can often cause adrenals to burn out. And I have heard clinicians say “Balance adrenals and the thyroid may self correct”. But after being on Armour thyroid medication for over 10 years, I anticipate always being on thyroid medication. I have recently switched to Nature Throid which is more hypoallergenic since I was reacting to corn ingredient in Armour. I don’t think I fit hyperpituitary picture like giantism as I am a small person. So nourishing the adrenals to resolve hypoadrenals sounds like a good plan. Thanks again!

 
Old 11-10-2008, 08:23 AM   #4
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Re: High ACTH caused by thyroid medication?

My ACTH was 300 and on retest 290 which is 10 times higher than normal range. Yes I have had an MRI (with & without contrast specifically looking at pituitary) and no pituitary abnormality was found. I have also read on the internet that 50% of MRI's may not reveal a pituitary tumor but I am not sure this is accurate information.

I have MDs in the family and one is a Ph.D./MD Nuerologist. I had him dig into this for me after finding my repeatedly high ACTH and my MDs telling me MRI is clean you are normal in cortisol. He did say that some people can have microtumors that are benign nodules of hyperproducing ACTH tissue. He really doesn't worry about the microtumors that can cause border line issues in ACTH (<1000) that are not visible on an MRI. He doesn't think surgery is the way to go in treatment. These tumors tend to be slow growing and benign aggravants of the gland. Like most Hashimoto's nodules.. they just are hot ACTH producers. However removal of the pit gland effects A LOT OF things so, in these cases you want to suppress the ACTH much like you would suppress TSH post TT cancer thyroid patients. You do this with cortisol supplementation. His advice made sense, especially after I processed for about a month.

I have followed my cortisol levels (saliva, blood and urine for a number of years) to test adrenal status. What extensive adrenal testing lab do you recommend or use?
I have done it all and believe it is all part of the whole picture.
1) Spot checks of fasting 8 am ACTH are a must periodically. When you do this you might as well check the cortisol levels too.
2) Periodic saliva rhythm cortisol checks are a must as well. you have to see how you are through out the day when supplementing cortisol. This allows you to best supplement your cortisol demands.
3) Urine isn't as necessary, but occasionally it gives you an overall average cortisol level for a 24 hour period that can tell you if overall you need to add more HC.
4) Having at least ONE ACTH stimulation test before supplementing cortisol is a must. ONCe on HC coming off of it is a B-WITCH to say the least. Just did that recently.. my levels are still in FLUX! UGH! The STIM test allows you to see if you have any specific synthesis deficiets. Before doing this test you need to be off birth control pills and steriods supplements for 6-8 weeks. Yeah, fun!

For a couple of years, my cortisol has been high 1st thing in the morning but now my cortisol is low mid day and in late afternoon indicating adrenal fatigue. I am now currently supporting adrenals with various formulas and taking a hypothalamus/pituitary glandular to see if this will help to lower ACTH. In the past I have also taken various adrenal formulas as needed based on lab tests. Over the past 2 years, I have had high morning cortisol therefore not Addison’s Disease and high ACTH 131 (3 X normal range) which led me to believe pseudo cushings as my body type didn’t fit typical cushings picture. Other organic acid markers and neurotransmitter testing revealed an over firing of the sympathetic nervous system and excessive catecholamines which I am now using various supplements/herbs to lower.

Depending on these supplements you may have to go off of them for and ACTH stim test.

My TSH is .1 which currently indicates more potential hyperthyroid range. I am waiting on test results for Fee T3 and Free T4 to more accurately give the whole picture. T4 and T3 within range.
This can also be a result of too little cortisol allowing for a T4 to t3 conversion free for all. this is common in hypoadrenal patients. the result is hypoT in T4 and hypoerT in T3.. sucks! Been there.. still visit it.. you can live with it IF you take your medications like a good girl.

I have also heard numerous clinicians imply that thyroid medication can often cause adrenals to burn out. And I have heard clinicians say “Balance adrenals and the thyroid may self correct”.

Uh? Huh? Bare facts.
HYPOTHYROIDISM if left untreated or undertreated will cause adrenal burn out/fatigue. Thus you need to treat your hypothyroidism as well as hypoadrenalism. In some cases treating the hypothyroidism will allow the adrenals to recover. This occurs in one-forth the patients according to statistical studies. I am not hopeful that mine will recover.

NOW in some HYPERTHYROID patients the adrenals go into hypercortisol production to slow down the converison and presence of T3 in the system.. over work here can cause adrenal collapse as well.

The adrenals and thyroid are interlinked, you can not optimize your thyroid treatment if you have adrenal dysfunction with out treating the adrenals too.. but you can not treat the adrenals effectively if you do not treat the thyroid. thus you have a Catch 22. Solution: Treat hypothyroidism SLOWLY 25-50 mcgs of T4 and get on 20 mg of HC. Work until Ft3 and Ft4 levels are balanced. Montior and increase thyroid supplementation as needed until optimal.

But after being on Armour thyroid medication for over 10 years, I anticipate always being on thyroid medication. I have recently switched to Nature Throid which is more hypoallergenic since I was reacting to corn ingredient in Armour. I don’t think I fit hyperpituitary picture like giantism as I am a small person. So nourishing the adrenals to resolve hypoadrenals sounds like a good plan.
THis sounds like you have the general idea. GOod luck.
MG
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Old 11-11-2008, 08:05 AM   #5
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Re: High ACTH caused by thyroid medication?

Well it depends on the size. But all ACTH tumors tend to be HYPER ACTH producers. When one is expected your MD should perform a dexamethasone suppression test. Depending on the stage of development of a ectopic ACTH tumor it may produce less or more than a pituitary tumor. There are guidelines assuming a fully developed ACTH producing tumor. How do they test for the tumor? they use Dexamethasone which is a dominant glucocorticoid. It goes straight to the pit gland/tumor and begins to shut down ACTH production. When the ACTH production is blocked the cortisol production will be decreased. Depending on the level of DMA needed you can oftimes tell if it is simple hyperadrenalism or a tumor.

The test typically goes like this:

1) you are given a PM dose of dexamethasone
2) you measure the next two days of urine to get a bulk average cortisol suppression rate as a result of the DMA.

The results and what they mean usually look like this(They should do this in two parts versus going straight for the high dose test):
Low dose testing:
Dexamethasone dose - first attempt low dose 2 mg
cortisol suppressed? - no, need a high dose test because there is a possible tumor source.
cortisol suppressed? - yes, most likely hyperactive pituitary gland with no aggravating tumor source.
High dose test:
Dexamethasone dose - 8 mg
cortisol suppressed? - no, you need to look for an ectopic source of ACTH, like an adrenal tumor or APUD tumor of lung. These tumors are larger and higher ACTH producers.

Dexamethasone dose - 8 mg
cortisol suppressed? - YES, probably an ACTH producing pituitary tumor, not as large as the ectopic tumors and can be regulated with DMA.

MG
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Old 11-12-2008, 05:56 AM   #6
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Re: High ACTH caused by thyroid medication?

Thank you SO MUCH MG! This gives me a very clear picture how to proceed. I really appreciate your time and knowledge! You could be a professional endocrinologist (: Best Wishes - Donna

 
Old 11-12-2008, 06:44 AM   #7
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Re: High ACTH caused by thyroid medication?

I COULD if I wanted to spend ten more years in school. I would also have to take biology classes. I was neglectful in that area. I am a chemistry, physics, math and engineering girl. the biology stuff I have only picked up on through personal experience. I have considered doing the Nurse practitioner thing.. but that means more schooling and loans AND I would have to deal with grouchy sick people all the time. I can be nicer on paper. In person I can be a bit brisk and to the point. Many would complain about my bed side manner if it wasn't a special problem. However a few prepared check lists for symptoms and physical issues would narrow down the diagnostic process.. ESPECIALLY if the MD/FNP bothers to read them before going into to see the patient. I hate spending hours filling out medical history reports and symptom check lists ONLY to be asked by both the nurse and MD so what is wrong.. what you here for.. how are you today? Well I normally do not answer fine. They normally get a bit of sass if they try this with me like, "I wrote it all down haven;t you read it yet? DO you want the summary and diagnosis? I can give you the probable diagnosis if you like.. or you can just write me a lab order for this list of tests and write me these medical scripts, thank-you for your knowledge and time."

My current MD comes in and asks how my medication level is and how tolerable are my symptoms. Then she asks me what is up for testing and what scripts do i need written and filled. She then will talk with me a bit and add additional testing if warranted and add treatment suggestions to help with symptoms. All in all we work well together. She likes treating me because she can take a break and not think as hard. We occasionally talk shop about some of the stories I read here and the general state of thyroid health care and treatment. She will ask me how three of my referrals to her are doing and how I think their treatment is going.. she knows I double check their labs and treatment regimes. We grin over it and things seem to be going better all around and her practice is becoming known as a refuge for the thyroid/endocrine system impaired. now if I could just clone Dr. Jump and Dr. Johnson and spread them across the US, Canada, and England.. everyone would be happy!

In my opinion being a good doctor isn't where you got your degree but how you use it. The key to a good physician is diagnostic approach and problem solving techniques. You can not just go by the text book because every individual skews the parameters involved. The MDs need to think like a scientist/engineer who have problem solving done to a KISS (Keep It Simple Stupid) process regime. In Medicine Each patient is a NEW problem. Each problem may have a simple or difficult solution. Gather all your knowns (physical statistics and symptoms). Analyze the knowns for a common root factor or cause. Group and isolate the issues. Each problem may be one LARGE issue like the thyroid or a bunch of little issues like allergies, poor diet, depression, etc. Careful questioning, establishment of symptom and diet logs, and thorough testing would determine what problem solving approach was best. Test thoroughly then approach the treatment one step at a time. This will allow for trial and error determination of the problem and solution. Now each time you try a solution it may not work, if the solution doesn't work then start again. VERY simple and straight forward, but most MDs fixate on one symptom or issue at the detriment of the whole system. As a result they are not that willing to employ such a holistic/scientific approach.

THANK-YOU for the compliment. It is nice to feel my research is paying off for me and others. It also feels good to turn the screws in more ignorant blinder wearing MDs out there.. WORLD WIDE! I love it when they get their just desserts!

MG
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Last edited by mkgbrook; 11-12-2008 at 06:55 AM.

 
Old 11-24-2008, 06:25 PM   #8
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Re: High ACTH caused by thyroid medication?

Hi MG,

Just wanted to give you an update. I went to an Endocrinologist today. He recommended an Cat Scan of the adrenal glands which I am in conflict about the test. Radioactive Iodine side effects include thyroid and kidney potential problems. I asked him about DMA suppression test and he said it was an involved test. I think I'd rather go through the inconvenience of a 24 hour urine test than take radioactive iodine and potentially cause damage to body. Just wondering what your take is on his recommendation. Is a Cat Scan kinda an extreme place to begin to determine why my ACTH is high 290 - 300 range (10X normal)?

 
Old 11-25-2008, 06:04 AM   #9
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Re: High ACTH caused by thyroid medication?

Talk with the radiologist the RAI dose for a Cat Scan/MRI is extremely small. It is not like dedstroying your thyroid with RAI. They give you a tracer dose that allows them to track iodine flow and build up through out the body. The radiologist would be the one to consult on percentages and risks of a traced Cat scan.

This Endo is thinking you have an adrenal tumor versus an issue with the pituitary gland. Well the pituitary is responsible for the ACTH production. The adrenals just manufacture the needed hormones. If there is a growth, blockage or dead zone rsulting in the abnormally high ACTH the Cat scan should allow it to be seen. I would run with the Cat scan... and I am allergic to the iodine dye they use.

MG
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Old 11-26-2008, 05:05 AM   #10
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Re: High ACTH caused by thyroid medication?

Hi MG, Thanks for the vote of confidence on proceeding with CT scan. Seems like the doctor should reorder my CT scan to include the pituitary as well as adrenals and not just adrenals. MRI over a year ago of pituitary with and without contrast didn't show any abnormalities. The doctor also order a 24 hour urinary cortisol test and a 24 hour urinary Metanephrines (Pheochromocytoma Evaluation) which I assume will determine if there is a potential adrenal tumor. My blood pressure is low but stress markers are high. Urinary stress marker testing may be a good 1st place to start and wait to get these test results back 1st before proceeding with Cat Scan? We are getting ready to go out of town for the Dec holidays and I want to be in tip top condition to enjoy my 10 day vacation (another reason to postpone Cat Scan till after the 1st of the year.)
What happens to you when you have radioactive iodine or iodine supplementation? I have been using Iodoral 12.5 mg daily for a couple of years and it has helped me feel better. I wouldn't want to become allergic to iodine from taking radioactive iodine as I feel iodine supplementation has helped me. I also feel it is an important breast cancer protective supplement. I do monitor thyroid antibodies annually just to make sure there are no adverse side effects like goitor from supplementing with iodine. Once I did try 25 mg Iodoral and it did give me a whopping headache.

I read that Cat Scan can also cause kidney damage if weakened kidneys. I have had kidney reactions to metal chelators (NDF) and other metal cleanse products. It took me almost 2 years nurturing my kidneys back to health to overcome the irritation from using the NDF for a brief period. Also I read you have to take potassium iodide for 2 weeks after the CT Scan to protect the thyroid from radioactive iodine. Were you able to take potassium iodide assuming you have had a CT Scan before? I will call radiologist to ask more questions. THANKS!!! Donna

 
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