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* Having strange problems since starting a natural desiccated thyroid product or T3?
* Not doing as well on desiccated thyroid as you hoped, even when your doctor had you raise above 3 grains or higher?
* 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 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, etc), or if you have been through chronic stress of any kind…..your stress-busting adrenals have been working extra hard to keep you going, or to make up for your low-functioning hypothyroid state, or the inadequate T4-only treatment! Additionally, periods of chronic life stress, as well as our exposure to toxins, could have further stressed your adrenals as well as the function of your HPA axis (hypothalamus to pituitary to adrenals).
Thus, there is a remarkably large percentage of hypothyroid patients, as well as those who feel they have no thyroid problem, who have low-functioning “sluggish” adrenals, or more aptly, adrenal fatigue. This is not the same as the disease called Addison’s in most. Instead, it’s simply a long term situation where your adrenals have become POOPED. They still work, but they have become weak. And sluggish adrenals equates 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 works with your cell receptors to receive thyroid hormones from the blood to the cells. On the other side of the coin, low cortisol 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 Armour 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 Armour, but are in reality low cortisol symptoms. 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 soon after you have started and are noticing strange symptoms, which become unmasked by the use of desiccated thyroid. 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 adrenals which are struggling (the STTM book has more questions in Chapter 5–see below):
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) 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. 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, you need adrenal support. If it is fluctuating but overall low, you need more adrenal support and thyroid. If it is 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. In other words, if each averaged temp is more than .2-.3 from each other, you are not on enough HC.
DISCOVERY STEP THREE: EVEN MORE CONCLUSIVE: a 24 hour adrenal saliva test. 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. 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. (And note that if you are very hypothyroid, you readings may actually be even lower than your saliva results will show, since being hypothyroid results in a slower clearance of cortisol from your body.)
Healthy, well-functioning adrenals will have the morning result at the tip top of the range; the noon result will be near the top; the late afternoon will be mid-or-lower, and the evening should be at the bottom.
WHERE TO TEST YOUR ADRENALS: Below are facilities (US, UK, Australia) where you can send off for the test, and without a prescription (If you know of another, use the Contact Me form below), then share the results with your doctor. The STTM book has detailed information on how to read your saliva labs:
LAB WORK packages designed specifically for readers of Stop the Thyroid Madness. Use the discount code STTM10 which will give you 10% off the already low prices! STTM Thyroid and Adrenal Lab Packages You can choose just saliva for cortisol, or use lab facilities around the US for blood draws.
LAB WORK designed specifically for STTM viewers, MyMedLab, where you know you’ll get the right tests already designed for you. The cortisol test is for 6 times in a 24 hour period–even more information. https://sttm.mymedlab.com/ (You’ll see cortisol labs on the left when you go to this page)
ZRT Laboratories Saliva and is called Adrenal Function Test for cortisol. http://www.salivatest.com/
Direct Labs/Sabre Sciences. 6 saliva samples for cortisol, and 3 samples for DHEA, collected at designated days and times. Also included is the Electrolyte panel of sodium, potassium and chloride. www.directlabs.com/
Vitamin Research Products Saliva Test kits including iodine, adrenals. They can do New York residents.
Canary Club. This website is not a lab, but offers saliva by ZRT
United Kingdom Labwork from NP Tech, where they will send out the kit for an ASI (adrenal stress test), plus sex hormones and a full thyroid panel etc. (thanks to “Mo” for this info) www.nptech.co.uk
United Kingdom Labwork from Red Apple Clinic. www.redappleclinic.co.uk
Australian Labwork from Analytical Reference Laboratories (ARL) or PathLab You can’t order the kits yourself, unfortunately, but can convince your doctor. Just ring either of these labs and ask what doctor in your area uses their kits. ARL: 568 St Kilda Road Melbourne,Victoria, Australia, 3004; (61-3) 9529-2922; fax (61-3) 9529-7277 info@arlaus.com.au. or PathLab: 68 Burwood Highway, Burwood, Victoria 3125, (61-3) 8831-3000; Fax (61-3) 9808 2247; (Nutritional Laboratory Services), Ed Sorich Integrative Medicine Dept; www.pathlab.com.au
***A WORD OF WISDOM ABOUT SALIVA TESTING: it is strongly recommended that you pay the higher price to OVERNIGHT your saliva. If you fail to do this, the samples may degrade and not arrive fresh at the facility and cause results which do not fit your symptoms.
IF YOU HAVE CONFIRMED LOW CORTISOL, WHAT IS THE TREATMENT? If you confirm that you have low cortisol production, whether from the self-tests above, or the saliva test, or simply the very strange reactions to natural desiccated thyroid, patients have learned from certain doctors that they may need cortisol supplementation. The suggested amount is approx. 20-30 mg of cortisol, and sometimes more due to some patients metabolizing cortisol faster than others, to bring sluggish adrenal function up to it’s proper and optimal normal daily amount, and for thyroid hormones to be received by the cells. Men can often need more.
Up to 20-30 mgs. and occasionally higher, is called a ‘physiologic’ supportive dose, as compared to the high ‘pharmacologic’ doses. According to doctors like Peatfield and Jeffries, a physiologic dose is safe and doesn’t cause the side-effects of larger pharmacologic doses. This would also bring your cortisol up to the amount to tolerate thyroid hormones and distribute them from the blood to your cells. You’ll know you are on enough when you once again do the temps mentioned above from Dr. Rind’s site, and find them stable instead of fluctuating.
It’s important to note that some thyroid patients discover that their cortisol deficiency is only mild and only in the early stages. We have discovered that the use of Licorice Root (in capsules, not licorice candy) can help extend the cortisol levels that you have. And there might be good OTC products to use to support your adrenals. Check with your doctor for ideas.
WHAT TO USE: Once adrenal insufficiency is confirmed, and it’s decided that OTC products are not going to help, patients and their doctors tend to use hydrocortisone or HC (such as the brand name Cortef) or Isocort (which is over-the-counter) or other quality brands. Hydrocortisone will give you simply cortisol, whereas Isocort et. al. gives you the entire adrenal cortex. But many patients seem to prefer HC and find it to work better than Isocort. Hydrocortisone or Cortef has a half life of approx. 8 hours, but can be much less depending on the metabolism of the individual. Thus, patients have to multi-dose it, and four times a day at the minimum is recommended, with four hours between dosing. Some patients have to move their doses closer together, and some have to have higher amounts than others due to a fast metabolism in their stomachs. Ingredients: hydrocortisone, lactose, magnesium stearate, maize starch.
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 enough, and most especially, they were unable to get thyroid hormones from the blood to the cells. Granted, if one’s adrenal fatigue was quite minor, there may be value in using herbs, vitamins like C and B, sea salt, and de-stressing. But the majority of hypothyroid individuals with adrenal insufficiency seem to need more than herbs and vitamins.
The other controversy lies in the amount of cortisol used. 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 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 some, many find that staying with 20 mgs simply doesn’t adequately get thyroid hormones to the cells. Temperatures are still unstable, and symptoms of low cortisol still persist. They will then raise a bit higher, and eventually find their sweet spot. Some even find that when higher doses aren’t doing the trick, i.e. around 27 1/2 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? Doctors we respect have stated that HC supplementation is short-term, meaning treatment lasts approx. 8 weeks to a few months. But patients and doctors who use the treatment have discovered that treatment seems to need the “few months” to 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, 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.
***CLICK HERE to read the basics on HOW TO GET ON CORTISOL AND THE ENTIRE PROCESS. We highly recommend that you find a good doc to share this with, and to work with. The 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, the daytime levels fall but nighttime levels can stay high. If so, try supplementing with 300-800 mg. Phosphatidylserine, aka PS. Take it before bedtime. You may need to be on the higher end of the range above to lower it. Lowering high nighttime cortisol can help improve your sleep!! Janie, the creator of this site, found herself with high cortisol and she kept waking up at night. Upon taking PS when she went to bed, she completely stopped waking up all night along and woke up FAR more refreshed. To read more about PS, click here: http://qualitycounts.com/fpps.html Melatonin is another choice to help restore the normal circadian rhythms–i.e. highest cortisol in the morning and lowest at night to help you sleep. 1-3 mgs before bedtime. It may take a few months to notice the difference.
- 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.
- Go here to read Dr. Jay Mead’s vitamin recommendations for 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.
