(NOTE: as patient wisdom has continued to grow pertaining to the importance of adrenals and treatment, so has STTM been updated. But if you see an error below, or something you think needs to be added according to the experience of patients, don’t hesitate to use the Contact below. Let’s teach others.)
REMEMBER: below is patient “information” as we know it. No more. It is not meant to be personalized medical advice. Never attempt to use this without a doctor’s help and direction.
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* Having strange reactions since starting a natural desiccated thyroid product or T3? or…..
* Not doing as well on desiccated thyroid as you hoped, even when your doctor had you raise above 3 grains or higher? or….
* Have a high free T3 with continuing hypo symptoms? or….
* Has your doctor or anyone else pointed out that you have symptoms of struggling adrenals and/or high or low cortisol, whether you are diagnosed with hypothyroid or not??
Here’s a potential reason why: If you were hypothyroid for several years before being diagnosed, or if you have been on T4-only medications (Synthroid, Levoxyl, Eltroxin, Oroxine, etc), or if you have been through chronic stress of any kind…..your stress-busting adrenals have been working hard to keep you going with extra cortisol and adrenaline, or to make up for your low-functioning hypothyroid state, or the inadequate T4-only treatment! Additionally, periods of chronic life stress, a poor diet, as well as exposure to toxins could have further stressed your adrenals, or even the function of your HPA axis (the communications between your hypothalamus, to your pituitary gland, to your adrenals).
Thus, there is a remarkably large percentage of hypothyroid patients, as well as those who feel they have no thyroid problem, who have poorly-functioning, sluggish or dysfunctional adrenals, or more aptly, adrenal or HPA dysfunction. This is not the same as the disease called Addison’s in most. Instead, it’s simply a long term situation where though your adrenals may still work, they are either out-of-sync thanks to dysfunctional messaging from the hypothalamus/pituitary, or have become weak. And dysfunctional adrenals equates first to combined highs and lows of cortisol that are not normal, then to low cortisol (and sometimes low aldosterone).
Cortisol, a corticosteroid hormone, has a variety of important functions, from the metabolism of carbohydrates, proteins, and fats, to affecting the blood sugar levels in your blood, to helping reduce inflammation, to helping you deal with stress. The latter is especially huge.
But cortisol also plays an important role for you as a thyroid patient. Namely, cortisol raises your cellular level of glucose which works with your cell receptors to receive T3 from the blood to the cells.
On the other side of the coin, dysfunctional adrenal function can result in high amounts of thyroid hormones to build in the blood, making your free T3 and/or free T4 labs look high in range with continuing hypo symptoms, or causing hyper-like symptoms on doses of desiccated thyroid which shouldn’t produce those symptoms. The latter can include anxiety or nervousness, light-headedness, shakiness, dizziness, racing heart, sudden weakness, nausea, feeling hot, or any symptom which seems like an over-reaction to desiccated thyroid, but are in reality low cortisol symptoms, or a mix of high and low in the early stages of sluggish adrenals. Low cortisol can also keep you hypothyroid with hypo symptoms.
- Click here to read actual recorded patient symptoms of poorly functioning adrenals.
Thus, it can be important for you and your doctor to rule out poor adrenal function before starting on natural desiccated thyroid or T3, or soon after you have started and are noticing strange symptoms, which become unmasked by the use of either. Some patients will notice the strange reactions early on, while others may not until they get as high as 3 grains or more.
DISCOVERY STEP ONE: Here are exploratory questions, and if you answer yes to any of these, you may have struggling adrenal function (the revised STTM book has more questions in Chapter 5):
1) Do you have a hard time falling asleep at night?
2) Do you wake up frequently during the night?
3) Do you have a hard time waking up in the morning early, or feeling refreshed?
4) Do bright lights bother you more than they should?
5) Do you startle easily due to noise?
6) When standing from sitting or from lying down, do you feel lightheaded or dizzy?
7) Do you take things too seriously, and are easily defensive?
8 ) Do you feel you don’t cope well with certain people or events in your life?
DISCOVERY STEP TWO: The following are self-tests to try if you suspect your adrenals are struggling:
TEST ONE:
Take and compare two blood pressure readings—one while lying down and one while standing. Rest for five minutes in recumbent position (lying down, tho some do sitting) before taking the reading. Stand up and immediately take the blood pressure again. If the blood pressure is lower after standing, suspect reduced adrenal gland function, and more specifically, an aldosterone issue–another adrenal hormone. The degree to which the blood pressure drops while standing is often proportionate to the degree of hypoadrenalism. (Normal adrenal function will elevate your BP on the standing reading in order to push blood to the brain.) It can be wise to do this test both in the morning and in the evening, since you can appear normal one time, and not another.
TEST TWO:
This is called the Pupil test and primarily tests your levels of aldosterone, another adrenal hormone. You need to be in a darkened room with a mirror. From the side (not the front), shine a bright light like a flashlight or penlight towards your pupils and hold it for about a minute. Carefully observe the pupil. With healthy adrenals (and specifically, healthy levels of aldosterone), your pupils will constrict, and will stay small the entire time you shine the light from the side. In adrenal fatigue, the pupil will get small, but within 30 seconds, it will soon enlarge again or obviously flutter in it’s attempt to stay constricted. Why does this occur? Because adrenal insufficiency can also result in low aldosterone, which causes a lack of proper amounts of sodium and an abundance of potassium. This imbalance causes the sphincter muscles of your eye to be weak and to dilate in response to light. Click here to see a video of fluctuating pupils, and thanks to Lydia for providing this.
TEST THREE:
Let someone shine a bright light your way. Even the above pupil test could have revealed this. Do you find yourself very sensitive and uncomfortable with the bright light? That could be a sign of adrenal fatigue. And this can also be true if you have searing headaches along with the sensitivity.
TEST FOUR:
You can determine your thyroid and adrenal status by following Dr. Rind with a temperature graph. You simply take your temp 3 times a day, starting three hours after you wake up, and every three hours after that, to equal three temps. (If you have eaten or exercised right before it’s time to take your temp, wait 20 more minutes.) Then average them for that day. Do this for AT LEAST 5 days. If your averaged temp is fluctuating from day to day more than .2 to .3 (with a lean towards .2), you need adrenal support. Again, your daily average temps should lean towards the .2 when on enough cortisol for your needs. Summary from Dr. Rind: If your temps are fluctuating but overall low, you need more adrenal support and thyroid. If your temps are fluctuating but averaging 98.6, you just need adrenal support. If it is steady but low, you need more thyroid and adrenals are likely fine. (We note that mercury thermometers are the most accurate.)
For those already on cortisol, the above temperature test (comparing at LEAST 5 days of averages) is ideal to know if you are on enough cortisol for you needs. In other words, if each averaged temp is more than .2-.3 from each other (and several are .3 apart), you are not on enough cortisol, patients have learned.
***Women: if you are still menstruating, it’s best to do your Daily Average Temps started at the end of your period i.e. away from your mid-cycle or ovulation.
DISCOVERY STEP THREE: EVEN MORE CONCLUSIVE, and the test which patients agree is critical if any of the above are suspicious: a 24 hour adrenal saliva test. Why is the saliva test so important? Because the symptoms of high cortisol can be exactly the same as low cortisol, and you need to know when you have either in order to treat adrenals correctly, say many patients.
Doctors tend to recommend a one-time blood test, or an ACTH Stimulation test, or a 24 hour urine test, but patients have found none to be adequate or complete measures to discern sluggish adrenals. The ACTH Stim will tell you how much stimulation your adrenals are getting, but not how much cortisol they are producing. Granted, the ACTH can be valuable if there is suspicion of a pituitary dysfunction, Addisons or Cushings. Let your doc help you with that! But we have noted that most patients with adrenal fatigue have healthy ACTH stimulation. A blood test will only discern cortisol at one time of the day, failing to tell you what goes on at other times. A urine test simply gives you an average of a 24 hour period, and that masks being high one time, and low another, which are important clues to sluggish adrenals. (More detail on this in STTM book)
Instead, we have relied on the 24-hour adrenal saliva test, which tests your cortisol levels at four key times in a 24 hour day and allows you to view your daily cyclic adrenal function. These results have also helped patients and their doctors know how to treat their adrenals. To see exactly what condition your adrenals are in, you’ll need to be off all adrenal support of any kind for two weeks (glandulars, cortex), as well as herbs or supplements like Ashwagandha or Rhodiola, Licorice Root, Ginseng, Astragalus, Schizandra, PS (phosphatidylserine), Holy Basil, Eleutherol…and even zinc and Melatonin. Here is an even more exhaustive list of what can influence your saliva results.
**Go here to directly order a saliva test, and type in STTM10 to get a discount. Or here to view known facilities elsewhere where you can order the 24 hour adrenal cortisol saliva test. This test can be crucial to share with your doctor.
IF YOU HAVE CONFIRMED ADRENAL DYSFUNCTION WITH LOW CORTISOL VIA THE 24 HOUR SALIVA TEST, WHAT IS THE TREATMENT? The answer depends on how mild or severe your low cortisol is. You can compare your results to healthy saliva results here.
If the low cortisol is very mild, some patients find success with licorice root (capsules, not the candy) which can help extend the cortisol that is still made. If licorice root is used, you have to watch your blood pressure, as some patients report it rising while on licorice root. Others do fine. Another strategy with mildly low cortisol results, or a mix of slight highs and lows, is in adding adaptogen herbal supplements such as Ashwagandha and Rhodiola. These have been used for hundreds of years in combating stress and evening out the cortisol reactions of one’s adrenals. It’s also common to see this mild mix of highs and lows (needing adaptogens), plus have just too high levels at bedtime. Patients then use certain supplements to lower the bedtime cortisol, which can include zinc (with food in the stomach), holy basil, melatonin, Phosphatidylserine. There are more details about the treatment of high cortisol in the revised STTM book, which is strongly recommended.
When cortisol saliva results reveal even lower levels, such as in the morning, later morning and afternoon, some patients with their doctor’s knowledge go to the over-the-counter products like Isocort or Adrenal Cortex only, dosing them as explained on the How to Treat page. All the above is presented in even more detail in the revised STTM book, Chapter 6 and is highly recommended.
Finally, when the low cortisol is more severe, patients report that the use of prescription HC (hydrocortisone) is the best way to go. Chapter 6 in the revised STTM book goes into great detail about what patients have learned with dosing of HC and in working with your doctor.
A completely new and successful adrenal treatment is the use of T3 in the early morning hours, which can stimulate the adrenals in a positive way. This was first discovered by author Paul Robinson and is mentioned in his T3 treatment book on the Recommended Books page on STTM. This protocol only works if you do NOT have blood sugar issues like Diabetes, Addisons, or hypopituitary. You can read a summary of his protocol here.
You can also particpate in discussion on either of these methods on the Facebook STTM Adrenals Discussion page.
ARE THERE CONTROVERSIAL OPINIONS on ADRENAL TREATMENT? The controversy with treating sluggish adrenals is in two areas. First, there are some who claim that sluggish adrenals can successfully be treated with herbs, vitamins and a change in lifestyle. But patients who have wholeheartedly tried the former for a length of time will state that it simply didn’t help, and most especially, they were unable to get thyroid hormones from the blood to the cells. Granted, if one’s adrenals are healthy and there is simply need for support in stressful times, or if sluggishness is very slight, there may be value in using herbs, vitamins like C and B, sea salt, and de-stressing. The beginning of Chapter 6 in the revised STTM book covers this extremely well and is highly recommended.
But hypothyroid individuals with moderate to severe adrenal insufficiency find they need more than herbs and vitamins.
The other controversy lies in the amount of cortisol used if one needs to supplement. Some information and individuals will claim that 20 mgs of HC is a full replacement dose, so if you go any higher, you are risking permanent suppression of your adrenals and the HPA axis (hypothalamus, pituitary, adrenals–explained in the revised book). Yet others will state that the full replacement can be much higher, such as 40 mgs at the minimum. So the question remains: how much is too much?
What doctors and patients who have adrenal fatigue have noticed is that though only 20 mg may work for a few, 20 mgs simply doesn’t adequately raise cellular blood sugar levels so that thyroid hormones can get to the cells. Temperatures are still unstable, and symptoms of low cortisol still persist, as well as the discomfort of adrenaline surges. They will then raise a bit higher, do their Daily Average Temps (see Discovery Step two, number four, above) and eventually find their sweet spot. Most need to start on 25 mg HC, we’ve learned. Some even find that when higher doses aren’t doing the trick, i.e. around 30 mgs or higher, they move the dosing schedule to 3 hours apart rather than 4. A minority may switch to Medrol, a longer acting version, and find great success. Patients and certain doctors surmise that some thyroid patients end up needing more HC because of digestive issues from their hypothyroid state. Patients will need digestive aids, in that case.
Bottom line, wisdom on the amount of cortisol you need comes from listening to your symptoms, taking your daily averaged temps, and finding what works to support your low cortisol situation. And we highly recommend finding a good doctor to work with you.
IS CORTISOL TREATMENT SHORT-TERM OR FOR THE REST OF MY LIFE? When we first started to learn about the use of cortisol in treating our adrenal fatigue, doctors we respected stated that HC supplementation is short-term, i.e. 8 weeks to a few months. But patients and doctors who use the treatment have discovered that treatment seems to need a year or two or more before one is able to succeed in a slow wean. Additionally, HC treatment needs to be enough to take the stress off the adrenals, to stabilize one’s temps, and to allow thyroid hormones to the cells…the latter which plays a part in de-stressing the adrenals. We suspect that if the wean fails, i.e. the patient can’t seem to get off, it can point to a failure to have achieved the above, weaning too fast, adrenal fatigue far worse than others, or a pituitary problem that wasn’t properly diagnosed, or the need to correct others issues such as gluten intolerance, low ferritin or iron levels, low B12, etc. Some answers are probably still to come. And since this website is simply sharing information, we strongly recommend that you work with a good doctor over the complete treatment process, teach the doctor and learn from other patients.
- CLICK HERE to read the basics on HOW TO GET ON CORTISOL AND THE ENTIRE TREATMENT PROCESS. We highly recommend that you find a good doc to share this with, and to work with. The revised STTM book has even more detailed information, and may be a good book for your doctor’s library and continuing education.
Have HIGH CORTISOL, especially at night? In the first stages leading to adrenal fatigue, your cortisol levels can go high. This reflects the early and persistent stress on your body. As your adrenals start to become fatigued, you can find yourself with a mix of highs and lows, and with nighttime levels too high. If so, patients supplement with 300-800 mg. Phosphatidylserine, aka PS before bedtime to improve sleep. Melatonin is another patient choice for better sleep; treatment 1-3 mgs before bedtime. It may take a few weeks to notice the difference. Be careful with melatonin as taking it more than a few weeks can serve to lower morning cortisol. Taking zinc one hour before bedtime has also worked well, but make sure you have food in your stomach to prevent stomach upset. 50 mg – 100 mg has worked well for patients to lower high cortisol. The revised book has more details.
I HAVE ESTROGEN DOMINANCE! IS THAT CAUSING ISSUES FOR ME?? Definitely yes. When your adrenals become sluggish, the ACTH from your pituitary gland can continue harassing your sluggish adrenals to produce, even tho they can’t. And when the adrenals can’t respond with cortisol, they respond with extra estrogen production. And sadly, the higher your estrogen, the more bound both your thyroid hormones and cortisol will be.
Explains Dr. Hotze here (in relation to childbirth and postpartum, but applies to what I explained above):
High levels of estrogen causes an increase in levels of cortisol-binding globulin which – you guessed it – binds cortisol in the blood. The amount of free cortisol available to enter the cell membranes and activate receptors inside the cell is now greatly diminished. In addition, estrogen dominance interferes with the release of cortisol from the adrenal cortex. Another key fact is that cortisol is made from progesterone. When progesterone levels dramatically decline after pregnancy, so does cortisol production. Whether it is an inhibited output of cortisol from the adrenal cortex, an overall decrease in cortisol production or whether cortisol is bound in the bloodstream, all follow with the same result: adrenal fatigue.
- Click here to read a thyroid patient’s opinion about WEAK ADRENALS and her experience with adrenal support.
- Click here to understand the 7 stages of Adrenal Fatigue. Find where YOU are.
- Click here to read the most FREQUENTLY ASKED QUESTIONS about adrenal support.
- Adrenal Support (from The Great Thyroid Scandal and How To Survive It) by Dr Barry Durrant-Peatfield
- Why exercising after the baby is born is not a good idea if you have low cortisol.
- A comprehensive article explaining the adrenal glands.
- Go here to read the Internt’l Hormone Society’s CONSENSUS on CORTISOL REPLACEMENT, and sign the petition
Please let me know if any of above links suddenly fail to work. Websites do change occasionally.
Get the revised STTM book for more details. Chapters 5 and 6 are excellent resources.
