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Finding a doctor who understands thyroid/adrenal problems

Hello, I am helping my cousin out who has suddenly (in the last 3 weeks) became homebound because she is so ill.  She saw a holistic doctor who said that her thyroid is low and that she has adrenal fatigue.  She has all the symptoms of both.  After a detox diet which coincided with her quick and steep decline, he told her "to think happy thoughts" to decrease her stress.  If only it was so easy to get better.

Everything that I read on the internet tells me how important it is to find a doctor who treats both the thyroid and the adrenal gland, and doesn't blow it all off as a psychiatric problem.  She said that she doesn't even have the energy to pick up the phone and make calls, so I want to find a doctor for her.  I'm finding it hard to find to find recommendations for a good endocrinologist in NYC, so I'm left to just calling doctors blind.  What should I be asking them on the phone to find out if the doctor is good?  I don't want my cousin going from doctor to doctor and being sick for years because she needs 120 mg of T4 and she's only getting 30 mg, or something like that.

Thanks.
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Avatar universal
Jane, can u let me know who this wonderful doctor is.
I live in Bucks county, Pa and am searching!
Jan
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Avatar universal
I recognize alot of your symptoms very well.  Here are my thoughts:
Need cortisol levels checked.  Check for problems of pituitary gland (its the master gland which sends signals to the thyroid, adrenal, hormones, etc. to do their jobs). (  Nausea after eating, weakness, faintness or dizziness.)

Check for blood abnormalities, such as Thal trait (low count, small, or slightly misshapen blood cells which results in sleepiness and the kind of borderline underachievement you described).  Sounds worse than it is.

Check for insulin resistance as well.

Eat lots of vegetables to build up blood. Protein too to stabilize blood sugar levels throughout day and avoid progressing to diabetes.  Mild exercise, fresh air and sunshine for vitamin D which supports a bunch of other functions.  Don't take iron unless blood test shows you are in fact deficient. Can make you worse if you have the Thai trait.  First and foremost get cortisol levels/pituitary checked out as it is the only condition I mentioned above which is life threatening. Listen to your body and what  works for you. Be careful about mega doses and questionable supplements.  First do no harm. Balance and old fashioned common sense will take you far.  
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Avatar universal
Jane,
It probably is stress.

But what about Candida and Lyme disease.  I have major brain fog from both.
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Avatar universal
Stella,  my Armour has been making me hyper and anxious in the morning By afternoon it calms down I am trying multidosing taking 30mg at 8 am and then 30 mg at noon. Little better take Tums and ibuprophen to calm me down. had saliva test and cortisol was high in am  Taking vit c vit b complex iron hema plex. Have low energy trouble thinking at times blood pressure has been a little high used to be so high functioning had thyroid removed for pap cancer jn 2000.  Armour worked beautifully for years until I took diabetes meds whicj I am off of now controlled by diet. Any advice. Thanks Karen. ***@****
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Avatar universal
i have been reading your comments even though somewhat dated.  i too am looking for naturopath for the same symptoms.  did the dr in yorktown work out for you?  since i live in the area i would like to try him/her.  could you list his name and address?
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Avatar universal
Wow Jane........no wonder your confidence in your doctor hit the floor.......I don't know what to make of her behavior.......it certainly is baffleing !She sounded so confident during your initial visit........and only 10 days later acted like she'd just met you ? Strange indeed. Well.....I guess you're stuck at least till you get your cortisol test results back.........hopefully they will tell you something.......if of course......she can interpret them correctly. What a shame.......after all the differing opinions you've had to listen to.Hopefully.........she was just having a really off, off day ! When you see her again, it'd be nice if she could restore the original confidence you had in her. Sometimes we forget.......Dr''s are only people..........quite fallibale......like us ! About her not knowing what the Axis tests were.......I don't know WHAT to say. Except......I'm an R.N. { haven't practiced since 1968 }........and I don't know what they are........but let's face it......40 years is a long time to be out of the game. All I can say is......I'm so sorry you're having so much trouble getting the proper help. When I get to your stage { and I've been there }........I tend to pray for help and direction......if you believe that aid can help you.......use it..........it's worked for me when nothing else would. I wish you the very best of luck in getting help. Hopefully those cortisol tests will tell you something !..........peace and love......Norma
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393685 tn?1425812522
The Hashimoto indicator is the TPOab and Tgab test. Thank you for clarifying the Rt3 has nothing to do with Hashimoto.



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Avatar universal
Thanks for your post, and I do understand how you got the impression you did.
I left some things out about my 2nd appt with the doctor that also have me wondering if she was a good choice.  
At our 1st appt, based upon the symptoms I stated and a couple of in-office tests she performed, the dr initially was adamant I had adrenal fatigue, was possibly menopausal (I've had a hysterectomy so we can't tell the usual way), probably had hypoglycemia, and a host of deficiencies, and the lab results would give her a plethora of diagnoses that would allow her to begin treatment and extend my disability.
On the 2nd visit, she had no idea who I was.  She did not remember our 2 hour appointment 10 days ago.  She made no mention of adrenal fatigue or any of the other disorders.  She said I was premenopausal and I said, "The results show I'm pre-menopausaul?"  She said, "You still menstruate right?"  I reminded her I had a hysterectomy.  She apologised and said she forgot.  My anxiety did rise up quite a bit because she seemed to have no idea why I was even there.  We had to remind her of the pending 24-hr cortisol tests.
She did agree to extend my disability, and when she was filling out the forms, she said she didn't know what the diagnoses codes are.  So 1st she tried looking at the blood work up order, which has codes on it.  Then I gave her notes from my therapist, which she copied verbatim because the dr said she didn't know what Axis I, II, III, or IV meant.
This troubled my husband and me that she wasn't familiar with some medical terminology as well.
My husband says he was completely fooled from the 1st appt, he thought she was going to be great.  He went away from the 2nd appt very upset (for me) and angry (he never showed her this).  
I'm happy my husband was with me because he was able to see this a bit more objectively than I.
We'll go back to her when the cortisol tests come back to see what they say.
But we both were disappointed in her lack of preparedness and lack of knowledge of how the adrenal and thyroid interact.  
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Avatar universal
Hi Jane........I can't help but notice, by reading the progression of your posts.......that your anxiety seems to play a large roll in how you're responding to the results of your blood tests.On the one hand, you seemed rather confident in your latest doctors ability to get to the bottom of your problems. But.......after the test results.......your confidence seemed to plummet and you asked many of the well meaning people in this forum for their opinions. It seems you'll get many, many, differing opinions as to what your results mean.........whereas it's my opinion that you return to the doctor in whose confidence you believed.......and ask her........what do the low B's mean ?..........should I be taking synthroid before we settle the adrenal problems ? all the questions you have.......ask her directly and see if you can't again build the confidence you had. I'm also sure that you're aware that the diazepam you've been on for quite a few years......is valium......and can act as a depressant for some people. I would speak to your psychiatrist about that issue.......it could be playing with your head with all this anxiety you're feeling. I guess what I mostly have gotten from reading your posts........is......that you're getting lots of differing and sometimes conflicting advice from some very well meaning people..........but..........they're not doctors.........and if you ask more than one doctor.......you may get many differing opinions.........so.......it boils down to picking one person to believe in.......then.......do what they say. I wish you nothing but the very best in your quest for answers.........I can hear the panic in your posts and it's very understandable..........good luck............peace and love......Norma
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Avatar universal
Thanks all of you so much for posting.  My anxiety is increasing by the minute, and I've had to take more diazepam to stop crying.  Your posts do make me think I've picked the wrong doctor, though.
The doctor didn't say anything about adrenal fatigue at our last visit.  She didn't say anything about low sodium or low B's being linked to adrenal fatigue.  All she talked about was maybe I would get Hashimoto's and that it would be OK to take synthroid even though I said I'm concerned about my adrenals getting messed up even further.
I mentioned Armour and she's willing to prescribe that, but I read on some other sites that it may not help someone like me who is so very sensitivie to meds/vitamins/supplements.  Something about the ratio of T4 to T3 being very high.
The problem with B's is if I take even small doses in a multivitamin, I get very jittery.  Maybe I should take a children's dosage?
My doctor said nothing about the low Bs and that bothers me a lot, as well as her not saying anything about the low sodium.  
How in the world does someone find a doctor who knows what he/she is doing?  I dont' have the stamina or motivation to call a bunch of places and keep repeating my case.  I'm on disability from work for the past 6 weeks, but they'll only wait so long before they terminate me.  Which adds a lot more stress.
My husband has been taking off so much work time to try to help me, and it's taking a huge toll on his emotional reserves.
I though of going to an ER, but I'm worried they'll put me in a psych ward and not even look at the physical side of things.  My anxiety is out of control and I have to get help with that, but then what?  I am so scared.
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Avatar universal
Oops - made a mistake.  A high Reverse T3 is NOT an indicator of Hashimotos.  There's another test (don't know it) and if the presence of antibodies is positive, then it's called Hashimotos Thyroiditis.

And sorry, moderator - I didn't know that mentioning other groups was not OK - won't do it again.  Jane, if you want to know the location of those groups, send me an email.
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Avatar universal
Hi Jane,  You should definitely join two ***** ******:

NaturalThyroidHormonesADRENALS
NaturalThyroidHormones

The people there, Janie, Val and others are amazing with the support and knowledge.  They analyze lab results and have experienced exactly what you are feeling.  Another invaluable website is www.stopthethyroidmadness.com.

From everything that I've read, Armour Thyroid is superior to Synthroid.  With just a little research (search google for 'armour vs. synthorid' or 'benefits of synthroid' which just turned up results of the disadvantages) you'll learn a lot more about Armour.

Re: your labs, I know very little but do know that the Free T3 should be at the top of the range, and the reverse T3 looks too high which is an indicator of Hashimotos.

Sometimes, a doctor/RN is open minded to trying different thyroid meds.

But, if there's one piece of advice that I can give, and that is to join those 2 ***** ******.
Helpful - 0
393685 tn?1425812522
I agree with Enzy - stick to this protacol with this doctor. She is right on about the sodium linked to adrenal fatigue.

As we all know thyroid function and adrenals go hand in hand. Here's what I see in your labs.

Mostly, WOW your B's are LOW. Didn't anyone pick up on that? That's related to thyroid/adrenal disfunction - big time.

Concentrating on the thyroid labs here - You are not balanced. Your Rt3 is high - your pooling T3 hormone significantly. Your Free T3 is LOW - little hormone is moving around in your system to relieve any hypothyroid symptoms. and your a bit HIGH on the FT4. FT4 is the needed hormone to convert into FT3 - It's reversing - You should benefit from Cytomel ( T3) and be backed off Synthroid right now.

My thoughts on adrenals - You need the 24 hr test for sure. What time of day was the test done? at a 12.5 blood test that would be normal right around 3 to 5:00 in the afternoon. There is nothing else to go on.

Hypothyroid is low functioning thyroid. Hashimoto is antibodies attacking the thyroid to cause low function ( dies off the gland) which results in low functioning  Autoimmune Hypothyroidism.
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Avatar universal
  Hi Jane.  Sorry you're still feeling rotten. First of all, your serum sodium is low, which is an indicator of adrenal fatigue. Taking synthroid before hydrocortisone (or fludrocortisone, if tests indicate this is what you need) could lead to lightheadedness, vomiting or passing out, depending on the severity of your condition. You said you're still waiting for your saliva cortisol results. Just be very careful to have adrenal support in place if you decide to go with synthroid. Unfortunately, i don't read test results well enough to comment on your other levels.
Hashimoto's is hypothyroidism that is caused by an autoimmune disorder. There are many other causes of hypothyroidism also.
Don't depend on just one cortisol test either, unless the level is so extremely low there can be no doubt.
Oddly, my son's adrenal insufficiency was first noticed on a hair mineral analysis test. The sodium and potassium loss was so dramatically obvious.
It's interesting that your nausea and headaches subsided after you stopped working. Perhaps there is something in the building contributing to your illness. Have you heard of "sick building syndrome"?
Don't give up on your holistic doc just yet. Ask her to explain why she thinks you have the diagnosis she comes up with. She should be able to point to specific results on your tests, and explain them to you.

Take care,   Enzy
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Avatar universal
I've posted before thinking I have adrenal fatigue.  I though I found a doctor who could help me, but now I'm not sure.
I got a bunch of tests done (still waiting on the saliva test which will give info on cortisol and neurotransmitters).  The dr. said I'll probably get hasimoto's hypothyroidism, and wants to start me on synthroid.
I am very, very, very sensitive to meds and vitamins and supplements.  I can only tolerate about 1/3rd of normal doses.
1)  I thought hashimoto's and hypothyroidism were different diagnoses?  Am I wrong?
I thought I had adrenal fatigue (I have all the classic symptoms) and read I shouldn't start any meds for the thyroid because they could hurt poorly functioning adrenals. I'm very confused because this dr said adrenals and thyroid work together.  I was sent to a psychiatrist because my anxiety level is so high and I'm having bad sleeping problems.  The shrink thinks it's depression related, but I just don't feel depressed.  I'm really anxious, and am on diazepam (for many years) to help that, but it's increased dramatically the past couple of years, since my stressors have increased.  By the way, I've been very 'high-strung' all my life and started on diazepam in 2003.
FYI: My severe headaches and nausea and constant hunger disappeared about a week after I stopped working.   My brain fog has eased up a bit in the last week.

2) I read that helping the adrenals get back in shape will be faster taking medications like hydrocortisone, Cortef or Isocort as opposed to going with vitamin supplements,  dessicated adrenal, or herbs.  Is this true?

3) What do the following results mean to you?
Selenium 290 (100-340)
T3, Reverse 29 (11-32)
T3, Free 295 (230-420)
Vitamin B12 327 (200-1100)
Vitamin D 15 (>30)   --this is low and I've been given Vit D supplement  
Thyroid Peroxidase Antibodies 177 ( or = 1.00 mean Antibody detected)
From March tests:
Sodium 134 (135-146)
Cortisol, Total 12.5 (4-22)
T4, Free 1.1 (0.8-1.8)
TSH, 3rd generation 1.88 (0.40-4.50)

I'm so very confused and feel like I have to be the doctor and diagnose myself.  I have to get better real soon, because I have to work.  If I don't work I don't have insurance or money to live on.  What would I do?  My job is a big stressor, but I'm not strong enough to search for another.  I tried the top-docs website and there's no one near me who is good from that site.  I just don't know where to turn.  It's been 5 weeks and I'm only a tiny bit better.
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Avatar universal
Karen,
  Thanks so much for the post.

  I think I've found a holistic doctor (she calls herself a functional medicine doctor) who will be able to help me.
  She ordered 23 different blood tests.  I also was given at at-home test kit that will measure cortisol levels throught the day and info on my serotonin, norepinephrine, etc levels.
   She said I definitely have severe adrenal fatigue. She asked many, may questions and also performed she did the eye test on me and they did not contract with light.  I've read this is an indication of adrenal problems.  She also feels I have Hashimoto's and may have hypoglycemia, and I may be going through menopause, too.
She's started me on a large dose of fish oil to help with the 'brain fog' I'm experiencing.
Once all the blood test results get in she'll probably start me on a regimen of supplements.
   She's sympathetic and listened to me.  She ansered questions that all prior doctors haven't been able to answer (like the reason why I can't go to sleep if I take a multivitamin after 4PM is because I'm highly sensitive to all meds/supplements and the B vitamins(energy) keep me awake.  No other doctor has ever even tried to answer that question.  She was thorough, smart, and I think I lucked out here.
   I've also started working with a holistic therapist, who believes that my lifelong 'general anxiety' is post-traumatic-stress-disorder due to a traumatic event I experiened early in my life.  She's fantastic and has connected so many pieces of the puzzle of my life together into one basket.  She plans on using the EMDR technique to help me reduce my overall anxiety level, which she believes causes me to stress out more easily than most people, thereby causing the adrenal fatigue.

I've been on antidepressants and anti-anxiety meds since my 30s, but very, very low doses because I hate synthetic medicine.  I am hoping these two professionals will heal me and allow me to get off those meds.

So, right now I think I found a good team and am keeping my fingers crossed.

Karen, thank you so much for caring. It means a lot to someone like me, who has been feeling so lost and scared.
Jane
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Avatar universal
P. S.  Stress is a major factor, do not let anyone start you on antidepressants or relaxants till you have had all the necessary testing done to see where your levels are, they may make you feel better at first, but will not stop the damage being done to your body.  Hopefully you will get better dr''s than I found(other than my natro.)  Be your own advocate, bring in your journal of symptoms, triggers, and results(fatigue, wired, etc..) this will help your dr.s if you have it in writing, makes it more 'real' for them.

Good luck.
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Avatar universal
Try to find a Natropathic Doctor if only for a visit to have them get the lab work set up.  Tell them your insurance doesn't cover them, they might get you a lower fee for cash.(doesn't hurt to ask). Mine saved my life, yet the doctors I saw after dragged their heels, including a renown Endocrinologist. The bloodwork will show where you are at.  Do you have Quest Labs nearby?  He uses them for labs as they do a better job.  After you get the results, see a GP you trust or a specialist. (My primary Doc did not care for Natropaths, so he did very little.) A test of a great doctor is one who will not let his "pride" interfere regardless of your choice of Dr's. The cortisol test is done early a.m. and it is fasting.  There is another cortisol test done by an Endo. which takes a blood sample, injects a cortisol stimulating drug, then takes samples 30 mins, 60 mins 90 mins later. I would suggest total thyroid, adrenal, pituitary, vitamin levels, hormone levels, as well as the 'usual' labs of iron, blood counts, vit d3 levels.  I wish you luck.  I am still working on getting my adrenals addressed, they are only addressing the thyroid  and very low vit d3 levels.

Karen
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Avatar universal
   I too, believe the information about mercury in tooth fillings being a cause of a number of health problems. I have a large number of silver fillings and have had many root canals over the years, and my mouth is in bad shape. So far, no terrible health problems for me, but I want to get my silver fillings replaced at some point in the near future to get the mercury out of my mouth. Maybe I won't be quite so tired and blurry eyed all the time!
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Avatar universal
Maybe my cousin's doctor has us barking up the wrong tree, but the more I read about mercury toxicity caused by  fillings in the mouth, the more I'm learning how dangerous this is and how many unexplained ailments are caused by this.  This article was a real eye-opener: http://www.lef.org/magazine/mag2001/may2001_report_mercury_1.html and there are hundreds of articles saying the same thing.  
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Avatar universal
Wow !!  That was alot of reading.  But this post was very helpful.  I am experiencing severe exhaustion, thyroid labs perfectly normal.  Well I have a ton of questions for my pcp tomorrow afternoon.
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Avatar universal
  Good luck with your doc. appoint. tomorrow. Don't let him make you walk out of there no better off than you are now. You know you are not well, and I don't believe it's all in your head. It's time to get some answers. There's a lot that doctors can do, (and insurance will pay for) if you are insistant that they listen to your symptoms (they seem to be better at reading about them, they listen, but they don't hear, which is why I suggested the journal).

I hope your doc orders the right tests and gets you some answers. Insist on a blood glucose kit, and monitor your blood sugar consistantly for a few days, if for no other reason than to rule out this problem.

You should have your adrenal hormones tested: aldosterone, cortisol and DHEA, and of course a metabolic panel and electrolytes.

My son never had an anxiety problem, until his adrenals crashed. He was symptomatic long before it showed up on a blood test, which is how it is with so many illnesses. Before he got sick, he had so much energy and was so outgoing, he was ready to take on the world. If his doctor had listened to me from the first, he would have gotten the help he needed much sooner.

So, stare your doctor in the eyes if you have to, and make him really think about what you're telling him. That's what you're paying him for.
( Ummm..... don't go overboard though...... we don't want to act crazy, now do we?) :)

Enzy
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Avatar universal
enzymelover:  you sound very informed about all these things.  I read that adrenal fatigue can cause hypoglycemia, so your saying it as well just validates that for me.  Thanks.

Thanks for the info on the salt.  And for the info on the blood sugar home testing.  I didn't know I could get a kit from a doctor.  Thank you for that!
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Avatar universal
   Yes, if it truly is a low cortisol problem, salt can help with nausea. Your symptoms sound like hypoglycemia also, which can be adrenal caused, as the adrenals are involved with insulin regulation.
Have your blood sugar levels checked at different times of the day, especially when you first get up in the morning (nighttime hypoglycemia is fairly common), and during those times you feel like crying (an effect of low blood sugar) or panicky feelings.
Most doctors will just give you a home test kit, if you believe this is a possible cause.
Brain fog is also a symptom of low blood sugar. (as well as other stuff, of course).
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