Hypothyroid... or Low Cortisol and Adrenal Fatigue

[amdiegelman]

Hi -

Is this a popular area of confusion? I went to my PCP today and presented him with a lot of information. List of symptoms, comparisons of blood work and even this article (http://www.hormonerestoration.com/Thyroid.html) to explain my push for a diagnosis of hypothyroidism.

In review my labs are:
TSH: .68 (.50-5.0)
FT3: 1.0 (.8-1.7)
FT4: 2.7 (range 2.3 – 4.2 )

List of symptoms:
WEIGHT GAIN (20lbs in 2 years - and I'm active)
Very brittle nails
Occasional constipation
Shortness in breath during exercise  (noticed Dec 2012, increasing)
Depressed/crying (Began Jan 2012)
Irritability
Decreased libido
Tightness in throat
Lightheaded when I stand up too fast
2 week period of body temp 96.2-97 degrees, with occasional 97.9. – ongoing, see notes
Waking up with thick white coating in mouth
Dry eyes (I do wear contacts, but drier then normal, age?)
Fatigue
Dry skin
Cold hands and feet
Next day effects after a few drinks

AND he believes that these are symptoms of low cortisol and adrenal fatigue rather then Hypo. He also stated he isn't a big fan of the doctor who wrote the article, because he has no evidence to back statements up. So, I have a huge battery of bloodwork to be done tomorrow morning, first thing.

What does the community think here? Any thoughts on how to proceed?

[rumpled]

What time did you do the test?

Sadly, doctors are told, in error, that patients have to exceed the range for cortisol by 2x or 3x the range (so, um, the point of the range is what, exactly?) leaving patients to be ill for no reason other than ignorance.

Elevated cortisol would certainly cause fatigue.

[amdiegelman]

Yesterday my PCP called to tell me my blood results were normal - and he had no explination for my fatigue or brittle nails. (He didn't know I saw an endo on Monday and already had part of the results)

I went to pick them up today - for my records - and since cortisol was brought up I checked the results. It was a blood cortisol test.

Cortisol, Total, Serum     30.1 mcg/dL
AM range 4.0 - 22.0
PM range 3.0-17.0

First - if doctors are going to stick to "whats in range" for everything else, then why didn't this come up? It clearly isn't in EITHER range listed. Right? (This will be my first question when he calls me back)

Second - maybe we are on to something with this coritisol theory - while I do feel my thyroid is in the starts of a problem... maybe this is a key indicator of something going on...

[kevieb]

My most recent doctor was a holistic MD.   My body WILL require certain prescriptions for the rest of my life.  Because my pituitary is not working, I cannot maintain certain hormone levels without them being supplemented.  I can get them up to normal levels----then when I stop the supplements, my levels drop again.

You can't live without cortisol,so I will always have to take HC, and you will never feel better if you are hypothyroid, so I will always have to take thyroid medication.  I also don't make enough DHEA, and my body can't keep it's testosterone levels high enough--even for a female.

My doc believes in using as little prescription medication as possible and he treats los vitamins and minerals with supplements.  His goal is that eventually,hopefully, a person will need less of their prescriptions and supplements when the endocrine system is balanced and a good diet is eaten.

[mermaid7seas]

Hello:
I just posted a comment on adrenal deficiency which has to do with the wearing off your defenses and all years of struggles in life,your thyroid is going out of whack , and hypothalamus gland  located center upper rip cage thorax  is connected to your heart. Have you ever thought about an alternative holistic  therapeutic modality? You empower yourself to heal in other words you listen to your body that won't lie and you connect to the energy using a holistic approach  as a bridge mediator that will connect you with your heart.  
You know now that the answer is not with a pill prescription med...and the majority of mds nowadays are trained to promote drugs that in the short or long term will cause you side effects and mess up other aspect and / or organ of your body and  your health will be more compromised. Do your own investigation and find an alternative or complement

[kevieb]

I had completely forgotten that my first endo had diagnosed central hypo.  I had an MRI with contrasts that showed no pituitary disease---she told me that sometimes some cells just quit working.

I was talking to my GI, who is also an internist, and was quite surprised, when i was telling him everything I was low in hormonally, that he immediately knew I had central hypothyroidism.

Everyone else kept treating me like a primary hypothyroid patient----it didn't help that the second endo i saw pulled me off everything and then didn't test anything except for the sham of an ACTH stim test his nurse practitioner did.  

I even asked them if they would test anything else--and they wouldn't, they said they would only test my presenting symptom????  I didn't come in with a presenting symptom----I came in with multiple endocrine issues.

I think my worst symptom these days is this overwhelming fatigue and total apathy about life and ongoing depression.  I have chronic pain--but I've had it for 13 years---I think I could handle it better if I felt like doing something and wasn't so depressed and tired.

[rumpled]

I have central hypo - my TSH is simply not used in changing my meds. My docs test it only to check on my pituitary and to see where it is as they know it is failing and I may have to radiate. Your case may be different since you did not have surgery?

I would look more toward the free T4 and free T3 and how you feel than TSH - if you have central you already know the pit is not working?

[kevieb]

seems to me that just when we start to figure some of this out----one of us add some more information, or different experiences---and suddenly it all gets kind of murky again!!!LOL!!!

MY TSH was 0.01 the last time it was tested--but I have read that with central hypothyroidism, it is supposed to be really low when I am treated correctly.

When I first got thyroid nodules, I was on suppression therapy and my surgeon would let my TSH stay at 0----I felt better in those days---and it took not a lot of synthroid to keep my TSH at that level.

I feeel crappy most days, now and seem to have extreme fatigue that just gets worse.   i live with this fear that I am just going to get worse and worse and become a burden to my family.

[rumpled]

High cortisol can suppress TSH. Ironically, low and high TSH have very similar symptoms. I have had both - had adrenals removed to cure my elevated cortisol.

I know people with low cortisol and no thyroid issues - and lots and lots of people with thyroid issues with NO adrenal issues (my entire family is hypo for generations - no adrenal issues until me!)  I don't see that one begets the other. I do see that once you have an auto-immune issue though you do tend to get more...

[kevieb]

IF the TSH test was right, your low levels would indicate hyperthyroidism.  I personally don't believe that TSH is reliable.  Your symptoms seem to fit more with hypothyroidism.

[amdiegelman]

Yesterday I had several blood tests run- including Hashi's Antibody as well as FT3, FT4 and TSH, Cortisol, ACTH Stimulation and the typical CBC/Iron etc panel.

I have obtained copies of my blood work from 2000, so basically 13 years ago, when I was sick and diagnosed with Chronic Fatigue Syndrome - which I somehow overcame by taking a battery of prescription drugs. In looking, I've ALWAYS had very low Iron, B12 and Ferritin. Along with a steady TSH level of 1.0 - until last June when it was 0.68.

This weekend I have felt like I had a hangover for the entire weekend. I've had a headache and been VERY foggy until around 5/6pm or later when I've suddenly cleared up and felt great. I've read several places that low cortisol often goes hand in hand with hypo - when I asked my PCP this Friday, he told me no.

I'm starting to think I may need someone new...

[kevieb]

The doctor I saw last would terst thyroid and cortisol--with blood tests.  then he would do a physical exam to look for physical symptoms of low cortisol--I had orthostatic hypotension---but i had already been diagnosed at one time with adrenal insufficiency--not adrenal fatigue, I had been on HC, then a different doctor pulled me off it.

This doctor would start you out on 1 grain of natural thyroid for a month, then slsowly start raising 1/2 grain every 10 days.  If you started to show signs of cortisol deficiency, he would prescribe cortisol.  His theory ws that as the thyroid started to increase the body's metabolism, that the adrenals may not be able to keep up with the increased metabolism at first.

He would contiune to raise the thyroid until your symptoms were better, or until you got symptoms of hyoerthyroid--if that happened, you stopped the thyroid for several days and then went back to the dose you were on before you got hyper symptoms.

He would do blood work every 3 months--and tested many things, to try to balance the endocrine system.  Hopefully, a person would eventually be able to get off of the cortisol as their endocrine balanced.  he believed in using as few prescriptions as possible and used supplements whenever appropriate.

His feeling was that as things got in balance, less of the hormones and supplements would hopefully be needed.

Don't know if his theory is exactly right--but i wasn't getting help from anyone else---and I liked that he tested so many things.

Unfortunately he has been ill and does not know if or how much he may be able to continue his work---bummer--now I've got to find someone open minded who is not a total quack.

[rumpled]

It is odd for an MD to bring up adrenal fatigue - as it is not an accepted diagnosis.

I am not in the adrenal fatigue camp. I am sure there is something wrong, but I don't buy that an organ or gland gets tired - what is next - pancreas fatigue?

Hopefully your doc will do good thyroid testing - which is more than TSH and T4.

[kevieb]

first of all, your doctor is saying these are symptoms of low cortisol and adrenal fatigue---he is basically saying the same thing, which makes me wonder how much he really knows. Either you actually have adrenal fatigue, if it is a real thing, or you have low cortisol, which would be adrenal insufficiency.

I'm not sure yet what i think of adrenal fatigue, i have secondary adrenal insufficiency, which was diagnosed with an ACTH stimulation test---but I have central hypothyroidism, which is different than primary hypothyroidism--mine is a form of hypopituitarism.

A lot of doctors only recognize either cushings or addison's---which are at the opposite ends of the scale.  I can't help but think it could be possible for a person to be a little low or a little high without actually having either disease.

All three of your test levels appear to be on the low side---and you definitely have a number of symptoms of hypothyroidism.

Your TSH should not  be low along with your FT3 and FT4--that is abnormal.  It actually could possibly point to something similar to what I have---a TSH is totally unreliable on me and when I am treated appropriatly, my TSH levels should be very low.

TSH levels are not a good indicator of thyroid activity, there are too many things that can throw them off, yet so many doctors think they are so accurate for telling the state of your thyroid.

If you are low thyroid, there is about a 50% chance that you are probably low in cortisol, also.

Do you know what tests you are having done tomorrow?  Hopefully the tests include all the proper thyroid tests.