Question for Bob H

[mle_ii]

I wasn't.

At the risk of sounding like a broken record that keeps repeating itself, I personally would not start walking that road if I had labs and symptoms of low cortisol and thyroid. I would put the other stuff on my "to do" list.

That is how important I think the metabolism issue is, or at least for me, as mine had a long way to go in order to approach normal.

My only point here is that it does no good to treat something if you don't even think about treating the cause. According to one Dr I read he thought that toxins and/or heavy metals were a cause for issues with thyroid/adrenals and other autoimmune diseases.

[bobh]

Mike, that is a great analogy on the water thing. Truly, it is that vital. You can not continue to survive without cortisol.

Too much, or too little of anything is not good. Some things require a balance.

You asked if I do a larger dose in the morning and taper down, yes, exactly. I simply followed these instructions on dosing http://www.stopthethyroidmadness.com/co ... .php?t=994

And that is based on the work of Dr. Peatfield. People that do not have normal cortisol rhythms, can eventually convert their rhythm to look more like this http://www.chronicfatigue.org/ASI%20Normal.html if they follow that dosing schedule.

I can feel mine starting to change after a few months, I have more energy in the morning, and get tired before bed rather than being a night owl.

And a bit of a recap from that older thread, info on adrenals http://www.stopthethyroidmadness.com/adrenal-info/

And that sets you up for this one, with more detail on dosing and how to treat http://www.stopthethyroidmadness.com/ad ... w-to-treat

In closing, I'm not trying to talk anyone into doing anything they don't want to do. At the same time, this is info I wish I knew a long time ago, and I wouldn't want to "not" say it when anyone asks me about it.

[bobh]

My only point here is that it does no good to treat something if you don't even think about treating the cause. According to one Dr I read he thought that toxins and/or heavy metals were a cause for issues with thyroid/adrenals and other autoimmune diseases.

OK, sorry about that - I hadn't read that one.

But I do know that the adrenal expert on that site I keep referencing, Val, has mentioned some of those issues. Once the problem is there, we all need to darn near eat totally organic food, create our own meals, and then try to pick up the pieces.

[tex]

Beth,

Just to add my two cents worth here, I offer two points that I think are worthy of consideration.

1. As long as one is only replacing what the body fails to produce, there should not be any significant risk of adverse effects. Obviously, with any other use of corticosteroids, (I'm talking about treatment for inflammation, here, for example), the supplementation is in addition to, (in most cases, at least), normal production levels by the body, which means that the full dose taken, is in excess of needs for normal body functions. That's why those side effects are experienced by some individuals - they are receiving much more than their body needs, for normal good health. Their body probably perceives this as an overdose, for all practical purposes.

2. Bear in mind that there is a gender "effect" involved here. Most men are not likely to be particularly alarmed about the possibility of side effects such as excessive hair growth, acne, or other cosmetic skin problems, etc., and they're not even susceptible to some of the other side effects, (such as menstrual problems, and mood swings, for example - at least not directly). Men are problem solvers, and they just want to solve the problem at hand, and get on with their lives.

Contrary to what the "Politically Correct" crowd would have us believe, there is a huge difference in the way that men and women perceive certain issues, and certain aspects of their lives. To most men, this would be a no-brainer, but for most women . . . well, I'm sure you can see what I mean. It's like we're from different planets, when it comes to issues such as this. Also, age is a factor, and I can certainly see why you would be concerned.

Wayne

[bobh]

Good points Tex.

Part of that adrenal-thyroid group is devoted to people who's pituitary isn't working right, and their issues are more severe than ours. So they take more, and sometimes stronger meds.

The guy that runs that hypo-pituitary forum started to get acne and other side effects when he was taking too much Medrol, which is much stronger than Cortef. Here's the thread:

http://www.stopthethyroidmadness.com/co ... php?t=2271

When he says "secondary Adrenal Insufficency", that means the body is not asking the Adrenal Cortex to make cortisol. that is what hypo-pituitary means, it's not just weak or stressed out adrenals. It is a case of the pituitary not putting out enough ACTH to signal the adrenals to make more when it is needed, so they take lots of meds and have to watch out not to go too far.

Here's their list of symptoms of too much - the people on the hypo-pituitary forum. And again this is not likely for someone taking what Dr. Peatfield describes as an obviously healthy dose of Cortef.

I never hear of people with these symptoms on the forum that I watch, people that simply have underactive adrenals. http://www.stopthethyroidmadness.com/co ... .php?t=585

I don't personally consider all the items on the above list to be "side effects" of cortef, I see it more like a list of "overdose" of cortef. There is a big difference.

I have more fear of a car wreck than I personaly do of taking too much Cortef, because I know that most people need around 20 to 35 mg of Cortef if they have low cortisol. If someone took significantly more for a period of time... Yeah, too much of anything isn't good.

[mle_ii]

Hey Bob, back before you started taking cortisol what were your Alkaline Phospate levels? And what was the range?

Thanks,
Mike

[bobh]

I had a lot of labs done before starting cortef.

on 1-9-07 my Alkaline Phospate level was low, as 38 compared to a normal range of 40-129 U/L

I am not very familiar with that lab test or what it's for, I looked here http://www.labtestsonline.org/understan ... /test.html and clicked on the various tabs, seems to be mainly a liver thing.

[mle_ii]

:) Well, it is a liver thing if it's elevated. If it's low it has to do with adrenals, ACTH and other things. Very interesting! :)

Here's some info:
http://en.wikipedia.org/wiki/Phosphatase%2C_alkaline

[mle_ii]

Oh and mine was low as well. Had a reading of 35 at one point with the same range.

[bobh]

Gotcha. That link mentioned low levels in relation to thyroid - I didn't see the adrenal thing. But what you are saying seems consistent with my labs, and that my cortisol levels were flatlining.

[Beth]

Hi Wayne and Bob,

Thanks for the information and encouragement. I should get my labs back for thyroid and DHEA info tomorrow or the next day. As soon as I have all the info, I'm going to try the meds route. If it doesn't work, or I hate the side effects, then I can just ease off of them. None of this is irreversible, right? (I mean the taking meds part.)

Beth

[bobh]

Correct. Nothing permanent. Read the last sentence of this quote from Dr Peatfield:

I pointed out that anyone with thyroid deficiency over a period of time, especially if it is more than mild, is likely to have their deficiency accompanied by the Low Adrenal Reserve Syndrome. If this is not dealt with before providing supplementation, response may be disappointing, and there is a risk of a thyroid crisis. This occurs when the system becomes overwhelmed with thyroid replacement from the medication, which it is unable to deal with, and the patient may have violent palpitations, headaches or collapse. The obvious difficulty lies in knowing whether adrenal support is required. Well, the difficulty is more imaginary than real. Firstly, the history of the symptoms, the postural hypotension, the fainting attacks, the digestive upsets and other problems I mentioned in the last chapter, along with possible pointers from a blood test, are likely to make low adrenal reserve a strong possibility. Secondly, if there is any doubt, initial support must be given since there are real problems if it is needed and not given. Thirdly, prescribed in the way I am going to discuss in a few moments, there is no risk, since the amount of adrenal support is physiological (explained below). This means even if it isn't necessary, no damage is done, no risks are taken, and it can be withdrawn whenever thought appropriate.

And as he says at the start, if the adrenals need help, you do that first, before taking thyroid meds. As I recall, your labs showed weak adrenals.

Earlier on this thread (or was it the last one...) there was a complete dosing schedule mentioned, and I want to stress that you START SMALL, GO SLOW, AND GRADUALLY.

Seriously, you won't (shouldn't) be feeling side effects. I know you took Pred before, and this stuff is 1/4 the strength, and is a lot "cleaner" for the body. It is as close as you get to the body's own Cortisol.

That last quote was from here http://featherstone.bravehost.com/thyro ... renal.html and further down he says this:

It is essential where low adrenal reserve is suspected, or indeed, obvious, that no thyroid supplementation should be considered until adrenal support is in place. Undoubtedly for the physician, the replacement of choice is hydrocortisone, since this though synthetically produced, is identical to naturally produced cortisone. But, the initial approach has to be restrained and cautious, and the lowest possible dose given at the start. I find that 1/4 of a 10 mg. hydrocortisone (that is 2.5 mg) is an excellent starting point. The reason hat it is so low to start with is that patients ill for some time, and perhaps receiving synthetic thyroxine, may have substantially high levels of T4 and T3 which the system cannot use. The adrenal support may kick in quite quickly, causing the T4 -> T3 conversion and receptor uptake to start working quite abruptly. This may cause a sudden overdose situation to occur. The patient may find the pulse rapidly accelerates to give palpitations in the chest or even promote irregularity of the heartbeat. They may feel ill, may collapse, they may have tremors in the limbs as if they were thyrotoxic. With small starter doses of adrenal support the risk of this is avoided. The first two or three days of 2.5 mg. of hydrocortisone given in the morning soon after waking, will be monitored by the patient for any adverse symptoms, checking pulse two or three times a day, and of the course morning basal temperature.

I just wanted you to read it from a published MD, the dosing info on the "stop the madness" site is from Peatfield. Find that other post, you work up to about 15mg Cortef before introducing Armours, and just follow the dosing protocol.

If your cortisol is low, this is the ticket. But it isn't something you just "stop". If you want to see if the adrenals have come back to life, you wait unitl you have maintained your optimal dose of thyroid meds for a period of months, then GRADUALY wean off the Cortef to see if you can. That is explained here: http://www.stopthethyroidmadness.com/co ... .php?t=994

BTW, why are you checking DHEA? What did the Diagnostech lab find on the DHEA? usually they have 7 zones, and there will be a black square in one of those zones.

I ask, because some people have very low Cortisol and high DHEA like me, as shown here http://www.chronicfatigue.org/ASI%206.html and yet they try to take more DHEA but they don't need it.

[Beth]

Bob - this information is enormously helpful. Thank you so much.

I'm checking my DHEA because for some reason when I did the adrenal fatigue test my naturopath didn't indicate that she wanted that one tested, too. I called Diagnostech, and they said that there wasn't any information on DHEA levels, so I just want to have that information to compare to where I am in terms of cortisol levels.

Will keep you all updated.
Beth

[bobh]

I called Diagnostech, and they said that there wasn't any information on DHEA levels,

OK. Do you have copies of the Diagnostech labs? For example here's Reggie's

Typically, with that lab, you go on-line and download 3 PDF files, one of them will have the graph showing cortisol levels at 4 points in the day, and the bottom of that page will have the "DHEA to Cortisol level" per the image from Reggies.

That is from page 3 of this thread: http://www.perskyfarms.com/phpBB2/viewt ... c&start=30

If you go here http://www.chronicfatigue.org/ASI%20Normal.html and look at the 2nd to last paragragh, you see this

We shall begin our journey by examining a normal person's readings as demonstrated from Diagnos-Techs Adrenal Stress Index (ASI) test.

And you click at the bottom of each page, to see the next chart.
If that is the test that was done for you, part of that test is getting the DHEA level and comparing it to the cortisol level. That is part of the process of determining what the status is on the Adrenals.

[Magyar]

Hi Bob,

I have this scenario as well -- DHEA of 234 but low cortisol. What does this mean?

Also, my cortisol levels are -.03 from 10 p.m. to 12 a.m. How can cortisol be negative?

Finally, what role does exercise play in all of this? I am an aerobics instructor and my doctor has told me I need to quit and do something that doesn't get the heart rate up as high. There have been two instances where I nearly blacked out while teaching a step class and I'm assuming it's related to the adrenal issue.

Thanks,
Magyar