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fjones1 05-11-2008 04:57 AM

More Adrenal Questions
I have a question for people dealing with adrenal issues of any kind. When you treated the adrenal problems first, did it help your thyroid treatment? According to my tests Iím in the early stages of adrenal fatigue, though I didnít know it before. The doctor thinks that may be one reason Iím not responding too well to thyroid treatment. Iím on armour, and for a couple of months it seemed to work okay, then I started getting strange symptoms that seem to be getting worse. When my doctor tried to raise my dose by more than its usually raised, 30mgs, I felt so bad with the hyper symptoms that I was going to the emergency room, but they subsided some after a few days so I didnít go. The doctor is waiting on more test results, but she wants to get my cortisol levels to normal, then see how I respond to treatment.

m. m. 05-11-2008 02:26 PM

Re: More Adrenal Questions
The general rule is to treat adrenals first BEFORE treating the thyroid otherwise you'll end up in a situation where you can't tolerate the thryoid meds and are thrown hyper really easily.

There are others on the board who have experienced this...hopefully they can provide more perspective on the topic.

alikat709 05-12-2008 06:43 AM

Re: More Adrenal Questions
Im also thinking that this might be why Im not regulating also.

mkgb 05-12-2008 07:40 AM

Re: More Adrenal Questions
I have Hashimoto's, Graves Disease, adrenal INsufficiency, secondary hypoT.. I will stop. I could go on, but you get the picture.. I am an endocrine train wreck. So I have some personal experience in this dual nature endocrine dysfunction mess. What were your levels and ranges in the last and diagnosing blood work? Thyroid and adrenal please. Have you had your B12 adn vit D levels checked? Ferritin? All these can be affected by both the thyroid and adrenals, you need them tested if you haven't had them tested yet.

Treating the adrenals will help with any symptoms that are adrenal related it will also help with thyroid hormone balance. Too much or too little cortisol and aldosterone can affect the balance of your actual T3 and t4 levels. If you have too much cortisol you will surpress T3 production. Correcting this will allow the T3 to rise naturally, if you are on a T3 supplement when this happens you may go hyperT as a result of too much T3 being in your system. You must follow your FTs every 6 weeks while trying to get your adrenals and thyroid straight. Too little cortisol and it is a free for all in T4 to T3 conversion. This can quickly put you hypoT in T4 and hyperT in T3.. been there doen that.. over and over and over again.

[B][I]The standard rule of thumb is address the adrenals and then address the thyroid.[/I][/B] Occassionally you can not do this and must address both. Many fight for years to get the thyroid treated and then find out they have adrenal issues as well. (This was my case, fight to get my thyroid tested fully (5 years), six months more of fighting to get Hashimoto's treated.. then 4 months after that the adrenal issues arise). I have to walk a fine and variable line with my thyroid meds or it is welcome to hyperT land. The Graves ontop of adrenal insufficiency running hand in hand with hashimoto's makes me a hyperT space cadet in holding. I will be honest, treating and diagnosing adrenal issues is harder than getting a decent thyroid panel run.. and you all know how hard that can be! Hashimoto's/Graves and adrenal insufficiency is a syndrome all on it's own.. Autoimmune polyendocrine syndrome, Type II to be exact. So if you haven't been tested for the thyroid AITS ( Hashimoto's and Graves) do so, it may be revealing. Look into APEST (Autoimmune polyendocrine syndrome, Type II) It may click for you... you have blood sugar or diabetes issues? That is another thing to wait and watch for if you have APEST.

How is your MD trying to address your cortisol levels? You may have to go off the Armour and onto a lower dose of T4 only until the adrenal issue is stabilized. I make too much T3 because my cortisol is in the cra.. out house. My last Fts had me at 10% T4 adn 54% T3 levels. :D I find it amusing, I have to laugh and my dual nature. Determing I have Graves and Hashimoto's had me chuckling to myself for days.. I am a truly unique.. hyper/hypo personality. I just wish I could drop the pounds like my Aunt N with Graves.. but NOOO.. I have to take after Hashimoto's there. OopS! Sorry Tangent vent.. back on point...

Yes, treating the adrenals will improve your thyroids natural hormonal balance, it will not however fix a thyroid issue if you truly have one. So keep up with your level testing.. do not allow the MD to push you to appointments every 3 months. Get copies of all your labs and share them with us, we may be able to help you and share some tricks we picked up as well.


fjones1 05-12-2008 08:19 PM

Re: More Adrenal Questions
Thanks so much for all of the advice. My last labs were:

FT3 Ė 3.72 (2.30 Ė 4.20)
FT4 Ė 1.0 (0.6 Ė 1.8)
TSH - 1.228 (0.35 Ė 5.550)
Reverse T3 Ė 245 (90 Ė 350)
Vitamin D Ė 9 (30 Ė 60)
Ferritin Ė 73 (10 Ė 232)

So far Iíve had the adrenal stress profile. It is supposed to measure cortisol and DHEA. Itís the test that measures levels four times a day. My doctor said that two time periods were very high, the 11am to 1pm, and the 3pm to 5pm were especially high (DHEA is normal). She hasnít said anything about treating the high cortisol yet. She wants to do further testing first. Iím supposed to a 24 hour urine test this week, and she wants to do a cat scan of my abdomen to check for any adrenal tumors. She decided to check my adrenals because Iíve been on Armour since October 07 and have been having problems with it. I switched from .75 mg of Synthroid. This doctor is pretty thorough. Iíve had lots of problems with endos and other doctors, like may people on this board. I donít know how sheís going to treat the high cortisol yet. With the Armour, I worked up to 60 mgs, 30 twice a day. I was doing so so on that dose, not great but so so, then suddenly I started getting hyper symptoms along with other strange symptoms that I canít really attribute to anything. I canít tell whether theyíre hypo or hyper. The doctor tried to raise my dose to 90 mg, but I got so hyper on that, plus I kept getting these other strange symptoms Ė very stiff joints, shortness of breath, hot flashes in my face, weight gain in strange places, mostly around my abdominal area. So I went down to 60 mgs, but that dose is still causing me grief. Iím pretty new to adrenal issues. I didnít think that was a problem for me because I donít have low cortisol, but my doctor said the high cortisol levels are the beginning of adrenal failure, thatís why sheís doing further testing, which is good. I have an appointment with my GP tomorrow, and sheís supposed to order these tests as recommended by my thyroid specialist than fax them to her. I have to wait to see what the results are. I also supplement with 3000 units daily of vitamin D, and take various high blood pressure medicines, but neither of those are causing too many problems, just some side effects from the blood pressure meds.

mkgb 05-13-2008 07:22 AM

Re: More Adrenal Questions
TSH - 1.228 (0.35 – 5.550) This is NORMAL what is your problem.. just kidding you are imbalanced kiddo. Something is up. High cortisol doesn't jive with this behavior. The T4 to T3 imbalance can point to adrenals with out a doubt if you were on a T4 supplement alone, but your on Armour. If you are a good T4 converter.. balanced with out the need for T3 supplementation.. then taking Armour will cause an imbalance of 20 - 30 %. You are at a 45% deviation. (75.7-30). Let's look at your levels and numbers.

FT4 – 1.0 (0.6 – 1.8) You are at 30% of range here.. suboptimal to say the least. But you have my 10% level beat!

FT3 – 3.72 (2.30 – 4.20) Here is why your TSH is SO normal. You are optimal at 74.7%. This is bumping the top range of optimal.

Reverse T3 – 245 (90 – 350) This is good you are not improperly converting your T4 to rT3. 64.5% of range. However there is a larger source of error in the rT3, T3, T4 tests than the FTs. So you may be lower or higher than this in range by 10-20% depending on analytical method employed.

Vitamin D – 9 (30 – 60) Hummm.. bad body. You need to get this up. I am vit D deficient too. Getting out in the sun 15-30 minutes a day and taking your supplements is a must to try and boost this. You now have a script to sun bathe. :D I had someone tell me to do it minus clothes.. humm.. I passed. There shouldn't be beached whales this far in land.. it would scar my child and the neighbors for life.

Have you had your B12 tested? It can cause issues as well. You may need to add a super B complex vitamin to your mix.

Ferritin – 73 (10 – 232) - This is good. You want this in the 70-90 range. You are right where you need to be.. tell your body and supplements to keep up the good work. ;)

To rule out low cortisol or aldosterone causing you issues. You need your aldosterone and renin tested.. you already state that your cortisol is high. However in the case of AI induced adrenal insufficiency you may have elevated cortisol before your adrenal glands are killed off. The main adrenal antibodies that can be tested for are ACA (Adrenal Cortex Antibodies).

In the mean time... You need to taper back your T3 supplementation. I would go to 50 mcgs of T4 and 30 mg of Armour. Too much T3 can cause adverse reactivity in your body as well. many people can not geet stable on one or the other medication. Many need a mixture of T4 and T3. Most tolerate the Armour T3 better than the cytomel. Cortisol is the innate T4 to T3 conversion suppressor. Giving too much T3 to your system can cause your body to go into overdrive to shut the liver conversion of T4 down. Hence hyperadrenalism may be your issue and correctable.


fjones1 05-14-2008 04:33 PM

Re: More Adrenal Questions
Thanks again for all the advice. When I was on Synthroid alone I had a hard time converting to T3. My FT3 on Synthroid .75 mg was 2.9 with the same ranges. I have a question. You suggested I might have hyperadrenalism and that could be treated. Is this different from full blown Cushing's disease? How is hyperadrenalism treated, by lowering the cortisol and keeping within normal levels? My doctor recently ordered the other tests I'm supposed to take - the 24 hour urine test, a cat scan of my abdomen to look for tumors, and a blood test of some kind, which I think is for some kind of adrenal work. I don't get the results for a couple of weeks. My doctor wants to proceed when I get the test results. I think she wants to rule out adrenal tumors to see why my cortisol is high.

mkgb 05-14-2008 07:46 PM

Re: More Adrenal Questions
I am not saying that you do not need Armour.. just that pure Armour may be too much. My Aunt B1 had no adrenal issues, but she ended up with hyperadrenalism when she was on pure Armour because it gave her too much T3. But like you T4 alone was not enough. She ended up with a grain of Armour and 75 mcgs of Synthroid being the perfect balance. With out the excess T3 being dumped into her system Her ACTH dropped and cortisol levels lowered accordingly.

The main way to lower cortisol is to suppress the ACTH production. I am not as familiar with the drugs that do this.. I am at the other end where my cortisol is LOW. Well at least i am hitting the 25-30% range on meds now. Hey maybe we can share.. I give you a bit of my low and take a bit of your high! ;) If only it were that simple. *sigh* Let me know how the next round of blood work comes out and all those scans.


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