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Old 12-03-2008, 05:10 AM   #1
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dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

just been reading an article on dexamethasone, and at high does it reduces the conversion of thyroid hormone to its more active form. it can be used in the treatment of hypethyroidism.

Now I thought cortsiol replacements would support the adrenal gland and increase T4/T3 conversion, more suitable for hypothyroidism.

anyone have any more info on this?

 
Old 12-03-2008, 06:28 AM   #2
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

What is the title of the article?

Now too much cortisol and too little cortisol can both drive you hyperthyroid. They are just opposite ends of the pool. Too little and you are driven hypothyroid in T4 and hyperthyroid in T3. Too much and you are driven hyperT in T4 and hypoT in T3.

Do you have too much or too little cortisol/sldosterone?
Have you had a thorough adrenal stimulation test done? You can not produce valid results post cortisol treatment for the ACTH stim test unless you are willing to go off of your HC tablets for 6 weeks. TRUST ME.. if you need it and are forced off of it.. IT SUCKS!

But to the core of your question what is Dexamethasone and how does it work?
Dexamethasone(DM) can be used to treat hyperthyroidism due to too much iodine in your system.. normally caused by taking iodine containing drugs OR to treat hypoADRENALISM where the patient is not as needful of cortisol REPLACEMENT supplementation. It is another glucocorticoid like hydrocortisone and cortisone, but its main service is as an anti-inflammatory agent. The benefit of DM is it does not have sodium-retaining properties like cortisol/cortisone supplements. It can be used in patients that have mineral balance issues and difficulties maintaining electrolyte balance. DM is a synthetic analog of cortisol it is primarily used for its anti-inflammatory effects in disorders of many organ systems. It will not directly treat hyperthyroidism.. nor directly treat hypoadrenalism. It maybe able to supplement and improve the treatment of both hyper/hypothyroidism and hypoadrenalism.

NOW ANY Corticosteroid can produce reversible hypothalamic-pituitary adrenal (HPA) axis suppression. When this occurs removal of HC or DM from the system results in the potential for corticosteroid insufficiency (hypoadrenalism) after withdrawal of treatment. Adrenocortical insufficiency may be averted/minimized by gradual reduction of the corticosteriod dosage. Given the delicate nature of the adrenal system and HPA loop trying to ween yourself off corticosteroids can cause fluxes in adrenal sufficiency that could persist for months. As a result you still have to follow proticol and have some HC or Dm on hand to help coop with any situation of extreme stress occurring during that period of time.

Metabolically speaking how does your thyroid play apart? Well clearance or passage of corticosteroids from a patients system: decreased in hypothyroid patients and increased in hyperthyroid patients. If your thyroid levels are fluxuating your adrenal supplementation may need adjusting as well. Often CHANGES in the thyroid state of a patient necessitates an adjustment in corticosteriod supplementation.

So to restate a point here. Too much cortisol and too little cortisol can both drive you hyperthyroid. You can be hypothyroid and driven hyperthyroid by thyroid supplementation if you have an adrenal sufficiency issue. Which type of adrenal issue is irrelevent. Either is bad. You want to be balanced in your adrenals just like you want to be balanced in your thyroid levels. Too little cortisol/aldosterone and you are driven hypothyroid in T4 and hyperthyroid in T3, and Too much and you are driven hyperT in T4 and hypoT in T3. All in all if you have a thyroid issue AND an adrenal issue you have to test your ACTH, cortisol, TSH, Ft3, Ft4 as a standard set every time you go in for blood work. When in the adjustment medication phase, I go in every 4-6 weeks to get tested. I make sure that I get my appointments between 8-9 am and go in fasting on NO medication. This allows for minimal absorption spike balance issues in the analysis of you blood work.

When you list your actual blood work results and ranges many more will be able to input there opinions on what should be done.

MG
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Old 12-03-2008, 08:54 AM   #3
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

it was called "focus on treating hyperthroidism in the ED"

the section "Once the thyroid gland has been suppressed, the last step in correcting the hyperthyroidism is to reduce the peripheral conversion of T4 (tetraiodo-thyronine) to T3 (triiodothyronine). T3 is approximately 10 times more biologically active than T4. PTU, propranolol, and steroids (dexamethasone, in stress doses equivalent to 200-300 mg of cortisol) all reduce the conversion of thyroid hormone to its more active form. Fortuitously, these drugs all have indications for use in the hyperthyroid patient that make them effective for multiple reasons."

I was on Dexamethasone for a short time, but it improved my symptoms greatly. but i couldn't take side effects for long eventually, even in 0.5mg ;o(

was not nice coming off it.

i was just hoping if i understood why it helped it might give me some clues, but as you say it could work for either hypo or hyper.

I can tell you what has helped me aswell:

vitex but it stopped working ;o(
Atenolol but it stopped working too (

Also I purchased some natural cortsol inhibits to experiment if that helps, and they did, one was lemon oil, ok they make little difference but it an escape from hell lol

i think my adrenal gland goes crazy sometimes when its struggling

I never tested aldosterone or ACTH

I have been on a fair few drugs mainly because i can;t cope with anythingfor more then a few days, my dr almost said nothing will work we tried the lot, armour made everything so much worse, but was that because i was hyper already or my adrenals were weak?, i wish i knew

when Dexamethasone was working, i was still hyper sadly, but neck swelling reduced, sex hormones up i think, i get a little discomfort in the breast area, this improved (possibly prolactin) and full of energy.

but still hyper grhhhh

Last edited by krisuk; 12-03-2008 at 09:00 AM.

 
Old 12-03-2008, 10:22 AM   #4
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

Let's bring things together... My post in answer to your other response in a different thread it applies here as well.

testosterone 350, 407 range (400 -1200) low
Estradiol 0.1 range (0.5 to1.5) low
Cortisol morning 5.7 range (3-8) normal
Cortisol night 0.1 range (0.5-1.5) low
Progesterone 10 range (25-100) low
DHEA 3.5 range (3-10) normal
adrenaline 35 and 59 range (35-165)
Nor-adrenaline 401 and 469 range (165-460)
TSH 1.7 range (0.4- 4.0)
free T4 19 and 21 (10.3 24.5)
TPO 1 range (1-49)
Prolactin 365 range (53-360) high


You definitely need adrenal supplementation now. Hydrocortisone/pregnenolone. Some have an easier time on pregnenolone. It is OTC and the parent of HC and DM. You body gets to break it down and move it where it is needed.. thus some respond better than supplementing the cortisol which is at the top of the adrenal synthesis chain. See which your MD favors. Normal replacement dose for adrenal insufficiency is 20 mg of HC spaced out through out the day. I do best with 10 mg upon waking(6-7am), 5 mg 11am-12pm, 5 mg 2-4pm. Pregnenolone would require a higher dosing scheme and different supplementation time schedule. Any supplementation after 4 pm and I am wired.

The sporadic spurt of cortisol a few years back sounded like a possible tumor or the death throws of your adrenal glands. Have you been tested for the adrenal autoimmune antibodies? ACA? Humm? Bet not. You may have more than one AI attack going on and keeping you locked in Hades.

You also need your thyroid antibodies tested. Your TPO was tested.. not TPOAB. Low TPO may mean high TPOAb. When a Hashi patient has high TGAb they have suppressed TG as well. The two Hashimoto's identifiers are TPOAb and TGAb. These tests have a 80% and 60% positive identification rate for Hashimoto's.

You also need an FT3 and RT3 run in my opinion. Your higher Ft4 level may just correspond to a Hashimoto's tissue destruction T4 dump that was caught by coincidence.. or it may be a sign that you have poor liver conversion of your T4 into RT3 versus T3. We can see it is not due to cortisol suppression of T4 to T3 conversion.

Why haven't they run an ACTH? That is important too? It could be that your pituitary gland is kaput and not asking your adrenal gland to do anything. Ugh!

Okay... My take summarized:

You do not look hypoT or hyperT by your TSH and FT4 results.

You can not tell for sure if you are hypoT or HyperT without a thorough evaluation of your thyroid hormones. FT3 and RT3 included. So for cross confirmation you need a TSH 3rd Gen, Ft3, Ft4 and RT3 test run.

You can not confirm Hashimoto's with out a positive TPOAb and TGAb blood serum tests or a positive thyroid biopsy tissue signature.

Your adrenal hormones are a mess. You are definitely hypoadrenal and in need of supplementation. This is important to get under control now. You need an ACTH run too see where your pituitary gland stands on adrenal output.

To ensure that it is not a microtumor or damaged gland causing these issues you need imaging of the pituitary and adrenals. To see the pituitary (you get an image of the hypothalamus for free) you need a MRI. To see the physical state of your adrenal glands you need a targeted adrenal US. This is what I would have done if I was you.. heck i have had both done. By my thyroid issues and adrenals issues are autoimmune in nature. My antibodies tell the tale.

I would also insist on a thyroid ultrasound as well. You have had goiter/visual swelling issues. As a result for peace of mind I would want an US of my thyroid as well.. I have had two and have a third scheduled. US (ultrasounds) are non-invasive and a breeze.

Your prolactin is high your TSH is not running true to symptoms.. these are anomalies that point to your pituitary gland acting up.. hence the ACTH test and MRI. Something is up.. now you have to make your MD search for it.

DM and HC help because they are dialing back your T4 to T3 conversion. You need that supplementation. I take pindolol successfully as my beta-blocker. My husband has had success with toporol(sp). You may need to look for an MD with a better understanding of the endocrine system to get the best care. Right now you are not getting the best from what I can see.

MG
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Last edited by mkgbrook; 12-03-2008 at 10:33 AM.

 
Old 12-03-2008, 10:49 AM   #5
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

Thanks again good info

I just never thought about ACTH, I didn't even know there was a test for it.

so being hypoadrenal might explain why thyroid products we so uncomfortable???

thats interesting you do a few doses, I kind of thought to copy cortisol you only need one dose.

do you have any idea why i feel so hyper all the time, if my adrneals are low, could it be thyroid related? its one thing i can't work out, i doubt its noradrenaline being high but not sure

could the thyroid be over working, I know its stabs in the dark, but this jumpy feeling/adrenaline rush started as soon as my thyroid swelled and it was adrenal crash related.

its very very difficult to get my dr to do anything, a thyroid scan will take a big effort

oh i forgot, i had a MRI and that was fine, i did that privately though


i had Dhea, things were so bad at the time though i stopped it, didn't want hair loss lol

out of interest, if the adrenal glads get too weak, would the gland start producing too much cortisol? i have read this

i just still don;t understand why in an "adrenal crisis" the gland goes mental and produces crazy amounts of cortisol.

Last edited by krisuk; 12-03-2008 at 10:50 AM.

 
Old 12-03-2008, 11:05 AM   #6
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

Thanks again good info
Your welcome.

I just never thought about ACTH, I didn't even know there was a test for it.
That is fine for you to know/not know.. the MD should know better. I know because I am a Chemist and I make it my business to know.. and I have RNs and MDs in my family.

so being hypoadrenal might explain why thyroid products we so uncomfortable???
Definitely. You can not tolerate thyroid supplementation with out controlling the adrenal supplementation. Supplementing the thyroid when you are hypoadrenal will drive you hyperthyroid in T3.. the condition is known as T3 toxicosis.

thats interesting you do a few doses, I kind of thought to copy cortisol you only need one dose. NO.. cortisol production is adjusted through out the day naturally by a fully functioning HPA loop. When you are hypoadrenal you have to try and mimic your supplementation routine. the half-life on cortisol is too short to just take once a day.

do you have any idea why i feel so hyper all the time, if my adrneals are low, could it be thyroid related? its one thing i can;t work out, i doubt its noradrenaline but not sure
That is the side effect of your adrenals not being able to reign in your T4 to T3 conversion. Low adrenals mean too much T3 thyroid hormone.

its very very difficult to get my dr to do anything, a thyroid scan will take a big effort
*sigh* A good steel toed boot.. nope can't do it. Nice thought though. Plead and beg. If they did an MRI.. they should be willing to do the US. Maybe you can talk your ENT into it.

do you take pregnenolone? what dose? No. I take hydrocortisone.. 20 mg spread out through out my day.

i had Dhea, things were so bad at the time though i stopped it, didn't want hair loss lol
Supplementing DHEA will make you get acne and grow hair.. it doesn't cause hair loss.

out of interest, if the adrenal glads get too weak, would the gland start producing too much cortisol? i have read this Normally if your adrenals are weak they do not produce enough. If they are dying or under antibody attack they may sporadically release/dump excess hormones as targeted tissue areas are destroyed.

i just still don;t understand why in an "adrenal crisis" the gland goes mental and produces crazy amoiunts of cortisol. It doesn't. By definition: adrenal crisis also known as Addisonian crisis is caused by acute adrenal insufficiency endocrinology. THIS MEANS YOU DO NOT MAKE ENOUGH CORTISOL which is a life-threatening. When adrenocortical insufficiency results in a severe drop in serum cortisol, seen in Pts with severe hypoadrenalism (Addison's disease, secondary hypoadrenalism). A series of issues are can cause severe reprecussion; Infections, trauma, hemorrhage, TB, surgery, dehydration with salt deprivation, destruction of pituitary gland, replacing thyroid hormone in Pts with hypothyroidism of hypothalamic or pituitary origin, underlying mild ACTH deficiency,

So what is adrenal crisis.. you get the following low BP, shock, fever, anorexia, weakness, apathy, headache, vomiting, chills, tachycardia, electrolyte imbalance (low Na, high K and WBCs), eosinophilia, hypoglycemia, BP support issues... if not treated with emergency HC dosing.. you can go into coma and die. I have only had one of these.. do not want another. Losing 48 hours was not a pleasant experience.

Now if your ACTH is sluggish you may naturally rebound and rebound hard. This may have been what happened to you. Your body realized it need cortisol and fast.. it sent out a scream.. but took a while to get teh ACTH to a high enough level to make the adrenal respond. Because the response was not quick enough the possible ACTH spike may have resulted in a cortisol spike to stave off the adrenal crisis your system detected.

Did I answer it all?
MG
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Old 12-03-2008, 03:56 PM   #7
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

yeah great many thanks, i really hope someone with similar problems to me get to read what you wrote, such good information

dam I should have got reverse T3 completed a long time ago

a couple more lab results i found,

Follicle sTIM hormone 1.4 and 1.4 range 1.5-12.4
Melatonin 13.5 range (25 - 60)

that second result will tell how these problems affect my sleep, i don't sleep too well

with regards to DHEA, i was more concerned with DHEA>>>>>Testosterone>>>>>DHT

do you take Vit C and/or B complex at all?

Have you ever tried Vitex either? any thoughts on it

Do you know if hypoadrnal suffers have ever been given a dopamine agonists?, my thoughts are this would surely aid noradrenaline and adrenaline and take pressure off the adrenals. I thought this would be more common. The focus is always on cortisol

 
Old 12-03-2008, 07:22 PM   #8
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

Okay you asked for it. Been a while since I shared my pill regime. Here is the complete list..

CPAP pressure 11 6-8 hours a night.. not a pill but still prescribed for my severe obstructive sleep apnea. your melatonin is low. You should supplement it at night to aide in your sleep cycle. Melatonin is important in producing a relaxant effect that allows one to slip into sleep quickly and transition into the later stages of sleep as well. How is your sleep hygiene? I have a stickied post on sleep hygiene on the sleep disorders board that you may find helpful.

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are gonadotropins. The stimulate the gonads - in males, the testes... females the ovaries. These two hormones are secreted from cells in the anterior pituitary called gonadotrophs. Being low is a sign that your pituitary gland is sluggish in its job to manage and regulate your fertility. Low LH and FSH are linked to infertility.

I take 100 mcgs of T4 now, up from 75 mcgs.. YEAH! My thyroid is almost dead.. you have to have Hashimoto's to understand that joy... first thing in the morning on a fasting stomach. I wait 1 hour to eat or drink after taking my T4.

I take 20 mgs of HC for my adrenal insufficiency.
10 mgs ~6 am with my T4.
5 mgs 11 am
4 mgs 2-3 pm

I take 1000 Metformin XR with dinner for my insulin resistance and PCOS.
I take zyrtec, and nexium in the evening for allergies and Gerd.

At bed time, 8 hours before I take my T4, I take the following supplements to address insufficiencies in Mg, B12, D, K and Ferritin... Yeah i was insufficient in them all and I test my levels every eight weeks to make sure I am staying in my normal levels.

30 mg Ferrous Fumerate
400 mg Mg
Super B Complex (All B vitamins in concentrations 1000%+ normal daily requirements)
200 mcg Selenium
1200 mg Fish Oil with DHA and EPA
Active Multivitamin with iodine
200% recommended daily dose of K
2000 of vit D
I would have to look up my Calcium intake.. it is up there as well.

I know I am missing something..
Pindolol 5 mg twice a day. 6 am and 2-3 pm.

It ends up being 31 pills spaced out through out the day for optimal absorption and level balance. Folic and Ascorbic acid are part of the Ferrous fumerate and vit D regime... if I deviate and decide to try and drop one of my vitamin supplements for a couple of weeks.. well I return to my insufficient state. I have a malabsorption issue that is common in people with hypothyroid/hypoadrenal issues. It is always important to follow your levels you can not assume you are getting what you need from your diet alone. You must check. My aunts and Hubby check there levels every 3 months.. but they are stable on their various meds I am not.

Never tried vitex. I look up the FDA and MSDS information of specific species and find the optimal ones as far as absorption versus side effects ratios are concerned. I am glad I was helpful. I hope you look into my thyroid care and concerns series and find it helpful as well.

MG
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Last edited by mkgbrook; 12-03-2008 at 07:33 PM.

 
Old 12-04-2008, 12:13 AM   #9
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

Quote:
Originally Posted by mkgbrook View Post
What is the title of the article?

Now too much cortisol and too little cortisol can both drive you hyperthyroid. They are just opposite ends of the pool. Too little and you are driven hypothyroid in T4 and hyperthyroid in T3. Too much and you are driven hyperT in T4 and hypoT in T3.
I was actually the opposite of this - low Cortisol (bottom 3rd of normal in 24 hour urine test) and low-normal FT3 and close to top of the range FT4.
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Total Thyroidectomy Oct 06 due to Massive Multi Nodular Goiter and Hashi
Adrenal Fatigue
180mg NTH
28mg HC
2 x Caltrate

Rach xxxx

 
Old 12-04-2008, 07:51 AM   #10
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

tygwyn,

Do you have high RT3 levels? That would explain the deviation from the normal trend of high T3 for low cortisol levels.

MG
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Old 12-04-2008, 11:51 AM   #11
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

Quote:
Originally Posted by mkgbrook View Post
tygwyn,

Do you have high RT3 levels? That would explain the deviation from the normal trend of high T3 for low cortisol levels.

MG
Ah right - I've got a low RT3/FT3 ratio yes...just 10%
__________________
Rach xxxx

Total Thyroidectomy Oct 06 due to Massive Multi Nodular Goiter and Hashi
Adrenal Fatigue
180mg NTH
28mg HC
2 x Caltrate

Rach xxxx

 
Old 12-05-2008, 12:39 PM   #12
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Re: dexamethasone for hyperthyroidism, cortisol for hypothyriodism?

200 mcg Selenium

that is more for thyroid support then adrenal???

is low melatonin linked to thyroid or sdrenal problems, it feel like something is suppressing my melatonin, well its the same thing that makes me have this adrenal bloody rush all the time. found when i took melatonin by body was fighting against it, sounds strange just how it felt, it soon became useless.

"Active Multivitamin with iodine"

i probably should avoid iodine???

super b complex looks interesting, i'll google that

 
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