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* Having strange pro­blems since star­ting Armour or any other desic­ca­ted thy­roid product?

* 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 Armour, or soon after you have star­ted and are noti­cing strange symp­toms, which become unmas­ked by the use of Armour or other natu­ral desic­ca­ted thy­roid pro­ducts. 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 STIM test, or a 24 hour urine test, but patients have found none to be ade­quate or com­plete mea­su­res to dis­cern slug­gish adre­nals. The ACTH 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.

Ins­tead, we have relied on the 24 hour adre­nal saliva test, which tests your cor­ti­sol levels at four dif­fe­rent times of 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 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 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 Armour, 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. Or some 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 may come from lis­te­ning to your body, 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 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.

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