If my doctor offers Thyroxin, do I decline at this point?

[sip1]

For anybody not familiar with my circumstances - I had a full blood count last summer because of feeling *extremely* tired, but my thyroid came back in the normal range (2.67). In Jan, I did a saliva test to check my adrenals, which showed I am in the resistance stage of Adrenal fatigue - with my DHEA low, and cortisol levels low in the morning. A few weeks ago, I did another private urine test to check my thyroid, which showed my T3 low and T4 normal.

After much deliberation, I took my results along to my doctor last week - and he didn't mention adrenal fatigue at all (neither did I, as I wanted to see if he knew about it himself first!), and he suggested I had a blood test (which I had early this morning) to check my morning levels of cortisol. He wants to check for Addisons Disease (or rule out anyway as I'm fairly convinced it's not that!) and also check my TSH levels again He did say he understood that some people within the 'normal' range sometimes needed thyroid medication - so at least that's a good start. However - I'm not entirely convinced that if he prescribes Thyroxin (which is what the nurse said they use this morn) - it's a good idea to take it with weak adrenals? I'm thinking as well, that he may prescribe a low dose hydrocortisone too - again, I'm really not sure this is wise right now?? Or ever!? I've read both thyroid meds and steroids are not a good thing when adrenals are weak, so to be honest - I'm not sure what I'm really expecting from my doctor. I was *hoping* he'd know about Adrenal Fatigue, but I knew that was a long shot lol.

Can anybody advise on how I should proceed? I have my next appoint on the 10th. Do I just see what he says, and if he prescribes me anything - I don't HAVE to take it right?!

[susymac]

There are differing opinions on this. I belong in the by treating with thyroxine (or other appropriate medication) that your adrenals will sort themselves out camp, although if they are testing for addissons then it would be wise to wiat for that to be ruled out first.

Other will say you have to support your adrenals first, and I think this is what is suggested on the patient information leaftlets as well. However most drs including the late Dr Skinner disagreed that this was necessary, and its therefore there more to absolve the pharmacutical companies from blame if a patient does have addissons.

It is unlikely your doctor will know anything about andrenal fatigue as according to the NHS it does not exist.

.. and no, you do not have to take anything a doctor prescribes or offers you.

[jimh111]

Adrenals can get weak with longstanding hypothyroidism but usually recover with thyroid treatment, you just have to take it more slowly. I wouldn't take any results from a saliva test as a diagnosis, you would probably get a different result the next day. I think 'adrenal fatigue' is a bit of a myth. I did a saliva adrenal test many years ago but wouldn't waste my money on it now. Low adrenal reserve due to hypothyroidism is rare, there are thousands of thyroid patients started on levothyroxine every week and they do not suffer any consequences from weak adrenals. If you can start on levothyroxine and gradually work up as far as 50 mcg then your adrenals are fine. It depends on the formulation but many supplements for 'adrenal support' either do nothing or contain adrenal extract. The problem with taking adrenal hormones is that in the long term you will weaken the adrenals and become dependent upon the supplement.

The only evidence I've seen (and there is very little available) is that untreated hypothyroid patients in general have mildly elevated basal levels of adrenal hormones. This is probably because their metabolism is slow and clearace is reduced. The problem with supplements is that they can elevate basal levels which suppresses adrenal output. If someone does suffer from Addison's Disease or Addison's Syndrome they need medication but any mild weakness due to hypothyroidism usually corrects itself and this is the best way to proceed.

Jim.

[sip1]

Thanks for replying. Now I'm even more confused as to what to do lol. Everything I have read so far has said not to treat thyroid if there are underlying adrenal issues. I have read countless books on Adrenal Fatigue (Dr Wilsons being the most recommended, and also Dr Lam seems to be of the same thinking) and I very much believe it exists. Being an extremely anxious person all my life, I believe has brought this on, and it makes sense if the adrenal glands pump out adrenaline on a too regular basis then they are going to struggle at some point. I've read it can be really dangerous to take Thyroid medication with adrenal fatigue, so I'm really stumped. I'm not sure if I should be taking the risk to find out, but I also want to feel better!

Taken from Dr Lams site:

Low Thyroid Function Due to Adrenal Fatigue

Hypothyroidism can be primary or secondary. Primary hypothyroidism can easily be cured with administration of thyroid replacement therapy. If hypothyroid symptoms such as low body temperature, fatigue, dry skin and weight gain persist despite thyroid replacement therapy regardless of laboratory values, one must look elsewhere for the cause of the low thyroid function.

Secondary hypothyroidism is low thyroid function caused by malfunction of another organ system. One of the most frequently overlooked causes is adrenal fatigue. Adrenal fatigue is perhaps the most common cause of secondary low thyroid function, both clinically and sub-clinically. Low adrenal function often leads to low thyroid function, classically evidenced by high levels of thyroid binding globulin (TBG), low free T4, low free T3, high TSH, slow ankle reflex and low body temperature. Few physicians are trained to detect this connection. Fortunately, secondary hypothyroidism can be reversed when the underlying root problem (such as adrenal fatigue) is resolved.

Administering thyroid medication in cases of advanced adrenal fatigue without concurrent attention to adrenal recovery will often fail. In many cases, it is analogous to pouring oil onto a fire. An already weak adrenal system in a low energy state may not be able to carry the burden of extra energy output. What the adrenals need is rest, not extra work. Thyroid medication administered under such circumstances may lead to a temporary relief of symptoms and a slight boost in energy at first. However, this is often short lived. Ultimately, fatigue returns as the thyroid medication further weakens the pre-existing adrenal fatigue condition and often precipitates an adrenal crisis. The overall fatigue level continues to increase well beyond what the medication is trying to combat. Only by increasing the thyroid medication dosage or switching to more powerful thyroid drugs can the worsening fatigue be avoided

[puncturedbicycle in reply to sip1]

I just want to point out that lots of us with adrenal issues take levo and while it may not suit every hypo person, I'm not sure how it's meant to be dangerous.

It would be great if you could continue to read up on adrenals and support them, but if your doc offers levo I'd take it with open arms just to see if it helps. Adequately medicating you with thyroid hormone may have its own healing effect on your adrenals (though whether you believe that or not depends on who you listen to).

A lot of people here have had a difficult road with thyroid issues, but don't discount the thousands of people who take it and feel much better so don't have to resort to an internet forum (at least not immediately). It suits a lot of people.

[jimh111]

I think you need to wait and see the results of your thyroid blood tests. Your doctor seems very good in that they are prepared to prescribe if your results are borderline. I haven't studied Dr Lam's website but he appears to be saying that if you have 'adrenal fatigue' you require more and more thyroid medication to mask the underlying 'adrenal fatigue'. In fact, if your adrenals did have a problem you would not be able to tolerate higher doses of thyroid hormone (and your test results would show you have low levels.

If your doctor thinks you may be hypothyroid and offers to prescribe levothyroxine take the opportunity. If you are concerned you can let them know and ask if it would be OK if you started on 25 mcg. This is perfectly acceptable, the only downside is that it will take a little longer to fully recover which isn't much of an issue.

Jim.

[sip1 in reply to jimh111]

Thanks for your response Jim - I really appreciate the advice. If he does suggest using the Thyroxine - but I end up feeling unwell taking it, do you think it would be wise to stop? I am really worried about it making the adrenals worse, and would hate to end up in situation where I feel worse than I already do. Also, am I correct in saying Thyroxine is T4, and people tend to do better on T3? I find it all very confusing, my brain just can't handle all this info lol. The urine test I did showed that T4 was normal, but T3 was low

Shantel x

[sip1]

Thanks for your response Jim - I really appreciate the advice. If he does suggest using the Thyroxine - but I end up feeling unwell taking it, do you think it would be wise to stop? I am really worried about it making the adrenals worse, and would hate to end up in situation where I feel worse than I already do. Also, am I correct in saying Thyroxine is T4, and people tend to do better on T3? I find it all very confusing, my brain just can't handle all this info lol. The urine test I did showed that T4 was normal, but T3 was low

Shantel x

[jimh111 in reply to sip1]

Of course if you find the levothyroxine starts making you worse you can stop it although you should discuss it with your doctor, it's only fair to do so, give them a chance. Levothyroxine does not make adrenals worse, it can improve them if they are weak due to hypothyroidism. If you have longstanding severe hypothyroidism the adrenals struggle to cope with the levothyroxine and then you have to take it slowly. This is very rare.

As for people doing better on T3 containing medicines this is true for some people, myself included. These are the more complex cases. Most people have a simple form of hypothyroidism that responds to levothyroxine treatment and it makes sense to give this a good long try first before getting into complex issues with other thyroid medications. Once you start on levothyroxine it can take about a year to fine tune your dosage.

[sip1]

They are doing a full blood count, which I know checks Ferritin and also B12 and Folate looking at my previous test in June.

By NDT - do you mean Armour? Would it be worth asking for this, or similar (if there is similar?) I seem to remember somewhere that Armour wasn't generally given in the UK, but I may be wrong. I don't want to come across as pushy, but I definitely would like to start off with the better medication if it's more likely to work.

Shantel x

[sip1]

Thank you, that's good to know. I'll see what they come back as then, and if they come back low - would the doctor pick this up and prescribe what's needed, or would I have to supplement myself?