Adrenals weak?

[zbs5]

I'm currently titrating T3-only (first 3 weeks, currently at 30-40µg) and i'm not sure if i should do something about my adrenals. Some details (all tests before any thyroid medication):

- Morning cortisol blood tests are high (near upper range)

- Saliva tests shows high morning cortisol, but low midnight and evening cortisol

- Morning aldosterone is very low (still in range)

- DHEA-S is very low (still in range)

- ACTH test 5 years ago positive (no adrenal insufficiency)

When i'm taking T3, my body temperature increases, but they fluctuate around 0.5°C over the day. When i'm forgetting one dose of T3, they crash to under 36.0°C and i feel cold.

I also have heart palpitations (like the heart works harder) and sometimes chest pain, but mostly in the evening / night. Every time i check my blood pressure and pulse readings are normal (~120/70, 60-70 pulse).

I've tried the CT3M method, but i don't notice a big difference. My desire for chocolate and sugar is less, but i'm still feeling extremly tired in afternoon and evening. Does CT3M even work for low cortisol later in the day?

How did it feel for you starting T3-only? Did the adrenal issues resolve itself after some time?

[humanbean]

I'm not sure what is being displayed in your graphs. The cortisol, aldosterone, and DHEA-S results listed are not in the 1000s, so the graphs appear to be showing another substance, but doesn't say what.

- Morning cortisol blood tests are high (near upper range)

- Saliva tests shows high morning cortisol, but low midnight and evening cortisol

These are the type of cortisol results that every healthy person should see.

Cortisol has a circadian rhythm - it doesn't stay at the same level 24 hours a day.

If you look at Example 1 on this link :

rt3-adrenals.org/cortisol_t...

it gives the following optimal results :

Optimal levels

• Morning at the top of the range

• Noon approximately 75% of the range

• Evening close to 50% of the range

• Nighttime at the bottom of the range

And to see the "shape" of the cortisol circadian rhythm, see this graph :

sarahwilsonnd.com/wp-conten...

Very few people actually quote aldosterone and DHEA-S results on the forum, and I've never had them tested so I don't know what results to expect for those. You might find these links helpful :

From this link : rt3-adrenals.org/Miscellane...

Aldosterone and Renin

Optimal aldosterone, when the range is 0-30, is around 14-16. Levels

below 10 should be addressed with fludrocortisone. When aldosterone

is low, renin should be relatively high.

Over-range renin, even with mid-range aldosterone, indicates a need

for fludrocortisone.

Low aldosterone with low renin may be due to dysfunction of the

autonomic nervous system causing secondary hypoaldosteronism.

However the treatment is generally the same.

High renin and high aldosterone may be the body attempting to

compensate for low blood volume, most likely due to an inability of the

kidney to retain salt.

Unfortunately, the above paragraph is like so many suggestions for optimal levels of so many substances... It doesn't tell you the units of measurement, so if yours are different it can be difficult or impossible to compare. But it suggests that aldosterone should, ideally, be mid-range.

According to this link : rt3-adrenals.org/supplement...

DHEA

• A prohormone primarily needed to convert to other hormones

• Most likely will not convert properly in adrenal fatigue

• See steroid conversion pathways chart here

• Will lower cortisol so is not recommended in adrenal fatigue

I don't see any evidence for adrenal fatigue or adrenal insufficiency in your results, but as far as I can tell you've only had cortisol measured at 8am. I also don't think that lowering your cortisol is a good thing to do in your case - your cortisol is not high.

If you want to know some of the things that can help adrenals, please see my replies to another member in this thread, and follow the links :

healthunlocked.com/thyroidu...

...

When i'm taking T3, my body temperature increases, but they fluctuate around 0.5°C over the day. When i'm forgetting one dose of T3, they crash to under 36.0°C and i feel cold.

Body temperature is another thing that varies throughout the day for everyone.

chronobiology.ch/wp-content...

Having problems regulating body temperature is very common in people with thyroid disease. And it is common for hypothyroid people to have very low body temperature, and/or to feel the cold a lot.

...

I also have heart palpitations (like the heart works harder) and sometimes chest pain, but mostly in the evening / night.

There are lots of possible reasons for palpitations and chest pain. Some of the more common factors affecting people with thyroid disease that affect the heart are :

1) Low iron and/or ferritin (iron stores)

2) Low vitamin B12 and/or folate

3) Low or high Free T3

4) Low magnesium

5) Low blood volume

6) High blood sugar

7) High intake of caffeine

8) Problems with blood pressure

9) High potassium

[zbs5 in reply to humanbean]

Thank you for your great response and links!

The two graphs show each a 24 hour cortisol saliva test result. The morning values look great, but the late afternoon values are very low. I did interpret them as too low, as i have symptoms with tiredness. One of the test points even showed 0. The unit is pg/ml.

For the DHEA i just found a reference in Paul Robinsons book "Recovering with T3":

"A low or low-in-range DHEAS, without any recent HC or DHEA use, can be strong indicator of hypocortisolism." [p44]

Thank you for the list of possible issues creating palpitations, i will check each of them.

[thyr01d in reply to humanbean]

Fantastic, informative post humanbean, thank-you.