Adrenal issue?

Hi all,

I was diagnosed with hashimotos hypothyroid 4 years ago and was seeing an Endocrinologist that put me on Levoxyl and seemed to base my dosage on the TSH only even though I was still having many hypo symptoms. More recently I started to see a highly recommend doctor for the thyroid issues. He started me on a "thyroid compound" of T3 and T4 meds. I honestly felt terrific for a few weeks and then felt absolutely horrible all of a sudden. He then tested me my cortisol and a few other things. Soine of the results:

AM Cortisol  0.5 (normal 4 - 22)
ACTH Plasma <5 (normal 5 - 27)
Adolesterone 22 (not really sure what the normal range is supposed to be - I guess it depends on my position during the bloodwork? If that is the case)
DHEA is low 19 (normal40 - 325)

Parathyroid Hormone is normal
Sodium is borderline low 137 (normal 135 - 149)
Vitamin D is always low despite taking daily supplements (and last year I had to take 50,000 once a week for 8 weeks)
TSH is 17 (the highest it has ever been)
Thyroid Antibodies are really high - 400s
All other Thyroid #s look good (best they've looked in years)

I am seeing another Endo on Wednesday, but I am not optimistic as I find that they know a lot about Diabetes, but don't take other issues very seriously. At least in NYC.

Any insight into what is going on? Secondary Adrenal Insufficiency? I'm wondering if I"ve had this for quite some time...and its no wonder I didn't feel well for all of those years while on Levoxyl. Its also scary to me that my other doctors didn't test me for this considering how sick I was.

If anyone has any info about adrenal insufficiency (or whatever this may be) and how it relates to thryoid issues...I'd be very happy to hear it! Thanks!!!

[rumpled]

Unless you were standing for an hour before the aldosterone - look at the supine range.  That seems a bit high. ACTH is very easy to botch - was it a chilled tube, put in a centrifuge right away?

Have you had a thyroid ultrasound?

The thyroid and adrenals are not related (same hormone loop) - so just because you are sick in one does not automatically mean the other will go. Some people get both but it is not typical. High cortisol can suppress the adrenals but high cortisol typically wrecks a lot of the body - low cortisol does not have the same effect. It could be that you have some auto-immune stuff going on though.

[Maggie2007]

Thanks for your response.

I didn't see the guy from the lab do anything special with my blood after he took it...he definitely did not put it in a chilled tube. I guess that result isn't very reliable then.

I've had a couple of thyroid ultrasounds over the past few years. The one was this past spring. I don't remember the wording of the report, but I remember it was consistent with hashimotos...like there was some thickening of the thyroid, but no distinct nodules. Something to that effect.

Adolsterone - I live in NYC, so the morning of the bloodwork...I walked about 15 minutes, then took the train (I think I got a seat that morning) and then walked another 15 minutes. Then I sat for about 15 minutes until someone called me to take my blood.

Thanks so much for your response. I really appreciate it.

[rumpled]

Most labs (including the large hospitals) do not do the ACTH right... I sometimes bring ice with me just to make a point. So the ACTH was low due to handling botched.  Aldosterone - go by supine range as you sat during the draw and before the draw.

Have they done the Hashimoto's blood test? That TSH is super high - they should look into the thyroid more. Are you on meds? Free T3, Free T4? I used to work in NYC - it is hard to find a good doc there - at least, I found it impossible.

[Maggie2007]

Thanks.

I was diagnosed with Hashimotos about 4 years ago. I was on synthroid for years and still had some symptoms (some fatigue, would have to work out like crazy just so I wouldn't gain weight) as well as very, very high thyroid antibodies. I finally found a great thyroid doc that put me on a compound of T3 and T4 meds and some supplements. I felt great (more like myself) for a month, but then started to have my current symptoms rather suddenly (which my thyroid doc thinks is cortisol-related since they are new symptoms for me - very puffy face, sensitivity to light, getting a somewhat dizzy feeling, getting headaches while craving salt, flying off the handle over small things like the coffee shop doesn't have soy milk, etc.). You can see that I am a real joy to be around :)

You seem to know alot about this - I herniated 2 discs in my back in September. I had 3 epidurals of steroids over the course of Sept/Oct. Could that have triggered the low cortisol?

I've been wondering if the fact that my thyroid was under treated for years caused this cortisol problem. I was really pushing through some serious fatigue for years.

I read something that explained why being undertreated for thyroid and then all of a sudden being properly treated for thyroid can then bring cortisol stuff to the surface. It even explained the suddenly high TSH (my Free T3/T4 was good...but don't have the labwork with me right now). Of course, now I can't quite articulate what I read....did I mention that I feel brain-dead too? :)

Thanks so much for your info. I really appreciate it.

[rumpled]

I dunno, but you are sounding high cortisol to me, not low - and I know at least a few people that after shots went into Cushing's, not AI. Puffy face, mood swings, headaches etc, sound more like high. Brain dead can be both. LOL. Salt craving is low - so you can swing both ways. I was cyclical. Fatigue hits both hard.

I like T3/T4 better - it made me feel human again! But I can't say that under treated thyroid causes cortisol issues - cortisol usually causes the thyroid issues per medical papers. You need to get a good doc to help you if you have cortisol issues as most don't know how to handle them well.

[Maggie2007]

Cyclical? Very interesting.

Went to doc today. He is running more bloodwork, will schedule an ACTH stim test and an MRI of pituitary area. What a pain...but, will do what I need to do.

Thanks again!!!! Have a Happy Thanksgiving!

[rumpled]

Make sure the MRI is dynamic! Call the place ahead of time and ask if they do pituitary MRIs and if they do dynamic protocol. They have to give you the contrast IN the machine. That means smaller lesions have a better chance of showing up.

Happy Thanksgiving!

[kevieb]

maggie, what i have heard about the thyroid and adrenals is that when you are given thyroid meds it ups your body's metabolism.  if the increase is too much, your adrenals aren't prepared for it and then you start to feel crappy again.  so, what i've read, is that they start you out on a low dose and hold that for awhile----- i've heard 2 weeks and i've heard a month----if you feel lousy and you have low cortisol, they give you hydrocortisone, and then  continue to raise the thyroid about 1/2 grain at a time--holding each dose while your body adjusts to the increase in metabolism.  i read somewhere that it has something to do with your body releasing the waste products it has not been able to release properly when your thyroid is too low.  i guess your body needs time to Adjust.  i can't tell you where i read that--maybe someone else knows something about it?

I'm new at this myself, so i'm just learning.  i also had low cortisol, low acth, an acth stim test (done according to protocol) that did not show an appropriate response.   i also had low dhea and low testosterone and really low vit D--although no one ever said it was low because it was "in range"---3 points above the bottom.

I was originally diagnosed with central hypothyroidism and secondary adrenal insufficiency.  you can look at my old TSH and free T4 tests and see that they did not look quite right, but no one seemed to notice.

my cortisol and acth both tested low, so my endo ordered the stim test--but i got steroid shots in my heels 18 days before the stim test.  i have researched and asked doctors--the orthoped who gave the shots and an endo from UCLA--neither of them said they thought the shots would shut down my adrenals--but according to info on the shots, it looks like it is an ifffy thing as to whether or not the shots could have affected the test.  i saw a second endo who said the shots were definitely the cause of the stim test "failure", but he also did not seem to notice that the dates of my low cortisol and low acth were both before the steroid shots.   He pulled me off my hydrocortisone and was planning on pulling me off my armour thyroid.   they did a really shoddy stim test and said i was fine.  they used a 2 day old serum cortisol test as my baseline---and i had taken 5 mgs of HC, which would have thrown the levels off---i complained about their shoddy work and lack of noting the low levels of cortisol and acth before the steroid shots---they have not sent me a bill and the doc is going to hae a medical review to see if he treated me appropriately---but in the meantime, i am planning on seeing a doc in connecticut---i live in idaho.   i have already started my blood testing--and get this---my cortisol came back higher than optimal!!!  

I have no idea why my cortisol levels are jumping all over the place, we've been under alot of stress and i an quite often anxious--these things can cause cortisol levels to rise, but i don't know if they mean stress and anxiety over a period of time or just on the day of the draw.

regardless, the doc decided to run the test again and also to do a 24 hour urine cortisol test.  i'm listening to rumpled, and making sure i keep it cold!!  i also have now found a great excuse to tell my family that for the next week everyone has to be really cooperative and not get me upset or anxious about anything!---sometimes moms have to use whatever they can for their advantage.

keep testing, someone on here told me that if your body is making some sort of change, going into cushings, hormonal changes, hashimotos---that your levels can jump around.  one test isn't enough to make a diagnosis.

hope i got all that right!

[kevieb]

i keep hearing that it is really hard to find a good endocrinologist because they usually work with old people with diabetes, also, they are notorious for not keeping up with the newest research and best way to treat endocrine problems----the second endo i went to refused to test anything besides my cortisol blood serum level and my TSH.  they would not even do a T3 or a T4 because i was on armour???   all they would have had to do was tell me not to take my thyroid meds before the test and the armour would not have affected the test.  they didn't tell me to not take my hydrocortisone--and it would affect the test, but they were perfectly happy with the results even though they would have been skewed by the medication i took.

[Gesam]

Go online and pull up Dr. Lamm.com.  It is amazing the information this doctor from CA can give you.