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Weight gain with Cortef?
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Weight gain with Cortef?

Is weight gain a common problem with using Cortef?  I am a very lean, fit person who has been given a script for Cortef due to adrenal fatigue.  What is the likelihood of weight gain on this product?  Super nervous to start this treatment to say the least with fear of any/all side effects.
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657231_tn?1390151580
If you take it and you do not need it, you will gain. If you take too much, you will gain. If you take it at the wrong times, you will gain.

If you need it, follow dosing to mimic a diurnal rhythm of bulk of dose in morning lessening through the day tapering to nothing at night - then you minimize side effects.

Longer acting corticosteroids tend to cause more side effects like weight gain and the hidden ones like bone loss etc.
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1646889_tn?1301484828
Oh, thank you!  So great to hear.  I am petrified to start this therapy, to say the least, due to this, amongst other possible side effects.
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If you are lean and fit - kinda odd that you have AI - usually someone with AI is pretty sick and cannot exercise. Salt loss is too much for them. Plus they would have lost a lot of un-intended weight - so some weight gain back would not be bad.
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1646889_tn?1301484828
I never realized that there was a difference in AI and Adrenal fatigue.  Mine must be fatigue.  I have always been lean and fit, no weight loss, and I do exercise on a regular basis, just big shifts in energy, mood, etc., and very wierd symptoms when my T3 wears off.  I tend to get most of my AF symptoms on days my thryoid meds are off (I have 20 AF symptoms, so I am confident that this is what I am dealing with).  This will all change in a pattern like form, depending upon whether or not I can keep my Armour meds up without stacking.  I have had pretty much no thyroid symptoms (except the energy, fatigue, past depression thing).  I was placed on Armour in 3/09 due to low thyroid readings.   So, with AF vs. AI, is steroid therapy even a likely treatment for most anyways?

I am confident that being on thyroid meds has further stressed my adrenals (have read where this is quite possible).  I tried going off back in Feb.  All I can say is, VERY BIG MISTAKE.  I cannot go it without Armour.  If I was treated for AF prior to thyroid meds, I am confident that I would have never needed thyroid meds at all.  I almost think that if I could get my adrenals built up, I can get off Armour and that would be a great thing about now.  So...here I am and don't know which way to turn at this point.

Sorry about my long posts, but here is another piece of key info:  Back in 2/08 (7 months post partum), I was diagnosed (labs and ultra sound to confirm) with poly cystic ovarian syndrome and was placed on Metformin.  Over the next year or so, all tests proved negative and I seemed just fine (I am/was a very unlikely candidate for this disorder).  I stayed on Metformin refusing to rock the boat for fear of getting off track (had a terrible postpartum depression/hormone thing go on).  Well, just here in Feb. '11, I went off Metformin (per my ob/gyn advice) and this is when I could no longer tolerate the 60 mg Armour I was taking (while on metf) without any stacking along the way.  Almost immediately upon going off met., I started with the hyper sx at the same 60mg.  I then concluded (very foolishly on my own) that I really did not need thy meds, it was the metf that was causing my thyroid to go low.  I ceased Armour and in three weeks, I was almost non functionable.    I then restarted Armour 60mgs, things went pretty good along the way, and about six weeks later, the stacking started.  This is when the cut back, increase, cut back, increase, cut back , increase thing began.  I am seeing Dr. after Dr. to no avail.  Primary does not understand this and the current dr. I am seeing I believe has limited knowledge on treatment.  I just had blood drawn to check RT3, blood sugar and insulin.  Results to follow. There has to be something going on here that simply has not been uncovered!!   Ideas?? (sorry about making two different threads on this with relating info.  One thing lead to another in this thread).  Thanks  Debbie
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Ah, the old *female must be a female problem lets blame the ovaries!* thing... and what a nasty drug metformin is (at least it was to me). I was in the same boat.

Have you had a a good set of testing? Do you get copies of your tests?

Perhaps you should get another opinion - it just does not sound like your hormones have been addressed correctly. It can take a while after meds or changes in meds for a body to regulate and people's body's react differently.
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596605_tn?1369950227
Hi-
I don't usually post in the adrenal forum as it is not my area of expertise, but I do look. I wonder if you ever had pituitary testing after the birth of the baby in 2007? There is this condition called Sheehan's syndrome. But in a nutshell it could be that your doctor is not looking at the right source of your woes? I am not saying that this is the case but asking if pituitary was ruled out. Since the pituitary gland controls TSH, ACTH, FSH, LH, growth hormone etc which in turn control your thyroid, adrenals and ovaries.

Do you remember if when you were dx'd with the polycystic ovary syndrome if you actually had cysts or not?
Is your TSH low?

Have they ever tested your IGF-1 aka Somatomedin C level (insulin like growth factor/ growth hormone)?

I ask because all of the hormones do work together as a group and because I don't but into the adrenal fatigue thing. You either have adrenal insufficiency (or not) But you are right in that if you have it, it needs to be addressed in order for your thyroid to be corrected.

Another question separate from the pituitary one, Do you have Hashimotos or nodules?
That would be another reason that would make it hard to get your thyroid under control.

See if you can gather up your lab tests for us and for you.
Horslip
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1646889_tn?1301484828
Thanks, any and all info is good info at this point.  When diagnosed with PCOS, I did have the high testosterone (3X normal limit; then immediately had a recheck to see if it was a false positive, which it was not) as well as multiple cysts on ovaries (none of the other traditional symptoms though).  I took metformin without challenge (that I know of); wasn't necessarily nasty for me in any way, thinking it was causing constipation even though the usual is diarreah (diarrhea) with that drug.  I had a number of dr's after this dispute the diagnosis and it always remained a mystery.

Rumpled--you asked about a good set of testing; what tests are you referring to?  I have had thyroid checked along the way (FT3, 4 and TSH), have had random other ultrasounds (for incidental cysts, not indicative of PCOS) and testosterone testing which has consistently been normal for a couple of years now.  Last week, I had blood drawn for purposes of testing blood sugar, insulin and RT3 (yet to get results).  I have never had the IGF-1 tested nor any other indepth things like that other than basic female hormone panels and thyroid.  My TSH has never been anything too low, nothing out of the ordinary with being on Armour.  I was tested for Hashi's, which was negative, and have never been told I have had nodules nor do I think I have based upon feeling, etc.

There are so many variables with this sort of thing, I know.  Based upon everything I have learned/studied and if I had to make a guess with symptoms, pattern of issues, etc., I am guessing that I have had adrenal fatigue for years and when going on Armour, it stressed my adrenals even more.  I have not always had this stacking of meds thing, it started in 2/11 after going of metformin (I was only on 500mgs).  I have over 20 symptoms of AF and as I said, almost no true specific thyroid sx (had low levels back in 3/09 which prompted the start of Armour).  

If adrenal fatigue is present when going on thyroid meds, it is known that the adrenals can stress all the more (things have progressively been going downhill). It is also stated that thyroid meds can build up (too little cortisol cannot push meds out to cells efficiently causing pooling of meds) and make one feel hyper sx when in reality I should not be ("current" levels as of 6/11are still moderately low).  It is also known, as mentioned, that the thyroid can be impossible to stablize when AF is present.  

My last (6/7/11) thyroid labs are:  TSH 1.32 (.55-4.78), FT3 2.9 (2.3-4.2), FT4 .9 (.89-1.76).   On this day, I had major hyper sx going on.  The sx had been coming on that week over the course of a few days until I was full blown hyper state, and then, of course, I had to snip a bit off that pill the next day to get the sx to subside, which they did in a matter of a day or so.  THEN, however, things started falling dramatically day by day until I could just about not get out of bed at all I was so weak and depelted, I then must add a small piece of pill over and above the 45 mgs to make around 50- ish or so.  This is my vicious cycle which never ends.  Over and above everything else, I am most concerned about what all of this is doing long term in my body.  Am I destroying my adrenals until I can get this all worked out?  Am I causing myself other disorders, diseases, etc.?   All of this is very uncomfortable physically, emotionally, mentally, but I can deal with it for now, if I know there is light at the end of the tunnel and I will get my body back to its healthy state.  It is amazing what a person's mind can do when it is allowed to run wild.  I know I have done waaaay too much reading on all of this and it has literally made me in a worse state of stress.  I am working on this for sure.

Am I in search of an endocrinologist here?  Internal medicine?  Some kind of wholistic practitioner?  other?  I am done with the guy I have been seeing although I need to go back next week to get labs from blood sugar, insulin and RT3.  I believe he has served his purpose but does not have a clear cut plan as to where to go from here.  I will not just jump right on steroid therapy with no testing whatsoever.  Clearly, he is happier dealing with simple, quick things vs. dealing with my personal history being so complex.  Thanks
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657231_tn?1390151580
It sounds like you have had only basic thyroid - and good that you had antibodies. There are a lot more hormones to test as Horsey said the pituitary - which in my case when my pituitary was off, there was no way I could get my thyroid to stay right.

Adrenals do not self-destroy? They can atrophy if you replace them and they can be diseased.

Armour is mostly T3 - that has a short half life.

Find a good endo!
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596605_tn?1369950227
Armour does not  really STACK because it is mostly T3 which has a short half life, There is some T4 in Armour and that could theorectically stack but you would not feel the effect of a dose change from that part of the Armour for about 10 days.With T3 you need to spread it out over the course of a day as it only lasts a few hours. That's why most people can not get stable on a T3 heavy med alone. They have to add a T4 med to it.

Levothyroxine or straight T4 stacks because it has a long half life, like 10 days. Some people who only take T4 can take a weeks worth of meds one day a week.

Adrenals do not "fatigue" like Rumpled said. But you can cause them to if you take an adrenal supplement that you do not need. It is better to have testing to know whether you have low adrenal hormones or not. And also to know why you have low adrenal hormones.

Taking an adrenal supplement that you don't need could screw you up the same way that Cushing's disease does.

I agree that there is something going on with you. But by tweaking your Armour every day and chasing this adrenal fatigue thing is not going to get you closer to finding out what it really is. You need a real endo, not a quack. Preferably a neuroendo to run a full panel of homornal testing to figure why you cannot get your thyroid straightened out. It could be pituitary, it could be that you lack a gene to process some mineral in one of the hundreds of steps in thyroid metabolism.

Horselip
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1646889_tn?1301484828
I had an appt scheduled with an endo that my neighbor referred me to; one that prescribed her Armour at one point, so I thought, great, at least the guy understands the drug I am on as most endos do not.  This appt was set for Sept. 20!  I thought, great, now what.  Well, they called me at 9:30 yesterday morn wanting to see if I could be there by 10:30 (last min cancellation).  Absolutely!

First of all, he was at least in his late 70's which concerned me right off the bat.  When I showed him my labs from the beginning of my diagnosis (3/09), he was appalled that anyone ever put me on thyroid meds (I completely REGRET ever doing this, thought it was the right thing to do based upon how I was feeling and a readings and an experienced practitioners advice.  Who was I to question the practitioner at that point.  I knew nothing).  I went through my whole story with him about being diagnosed with PCOS (which he emphaticaly denied, which is a great thing at this point), going on metformin 4/08 and then going off metformin in 2/11, subsequently going off thyroid meds in 2/11 and not being able to function at all after three weeks of no meds.  He looked at my numbers from when I had been off for three weeks and said, these are perfect!  He almost acted like, "what is your problem here!  Numbers were (3/28/11), TSH 2.54, FT3 2.4 (2.3-4.2), FT4 1.02 (.89-1.76).  I literally was almost debilitated from weakness and depletion and attribute it to the low T3.  He was ALL ABOUT TSH and NUMBERS (period).  If you fit that chart, I cannot help you, he have no thyroid issues.  

As for adrenal fatigue, well, he shrugged this off even when I explained about my many symptoms.  He went on to explain about JFK and Addisons disease and how very sick you would be with this (yes, I know).  I was not suggesting that I thought I had AI, I was saying I have many symptoms weak adrenals.  I have read and learned that if you do not address adrenals first if they are weak, you can further stress adrenals with the use of thyroid meds.  Building of hormones is possbile making you feel hyper when you are not, possibly having high numbers and still feeling hypo.  He said there is no such correlation.  The guy really thought all this was absurd.  I asked him about coming off Armour.  He says go off now cold turkey.  Well, been there, done that, not even possible the last time I tried.

He said that he would do some adrenal testing which is the following:  Adrenocorticotropic hormone (ACTH), Aldosterone LC/MS/MS, Androstenedione, LC/MS/Ms, Cortisol, total, LC/MS/MS, DHEA-Sulfate, Aldosterone/Plasma Renin Activity Ratio, LC/MS/MS, Metanephrines, Fractionated, LC/MS/MS, T3 total, T3 Uptake, T4 Free, T4 Total, Thyroglobulin panel, Thyroid Peroxidase Antibodies, TSH, Cortisol  Free 24 hr urine.

Does this look like a comprehensive list to get somewhere?  Could it be possible that at even a low dose (most I ever took was 60 mg), my body could have become almost "addicted" to the T3 and will always need it now?  I want more than anything to come off this stuff and live a stable quality life, more than anything.  Will my T3 production ever come back to a decent level if going off or would some level of supression have set in by now and I will remain low "forever"?  
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657231_tn?1390151580
He is testing your adrenals to show you if you have weak adrenals (which is something that is just on websites - as we keep trying to tell you - they are built for a lifetime - not everything you read is really true, sadly...). So you may uncover an adrenal issue - but likely you will have a really good set of tests - if you look in the health pages I put a link to a place where you can look up the lab tests and see what all of them mean - but he covered you pretty well!

If you have too high of cortisol, my thyroid was effected. My cortisol is critical low now - since I have no adrenals - and my thyroid is now fine! If you look at medical sites like pubmed - the correlation is just not there and the other sites don't cite studies - they just say it happens.

The thyroid is very resilient - you should be fine.
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1646889_tn?1301484828
You are right.  Why is there so much conflicting information; it is sad.  I appreciate your support and encouragment.  I will admit I have been very guilty of studying and reading far too much info, and then have speculated to the enth degree.  I am sorry if I have misunderstood in the past posts; are you saying that there is no such thing as weak adrenals that affect thryoid function/meds, etc.?  

I promise (I don't mean to sound smart or condencending) I am not a neurotic, hypochondriac type person who thinks they are sick.  It just so happened that my symptoms along with thyroid challenges along with all supporting info (and there is A LOT of sites that say the same thing) add up to what this dr. has diagnosed which was adrenal fatigue.  Why in the world would a dr. throw me a script for steroids with no testing or no verification that this is what I actually need?  Ok, now this is scary.  I am so glad my gut told me to not get that filled and get another opinion.  

Why do you personally have no adrenals if they are built for a lifetime?  (again, not saying this in a smart tone)  Can they not weaken vs. shut down kind of like other organs can weaken vs. shut down totally; a heart, a thyroid, pancreas, even our bones can weaken?  Is it really an all or nothing kind of thing in this case?  Is there something that "does them in" so to speak, other than stress?  

I will look up the info you posted; hopefully this will ease my mind, which, yes, is a mess about now!  lol, not funny though.   Thanks so much:)!!  Debbie
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Mine were diseased! So they were cut out. I had Cushing's disease - pituitary tumor. The tumor caused a lot of damage to my body as well as enlargement of my adrenals. They were also nodular. When pituitary surgery could not cure my disease, the decision was made to remove them - and it is a heck of a decision since you need adrenals to live so it was not made lightly...
Adrenals get tumors, cancer etc.  just like any other organ/gland. They can also get auto-immune diseases like the thyroid. There are tests that show it!

Uh, yeah we all read!
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596605_tn?1369950227
This is a link to the endocrine society's stance on the Adrenale Fatigue Issue.http://www.endo-society.org/media/press/2010/New-Fact-Sheets-Dispel-Myths-of-Adrenal-Fatigue.cfm

Some people will not agree with me, but this is my stance. I know that when we don't feel well we hunt for answers that might suit our situation. So you might be having chronic fatigue type symptoms/weight gain or those types of things that have led you to the adrenal fatigue road.

Once you get your labs you will have a better idea of what is really going on. I was looking at your labs above and you thyroid labs are lowish (in range) but lowish. Were those taken while you were on the Armour? It may be that doc only chases the numbers, which is not necessarily good either. There does need to be a healthy balance of looking at your symptoms too, Looking just at TSH is a big no no. I asked about TSH because it originates from the pituitary gland. If it were low all the time than it might indicate that something is going on there.

The doc that gave you the steroids without testing sounds like a quack. Maybe he was just trying to appease you? I dunno. If he prescribed only say 5mg a day it probably wouldn't kill you or throw you into Cushings. But to do it without testing your cortisol levels????? that's not good.

You might think about bringing up the idea of switching to 1/2 armour and 1/2 levothyroxine (straight t4) this might be a way to stabilize your thyroid more if you come up low (or ok on meds) in your labs.

Good luck!
Horselip
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1646889_tn?1301484828
The numbers I posted above were when I cold turkey went off Armour and then three weeks later my levels were tested.  Why is it that prior to this I could take 60 mg consistently without any overload or underload on a three to four day basis.  I went off since I immediately felt an overload type situation once going off this other med; could no longer handle the 60mg.  I cut back a bit, and it still overloaded within a few days.  This is when I concluded that I don't need the meds at all.  Well, I did need them, went back on but now I am not sure why I will not stabilize, will not no matter what I do.  I have to keep switching it every few days.  What is up with this??  It doesn't make sense other than the fact that I also had went off another med about the same time and this is when it all fell apart.  

I understand about treating clinically/symptoms but also keeping numbers in mind.  The endo I just saw was ALL about those numbers being in the normal range.  If I was one tenth of a point inside that range, well it must be something else and not thyroid.  Really?  I say use some common sense here would you.  Obviously, not the guy for me by no means.  He was the guy, however, that ordered all the adrenal tests, which I plan to pursue.  Perhaps I need a mixture of meds; don't know how I will ever really find this out.  

Yes, the internal med doc has turned out to be a quack; done with him.  Ever heard of Bio Logic MD?  We have a location here in town that I am considering seeing.  I am curious as to whether or not they have a good reputation and will be someone that may be able to help me once and for all.  I am not concerned about the money, they don't accept insurance, but don't want to keep wasting my money and time either.
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596605_tn?1369950227
I am so confused!!!! This is what you wrote above:
My last (6/7/11) thyroid labs are:  TSH 1.32 (.55-4.78), FT3 2.9 (2.3-4.2), FT4 .9 (.89-1.76).   On this day, I had major hyper sx going on.  The sx had been coming on that week over the course of a few days until I was full blown hyper state, and then, of course, I had to snip a bit off that pill the next day to get the sx to subside, which they did in a matter of a day or so.  

But then you say that you were off of Armour for three weeks so I'm confused.

But you are not damaging your adrenals by taking thyroid hormone. That is AF thing.

It is not good to by in a hyperthyroid state but if you still felt hyper when you were off the meds for three weeks the new doc might be partially right in that you might not need as much thyroid meds? or maybe T4 and Armour combo?

Yeah I would give this new endo a little more time he may be too old school for you, BUT he did order all of the right tests for your adrenals. Which a lot of doctors will not do right off the bat like that.

Do you mean Body Logic MD? If so, yes. They perpetuate this adrenal fatigue thing, which I don't buy into. They don't take insurance, they sell a lot of supplements, and frankly do some things that I think prey on weak, sick people. So I am probably not the right person to ask about this one. Someone else might come along that has a different mind set though.

I think that we may be coming from different philosophies here so let me know if I am even helping.

Horselip
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