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  • Adrenal fatigue...Cortef questions

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    Old 12-22-2009, 07:42 PM   #1
    margaret62
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    Adrenal fatigue...Cortef questions

    I am treating my hypothyroidism with 112 mcg. of Levothroid and 2.5 mcg. T3 taken in the morning and afternoon. I have been trying to treat my adrenal fatigue with supplements, but my doctor suggested I try Cortef instead. Every time I raise the T3 I feel hyper, which may be the adrenals, or I may need to lower the T4.

    Most recent Cortisol testing (saliva):

    Morning 5.3 (Range 3.7-9.5)
    Noon 1.6 (Range 1.2-3.0)
    Evening 1.4 (Range .06-1.9)
    Night 1.8 (Range .4-1.0)

    I have a horrible time waking up and do not sleep as well as I'd like.
    Only the night Cortisol seems badly out or range, but are these numbers enough to try the Cortef? And if so, how do you take it and for how long? Thanks for any help!

     
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    Old 12-23-2009, 09:24 AM   #2
    javelina
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    Re: Adrenal fatigue...Cortef questions

    Your levels low in the morning (27% of range) and that high evening level will make your sleep issues happen too. Have you tried magnesium? It can help modulate the high cortisol levels. Magnesium citrate to bowel tolerance is recommended.
    My levels were also lowish in the am and high in the PM for my first two saliva tests and the third test showed dropping levels all around, with the am well below mid-range (it should be close to top of range). So I did start on the HC too. I take 25 mg and it's recommended you should start at a very low dose at first and slowly titrate up to this level. You will also need to back off your thyroid hormone replacement to a lower dose, perhaps 50mcg of T4 and 2.5 of T3 or lower so you don't get a dump of T3 into your cells once the cortisol levels rise. You need to take HC as long as needed to support your adrenals until you can get optimized on your thyroid meds and symptoms relieved. You also will need to "stress dose" with higher amounts whenever you are in a stressful situation like illness or other stressors. Then after a period of months you can try to slowly wean off the HC.

    I also have high reverse T3 levels which interfere with thyroid hormone replacement so you should check this as well because high cortisol can make this happen. Ask for an RT3 and FT3 test and see if your levels are high or the ratio between the two is off. Also you need to check your ferritin levels because low ferritin can cause problems too.

    Last edited by javelina; 12-23-2009 at 09:27 AM.

     
    Old 01-03-2010, 08:19 PM   #3
    margaret62
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    Re: Adrenal fatigue...Cortef questions

    Thanks Javelina for your response. I have cut back on the T3 and may eliminate it altogether, but I don't have a thyroid gland and haven't been on less than 100 mcg. of T4 in twenty years. I started the hydrocortisone six days ago with 2.5 mg. in am and three days later, with 2.5 added after lunch. Sometimes I feel better and sometimes I still feel lousy. Afternoons and evenings are the best. I'm continuing with my adrenal supplements hoping that as my adrenals rest, they will help them heal. Did you go through a lot of adjusting when using hydrocortisone or did you feel better right away? Also, my reverse T3 is in the high end of normal, and my Ferritin is OK. My Vitamin D was low and I am supplementing with that. Any suggestions are greatly appreciated as I have been on an unpleasant roller coaster this last year and would really like to feel better more regularly.

     
    Old 01-04-2010, 06:03 AM   #4
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    Re: Adrenal fatigue...Cortef questions

    Do you have your labs for the RT3 levels (it should have been run with an FT3 as well to come up with a ratio). If your ratio is low then you may want to consider going on T3-only for a period of time to flush out the excess RT3. RT3 binds with thyroid hormone receptors and blocks T3 from entering cells.

    In my case I simply started on the 25mg of HC (I divided my dose with the larger portion in the am and a smaller amount in the PM) because my RT3 levels were so high I wasn't as concerned about a large dump of T3 into my cells. If I hadn't had the RT3 problem I would have started at a much smaller dose and slowly worked up. I felt no real change of symptoms with the HC and was taking 2 grains of Erfa Thyroid at the time.

    I'm presently treating my high RT3 with T3-only, which I started after being on the HC for two weeks, something to consider if you find you still can't get right with your T4/T3 hormone replacement even with adrenal support.

     
    Old 01-05-2010, 04:22 PM   #5
    margaret62
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    Re: Adrenal fatigue...Cortef questions

    My Free T3 results were 2.88 (range 2.29-4.21) and Reverse T3 was 341 (90-350). I'm not sure how the ratio is calculated or what that ratio would indicate. It does seem that I'm not getting enough T3 for whatever reason, but have discontinued taking it while trying to titrate up on the hydrocortisone. Maybe that isn't the best idea right now because I'm still so tired and have had trouble staying asleep all night (wakeful about 3 or 4 am). I REALLY appreciate any advice. This last year has been so awful, but I feel confident that something will fall into place (hopefully soon!)

     
    Old 01-05-2010, 04:31 PM   #6
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    Re: Adrenal fatigue...Cortef questions

    Your reverse T3 is very high. The ratio between your FT3 and RT3 is 8 when it should be up over 20. To calculate the ratio move the decimal over three spaces on your FT3 number: 2.88 = 2880 and divide your RT3 into your FT3: 2880/341 = 8.4
    The reason your FT3 is so low is because your T4 is converting to RT3 instead of T3 and the RT3 is clogging your hormone receptors and keeping you hypo. The treatment is to go on T3-only for a period of time until the RT3 decays and leaves your body. This will take a period of months to happen and will only be effective if adrenals are well supported or not fatigued and your ferritin levels are at least above 50.

     
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