Adrenal Insufficiency Community
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Avatar universal

Adrenal Results/Thyroid

Hello all,

I was an original poster in the thyroid board, but I just found out I may have some adrenal issues as well.

My initial complain in terms of symptoms is muscle weakness, aches, pain, cannot recover from injuries at all, mild weight gain (main in pectoral/stomach area), and I think some muscle wasting.

My original thyroid blood panel wasn't really bad: TSH 5.98 (0.35 - 5.00), FT4 15 (12-22), and FT3 (2.6-5.7).
I was put on synthroid (25 mcg) and then switched to Erfa after a month to see if it would help. I am now on 90 mg of Erfa and have been taking it for three months. I took 60 in month 1, 75 in month 2, and 90 in month 3. My TSH has dropped to 1.0 and my FT3 is 5.1 (2.6 - 5.7) and FT4 is 9.6 (12 - 22). I also tested negative for thyroid antibodies

I have seen minor improvements, but also noticed an increase of muscle twitching.

I did an ASI on June 7th (I was at 75 mg of Erfa) and it revealed the following:

DHEA was 17 (4 - 15) ELEVATED
AM Cortisol 14 (2- 11) ELEVATED
NOON Cortisol 1.4 (1.0 - 7.) LOW
PM Cortisol 1.0 (0.5 - 3.5) LOW
BEFORE BED Cortisol 0.20 (.20 - 1.3)

I was placed on AOR Ortho Adapt (as I am in Canada). It has adaptagens, Vit C, Vit B, as well as Cortex and Porcine. So far I have seen no improvement in symptoms, but my ND said it would take a while.

What are your thoughts on the results and do you think cortisone supplementation would be useful and/or should I do any other testing. I am scheduling to see an Endo in October but I understand they can be short sighted.

Anyone else have this cortisol pattern - high AM an extremely low everywhere else. My cortisol drops to 10% of the  morning value, which apparently in the report is really bad. A normal drop is 41% and when there is stress is drops by 61%. This is what the report said from Rocky Mountain Labs.

Any help would be appreciated!
5 Responses
Avatar universal
I am a layman, but I used to have Cushing's before my adrenals were taken out - so I have lived both sides.

Elevated cortisol is Cushing's - not AI. In any case, for either disorder, one set of testing is not and should not be used before you are placed on any type of replacement regimen. If you do have elevated cortisol and you ADD a cortisol agent, you are adding fuel to a nasty fire and will only make your symptoms worse.

Cortisol normally varies - it is supposed to. It is supposed to be higher in the morning to wake you and lower at night to put you to asleep. You only had one test, one day. You should have several sets of testing AND a stim test IMHO so you have a much better idea if this is a pattern or an anomaly.

And yes - that pattern is consistent with Cushing's syndrome. You should see an endocrinologist - but they will not accept the lab results from Rocky most likely. You cannot test until you are off all the supplements (as they would add to the testing) and the biologic half life is out - so it would take weeks. The weaning may further hurt and add to your symptoms.

That TSH BTW - old range.
Avatar universal
I don't understand how you think I could have elevated cortisol? The morning cortisol was elevated by three points. The rest of the day the tank is empty.

I get great sleep at night. Usually 9 or 10 - 6 with the odd wake up of my two little men under three.

I have an endo appointment, but not until October. I am seeing a ND who placed my on the AOR Ortho Adapt supplement and so far no harm.

I would suspect my levels of cortisol at one point were very high throughout the day. I wouldn't say I am anywhere near cushings.. that would be a shock in itself and I understand symptoms mimic each other like hypo/hyper thyroid.

Avatar universal
Here is the details from the ASI. I also do agree you can't rely on one test, but this is all I have to work with at present.

Noon cortisol divided by morning cortisol (C2/C1) is 0.10. In other words cortisol drops sharply from morning to
noon; this may be indicative of a degree of dysregulation of adrenal function. In a study by Vedhara, noon
salivary cortisol in individuals experiencing low stress was 58% of morning salivary cortisol, whereas in the high
stress group, noon salivary cortisol was 39% of morning salivary cortisol. (Vedhara K, et al. Biol Psych
2003;62:89-96) A C2/C1 of less than or equal to 0.39 may be associated with increased perceived stress.
RMA database analysis (February 2008) indicates that a high first morning cortisol result has no ability to
predict cortisol levels throughout the rest of the day. Levels throughout the rest of the day may be normal or
even low in the face of a high first morning level, and a high level first thing in the morning does not automatically
predict high levels throughout the rest of the day. Symptoms correlate much better to the noon, suppertime and
bedtime cortisol levels.
Recognize that within the first 30 minutes after waking, cortisol roughly doubles, then falls back toward the
"eyes-open" baseline level in the subsequent 30 minutes. So within the first hour after waking, cortisol can
double, then drop back to where it started. This is called the Awakening Cortisol Response. Depending on
exactly when the sample was taken within the first hour and how long it took to give the sample, the first
Page 3 of 4
Interpretation Accession Number : 378513
morning specimen can be high normal or high due to sampling at the peak of the awakening response.
Subsequent levels throughout the day may still be normal or even low. Acute stress, eating or exercise
immediately after waking and before sampling can also elevate morning cortisol. Cortisol levels in the first hour
after waking have also been associated with pain (McLean SA et al. Arthritis Rheum 2005;52:3660-3669) and
anxiety/neuroticism score on standardized personality inventory (Portella et al. Am J Psychiatry
2005;162:807-809). Elevated fasting serum glucose has also been associated with high morning cortisol.
High morning cortisol is sometimes associated with anxiety. This symptom was not inventoried on our
Here, at least two of the cortisol points are low normal or below normal and there are symptoms consistent with
a degree of adrenal axis dysfunction. Fatigue (especially morning fatigue), anxiety, difficulty maintaining energy
throughout the day, feeling flat or "burned out", excessive use of caffeine, hypoglycemic episodes, depression,
allergies, and decreased exercise tolerance are some of the symptoms which can be indicative of adrenal
dysregulation/adrenal fatigue, although not all these symptoms will be present in every individual. Low or low
normal cortisol output may impair the action of thyroid hormone, and lead to functional hypothyroidism
(symptoms of low thyroid such as feeling cold, depression, dry skin, constipation and weight gain, with normal
thyroid tests). "Adrenal Fatigue: The 21st Century Stress Syndrome" by James Wilson DC ND PhD is an
excellent reference on this topic. Ultimately, the treating physician is best able to determine the appropriate
course of action.*
Bedtime cortisol is low; if the patient is having difficulty sleeping, it might be related to low bedtime cortisol.
There is some evidence that cortisol facilitates REM sleep. Addisonian patients who received hydrocortisone
(cortisol) at bedtime had more REM episodes and an increase in the percentage of time spent in REM sleep
compared to placebo at bedtime (Garcia-Borreguero D et al. J Clin Endocrinol Metab 200;85:4201-4206).
The ratio C/DHEAS is 0.81. This ratio normally increases with age. Based on a large in-house analysis of more
than 15,000 samples at ZRT Laboratory in Portland, the ratio at age 20 is approximately 0.6; at age 45 it is 1.0;
at age 60 it is 1.5 and at age 75 it is 2.3. This is because DHEAS declines with age whereas morning cortisol
stays the same or increases slightly. If the ratio is higher than expected, based on the patient's age, this may
be indicative of unbalanced adrenal function (cortisol too high or DHEAS too low). Factors which can contribute
to imbalance include acute or chronic stress, obesity, metabolic syndrome/diabetes, and hypothyroidism. If the
ratio is lower than expected for age, and DHEAS is within normal limits, this may simply be an indicator of
healthy aging (i.e. preservation of DHEA output
Avatar universal
It is good you have done a lot of research.

I am not a follower of the adrenal fatigue school - I don't find it valid. I don't believe that something/anything in our bodies get tired - diseased, yes! tired, no. Our bodies are built for a lifetime pending genetic disease, disease, our own stupidity etc.

That there are undiagnosed issues out there, yes.

Some of the sources you gave, but not all, are of that school...

DHEA is a precursor hormone for testosterone and estrogen. It is made in the adrenals - but it is not cortisol. I happen to take it as I don't have adrenals any more (nor ovaries) and my doctor wants me on it. When I am off it (as I had to do post-op hyst), my cortisol readings were not effected at all.

"J Sex Med. 2011 Nov;8(11):2960-82; quiz 2983. doi: 10.1111/j.1743-6109.2011.02523.x.
Dehydroepiandrosterone (DHEA)--a precursor steroid or an active hormone in human physiology.
Traish AM, Kang HP, Saad F, Guay AT.

Department of Biochemistry, Boston University School of Medicine, Boston, MA 02118, USA. ***@****

The circulation of large amounts of dehydroepiandrosterone (DHEA) and its sulfated derivative (DHEA-S) suggests a physiological role in human physiology. In the central nervous system, DHEA is considered a neurosteroid with a wide range of functions.

The goal of this review is to discuss metabolism, biochemical, and physiological mechanism of DHEA action and the potential role of DHEA in aging and in ameliorating a host of pathological conditions, associated with aging.

We examined preclinical and clinical data reported in various studies from the available literature concerning the effects of DHEA in normal and pathological conditions.

Data reported in the literature were analyzed, reviewed, and discussed.

DHEA mediates its action via multiple signaling pathways involving specific membrane receptors and via transformation into androgen and estrogen derivatives (e.g., androgens, estrogens, 7α and 7β DHEA, and 7α and 7β epiandrosterone derivatives) acting through their specific receptors. These pathways include: nitric oxide synthase activation, modulation of γ-amino butyric acid receptors, N-methyl D-aspartate, receptors sigma receptors (Sigma-1), differential expression of inflammatory factors, adhesion molecules and reactive oxygen species, among others. Clinical and epidemiological studies suggested that low DHEA levels might be associated with ischemic heart disease, endothelial dysfunction, atherosclerosis, bone loss, inflammatory diseases, and sexual dysfunction. Most importantly, no significant adverse or negative side effects of DHEA were reported in clinical studies of men and women.

DHEA modulates endothelial function, reduces inflammation, improves insulin sensitivity, blood flow, cellular immunity, body composition, bone metabolism, sexual function, and physical strength in frailty and provides neuroprotection, improves cognitive function, and memory enhancement. DHEA possesses pleiotropic effects and reduced levels of DHEA and DHEA-S may be associated with a host of pathologies; however, the clinical efficacy of DHEA supplementation in ameliorating patho-physiological symptoms remains to be evaluated.

© 2011 International Society for Sexual Medicine."

Cortisol is a very difficult topic and very difficult for even sort of competent endocrinologists to take on. Most endos are barely competent in thyroid and eh in adrenals. Yes, symptoms do overlap.
Avatar universal
You don't believe someone could be hypoadrena? Like hypothyroid? Seems odd to me you believe in one not the other. Most people don't like the name fatigue because it is crap like fibro and chronic fatigue.

Most people with severe adrenal fatigue or hypoadrena go on to develop AI. You can post the medical literature that MD's use and ignore the ample amount of people who have this and have gotten better through diet supplementation or cortisol.

Thanks for your time.
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