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Sco24 02-10-2006 07:15 PM

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.


Divermon 02-13-2006 11:14 AM

Re: thyroid adrenal?

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.

foxfire4321 02-13-2006 02:15 PM

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.

Divermon 02-14-2006 01:49 PM

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.[/QUOTE]

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?

foxfire4321 02-14-2006 06:47 PM

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.

Divermon 02-16-2006 08:24 PM

Re: thyroid adrenal?
Thanks for the direction. I discussed this with my Doc today, who does subscribe to the Adrenal Insufficiency theory (aka Adrenal Exhaustion). She wasn't to quick to pull out the prescription pad though.

I think we're going to do more testing for Addisons first. So I'll probably be checking in here for some good advice.

I did have elevated cortisol a couple of years ago in a 24 hr. urine test... was about twice normal. We followed with a dex suppresion test, which was normal.

Then one year ago I had a test done at four points in one day, to show my circadium rhythm. It showed about normal in the morning and at midnight, but very low at both points during the day. my DHEA was also low.

So, we'll see what comes next.

van7771 02-21-2006 05:18 PM

Re: thyroid adrenal?

You may want to look at having a saliva test done, l to was in the same boat my labs were fairly normal but not normal enough to stop testing, l have elevated cortisol and prolactin and decreased renin and testosterone. I had a saliva test that showed that during the day my cortisol goes to almost nothing then returns to normal at night and in the morning. It also showed that my DHEA was way high which means l am way stressed out and my adreanals g into overdrive in the morning to try and produce Cortisol for the ay. I am still learing about this but you can order a saliva test in the mail just go to online and read about saliva testing. Hope this helps,m let me know what happens, also what are your symptoms?


Divermon 02-23-2006 01:07 AM

Re: thyroid adrenal?
I see from your cortisol tests from other posts, and they look just like mine (low during the day, normal at night). My DHEA is low though.

Symptoms are fatigue, heat intollerance, and exersize intollerance. If I do anything mildly athletic for even one minute, I usually will get fatigued, and that will last for a couple of days.

I have had all the cardiac and pulminary testing done, and that is all fine. I was very athletic before all this started 3 years ago.

sue1234 02-23-2006 01:16 PM

Re: thyroid adrenal?
divermom--reading your post I was wondering if your heat intolerance is related to your adrenal problem, thyroid problem, or what????? I have Hashi's but when I try hormone replacement, I get hotter than my normally being hot all the time. That's what makes me quit the thyroid replacement, although my tsh is 6, and free t4 low. I show a low cortisol at my 8 a.m. but normal the rest of the day. I am lost as to why I'm always hot. Have you found out how your heat intolerance fits into the picture? :confused:


van7771 02-23-2006 10:08 PM

Re: thyroid adrenal?

I dont have problems with exercise, l go lifting everynight and seem to do okay most of the time, l do have extreme fatigue during the day and then feel better at night.
I dont know where my problems are coming from. I know that elevated TSH can cause cortisol levels to go down. I have posted with you on the Thyroid board, so l am still trying to figure out whats going on, is it my Thyroid, Adrenal or somethng else. My problem is l was put on Cortef and Florinef and l got worse, all my symptoms got 10x worse. I then tried Synthroid and LEvoxyl and the same thing happened. So what traditionally is done to fix adrenal and thyroid problems makes we wig out. Why this is l have no idea, l took synthroid for 6 months back 8 years ago and had no problems.
Anyway let me know what you think, do you have thyroid labs that you can post, have you had all your adrenal tests done. Personally l believe in the saliva tests more than the blood and urine tests but most doctors would not agree with me, but what do they know anyway is what l am finding out.
I would have your morning cotisol tested with DHEA, saliva test taken 4 times during the day. I would also have your IGF-1, LH, Renin, Aldosterone and Testosterone/Estrogen and Prolactin all tested to see if you can find anything abnormal.
The funny thing is the Thyroid can make some of these tests elevated like prolactin which can decrease testoserone levels, also thyroid can decrease cortisol.
What are your symptoms, keep me posted on what happens.


ImTheLucky1 02-24-2006 06:24 AM

Re: thyroid adrenal?
I don't want to hijack the thread so I'm off to start a new one. You all seem VERY knowledgable and I have some questions I think you can answer.

Thanks in advance.

Divermon 02-24-2006 09:37 AM

Re: thyroid adrenal?
Actually, Lucky1, thanks for your comment.... we (I) actually kind of did hijack this thread from Scott, who started it. But I think his correlation was interesting.

Thyroid hormones do decrease with surgery, then they return to previous levels. I am not aware how long that takes.

Adrenal hormones change also, correct? Can anyone comment on that?
Sue, I really don't know. I have such a narrow range of comfort (if you can even call it that). 67 to 68 is ok, although I am cold at the same time. Anything over that, like 70, I just wilt - usually. Then, occasionally I have a day here and there where I hold up fine, work out in the heat, and maybe not even be exhausted the next day. That is extremely rare though (like one or two days a year). On a good day (like once a month), I can handle the summer heat for part of a day, then I get extremely exhausted for the next 2 or 3 days.
Van - I did have the saliva test. Cortisol is normal at morning and midnight, but low during the day. DHEA was low also. Free Testosterone was normal. I have had no other adrenal related tests done to date.

Many people (and Doctors) seem to point to adrenal. Foxfire outlined his beliefs that if anything, it may be just the progression toward Addison's (if I paraphrased that correctly Fox?). I may be asking my Endo to do a full Addison's work-up.

I'm not acclimated yet to know what to do with the other's you suggest:

[QUOTE]I would also have your IGF-1, LH, Renin, Aldosterone and Testosterone/Estrogen and Prolactin all tested to see if you can find anything abnormal.[/QUOTE]

I have done a ton of research over the past few years on Thyroid, and can field most issues there pretty good. But I'm kind of burnt out on that. I'm not loooking forward to doing it all over again with adrenal, unless I'm convinced I have a problem there.

van7771 02-24-2006 12:03 PM

Re: thyroid adrenal?
I totaly understand, but if your saliva test showed that your cortisol was low during the day then your have a problem. Low cortisol can make you feel like crap.


Divermon 02-24-2006 12:06 PM

Re: thyroid adrenal?
Yes, that technical term you used there "crap", :jester: yeah, that's how I feel.... and really tough to get started in the morning, but usually much better in the evening. I used to think I was just happy to be home from work.

Actually, I see that I had a few other things that came with that salivary test:

Morning: 18.1 (13.0 - 24.0)
Noon: 4.4 (5.0 - 8.0)
Afternoon: 3.8 (4.0 - 7.0)
Midnight: 2.6 (1.0 - 3.0)

DHEA-S Average: 1.89 (2.00 - 10.00)

Salivary Estradiol: 2.1 (1.0 - 3.0 Male)

Salivary Estriol: 1.3 (0.0 - 3.0 Male)

Salivery Progesterone: 30.2 (5.0 - 100 Male)

Testosterone A.M.: 105.7 (40.0 - 130.0 Male A.M.)

Melatonin P.M.: 16.8 (12.0 - 23.0)

Not sure any of that is what helps in this discussion.

van7771 02-24-2006 05:30 PM

Re: thyroid adrenal?

Ya that helps, my saliva labs were the following:
Testosterone: 127 (50-200 pg/ml)
DHEAS: 35.4 (3-10 ng/ml)
Cortisol Morning 6.7 (3-8 ng/ml)
Cortisol Noon .5 (2-4 ng/ml)
Cortisol Evening .7 (1-2)
Cortisol Night 1.0 (.2-1.5)

So as you can see my labs were low also, normal blood tests dont show this very well.
Anyway DHEA is an indication of your stress level, the way my doctor explained it to me was my body is fighting in the morning to make cotisol so my DHEA goes up because of the stress the adrenals are putting on your body. LOW Dhea can be a bad thing because your body isnt able to fight stress off. ITs your bodys way of coping with stress. Your male l am assuming so your testosterone looks good, how old are you, the older you get the lower the valvues. I am 27 and my testsoterone has been as low as 200 with the range from 200-1000. So for a 27 year old male 200 in this type of range is way low.
I would have the doctor do the following labs if you want to know whats really going on with your adrenals:
Metyrapone test (this tests your pituitary function)
ACTH Stim Test: Tests your adrenals to see if they can be stimulated
Prolactin: Cand tell if you have a pituitary tumor
Aldosterone: Another steroid made by the adrenals
IGF-1: Part of the feedback system

These are just some general tests that could give you a little more insight, if you want you can also take adrenal extract, this can help rebuild the adrenal glands, however you shouldnt take the extract if your going to have these tests done. Adrenal Extract will raise your cortisol levels and give bad results for your blood test.
This is a long and slow process, l have had 2 MRI;s of my Pituitary and 2 CAT scans of my abdomen and chest along with having all the labs done twice and sometimes 3 times. Its not easy figurring out the problems the adrenals/thyroid can cause.
Hope this helps let me know what happens.


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