More ramblings. We've been discussing interactions between thyroid and adrenal function recently.
Another poster on this site mailed me the link to this piece on the management of cortisol/adrenal issues by highly respected thyroid doctor Dr. John C Lowe who passed quite recently:
It's interesting, because apart from being another source that sets out the adaptogen/adrenal supplement based approach to treating high cortisol and/or adrenal fatigue, it may in addition shine a little more light on the above issue, and on some of the symptoms that may arise during treatment of either as a result of these.
T3 Paul's book which covers circadian rhythm and its role in T3 supplementation very likely adds insight in this territory too - but i'm not yet up to speed on it.
Bear in mind that I'm no expert, and that this amounts to theorising by extension from what Dr. Lowe says.
His experience was seemingly that achieving proper T3 replacement may initially cause adrenal fatigue (and require the presumably short term low/naturally occurring/physiological level adrenal supplementation he mentions) as a result of improved liver function - because the resulting more rapid metabolism of cortisol can reduce the blood levels of cortisol. (this where the adrenals are already quite fatigued, but were just managing to cope while the patient was hypothyroid)
This is a guess - but it might also lead to surges of high cortisol and palpitation type symptoms at times too if the adrenals are misfiring (that's alternating between high and low outputs) as it seems they may do when they can't quite keep up. (see the Clymer manual linked before for the stages through which adrenal fatigue seemingly progresses - it suggests that cortisol output can progress from chronically high, to intermittently high and low, to low when fatigue sets in)
This faster processing by the liver is no doubt normally a good idea because it should result in faster clearing of cortisol after periods of stress.
Projecting from this again though, the converse is likely ( surprise!!) - that hypothyroidism leads to a reduced ability to handle stress, and to a tendency to run chronically raised levels of cortisol in response to a given level of stress. This because as above the ability of the liver to clear cortisol is reduced - not to mention that lots of other processes must also feel the effects.
High (and low) cortisol are meanwhile both well recognised as suppressing T3 conversion and reversing T3 to produce what should be short term hypothyroidism - but if the raised cortisol is chronic/longer term this hypothyroidism may become a significant cause of gut problems (correct gut function requires adequate thyroid), consequent auto immune illness, candida and the like. Which it's held can quickly feed into primary hypothyroidism (actual dysfunction of the gland) as well as a result of the resulting ineffective absorption of key nutrients/minerals etc in the gut among other issues.
Hypothyroidism/inadequate availability of T3 seems anyway likely to reduce adrenal capability along with the performance of just about every other cell based metabolic process in the body.
So it looks like we may have yet another mutually self reinforcing negative spiral - this time between adrenal and thyroid function - but with a lot of scope for variation in symptoms (and required treatments) depending on exactly what's going/not going on in each system.
There's potentially more than that to it too. Chronic stress/longer term raised cortisol it seems risks the possibility of HPA programming/learned/exaggerated stress responses (where the adrenal 'brain thermostat'/baseline cortisol level gets bounced into being set high by chronically high cortisol levels and remains stuck there) - as discussed in the Clymer manual and numerous research papers linked in previous posts on the high cortisol topic. (wonder if there could be any similar programming effect in play regarding our output of thyroid hormone?)
This is significant since these naturopathic docs commonly finger chronic stress and chronically raised cortisol and/or consequent adrenal fatigue as a common first cause of chronic fatigue and related metabolic illness, and as the common route to thyroid problems.
It's clearly unwise to permit stressful life situations/chronic stress to continue in our lives - so conversely it may be very important to find the courage to act determinedly but wisely to create the required change.
I'd a sluggish and fatty liver for years (was lectured by one doc that it was down to poor diet despite my going to enormous lengths to avoid problem foods and eat carefully) - yet one of the most pronounced symptoms when i upped my proportion of T3 a few months ago to get a big improvement in well being and especially gut function was gallstone like pains and a darkening of 'output' It's reasonable to bet that this was the liver clearing itself.
Reducing my cortisol levels (hope i can maintain it) has delivered a further very significant improvement in stamina and energy, and cleared remaining gout and joint/muscle aches - plus i'm losing weight quite rapidly.
These effects have all materialised as a result of supposedly minor changes - despite my long having in both cases been well within what conservative medicine regards as 'normal' blood hormone ranges...
I escaped symptoms of adrenal related issues like palpitations and got excellent results immediately upon upping the proportion T3 (but seem to need some T4 to feel well) - possibly because I'd by then already been on quite good thyroid replacement with a lower proportion of T3 for several years (i.e. it was only a step up), was well clear of stressful work situations and the like, and had completed several courses of adrenal supplementation.
So what is this saying? It's not advice, but the suggestion seems to be that small differences can count for a lot, and that there's likely scope for quite a wide range of interactions between thyroid and adrenals. It may also suggest that care is needed to avoid or at least safely and tolerably manage interactions when treating one, or other or both.
Guess I'm wondering what's out there by way of recognised guidelines in this area. (most of what we read tends to look at thyroid replacement or adrenals in isolation - but not both as a total system)
It sounds for example like there is a lot to be said for simultaneously treating both together (not exactly news for many of us) - but that perhaps it's advisable to progress slowly so as not to create a major imbalance in the capability of the two, and in order to give both systems time to adapt and literally grow into the new balance... (between tuning of receptors, gland growth and the like there seems to be considerable scope to adjust both responses and output)
PS. There's no significant discussion of the adrenal fatigue scenario here because that's not what i've experienced - and because i've no expertise in the area. It's perhaps worth mentioning however that should the issue of supplementation arise or even be considered that it's territory requiring great care.
This STTM page sets out a broad take on some posssibilities, and more to the point probably only some of the many and potentially serious pitfalls that can arise in the form of dependencies/side effects/HPA re-programming etc : stopthethyroidmadness.com/a...
Definitely best approached with expert professional assistance....
ian
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thanks varja will be on my reading list - off to physio this am - looks as though this could explain a lot for me - much appreciated : )
If you want to talk about things like this and more, unfortunately I don't think this forum is the one for getting much technical feedback, and of course it's narrowed down by it's mainly UK base... have you tried? allthingsmale.com/forum/for...
Some interesting concepts and approaches there, and discussion of a type where this kind of supposition would be well chewed over!
Ta P. Sounds good. I'll have a look. The aim here was to both share the sort of picture that to my mind is emerging on the adrenal/thyroid complex (it looks like they really shouldn't be treated in isolation?) - and to solicit some input..
This is a very interesting post rajra, and one that I can take on board. I have recently started T3 treatment of Cynomel Mexican, and was doing very well. Starting very slow and logging very carefully. The I just hit the 7week marker and was upto 50mcgs and tolerating well, but instead of dividing in the day ie 4 1/2 tablets of 25mcgs I took a whole tablet of 25mcgs in the morning and another twelve hours apart. This cause atrial fibrilations etc, I kept calm and stopped as of for 3 days now, watching the signs. I think I could have hit the adrenal cortisol barrier, and having to work that bit harder because they have speeded up 60 beats on Levo now upto 80. It is a fine tune game, and I am open to any suggestions especially as I have studied that some sort of adrenal support may be needed. Would welcome any advice, and one again thank you for this article, I am a great believer in Dr Lowe and Dr Peatfield
Thanks varja I have now read your posting again and looked at the Dr Lowe link. For me adrenals are always at the core especially as i had a kidney removed so may or may not have a right adrenal gland and it may well be damaged as the surgeon was on his first solo op as well as my having a severe post op infection - oh joy!
I seem to tolerate cynomel at between 30 - 40 mcg and with support from Nutri Adrenal x 6 and Nutri Thyroid x 2. Might be worth a try marmaris - like you I can't seem to take enough.
I have had a couple of crazy high blips recently - a few weeks ago I reacted weirdly to a pre dental check anaesthetic only to find later it had adrenaline as a component. Same treatment with one which is adrenaline free and I was fine.
This week I was tree pruning when a branch hit me in the face and split my lip. My physical reaction was akin to having been in frontline battle mode and left me feeling rather stupid. Mouth is much better, face only slightly bruised - ice and arnica are wonderful and only needed one steristrip but it was asif the "shock" has lasted for days! Both incidents indicate adrenal dysfunction to me.
Salt can help me at times of stress but the nurse was shocked to find me saying I would be fine to drink a salt water mouthwash to keep my mouth clean! She insisted I should spit it out - ( I did in view of poss infection).
My adrenal saliva test has improved to High ( a bit too high) in the morning and low for the remainder of the day . I think it rises too early, will re read this article again.
Thank you for taking the time to post this information Ian. I've felt pretty sure lately that the adrenals and the thyroid work hand in hand, because of a horrendous problem I've had with hayfever and skin irritation recently. Sounds pretty daft, I know, but I have my reasons to believe the two were connected. Certainly the adrenals, particularly the stress hormones, have an effect on the thyroid and interfere with T4 to T3 conversion. This is a known fact. If stress is continuous, then there is a reduction of metabolism and over time symptoms start to arise. There is a lot to be said for stress. I just wish I could do something about mine.
Just bear in mind that the above is speculative Sarah.
There seem to be quite a few parallels between our experiences - other than that my blood pressure is problematical and seemingly adrenally related too.
I'm at about 40mcg of T3 daily split in two lots too, with about 50 mcg of T4 - which isn't all that much by some standards. More than that (total dose of thyroid hormone) and my pulse starts to climb, i start to feel a bit hyper and my TSH goes to nothing. More T3 (with less T4 for the same equivalent dose) and i seem to develop a 'peaky' feeling - it comes on a bit too strong, and then fades to create some slight fatigue before it's time for the next dose.
I had my mercury fillings removed in two sessions, and had quite a strong reaction - a temperature and flu like symptoms after both. I put it down to escaped mercury, but i guess it could possibly have been adrenaline related too.
Sorry about your lip. My recovery from exertion/fatigue was very slow until the above steps forward - but my healing has always stayed pretty good. Small adjustments to adrenal function and thyroid replacement seem to make big differences in this regard....
I've not been able to find anything yet explaining where the action and control of the levels of the fast acting adrenal hormones (adrenaline, norepinephrine etc) fit in, and how it relates to cotisol and thyroid.
I've as you probably know been working with adaptogens like rhodiola and Seriphos to try to get my cortisol and hence hopefully blood pressure and tinnitus under control. It's been very effective in reducing the BP, and probably (to be tested but the symptoms and results seem clearly to point to this) cortisol levels.
According to the saliva test my cortisol was high in the afternoon, evening and night. Whatever is going on it's seemingly come right down through the day and early evening, but may have got more frisky overnight and in the morning - i think.
There's been a few odd days where it's gone back up for no obvious reason too - wondering if there might not be a food sensitivity/auto immune factor in play. (there's mention about that once genes get expressed that this sort of thing can be hard to fix)
So there seems to be re-programming going on, but i'm not too sure yet if (a) it'll deliver fully as i hope (still promising and to play for), or (b) what to do next. I'm going to try some anti histamine again the next time it happens. T3 Paul suggested it before with vitamin C, and it seemed to help.
It could of course too be just that I'm seeing the Seriphos act to reduce the cortisol output (it partially blocks the action of ACTH it seems - by temporarily tying up receptors), but that there's the possibility of some underlying physical/physiological issue (e.g. an adrenal, brain or pituitary abnormality) too. Ot just that i need to find a way to take some during the night?
My grandson suffered with CFS and with the GPs it was wait and see. In the end I took him to a Kiniesiologist. The first thing she looked at was his endocrine system and his adrenal glands were seriously fatigued, along with his pineal gland (day/night rhythms). She dealt with these problems with diet and supplements. He was better within 5 months. I've been so impressed with the results that I am going to see her for myself re my thyroid and the hope that she can get me off meds if at all possible. I can feel that my body is stressed, so will be interested to see what she has to say. I am a Bowen therapist and I know that everything in the body is 100% influenced by everything else. The amount of hormone we need to produce a reaction is so small and the meds they give us are so strong, is it any wonder are bodies are reacting so badly. The term for our bodies being in total sync is Homeostasis. We need to be as close to this balance as possible for optimum health.
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surprise!!) - that hypothyroidism leads to a reduced ability to handle stress, and to a tendency to run chronically raised levels of cortisol in response to a given level of stress. This because as above the ability of the liver to clear cortisol is reduced - not to mention that lots of other processes must also feel the effects. 
It's reasonable to bet that this was the liver clearing itself.
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