(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…
• if you have chronic inflammation

….your stress-busting adrenals have been working hard to keep you going with extra cortisol and adrenaline.  Even a poor diet and exposure to heavy metals and toxins could have further stressed your adrenals.

After any of the above occurs, your adrenal function can then move to becoming cortisol insufficient. You can even have a problem in the HPA axis, which is the messaging between your hypothalamus, pituitary gland and adrenals, and can result in the adrenals failing to respond well. This can mean adrenal function inhibition. And there is a remarkably large percentage of hypothyroid patients, as well as those who feel they have no thyroid problem, who end up with poor levels of cortisol. 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 or inhibited. And dysfunctional adrenal output equates first to combined highs and lows of cortisol that are not normal, then to low cortisol. Aldosterone can fall in some, too.

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, ATP and mitochrondria to receive T3 from the blood to the cells.

Additionally, dysfunctional adrenal/hpa axis can result in high amounts of thyroid hormones to build in the blood (which we call pooling), making your free T3 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 insufficient adrenal function before raising too high 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 two or more 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. (More about blood pressure plus how to take it correctly here.)

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 overly 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 any daily averaged temp is more than .2-.3 from another day’s, you are not on enough cortisol, patients have learned (most of those daily averages should be .2 from each other). Going way too high with HC can also cause this instability. 

***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. 

Saliva testing will measure your cellular levels at four key times in a 24 hour period–revealing whether you have high cortisol (which can have similar to symptoms to low cortisol), or a mix of highs and lows (which can be problematic in raising NDT and cause too much RT3), or a majority of lows, which is extremely problematic when raising thyroid meds, causing hyper-like symptoms and excess RT3.

Unfortunately, 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. Blood is measuring both your bound and unbound cortisol–not helpful, nor does it tell what goes on at different times. The ACTH Stimulatory will tell you how much stimulation your adrenals are getting, but not how much cortisol they are producing. Granted, the ACTH Stim test 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 sluggish adrenal function have healthy ACTH stimulation. 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)

IMPORTANT NOTE: Patients have discovered there are many supplements they need to be off of for up to two weeks to get a clear picture what is going on, here.

**GO HERE TO ORDER YOUR OWN SALIVA TESTING. PRICES VARY.   

IF YOU HAVE CONFIRMED ADRENAL DYSFUNCTION WITH LOW CORTISOL VIA THE 24 HOUR SALIVA TEST, WHAT IS THE TREATMENT?  This page explains what patients have learned for treatment of their adrenal issues, whether high cortisol, a mix of highs and lows, or mostly low cortisol. The T3CM has been a popular choice since it’s natural and with practically no side effects, but you will still need to work on lower toxicities, improving sex hormones, lowering inflammation and more. If a patient has confirmed hypopituitary or Addisons issues, the use of HC is the next choice. Chapter 6 in the revised STTM book gives an excellent explanation of what patients have learned in the use of HC. Minor low cortisol might benefit from adrenal cortex supplements.

**Do note that you have chronic inflammation, that can potentially cause a sluggish HPA axis, hampering even the T3CM. Test both ferritin and CRP to see your inflammation state. 

You can also particpate in discussion on either of these adrenal treatment methods by joining one of two STTM Facebook groups, listed here. NOTE: the STTM Facebook T3 group is for discussion of the T3CM. The STTM Facebook Adrenals group for discussion of Adrenals in general, or the use of HC or any adrenal supps.

We also have a private, patient-to-patient Yahoo T3CM discussion group here.

ARE THERE CONTROVERSIAL OPINIONS on ADRENAL TREATMENT? The beginning of Chapter 6 in the revised STTM book covers this extremely well and is highly recommended.

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 read the most FREQUENTLY ASKED QUESTIONS about adrenal support.
• 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.