Taking Hydrocortisone with NDT - Endo suggesting it’s the final option

[BreifneKing]

Currently taking 10mg Hydrocortisone with 3 grains Armour Thyroid.

I tried Levothyroxine, Levothyroxine with Liothyronine and finally NDT and always managed to initially get some respite from symptoms on a dose increase but this never lasted longer than a week even when FT3 levels were at the top of range.

Following 24 hour cortisol saliva test, which confirmed (Phase 2) HPA axis (adrenal gland) dysfunction, my Endocrinologist prescribed 10mg Hydrocortisone to be split between 2 doses and I have been on this regime for 10 weeks. Initially I had more energy and thought HC was the answer but 4 weeks ago I had a procedure that required a general anaesthetic and ended up requiring a Hydrocortisone drip 5 hours after the op - couldn’t breathe, mouth and throat incredibly dry (despite drinking 2 litres of water), severe headache over right eye, light sensitive and eyes rolling. Since then I have no energy and an almost constant headache / head pressure.

Thyroid results are as follows and it’s worth noting FT3 was higher on Erfa only, despite it having lower T4 and T3, compared to Armour with HC.

Latest:

FT3 6.34 3.1 - 6.8

FT4 15.7 12 - 22.0

TSH 0.009 0.27 - 4.2

April 2019 (On 3 grains Erfa Thyroid only)

FT3 7.02 3.1 - 6.8

FT4 15.0 12 - 22.0

TSH <0.005 0.27 - 4.2

Can anyone offer any explanation for the above or advise on what I need to do?

[SlowDragon Administrator]

When were vitamin D, folate, B12 and ferritin last tested.

Low B12 is extremely common

General anaesthetic can significantly delete B12

What supplements do you currently take?

[BreifneKing in reply to SlowDragon]

Vit D, folate and B12 are all consistently good but haven’t tested them for about 3 months.

Ferritin is around 30 but as I have Haemochromatosis my Haematologist doesn’t want it any higher as Transferrin Saturation is 75%.

I supplement Vit D as I used to be deficient.

[SlowDragon Administrator in reply to BreifneKing]

If not tested vitamins since had operation, perhaps that's next step.

Or simply start/increase vitamin B complex supplements

[BreifneKing in reply to SlowDragon]

Ok, will give it a shot.

One question though, if ferritin needs to be higher for thyroid hormone to work how do I do that given the Haemochromatosis diagnosis?

Or does the Haemochromatosis diagnosis mean I will never get relief from Hypothyroid symptoms as thyroid hormone won’t work without higher ferritin levels?

[SlowDragon Administrator in reply to BreifneKing]

Links about the two

redriverhealthandwellness.c...

endocrine-abstracts.org/ea/...

ncbi.nlm.nih.gov/pubmed/182...

[BreifneKing in reply to SlowDragon]

Thanks for those, but I can’t see any reference to how ferritin can be increased?

[Barrister]

My guess is that you need more Hydrocortisone. Hydrocortisone only stays in the body for 4-6 hours so you are essentially running on empty. Most people take around 20mg a day spread over 3-4 doses. I take 25 mg spread over the day. You should ask your Endo for a day Curve as this will be able to show when you are running low on Hydrocortisone.

Clemmie

[BreifneKing in reply to Barrister]

That was my guess also but then I got distracted by the results from my Synacthen Test (which the endo nurse said was normal if 30mins was higher than 550):

Baseline - 295 nmol/L

30mins - 550 nmol/L

60mins - 565 nmol/L

What do you think?

And should levels be higher for a 6’3”, 17 stone man?

[Barrister in reply to BreifneKing]

The base level is not desperately low but still low for first thing in the morning. It should be 500+ between 8-9 am. Was an ACTH level done?

Weight, height and gender isn’t really relevant.

Clemmie

[BreifneKing in reply to Barrister]

ACTH level was requested but the endo nurse said the lab didn’t run the test as my baseline cortisol level was fine.

I understood the ACTH test had to be done within half an hour of blood draw so I queried this with the nurse but she said it was the labs decision.

Do you think they’ve made a mistake and should have still run the test?

[Barrister in reply to BreifneKing]

The ACTH is helpful in diagnosing whether you have primary or secondary adrenal insufficiency - if it’s very high then it’s likely to be primary, especially if you have Adrenal antibodies but if it’s very low, then there’s a likelihood that you have secondary insufficiency. The treatment is practically the same. The blood for the ACTH needs to be taken, on ice, directly to the lab for testing.

Clemmie

[BreifneKing in reply to Barrister]

That’s useful to know, I’ll get in touch with the endo tomorrow to get a test arranged.

What times do you take your HC?

[Barrister in reply to BreifneKing]

I take my Hydrocortisone at 6am, 10 am, 2pm and then later in the day when I feel that my cortisol is dropping too low - my “tells” are that my voice becomes hoarse, I get very dizzy, my lips become numb and my speech is slurred. But my cortisol does drop very quickly as I’m not producing much naturally and I metabolise the Hydrocortisone that I take very quickly. My last cortisol was only 8.

Clemmie

[adin]

T3+ndt you tried? Good explanation here; restartmed.com/adding-t3-ndt/

[BreifneKing in reply to adin]

No I haven’t.

That article suggests it is necessary if FT3 levels are low in range, but as you can see above mine is towards the top of range.