Cytomel and Adrenal Fatigue

[Shareeni]

Hi.  I'm new here.  I have been hypothyroid (Hashi's) since 1996.  Started on Synthoid, switched later to levothyroxine (100 mcg) where I have stayed until recently.  In March of 2009, I began treatment for low adrenal function.  I was experiencing a myriad of symptoms including loss of appetite, insomnia, muscle weakness, feeling wired and tired all the time.  I had just turned 48 and am sure I was perimenopausal to boot (although I had had a partial hysterectomy a few years ago).  It seemed like a nightmare and I had to take a 3-month leave of absence from work.  I finally went back to work in August 2009 and have been steadily improving with a megavitamin regimen, including Vitamin D, Vitamin B12 shots and omega three oil.  My holistic MD did blood work which showed a normal TSH, but low T3, so on February 28, 2010, he started me on 5 mcg Cytomel per day and 75 mcg of Synthroid (switching me from the levothyroxine.  The first week, I felt really good, with the exception of some light headaches.  I slept well and had great mood and energy.  Starting last weekend, my mood started to dip and for two nights this past week, I've experienced some insomnia, where I'll be awake for a couple of hours in the night before I can get back to sleep (although I fall right asleep when I turn off the light).  I still cycle even though I no longer have a period because of the hysterectomy, and this actually would be "the week" I would have a period, so I'm thinking this may be caused by a dip in progesterone and elevation of estrogen, which would normally occur.  I hope this is the case and my sleep and mood will return to normal in short order.  But I don't want the Cytomel to undo all the adrenal healing I've done thus far, so I guess my question is...does anyone else have a similar story and if so, what should I look out for (obviously if all my low adrenal symptoms come back, I'll know, but by then it might be too late and I have to start all over again with the adrenal healing, and I can't afford to go through the nightmare of not sleeping and then not being able to function or work again.  Thanks!

[Shareeni]

I know I have a low DHEA reading, and have tried to take small amounts.  I seem to be sensitive and have to take small doses of whatever it is that I attempt.  It's very frustrating sometimes.  A year ago, my cortisol levels were "uniformly low," according to my MD at the time, but my adrenals weren't "tanked."  My first homeopathic MD wanted to put me on hydrocortisone, but this didn't sit quite right with me and it seemed like the more questions I would ask him, the more he seemed to get mad at me for asking, so I found another doctor, a holistic MD, who felt that I didn't need hydrocortisone (although he would treat with this if you're adrenals were tanked).  He felt mine were just low and would respond to treatment with supplements, adaptogens, stress management, etc.  He was right.  He has been an excellent doctor and I trust him.  The plan was to eventually tweak my thyroid meds when my adrenals were strong enough.  So, two weeks ago, after months of treating my adrenals and regaining a great deal of my health, my doctor felt it was the right time to change my thyroid medication.  My bloodwork also indicated that it would be helpful.  In retrospect, I think we should've checked my adrenals and dhea again first, but you know...hindsight and all.  Anyway, I plan to get the saliva test kit from him this week and see where I am currently.  And you're right; it is confusing all of this.  It has become a fulltime thing looking after my health, but I know it is one of the best investments I can make.  I envy those women who seem to sail through perimenopause without any problem....I never thought it would give me such a hard time.  

[LazyMoose]

Quote-"Not sure what you mean by "what times were off?""

- I meant what time of day. Adrenal cortisol saliva testing is usually a 24 hr, 4 point (4 times a day) test.

The results report will show your cortisol levels and suggested rages for four time periods during the day. Mine was in the low range at noon and Below range afternoon. Morning and night were fine for me.
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A cortisol / DHEA-s ratio can also be determined by adding the four cortisol values and then dividing by the found (on test) DHEA average.  A proper ratio range is given in the lab report. As DHEA depletion begins is will make the cortisol part of the ratio go over the range. I think that is why for some people taking cortisol (cortisone) will make them worse - they might need more DHEA to level the ratio. Its confusing.

[Shareeni]

I just underwent another battery of blood tests and I'll have to get a copy of them (they are with my holistic MD's office at present).  He went over the rest results with me and while I can't recall exact numbers, I know that the TSH was normal with a low T3.  I'll post all results with ranges when I get them.  Thanks!

[Shareeni]

Hi-

I had a major emotional blow about a year ago and that was the straw that broke the camel's back, so to speak.  Prior to this, I was a high-energy, high performer at work and in life, but I never really made quiet reflective time for myself.  So one of the first things I have learned to do is to treat myself with compassion and make time to read, take walks, etc.  Instead of going, going, going all the time, I have learned to say no when I need to and just slow down.  I see a therapist/counselor once a week and I have massage therapy twice a month.  Every day, I take Extension B (by VRP.com) twice a day, biotin 500 mg 1 x day, pantothenic acid 500 mg 2 x day.  Omega 3 fish oil 1 tsp per day, vitamin D 4,000 i.u. per day, Gamma E 1 x day, alpha lipoic acid 1 x day, selenium 200 mcg per day, Oil of Evening Primrose, 1 x day.  Initially, I followed Dr. Wilson's adrenal diet in his book on adrenal fatigue.  I still try to eat six times a day (three meals/three snacks) with each meal containing protein, complex carbohydrate and healthy fat.  I eat a lot of fresh organic fruits and veges.  I walk every day and I meditate every day.  For awhile, I was also giving myself B-12 shots once a week, but have now cut that back to about twice a month and then will taper to once a month as I improve.  Along the way, I have used melatonin to sleep, but that has now improved and I don't take it anymore.  I also take 1/2 of a magnesium citrate pill every couple of hours (it is very relaxing) and something called "Zen" (Vitacost.com) which contains theanine (which is found in green tea) and GABA (an amino acid) and greatly reduces anxiety.  I also take about 1 1/3 of a phosphatidylserine capsule.  It helps to keep cortisol levels in check.  Some folks find that ashwaghanda (an adaptogen) helps their adrenals (I couldn't take it because it tried to tease out T3 too soon in the healing process).  Isocort made me terribly jittery.  Gotu Kola is a nervine that I have used a couple of times.  5HTP is great for sleep as well.  Milky Oat is another nervine, and although I've bought it, I haven't tried it yet.   I briefly was put on hydrocortisone by one doctor, but was taken off of it by my current doctor.  It really wasn't for somebody like me with just low function, it is more for folks whose adrenals have tanked.  Yes, I have had extensive saliva testing to confirm not only adrenal function, but also hormone function such as DHEA, progesterone and estrogen.  Not sure what you mean by "what times were off?"  I hope this helps.  Shareeni

[gimel]

I think that before doing anything different, you should right away find out the levels of your biologically active thyroid hormones, which are free T3 and free T4  (FT3 and FT4, not total T3 and total T4).  Then when done, get a copy and post the numbers and reference ranges so that we can see where you are within the range.  

[LazyMoose]

What did you do to treat / heal your adrenals?

Did you confirm with a 24 hr saliva / adrenal test? What times were off?