Neuro type symptoms, Hashi's patient

[HashiMan]

Dr. Lupo,
I'm a mid-40s male, Hashimoto patient, taking Armour for several years and now have TSh at best level for me, about 0.40.
What I need some advice on, are neurological type symptoms I have, especially at night in bed. My hands get numb and tingle usually all night long and I get strange nerve pains, like hot pinpricks that can be anywhere on my body.  Neither of these symptoms are actually painful but are concerning. It also feels as if I don't get enough circulation to my head either in bed at night and some positions with my head turned sideways really make it feel like my head lacks circulation. My Dr.s did more tests and I have borderline low cortisol levels at times, other times slightly below normal but further tests ruled out adrenal insuficency. This lowering cortisol happens especially when my Dr. increased my thyroid med doses.  This was confirmed with testing that it did affect it considerably.
I've read the posts of others on here, who experienced worsening symptoms after started on throid med and I can tell you from my experience as well, this was true.  The worse muscle pain and other symptoms have leveled out now but i can tell you for certain the medication did this.  The only lingering ones now, are these darn neuro ones , that at times made me concerned about MS and other possibilities. I take my dose once in mornings due to taking vitamins/w iron later in the day. Do you think dose splitting might relieve the nighttime symptoms?  Your advice is well appreciated.
HashiMan

[Mark Lupo, M.D.]

I would split the dose - may not help the neuro symptoms, but worth a try.  Would check a B-12 level.  If the ACTH stimulation test was normal, would not treat with steroids for adrenal insufficiency. MS is tough to diagnose sometimes -- if the symptoms persist would see a neurologist for comprehensive evaluation.  Also pay attention to sleep positions - may be resting on a nerve at times that can cause numbness in arms/legs.

[HashiMan]

Can I add that my b-12 was tested and irons, ferritons. They were all normal. The b-12 was 635 in a 215-1100 range. The other post under mine about b-12 made me think I needed to add this to my question.
Thank you Dr.

[ancientmariner]

My doctor had me do the adrenal saliva test, which takes 4 samples at different times during the day. Mine showed low cortisol for all 4 samples. That didn't indicate adrenal insufficiency, but it did indicate adrenal fatigue. Some doctors think the adrenal glands either work or they don't, but there's no such thing as only working at partial capacity. Other doctors realize that the adrenals may be UNDERfunctioning, hence the diagnosis of adrenal fatigue. All I know is that once I started on adrenal support, I was able to increase my thyroid meds so that I now feel much better, with more energy, less depression/anxiety, and I've just started to lose some of this excess weight. I've read that you need cortisol for your body to use the thyroid hormone, so it makes sense that if your adrenal function is not the best, you'd use up the cortisol you have when you increase your thyroid, but your adrenals wouldn't be able to replace it right away, so your test showed borderline low cortisol.

[HashiMan]

That is very interesting information to go on, I like you have also read that you need proper level of cortisol for thyroid hormone to be used by the body.
I've seen some reading on adrenal fatigue too and feel very certain this is exactly what I have. I'm curious what your readings on those salivas were?  Most of mine came back lower normal range but my last two, taken just after thyroid dose increase were below normal. Heres what they were:  Sept 2005 "1.7"(L) Range 3-8ng/ml,  Oct 2005 "2.7"(L) Range 3-8 ng/ml.
These were only the morning levels I took on these but have done several with the morning and evening levels on it. Also did a urine test a year ago that also showed low.
I'm so glad to be corresponding with another person with this same condition and hope we can keep it up a while, to learn more from eachother. It is encouraging.
HashiMan

[ancientmariner]

I don't have the results here, but I was below the range for all four sample times. I take Isocort now - it's an adrenal cortex glandular with some herbals added, and it's not prescription. They don't say how much cortisol is in each pellet, but I take 2 with my AM Armour dose, 2 4 hours later and 2 4 hours after that. Within 2 days of starting it, many of my symptoms either went away or got better. For example, I had been having lots of trouble with my voice - it would just cut out intermittently and I couldn't get any volume - suddenly I noticed that I could talk - I think it was the cortisol in the Isocort allowing the Armour to be used.....It's really hard sometimes to get doctors to test things YOU want testes; I changed doctors 3 times before I found the one who tested adrenals and only prescribes Armour - I think he'll get me well!

[HashiMan]

Very good info again! I think my adrenal fatigue is similar in severity to yours. I purchased some Cortitrophin contains adrenal extract and a name meaning licorice extract but have been to afrid to use it on a regular basis and the occassional use with symptoms flaring, just spikes me up and then lets me down hard. I know this is because need to go ahead and take a longer more steady regiment of it. The fear I have is that it will cause symptoms to happen again even worse once I stop it and my body began dependency. I know you have to tapper off such meds or naturals but what if the adrenal become even weaker due to the use of it. Is your Dr. overseeing your dosing or are you treating the adrenal part on your own?  I know physicians have to be careful in these areas and I'm not against taking such suppliments if a Dr.s hands are tied. You could see by my test readings I wrote you earlier that mine goes down pretty good. I would like to be on higher Armour dose but this is what stops me. I have proved on other tests beside these ones I listed that my cortisol definately drops with increase of dosing with thyroid.  The thing that also is concern to me is my Dr.s not recognising this even when I have it on a test sheet, plainly shown! They say the ACT Stimulating test rules out needs for treating my form of adrenal problem. How can this be true if I have such proof of the hormone for hypo causing it to do this? and you have to have cortisol levels that help with thyroid hormones. If Dr. Lupo reads this one I hope he can respond also.
I'm glad I found you Ancientmariner youre the first patient I've known to get treatment for the adrenals along with thyroid support medicine.
With all I go through, I 'll take all advice I can! I'm smart enough to know risks but what about risks for doing nothing!

[ancientmariner]

I'm certainly no expert, but I've read that with low doses of cortisol replacement, when you get your thyroid optimized, and give your body enough time to heal, you can begin to slowly wean off the cortisol. But I figure that I'll need thyroid for the rest of my life, and if I have to take cortisol, too, then I'll just do that. I'm not going to worry about it, as long as I'm feeling good.  

My doc did order the testing and got me started on adrenal support, but if you can buy the stuff OTC, I bet there are a lot of folks doing it themselves.

There are a number of people on the natural thyroid hormones group in yahoo who are on adrenal support in one form or another. It's a big topic of conversation there. Also, a book by a Dr. Jeffries entitled "Safe Uses of Cortisol" or somehting like that is highly recommended. If you're interested, come join us and tell the moderator that I referred you.

You might be interested to know that the prescribing info for all the thyroid replacements, including synthetics, suggest strongly that adrenal function should be monitored.

What dose of Armour are you on? I am at 3-1/2 grains (210 mg) right now, and know I need to go higher, but I'm taking it slow. I've been at this dose for 3 weeks, but want to go at least six to allow the T4 to level off and make sure I don't get any hyper symptoms.

[Chocobabe]

There's 2 1/2 mg. of cortisol per Isocort tablet, by the way. :o)

[HashiMan]

I take 2-gr a day and also reads 120mg but I'm willing to bet I can get on a higher dose to feel even better if I can get more cortisol going. Right now, an increase would send my cortisol low and this makes symptoms that are just like hypo.
I'm not going to insult our good Dr.s out there I'm greatful for but I have tests plainly showing this cortisol problem and its as if they want me to pretend it doesn't happen.
I did have my certified endo say my readings were really low but also said theres not a treatment for it if the cause is not the adrenal glands or the pituartary. He at least was honest to say he didn't have farther explanation instead of acting as if the problem was not real.

[ancientmariner]

I bet if you can get on some adrenal support, it would help a lot. Check out the natural thyroid hormones yahoo group - there are lots more people there who are on adrenal support and thyroid. There are even some who have gotten to their optimal dose and still post to help the rest of us. Most of all, keep reading and learning - you're the best advocate you can have, and you have to ask for what you need!