Cortisol and ACTH low? I'm so confused now.

[Sally56]

Hi all,

I also have Primary Aldosteronism and no thyroid (goitres). I am back on T4 100mgs a day. I am meant to be on 10mcgs T3 also. I do not have any new thyroid hormones tested other than one than these on 14/5/19. I became under medicated because I couldn't raise the T3 I was on and hence back on T4.

TSH 20 (.03-4.0) (was 40 4 weeks prior)

T3 2.6 (2.6-6.0)

T4 10.9 (9.0-19.0)

I have not been able to take exogenous T3 with any success. I end up with adrenaline rushes and feeling over medicated (even though I am not). After some very chaotic cortisol results. High and low for the past few years. My last saliva test was so high that at last my Endo decided we needed to investigate further.

14/5/19: Saliva test results: 94.9 - Ref (6.0-42.0). healthunlocked.com/thyroidu....

31/5/19: 24 hour urine test results showed a very low cortisol 15 - Ref (<110)

So now I have had ACTH measured: 8ng/L - Ref (9-51) So low ACTH. I also have very low DHEA.

I'd would appreciate any advice, comments especially about the ACTH. I see my endo in a month. Thanks in advance.

[greygoose]

How much T3 did you originally start on? 5 mcg or 10 mcg? 10 might have been a bit much. And, by how much are you trying to raise at a time? It should be 5 mcg maximum.

According to your FT4, you are under-medicated on levo. Have you tried raising that?

[Sally56 in reply to greygoose]

Thanks for replying Greygoose.

This is my second attempt at T3. I tried T3 only for 3 months last year and couldn't get to the therapeutic dose of 30mcgs. I only got to 15mcgs and felt the BEST until I had those awful adrenaline rushes. Currently I am about to try slow release T3 at 10mcgs a day. I'm scared of this because I can't get past 5 mcgs of ordinary T3. without the rushes. Yes I have increased my T4 in the last 3 weeks from 5/7 to 7/7 at 100mcgs.

[pinkjess17]

Hi have you ever taken a lower amount of t4 on its own say 75 or 88mcg? You look to me like your stuck in a thyroid/adrenal feedback loop. The lower your t3 the higher the cortisol, which intern then lowers ACTH. If you were to convert better from a lower dose of t4 this may be a possible answer?

[Sally56 in reply to pinkjess17]

Thanks Pinkjess,

I've never heard of a thyroid/adrenal feedback loop? So low T3 (which is where I'm stuck) raises cortisol which lowers ACTH? Didn't know that either. Is it normal for the cortisol to be low and the ACTH low simultaneously?

[pinkjess17 in reply to Sally56]

If you look at the figures above, your t3 is very low indeed with extremely high cortisol. The high cortisol will lower acth. If your t3 was to increase your cortisol would lower as it will be utilised and your urine cortisol would increase with the improved metabolism. T3 uses up cortisol and because yours is too low it’s hiking up free cortisol as too little is entering the cells. That’s why I asked have you tried lower amounts of t4 as 100mcg looks to be stoping conversion too much. My mum has a similar problem, on 100 t4 she doesn’t convert very well, but on 75/88mcg her t3 shoots up and blood pressure lowers as her cortisol and aldosterone lowers too. Your DHEA is also low because your metabolism is lowered.

[Sally56 in reply to pinkjess17]

Hi Pinkjess,

Thanks for that patient explanation, much appreciated. I see what you are getting at. It makes sense. However the day I had the urine test and blood tests 31/5/19, the low ACTH result was in conjunction with a low cortisol reading. However when I did the saliva test and blood test on 14/5/19 (17 days earlier) my cortisol was sky high, I had the T3 measured as low. My cortisol seems to be high and low? Today I have taken the slow release 10mcgs T3 and am having adrenaline rushes already. I took 100mcgs of T4 also, so I will not take the T4 tomorrow. Thanks so much.

[pinkjess17 in reply to Sally56]

This is just my opinion but I think you are swinging between high and low cortisol because your adrenals are weak. It’s a bit like a boom and bust cycle. If your intolerant to t3 is take it as a sure sign you have weak adrenals. You need to steady the ship with the amount of thyroid hormone your adrenals can handle and convert to t3 adequately.

[Sally56 in reply to pinkjess17]

Thanks PinkJess,

I do have conversion issues, so I was told. But I have upped my vits and minerals for about 8-10 months now. Once I am adequately T4 dosed I'm interested to see how the conversion is going. However I had a hard time with T3 slow release today, with aches and pains and breathlessness. It is compounded here in Australia, so I have halved the capsule, I will start slower, as Gregygoose suggested on 5mcg first. Yes I agree I have weal adrenals, as I have. Primary Aldosteronism and with that I am just reading new research 2019, that says cortisol is often an issue with Aldosterone. SO it could be that, but then again, it may be my stressed body which never really recovered after some heavy drug intervention in 2011. Anyhow, I shall nurse these adrenals. Thanks again.

[radd]

Sally56

Low cortisol & ACTH looks like secondary adrenal insufficiency. ie the pituitary gland can’t produce enough ACTH to encourage an adequate amount of cortisol from the adrenal glands.

Are you on meds for primary aldosteronism ? Maybe their action has suppressed pituitary function in some sort of feedback loop ?

And this could all be compounded further by a true cortisol deficiency if you have been unknowingly functioning with low thyroid hormone and high aldosterone for many years.

DHEA commonly goes low with cortisol issues as both have the same precursor, pregnenolone.

But that is all a guess. I really don’t know.

It is vital to raise thyroid hormones to support your struggling adrenal glands. Have you tried introducing T3 in minute amounts ie 2.5mcg starting with once a day for a week, then am & pm, then am, pm and evening, ... or something similar over the course of many weeks ?

I have read of some people having to split their dose up to four times a day to avoid the adrenaline rushes, until it was better tolerated.

What about your mineralocorticoid levels ? and are iron levels adequate ?

[Sally56 in reply to radd]

Hi Radd,

Thanks for replying. I googled Secondary adrenal insufficiency. Reading that I'm thinking maybe my endo will test me more because of the pituitary and low ACTH? No one has ever looked at this. (I know, like everyone's story on here, trying to get well). I can't work out why my saliva tests show I'm high cortisol on week and low the next?

Yes I am on Eplerenone and Aldactone. I have just looked up your question and Aldactone does inhibit the production of steroids aka cortisol. Eplerenone does not. However another study found that it (Aldactone) increases cortisol. I will talk to my Adrenals Prof and Endo about this. But thank you for helping me think about the medication I would never have thought to look there. SO complicated.

Yes i have tried T3 in tiny amounts, and in divided doses and taking it at night and 4 hours before I get up, all end up with the adrenaline rushes. However today I pick up sustained release T3. I'll give that a go.I know I need T3. I don't have a brain without T3.

They check my mineralcorticoid levels monthly, as I end up in hospital a lot because of the potassium and sodium imbalance which sends my BP high. I'm all good at the moment. My iron is good now. I had it tested and was anemic and I take a supplement daily and have for a year now. I also take B12, B complex, selenium. I was taking zinc but apparently that's a cortisol suppressor too. Thanks Radd.

[radd in reply to Sally56]

Sally56,

Has your endo specifically asked that you stop zinc supplementation ? Given its importance in the function of numerous proteins, including hormones, if you are deficient then I would say it should be replaced.

Zinc may have a temporary effect of inhibiting cortisol secretions but over time it actually helps to stabilise. We tend to think that only botanical adaptogens can help stabilise/normalise cortisol levels but there are many nutrients/vits known to exert this effect too.

Lots of luck with the sustained release T3. 🙂

[Sally56 in reply to radd]

Thanks Radd,

I'll get back on it then. No I took advice from here re the zinc and cortisol suppression. No Endo has never told me to supplement anything. My GP told me to supplement iron though. Thanks for everything.