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Thyroid (Expert Forum)
Adrenal fatigue with hypothyroidism
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
Adrenal fatigue with hypothyroidism
by MS Hashi, Oct 02, 2006 12:00AM
I think you mentioned that you do not believe in treating adrenal fatigue with hydrocortisone or other steroids. Can you give me your opinion why? Also how is a person with long standing hypo and adrenal insufficiency able to carry the hormones from the blood and into their cells without the use of steroids? Thank you
Doctor's Answer
by Mark Lupo, M.D., Oct 04, 2006 12:00AM
, Oct 04, 2006 12:00AM
I only treat adrenal failure (not fatigue) with steroids -- will wait for well controlled trials defining adrenal fatigue (this may end up being subclinical hypo-adrenalism) as the complications of steroid treatment are vast. If a person has adrenal insufficiency (abnl ACTH stim test) then steroids are clearly indicated. I simply have not seen enough evidence in the traditional endocrine literature that adrenal fatigue exists, and am leary of using steroids in patients who may likely not need them. I rely on ACTH stim tests to identify patients with adrenal insufficiency.
Empiric trials with florinef in patients with fatigue/dizzy spells is sometimes useful -- this is different from glucocorticoid administration.
Empiric trials with florinef in patients with fatigue/dizzy spells is sometimes useful -- this is different from glucocorticoid administration.
I hope the Dr. does answer this but that he does so, with at least a little detail.
Its been my experience that all but only a few catagories of Doctors, don't recognize adrenal fatigue-exhaustion and they will not call it adrenal insufficiency either, until it is the life-threatening type.
I understand their not wanting to treat with steroids necessarily but I don't understand the no-suggestions-at-all because there are nonsteroid treatments like the USP adrenal glands and DHEA but they act as if these have potential to cause side effects and yet the adrenal fatigue is a much worse side effect.
I'm one of these patients that had consistently low cortisol readings but was able to have a normal ACTH Adrenal Stimulate test, so therefore the repeated low cortisol supposedly is just a fluke.
US Health studies have sited cortisol deficiency but a less severe type than adrenal insufficiency, that is found in people with Post Traumatic Stress Disorders and in those with Chronic Fatigue and Fibermyolgia. This should be proof enough that it happens in different circumstances and thyroid conditions can affect HPA function, like these others because of antibodies blocking receptor sites that play a part in these glands communicating with eachother.
I'm glad you are asking the question.
I posted a freakin book down below under "adrenal symptoms after treatment for hypothyroidism" Just thought I'd let you know.
tell me what book? I can't see it
Best to you,
Ms H
Many types of MDs, simply will not recognize these natural treatments for adrenal fatigue but rely on lab-created drugs, as if these are somehow superior in every case. The synthetic and other lab created drugs are great for many things but to discount all natural treatments, as if they are silly or useless, is an incredibly strange view and it is hard to make common sense out of it.
Dr.s are not to blame, they are taught this and convinced of it, in a hard-sell fashion and this has been going on for many years thanks to the Pharmaceutical Industry. They make wonderful things but are trying to eliminate other wonderful things. What a shame.
Thanks for your comments, your insight is much appreciated. I'm interested in yours and others views as this is my (quick!)history....
Long standing hypo since 2003 and still struggling to get well. Was started on 100mcg levothyroxine, worked OK for about 3 months then started to become unwell again, I felt the hormones were not getting into my system anymore. Started moving up doses eventually reached 200mcg and was feeling much worse. Went through a couple of doctors, all said I was 'normal' and one said I was over prescribed. My Free T3 and T4 were very high (well above normal range) and my TSH was 0.02. I was feeling worse than ever. Yet another Dr (a good one). He said I was toxic, I was shakey and had a persistent headache that painkillers would not touch and no metabolism whatsoever with weight gain, extreme constipation. I was in a bad state. I now had to stop working (and I am still off) because the tiredness is extreme particularly in the morning although I am awake in the night. The Doc took me off thyroxine for about a week and started natural adrenal support. Dessicated bovine adrenal extract, liquorice root, 4g Vit C and Siberian Ginseng. I was also switched to Armour. This did help somewhat but I was not able to raise above half a grain without toxic symptoms returning. I took the Adrenal Stress Index (24 hr saliva test) which showed morning levels of cortisol very low normal and night levels high normal. DHEA was elevated above range. He started me on hydrocortisone and I moved up to 30mcg per day multidosed over a period of 10 days. The best 10 days I've ever had I can tell you! It must have picked up all the 'free' hormone in my blood and ran my metabolism beautifully and I felt really well. I have now slowly raised to 1.5 grains Armour and have noticed small improvements. I still have a way to go and would love to lift the morning fatigue, any suggestions appreciated!
Thanks very much for your comments. I am still also taking the natural adrenal support while adrenals are healing. I am not showing any symptoms of excess cortisol. All the best, Ms H
I've taken steroids for inflamation, using the same method you describe, going up in dose, then tapering down, using a 15 day period for this. I too felt wonderful during the treatment but then crashed into adrenal fatigue again. If you'll monitor your blood pressure, while on the steroid, you'll notice it raises it quite a bit. This is why I understand Dr.s not wanting to treat subclinical hypoadrenal, with steroids. This is why I mention other things that help, that they simply give no recognition to.
In regard to this forum's Dr., mentioning no studies establishing subclinical adrenal insufficiency, I believe what he means, is that there are no studies establishing a speficic treatment because low cortisol syndromes have been studied for many years, although the studies do recommend against steroids as the treatment. Here is an example quote from the U.S. Health Institutes, recognizing adrenal fatigue in Chronic Fatigue people.
"Doctors have long know, that even subtle deficiencies in cortisol can be associated with lethargy and fatigue." (NIH Embargoed Release, Oct., 1996)
link to article: http://www.nih.gov/news/pr/oct96/niaid-13.htm
Some good reading for drs & patients alike would be "Safe Uses of Cortisol" by Jeffries.
While many doctors don't treat adrenal fatigue, the symptoms can be devastating. Frankly, I think that it's wrong that patients aren't treated until they have adrenal failure! Just for fun, let's compare it to erectile dysfunction...I'm sure that most men wouldn't want to wait until they had complete erectile failure, right? No, they would want treatment as soon as they started to have even occasional symptoms.
Since adrenal fatigue can be devastating - patients can be bedridden, which is certainly devastating if you need to work or have children to raise, or simply want any quality of life.
Perhaps if the doctors who don't treat would imagine how their lives would change if they couldn't work or even get up out of bed, they would gain a better understanding of why adrenal fatigue REQUIRES treatment. It is personally, professionally & financially devastating to be bedridden for any reason at all, especially when a common medication will improve their condition.
And even if the physiologic doses caused they same side effects as the physiologic doses, which they don't, I think it would only be fair to ask a patient if they were willing to accept the trade-offs for an improved quality of life. After all, that's what we do with cancer