Adrenal Insufficiency and Past Prednisone Use

[DebE13]

I reached my breaking point last night. Enough is enough. I'm going to request my thyroid labs be done today instead of waiting and living in pure craziness. I am going to suggest switching from the generic levothyroxine to tirosint and Cytomel. It may be wishing on my part but I at least have to try.

My question is: how likely is it that I may also have adrenal insufficiency related or maybe not related to my long course of prednisone use in 2011? It created a host of additional problems, did not change my D, and I tapered faster than I should have (shame on me).

Should I mention this too or am I better to focus on the one request to try a different med? It seems the more I say, the more likely they are to refer me to a different specialty. However, adrenal problems can cause issues too........

[DebE13]

Oh, one more question. If I've always had my labs done first thing in the morning am I best to wait to have them done at the same time? Could I skew things a bit if I go at lunch or after work? I take the levothyroxine at 9pm every night.

[MBombardier]

According to what I've read, you should skip your dose prior to the labs and be fasting. When you do labs, you should do them at the same time and under the same circumstances every time. That will cut down on weird aberrations in values and give you a better idea of what is really going on.

I am surprised you take your levothyroxine at night. I take my first dose of NDT somewhere between 4-6am, the second about six hours later, and the last one around 4pm. If you are having any sleeping issues, you might consider moving your thyroid to the morning. Adrenal fatigue will also keep you up at night.

I am not a doctor, but I suspect that the prednisone may have thrown your adrenals out of kilter. Before I got on the NDT adrenal Yahoo group, I had no idea that the OTC hydrocortisone cream that I was slathering on psoriasis and other itchy spots was affecting my adrenals.

If you can afford it, I recommend you have the 24-hour cortisol saliva test. Maybe you can get your doctor to prescribe it, so it will be covered by insurance. It's about $100, and you get your results back in just a few days. Since I live about 30 miles from the lab, I actually got mine back in two days. Sunday is a good day to do it. Then you freeze the tubes as you do them and mail them Monday.

I found out that my adrenals were/are not putting out enough cortisol and that there was way too little in the morning and way too much at night. I am working with a cortisol supplement and adaptogens to give my adrenals a rest so they can recover, and also switch the output around so that it's right.

As I've mentioned before, I was on a really high dose of NDT because my thyroid was trying to make up for what my adrenal glands weren't doing. Now that my adrenals are doing better, I've cut down the dose of NDT I was on.

[tex]

with Marliss,

As far as I am aware, when only a single thyroid supplement is taken, it should be taken first thing in the morning (and skip it before doing a blood draw for a CDC). I take mine before breakfast. It's the only pill I take before breakfast.

Regarding making requests of a doctor:

Remember that doctors are usually very busy, and consequently they tend to have a very short attention span. If we make too many requests at one time (or ask them to read too many pages of medical research, etc.), they tend to become unresponsive, and they usually end up doing nothing. YMMV.

Tex

[gluten]

Hi, I have a friend that was on prednisone for a long period and after slowly reducing the dosages still had adrenal insufficiency. Jon

[DebE13]

http://thyroid.about.com/od/thyroiddrug ... edtime.htm

Night seems to work better with my morning schedule and I didn't think much of it. I like to take my entocort first thing in the morning because it tends to move things along. Plus there are all the other supplements that I'd have to drag to work with me. Plus I like my coffee within ten minutes of getting up. If I would take it in the AM it would throw off my eating/pooping before leaving the house schedule. I don't eat after 6pm so it seems to be a perfect time. My sleep issues haven't gotten any worse than before. My endo told me he has a colleague who takes all of his in one day at the beginning of the week because he continually forgets to take them. I don't think I'd do that but there sure are a lot of conflicting instructions out there. Could it really make that big of a difference? I figured its a good plan for me because there isnt a potential food or other med conflict.

For my labs, I always have them done at 7:30AM which I thought was good timing too. I called to ask to have my labs done now. He isn't in until this afternoon so I will get a call back later. If they agree, I will do them again tomorrow morning to be consistent.

I had my AM cortisol tested with a blood test this summer. I think it was normal. Haha. Is the saliva test more accurate. I'm sure if my endo won't do it my PCP would authorize it.

I will wait and address adrenal issue at my actual appointment in a few weeks. The nurse this morning seemed skeptical of my complaint. It seemed the mental issues weren't enough. I added the neck and shoulder pain which was a mistake. She asked if I was sure it was thyroid related. Since the surgery it's been constant so I was a bit snippy. I'm sure she didn't realize I recently had my thyroid removed but gosh, I didn't call just to check the weather and see what was up at their office- I have some issues.

I didn't mention the tirosint or Cytomel yet. Tex, I totally agree. Short and sweet or you loose them.

[MBombardier]

Man, all this and working, too. My hat's off to you, Deb. You are courageous and a fighter, and you will win through.

The 24-hour cortisol test is more accurate because it takes snapshots of your cortisol levels at four specific times of your day and gives you a graph of your cortisol levels compared to what they should be. My cortisol blood test showed a normal level, too, a few years ago, and my PCP at the time told me that adrenal fatigue was a myth. So I suffered more, including the whole "it's in your head" shaming until I wised up this summer.

I didn't think I had adrenal fatigue because I had few of the listed symptoms, but I wanted to know for sure. It was like why I had a colonoscopy--I wanted to know for sure that I didn't have colon cancer. It turns out that I had gotten so used to feeling bad that I thought it was normal. I was feeling really good until the flare took me down about six weeks ago, but I am looking forward to fully getting past it and feeling that good again.

If you decide to do the 24-hour test and your adrenals are fine, then it's one less thing to worry about. If they are not, you can treat them. If thinking about yet another test is too much, then it's too much. I've certainly been there.

We're all pulling for you.

[DebE13]

Marliss, thanks for the words of encouragement. I don't feel courageous at all and wish I didn't have to work. That's simply not an option. Although I find even though work adds to my stress levels it also is a distraction. It's a very fine line though because I'm a public employee who is in contact with the public all day long- I'm finding it difficult to be nice and that could get me in trouble. I'm even avoiding talking with family because I have such a sour outlook on everything and what comes out of my mouth is harsh. I don't want to subject them to that. Unfortunately, my husband gets a front row seat to my current disposition, unfiltered of course. It seems like it should be easy to fix because I know There's an issue - I recognize the problem but I can't shake the negativity. You're right though, we are all fighters here. I just need to keep remembering that's a figure if speech.

I am going to ask about the cortisol test at my next visit in a few weeks. Looking at my labs from June my AM cortisol was 12.8 ug/dL. The range given was 6.4-21.0 so the doctors never mentioned any issues. I'm not sure what optimal numbers are. Although it wouldn't surprise me if that's off too. Looking at my ferritin, that was at 15 ng/mL-also within range, but not where it should be. I started taking an iron supplement but I've been getting an upset stomach lately so I stopped. Not sure what to do about that one.

I wouldn't mind at all at doing the test even if it's to rule it out. It's funny you should mention getting used to feeling bad. I know that concept so well. Then there's a point when it hits you that there has to be more out there that can be done. Sad to say, we end up doing all the leg work while the docs tell us it in our heads.

I didn't get my call back yesterday. Sigh. My truck driver's mouth was in full force last night with a string of profanity. I carried my cell phone with me everywhere at work in the afternoon fretting that I may be with a customer when it rang. I avoided making lengthy phone calls just in case.......then nothing. So my plan of having my labs drawn this morning is shot. If he agrees, I will have to wait until tomorrow then through the weekend and next week to get the results. If they push me off long enough, I will have my labs done when they scheduled them on Wednesday anyway.

I don't know what I'd do without all of you!

[tex]

Man, all this and working, too. My hat's off to you, Deb. You are courageous and a fighter, and you will win through.

Looking at my labs from June my AM cortisol was 12.8 ug/dL. The range given was 6.4-21.0 so the doctors never mentioned any issues.

Hmmmmmmm. That result strikes me as rather low. Yes, it's in "range", but that's probably because a lot of the subjects used to determine that "normal" range, weren't actually normal — they may have had low morning cortisol levels.

Consider my only cortisol test, done back in 2008: The result was 18.3 at 9.25 am, with a "normal" range listed as 0.4–22.4. Obviously, that "normal" range doesn't mean much. I see that they've tightened it up slightly, over the years, but it's still so broad as to be pretty much meaningless. Your doctors didn't mention any issues, probably because they didn't know much about interpreting cortisol test results. Unlike some of the more common tests (such as cholesterol), doctors are not familiar with interpreting them, and the cortisol test results don't come with any interpretations printed along with the results. Consequently, the results probably don't mean much to most doctors (especially since the "normal" range is way too generous on the bottom end).

My endo told me he has a colleague who takes all of his in one day at the beginning of the week because he continually forgets to take them.

I forgot to comment on that ridiculous remark yesterday. Sorry about that — my memory isn't what it used to be. First of all, with many doctors recommending that patients should split their thyroid supplement doses and take them in 2 or even more doses during the day, in order to keep their thyroxine at a more constant level, any doctor who would be dumb enough to do that to his own health, is not exactly the sharpest knife in the drawer. But to admit that he does something that dumb (apparently on a regular basis) is even dumber. IMO though, any doctor who would repeat that convoluted line of thinking to a patient, commits an even dumber act.

Clearly, the capacity of both of those individuals to make rational judgments, is highly questionable. IOW, in less civil terms, they both appear to be nuts. What in the world are they thinking? That convoluted attitude clearly illustrates why so many doctors seem to discount the importance of proper thyroid functioning. They really don't get it.

Doctors who don't get it are unable to do a decent job of treating patients who have anything more than simple, textbook cases. And doctors who treat thyroid issues (on the average) appear to be trying to corner the market on "not getting it". They'll have a tough time outdoing GI docs who treat MC though, because GI docs have been "not getting it" ever since MC was first described.

Tex

[DebE13]

I'm laughing and shaking my head at your comments this is only after a loud roar of frustration I just let loose. Wouldn't be surprised if the neighbors heard. Haha. Just got off the phone with the receptionist inquiring why I have no had a return call that was promised yesterday. Clueless. Took down all the same info I gave yesterday and said she'd have another nurse call me back. At least I got yesterday's nurses name. If I get her again I will ask for another. This isn't the first time a message was lost. Geeesh.

My endo didn't endorse the all in one shot for the week but it really does bring to light the cavalier attitude about taking the meds. Makes me worry..... Hopefully he will be willing to be led along with what I want to try. He sure does get a lot of money to play with my good health and well being. Sigh.

Why have the cortisol test done if you don't know how to read them? That was more rhetorical than anything. Not at all surprised. Is it appropriate to ask my endo for the cortisol saliva test or do I need to look elsewhere? How do you raise it anyway? It's just like my iron levels being at the low end of the normal range. My PCP said to take a supplement if I thought it might help.

[tex]

Deb,

Knowing that your doctor's colleague can't even remember to take his own thyroid supplement on a daily basis (arguably the simplest treatment schedule ever specified), and assuming that the colleague is a doctor (maybe an endo?), how would you feel if you happened to be one of that doctor's patients, and you found out about his/her pathetic memory. Would you have any confidence in his/her prescriptions for treatment? Or anything else for that matter?

Most doctors pride themselves in their memory, because it's a vital part of their competence on the job. That's why your doctor shouldn't be spreading that kind of information about his colleagues around. But more importantly, is his colleague actually qualified to be a doctor, if his memory problems are that serious? It's downright hilarious, unless you happen to be one of his/her patients.

I've already forgotten what it was, but didn't Brandy suggest an iron supplement that worked? That memory thing is obviously highly contagious — now I've got it. I hope I can remember to take my thyroid supplement tomorrow morning.

Tex

[Thumbs]

http://www.amazon.com/Nelsons-Spatone-1 ... B0019M7OCA

Possible Iron that doesn't cause upset? LowHistamineChef recommendation. Not sure what ingredients are.

[Thumbs]

A friend of mine is currently battling with adrenal fatigue. She did the saliva testing. It is not an easy road her MD stated to not stress, walk only, no major work outs, sleep... but no major breakthrough yet. Isocort is the cortisol replacement vitamin that she takes.. I don't know if that would be safe to add plus if you are on Entocort.. doesn't that supply some cortisol? Seems like less is more around these parts.

[DebE13]

Tex, just thinking how I feel right now scares me to think a doctor could be feeling the same way and making important decisions about other people's health. The comment was meant to ease the scariness of a new way of life but your right, that probably should have been left out of the conversation. I imagine most endo's have never experienced the feeling of wanting to crawl out of their skin.

Thumbs, thanks for the suggestions. I was taking an iron pill equivalent to 325 mg of ferrous sulfate. I'm having those labs done again tomorrow so I will know where I'm at. Once I see what those numbers are I will move on to the cortisol test.

It should be interesting to see how the office visit goes. I got a call back this afternoon from the nurse. She apologized no one got back to me yesterday and said the doctor did not have time to check my case today and he was now gone and would not be back until Monday. I went through the roof. At first she didn't seem too concerned because after all, I was getting my labs done next Wednesday. I asked her if she had looked at my lab results from October. There was silence. I filled her in. She said she could ask another endo if it would be ok to change my labs tomorrow if I didn't mind. Why yes, I would appreciate that greatly considering I only asked to have them done yesterday. The other endo agreed.

So now I will take my lab order from my GIs office and get it all the tests done in the morning. It's going to be a bummer if the numbers improve because I'm not feeling it. But, chin up........

[tex]

I imagine most endo's have never experienced the feeling of wanting to crawl out of their skin.

You're right. And that precisely defines the problem. They're just like the GI docs who wave MC off as a "minor inconvenience", because they have never had a reason to be afraid to get more that 20 feet from a bathroom, and they have never had to worry about their "minor inconvenience" streaming down their legs in public.

Wow! Your doctor didn't have time to take a quick glance at your file, because he needed to rush home for a 4-day weekend? All I can do is shake my head in disbelief, but I suppose I'm not surprised.

The other endo agreed.

If this happens to be your doctors "colleague", he probably simply couldn't think of any reason not to do it. Poor guy.

Seriously — that's great. Kudos to him (or her), and good for the nurse, for offering to ask.

Good luck tomorrow. And don't waste any time thinking about how the results are going to turn out. Always think positive thoughts. Things are going your way, for a change. Tomorrow will get you one step closer to finally experiencing relief.

Tex