What do I do first?

[grantj]

I have seen an internal med dr. (with a wholistic approach primarily) a few times who diagnosed me with adrenal fatigue based upon symptoms and history.  He feels the testing is worthless and started me on an adrenal supplement.  It took a bit, but after a couple of weeks, I was feeling much better, was amazed actually.  One month since starting the supplement, I have had a relapse and seem to be back to square one.  Key point:  I am on Armour for hypo and my meds are either building up or falling since I have to increase and decrease on a very regular basis (like every few days); ridiculous roller coaster ride.  I am 100% sure, based upon specific symptoms, that he is right with my diagnosis, but am not sure I am confident with treatment methods, lack of belief in testing,etc.  He may be spot on, but I am not sure.  He is a "stop watch" kind of dr. who is done when your 15 min is up.  He spends a good deal of this 15 speaking of additional supplements I could be using and even acted a tad bit put out when he realized that I was a tougher case than usual.  He told me my case is unusual with what I have going on; relapse, build up of thyroid meds,etc.  Is he interested in working with me and really helping my specific challenges, or is he more concerned about having to take too much time with me to really want me as a patient?  Nice guy for the most part, but I see subtle signs of the latter.  I don't want to give up on him yet, either.  

I do a ton of reading on my own and have read where with Adrenal insuf., your thyroid meds can build up due to lack of meds being distributed out to cells and you will get hyper symptoms even when you shouldn't be based upon levels, etc..  This is exactly what is going on with me and where my real challenge lies.  I feel I run on T3 depending upon where it stands on a daily basis in my system, and when that gets off even slightly too high or low, I am 100 % different in how I feel, act, etc.    

Bottom line:  Where do I go next?  Is there reliable testing?  He gave me a script of hydrocortizone (low dose) yesterday, but is he really taking the time to analyze my case individually enough to do this safely and effectively?  Shall I continue on supplement for a while as I know setback are common?  Are supplements really the most effective way of dealing with adrenal issues?  Please help!!  I am a very active person, healthy otherwise and cannot bear this total lack of consistency in my health.  I have a four year old that I cannot seem to enjoy on a regular basis nor can I really plan events with friends, family, etc. for fear of being a zombie.  I am sure we all suffer similarly with this and have the same fears and concerns.  Thanks so much for any and all help you may give.  Debbie

[grantj]

Thanks, and again, sorry to have made duplicate posts (see other thread on "Cortef causing weight gain".  All the info I put in the other thread would have made more sense to be here.  Still making sense of all of this, but am so incredibly happy to have found this board.  Thanks so much

[rumpled]

From what I know, armour is mostly T3, T3 has a very short half life - so that is not stacking. It would more likely make your hyperthyroid than anything...

An endo is good - but frankly, a lot of them are lousy. But yes - the supplements can interfere with testing and may or may not do things to the adrenals as it depends on the supplements. The vitamins - not so much for what I know.

[grantj]

So, I am wondering if I really NEED thyroid meds at all since my very small dose is stacking.  I know it doesn't make sense.  I cannot think of what else it could be and can't seem to get a good answer from any dr.  Have you ever heard of someone stacking thyroid meds?  I did read this, so I must think that it has happened before.  Do you think that adrenal essence as well as a side of pantithene along with liquid multi viatmin is enough to ruin my adrenals forever?  

This is what I mean; one hears this and that and how can we ever be confident that we are in good hands treatment wise??  Yes, I agree, I need good, solid, reliable testing before starting a steroid therapy.  As for another hormonal issue altogether, very possible.  Where do I begin; an endocrinologist?  

[rumpled]

I used to take hydrocortisone - however, I recently made a switch to dex only because my ACTH is very high (normal is 6-48, post bilateral adrenalectomy can be up to 600 - I am 4000 or so) so I am working to do something to lower it. I don't advocate long acting steroids due to side effects.

HC is most like what the body makes. It has a short half life - long acting meds - I guess that makes you pool - or as I say stack - doses - one dose is not gone when you take another. BTW the dose given to you is not even a normal replacement dose. And yes - it does take more - if you have AI.

Adrenal insufficiency = addison's disease and other disorder. Adrenal fatigue is not defined and why should adrenals stop working unless diseased? No other gland in the body does - the body is built for a lifetime. Sadly, I know those treated for AF can take enough supplements that they can ruin the adrenals forever - thus making themselves AI. Those that take corticosteroids for other disorders risk this as well.

It could be another hormonal issue altogether. Another doctor is not going to take you on without any testing - does your PCP do any baseline testing?

[grantj]

Such great info as I am so desparate for help; great to know that there is, in fact, reliable testing, negating this dr's idea that there is not (red flag).  Regarding my Armour, I take 30 mg at 7am and then a bit more than 30mg at 3pm, and adjust this second dose every few days based upon symptoms of feeling overloaded (levels on paper do not show overload, nor does my low dose).  

You say you take thyroid meds with adrenal meds, no challenges.  I am thinking that I would not either (have challenges) if I can get on the right adrenal support/meds; and, of course, this is pre-empted by finding the right dr.  According to info that I have read, thyroid hormones, if not distributed out from blood to cells due to adrenal fatigue, will (can) build up in blood leading to what appears/feels like hyper symptoms.  The build up of the thyroid hormones causes even more stress on the adrenals.  My body must get the hormones out to cells.  This is what is happening to me, I am confident.  When this happens, I then reduce my afternoon thyroid dose (still take a 30mg in morn) just by a pinch, literally, and the next couple days I cannot hardly function at all with a severe depleted, weak, zero energy situation.  This causes me then (couple of days later) to do a pinch more than half of that second 30mg to get things going up again; vicious cycle that never ends, build up starts, etc. etc..  The way I feel in each situation is so radically different that I know there is something serious going on that needs to be addressed.  

This dr. that I am dealing with really had no clear ides of what may be going on with the thyrid meds, ordered the RT3 test and keeps pushing the supplements.  He also said, "Here, try the hydrocortizone. It's low dose, no side effects.  I don't want to waste your money on testing since they are worthless."  Script is for 5mg in am. 2.5 in afternoon.  So now what?  From all that I've read, there is a lot more to this than just "here, try this".  Again, does he want to be bothered with a tougher case than usual?  Is he experienced with a tougher case?  I am confident that if I had the adrenal issues addressed first, I would have never needed thyroid meds at all.

Does my situation sound familiar to anyone (build up, that is)?  I have seen the term "pooling your meds" to describe this.  Any ways to avoid "pooling of meds"?

Rumpled, what adrenal meds are you on?

I am tempted, seriously, to travel anywhere in region/country, if need be, to see the very BEST dr. on this subject.  I live in Jacksonville, Fl, and I am open to any/all suggestion as to who to see, trust, believe in, and who will take the time to really want to help me.  I am looking for names/contact info if anyone would be so kind as to share.  Thanks!! Debbie

[rumpled]

If you have done the proper testing - that is cortisol, ACTH, adrenal antibodies etc. and a stim test - then the hydrocortisone is a usual and proper replacement. One can sometimes add florinef and other supplements to the mix as well as the issue with AI is primarily not being able to hold on to sodium - so you may need the mineralcorticosteroid to hold the sodium.

So there is reliable testing for sure.

I take thyroid meds with my adrenal meds. I have no issue taking them. T3 has a very short half life - are you taking your meds frquently? I take a T3-T4 mix.