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Thyroid (Expert Forum)
adrenal failure following thyroid treatment
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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adrenal failure following thyroid treatment
by edra, Jul 14, 2006 12:00AM
I am interested in hearing from anyone who had long-term hypothyroidism, had it successfully treated, then had adrenal problems following that.
Briefly: I had long-term hypothyroidism (caused by Hashimoto's) whose symptoms first appeared in 1989, and which was not successfully treated until 2006, after I got rid of the antibodies. I had had adrenal tests in 2002 and 2004 that showed borderline low (but still OK) output. After I got my TSH/FT3/FT4 into normal ranges, my exhaustion and insomnia got much worse. I had the same type of adrenal test done recently, which showed my adrenal output had gone very low, with total daily output of cortisol and DHEA about 1/3 of low normal. My morning cortisol peak was very low, and my cortisol output from noon on was a flat line barely above zero.
If there is someone out there who has gone through this, I'd like to know what kind of treatment(s) you used to revive your adrenals.
Briefly: I had long-term hypothyroidism (caused by Hashimoto's) whose symptoms first appeared in 1989, and which was not successfully treated until 2006, after I got rid of the antibodies. I had had adrenal tests in 2002 and 2004 that showed borderline low (but still OK) output. After I got my TSH/FT3/FT4 into normal ranges, my exhaustion and insomnia got much worse. I had the same type of adrenal test done recently, which showed my adrenal output had gone very low, with total daily output of cortisol and DHEA about 1/3 of low normal. My morning cortisol peak was very low, and my cortisol output from noon on was a flat line barely above zero.
If there is someone out there who has gone through this, I'd like to know what kind of treatment(s) you used to revive your adrenals.
Doctor's Answer
by Mark Lupo, M.D., Jul 15, 2006 12:00AM
, Jul 15, 2006 12:00AM
It is possible -- the best test for adrenal failure is an ACTH stimulation test where an injection of ACTH is given and Cortisol is measured usually 30,60 and 90 minutes afterwards. With the history of hashi, there may be an immune attack on the adrenals, so adrenal antibodies may be interesting.
If the adrenals are low, then steroid replacement therapy is necessary.
PS- how did you "get rid" of your thyroid antibodies? Sometimes they will vanish over time after the thyroid is fully destroyed by the immune system but this is not typical.
If the adrenals are low, then steroid replacement therapy is necessary.
PS- how did you "get rid" of your thyroid antibodies? Sometimes they will vanish over time after the thyroid is fully destroyed by the immune system but this is not typical.
I have found that I feel normal when my TSH level is kept at the lower in of the normal range--1.0 . Over the last 5 years my Endo Dr. has been successful in keeping me in this range by adjusting my dosage of synthroid. My dosages have run from .112 to .2. In April, 2006, my TSH jumped to 6.05 and my Endo Dr. increased my synthroid dosage to .250 (2 x .125 pills). I have always taken my synthroid at the same time each morning with water one hour before eating. So, I didn't know why it would have jumped to 6.05. I just received the results of the blood test that was run on July 3rd and my TSH level has gone even higher to 12.61. My Endo ran another blood test 2 days ago in his lab (the other tests were done in Quest Lab)just to make sure there weren't any control issues. So I am waiting to hear from that test. I am looking for any direction that anyone can give me as to what would make my TSH level continue to rise. Is there another organ problem going on that is causing the elevation in TSH?
I also have hyperparathroidism that we are watching. I had 2 parathroids removed in 2002 but my calcium never came down as was expected--it stays around 10.5 to 10.7.
I didn't find out until 2003 that I had a positive response to the gliadin antibody test. After deleting gluten from my diet, my anti-thyroid antibodies gradually went away. It appears that this reduced the anxiety response I would get when trying to take thyroid hormone. I'm now on 112mcg Synthroid with TSH=0.38, FT3=4.46 pg/ml, and FT4=1.42 ng/dl.
But there's obviously something else going on. My adrenals are obviously low. Getting my thyroid fixed has certainly not cured my primary symptom (insomnia).