Why does Paul Robinson insist there’s no such thing as adrenal fatigue and T3 will fix low cortisol. It certainly hasn’t in my case .

[Jamima]

I’m currently using armour thyroid at 2 grains and feel bloody awful. Same old same old symptoms I get when I try to increase Levo or Levo/t3. My adrenals suffer. I know it’s adrenals because I’ve been doing this for almost 5 years now. Really surprised with his info/advice which makes me doubt everything else he claims.

[Incoguto]

I think he says that low cortisol is caused by slow pituitary gland (pituitary gland required a good amount of hormones to work). Slow pituitary gland will not stimulate adrenals enough for them to work. So his opinion would be that t3 should fix struggling pituitary adrenals. Is your cortisol dropping as you add t3 or t4?

[Jamima in reply to Incoguto]

Thank you, yes that’s what he’s saying. I’ve tried, Levo solo, with t3 and now on armour, I’ve also tried the glandulars. In every case I get to a certain point, eg above 50 for Levo and start to feel much worse. I’ve never tried the t3 in the middle of the night thing, but have dosed at bedtime. My point really is that I’ve used t3 (never solo) for quite a while and my adrenals (according to tests) haven’t budged and I know the physical symptoms very well now. In short, I don’t know if it’s t3 or 4 but thyroid hormone makes me crash. The only time I felt like me in the past 5 years was after a SST, I felt absolutely wonderful.

[Incoguto in reply to Jamima]

What about t3 only? For me it's raised my salivary cortisol quickly, when I added more straight t3

[Jamima in reply to Incoguto]

I have considered that, and I do wonder if t4 is what always unsticks me. I’m under the care of a doc from thyroid uk list, I trust her as she seems to absolutely understand everything I’ve told her/been through, so I’d prefer to speak to her before making any changes. She did tell me to continue with adrenavive as the armour might make me crash. She was right!

[Incoguto in reply to Jamima]

Your acth was in range, but low, that's dictated by too low of a dose of thyroid meds I'd say. It's a vicious cycle, I'd definitely speak with your doctor. Armour can be great, but it depends it this is the right dose for you. Could I ask you for the name of your doc in a private message? I could do with a good doctor! Thanks

[Jamima in reply to Incoguto]

Thank you, I’ve sent you details of my doc.

[YazzzM in reply to Jamima]

could you share details of your dr with me privately please

[Jamima in reply to YazzzM]

I've sent you a message.

[DippyDame]

Sorry...but that's a tad harsh! Paul does a lot of good work. We are all different with different needs.

2 grains NDT will provide 18mcg T3 with 76mcg T4

Are you sure 18mcg T3 is adequate....possibly not.

How much T3 did you take?

As we add T3 and & titrate the dose up we can reach a point where we do feel worse, it can be the body signalling that more hormone is still required

Yes, I also recall the boost following the SST, it's transient!

I understand how frustrating it is struggling to reach your therapeutic dose....it took me many years to discover I have a form of Thyroid Hormone Resistance. The only real help I received was from a group of experienced and knowledgeable members here.

Maybe you need to ride out the rough patch and try increasing your T3

Do you have recent lab results?

[Jamima in reply to DippyDame]

I can’t even tolerate 2 grains without crashing, that’s my point.

[DippyDame in reply to Jamima]

Yes, I understand that was your point and I tried to explain why that might be

Are you perhaps having difficulty tolerating levo/ T4?

Just looked at your previous posts....FT3 is consistently on the low side.

For good health every cell in the body must be flooded with T3 by way of a constant and adecquate supply....this isn't happening for you

Treating thyroid problems is a very long, slow, tiresome journey....there are no quick fixes, but there are fixes!

Lack of adequate hormone (or wrong hormone) will cause a crash.

You seem very focussed on adrenals, important yes, but they are only part of the jigsaw of symptoms.

Incoguto has already referred (above) to a struggling pituitary gland/T3.

Each dose change needs around 6 weeks to settle in the system.....shorter and it fails

Have you thought of taking an adrenal cocktail, many find this helpful...it provides nutrients to support the adrenals.

One example

thealmondeater.com/adrenal-...

[Jamima in reply to DippyDame]

Thank you DippyDame. Yes I’ve tried adrenal cocktail, I take 2mg of vit c daily anyway, I’ve also tried glandulars, adaptogenics and hydrocortisone, the HC worked best. I’m not focussed on adrenals I’m just saying what thyroid hormone does to me.

[DippyDame in reply to Jamima]

Time to address your low FT3 now....as we have pointed out, it gets worse before it gets better!

[Jamima in reply to DippyDame]

Thank you.

[ShiningStar77 in reply to DippyDame]

Hi DippyDame what is "Thyroid Hormone Resistance"?

[SlowDragon Administrator]

looking at previous posts you only just started on Armour

It’s common to initially feel worse as body adjusts to increase in metabolism

Get bloods retested 8-10 weeks after being on constant dose

Test early morning and split Armour as 2 or 3 doses spread across the day with last dose 8-12 hours before test

Likely to need further increase in dose after next test results

[Jamima in reply to SlowDragon]

Thank you SlowDragon, I do understand that I have to wait and adjust but this isn’t a feeling of metabolism being ramped up, it’s quite the opposite; I’m constipated again, my brain fog is worse and I’m pretty much staring at the walls all day, I feel weak and listless. I’m under the care of a doc from the thyroid uk list who I think is very good and I’m due a review mid August, but I can’t keep going like this until then. It’s not just armour, every thyroid med does this. I’ve emailed the doc but I know she’s incredibly busy so don’t expect an immediate reply.

[JumpJiving in reply to Jamima]

Jamima

Reading this thread and having had a quick look at your previous posts, here are my immediate thoughts (as somebody diagnosed as both hypothyroid and with adrenal insufficiency):

Both hypothyroidism and adrenal insufficiency make you feel rough, and both can take a while to get medication right. Chopping and changing, particularly changing more than one thing without letting the previous change settle, prolongs how long you will feel rough as you don't know which change is making which difference.

You have been on hydrocortisone previously, so presumably have a diagnosis of adrenal insufficiency? If not, how did you get hold of hydrocortisone? Are you still taking hydrocortisone? If so, what doses at what time of day?

When you had your SST(s) done, particularly the one that came back with low results, did you also have your ACTH tested? NICE guidelines say that it should be done before the SST is started, but many endocrinologists/hospitals fail to do so. If it was done, the blood sample would have been put on ice and sent to the lab straight away. If you had your ACTH tested, what was the result? Did whoever prescribed your hydrocortisone identify why your cortisol level was low? Had you already started taking Adrenavive etc before the SST that showed your cortisol low? Or had you been on steroid-based medication of any sort?

You mention taking Adrenavive. With NDT from good manufacturers, you know what is in the NDT. With Adrenavive, can you tell me what hormones are in it and how much of each hormone is in it? Nobody has ever been able to answer that question when I've asked it previously. Given how sensitive the body is to cortisol levels and how dangerous messing with those levels can be, you really need to know what you are taking when using products such as Adrenavive. If you don't know the quantities of hormones in it, I would suggest not using it (TBH, I would suggest not using it anyway). HOWEVER, assuming it does contain cortisol or something that converts to cortisol in the body, stopping it suddenly could be dangerous, so you'd need to ensure that you are taking hydrocortisone instead before weaning off it. I suggest talking to an endocrinologist about how to do that safely.

Regarding chopping and changing - as others have said, when changing thyroid medications, you need to wait at least 6 weeks for things to stabilise before repeating blood tests. With adrenals, despite the short half-life of cortisol, how long it takes to feel more normal on hydrocortisone varies dramatically, For some people it's days. For other people it is 18 months or more. For me, it was about 5 months. Amongst other things, it depends on how low your cortisol had been and for how long prior to starting the hydrocortisone, and also depends on whether you are started straight onto a maintenance dose or started onto a higher dose and then taper down to the maintenance dose. Patience is required, and because you need to address thyroid & adrenals, you may have to expect to feel rough whilst addressing one before later addressing the other.

[Jamima in reply to JumpJiving]

Thank you. I’ve not been diagnosed as adrenal insufficient. Here are the result from my last sst.

ACTH 19.8 (7.2-63.3)

Cortisol pre SST 216

Cortisol post SST 611

I self source HC and use 5-10mg doses because it makes me feel better.

[JumpJiving in reply to Jamima]

For info, if you don't have a prescription for it, if whoever is supplying the HC is in the UK, be aware that they are almost certainly acting illegally. Be aware, that if your supply dries up and you have to suddenly stop taking HC, that can be dangerous.

When you say you use 5-10mg doses, is that one dose per day? If so, the short half-life of cortisol will mean that you will hit a cliff as soon as it leaves your body, and it may suppress your ACTH production resulting in a vicious circle. Having said that, I am not suggesting you take more. If you really feel that HC is helping you, I would suggest paying for a private endocrinologist to do what is called a day curve, measuring your cortisol level through the day as you take whatever doses you normally take to see what effect it is really having. Having come close to death last year as a result of adrenal insufficiency, I would be very cautious of experimenting with your cortisol levels without knowing what is really going on as a result.

[Jamima in reply to JumpJiving]

Thank you, I’m under the care of a thyroid uk doc, I’ll do what she recommends.

[FancyPants54 in reply to Jamima]

Does she know you are self-sourcing and using hydrocortisone? If she doesn't, you should tell her in your review. She might be able to help you with it.

You said you have never taken pure T3 in the middle of the night so you don't know if Paul's method would work for you. It can be very affective if you have low morning cortisol. But it takes time to find the right time of morning to take it and how much that dose needs to be. Paul is very knowledgeable about it. But you would have to know a) if you have low morning cortisol and b) try it following his instructions to see if it helped you. But right now you need to stick with what you are doing until your review and talk to your doctor. And tell her about the hyrodcortisone. It might be a missing piece of the jigsaw for her to help you.

[Jamima in reply to JumpJiving]

My last 4 point saliva. Underange dhea and my last thyroid had an undetectable free androgen index.

Cortisol graph

[JumpJiving in reply to Jamima]

My understanding is that saliva-based cortisol testing is ok for testing for high levels of cortisol, but is not considered reliable for testing low levels. I believe there is one hospital trust currently investigating its use for low level testing, but it's not more widely accepted currently.

[Jamima in reply to JumpJiving]

Honestly, I don’t need a test, I’m living it. But thanks anyway.

[FancyPants54 in reply to Jamima]

That's the sort of example graph that Paul's method could help. But as I said above, you need pure T3 and you have to follow instructions on how to begin with timings and dose.

[arTistapple]

I have been reading Paul Robinson recently because I have encountered big problems taking T3. I don’t recall him saying at all that there is no such thing as adrenal fatigue. He does however talk about ‘insufficiency’. He does also say that it can be overcome with judicious use of T3. His third book is in fact called “The CT3M Handbook. Recovering Adrenal Health using the Circadian T3 Method.” So really, he has continued to work out a method to introduce T3 in ‘difficult’ cases.

He emphasises a number of times that “thyroid hormones will not work well in the presence of low cortisol levels and unhealthy adrenal gland performance”.

So entirely unsure where you have gleaned the idea that he does not address adrenal insufficiency.

I have as yet not tried his CT3M as I feel I must understand more about it. After three horrible attempts at T3 I am very wary indeed. So I can’t comment on using the actual system he outlines.

Two endocrinologists have now drawn my attention to the fact that high T4 levels depress T3 levels in some patients. The first one put it very clumsily. “ Levo can’t help you any more and you can’t take T3”. She might as well have given me a terminal prognosis. It was shattering. The most recent one wants to work with dropping the Levo and introducing T3. This remains speculation as I have not started this regime yet. I found when I tried T3 people on the Forum were telling me I was in effect making myself more hypo in the way that I was taking T3. I never could get my head around it but the high T4 levels is a strategy I feel I can try. So perhaps, in the absence, of attempting Paul Robinson’s CT3M, you could, as you say yourself, do something about your T4 levels too before going any further.

[Jamima in reply to arTistapple]

Thank you, I’m sorry you’re having such problems, I do empathise. I can’t increase my t4 levels without crashing, I’ve already increased them to what was considered ‘close to optimal’ and I felt awful, even my thyroid uk doc acknowledged this is a problem for me. I will endeavour to post the link I found from Mr Robinson.

[Jamima]

I can’t seem to copy the link but the title is:

Can T3 Thyroid Hormone Treatment Stress The Adrenal Glands in Thyroid Patients?

12th October 2019 | Paul Robinson | Cortisol Information

Adrenal Glands, Circadian T3 Method

[Link added by admin] paulrobinsonthyroid.com/can...

[RedApple Administrator in reply to Jamima]

I've added the link into your reply 😊

[Jamima in reply to RedApple]

Many thanks RedApple.

[arTistapple]

Jamima I think there is something here we don’t fully understand. However I have written a long reply to you but somehow can’t send it. I will attempt again later. I really think this issue is important for both of us!

[Jamima in reply to arTistapple]

Ok, thank you.

[radd]

Jamima,

‘Why does Paul Robinson insist there’s no such thing as adrenal fatigue’

It’s just the way people interpret the wording. A few years ago it became fashionable to call adrenal fatigue an ‘HPA axis dysfunction’ which gives a more credible description, as opposed to worn out, yawning and incapable adrenal glands.

Unless there is a condition such as autoimmune Addisons, the adrenals remain capable as they once were but now lack the correct stimulus. Therefore, it’s the stimulus that is the problem and not directly the adrenal glands. (A raise in cortisol during a Stim test evidences this).

I agree with this theory to an extent but will point out for many of us who have suffered years of adrenal abuse, possibly since childhood, even with the right stimulus the adrenals might start to work better as mine have but they remain lacking a certain stamina and resilience, as I think the set (base) points change.

And the name adrenal fatigue remains because that is exactly how people suffering poor HPA axis function feel.

The T3 therapy I can’t comment on. I have his books and understand his concept but have never used his methods.

[Jamima in reply to radd]

Thanks radd - I agree and I know what he means but his language is it’s all rubbish and my method will cure you. It’s wandering into snake oil salesman territory; here’s the problem and I’ve got the cure. I used to work in advertising and I recognise that language. As we all on this forum know, it ain’t that simple.

[AKatieD]

PR says adrenal problems are real, just mislabelled as fatigue. Your adrenals don't get tired when they are not working probably so fatigue is the wrong word. He also suggests a method which worked for him, which you don't seem to have tried, but I don't think he claims it works for everyone.

[Jamima in reply to AKatieD]

Thank you.

[DippyDame]

Sorry, haven't time to immediately read Paul's article but I might comment as follows....

Do you have a form of Thyroid Hormone Resistance? (RTH)

If so how was this diagnosed?

Are you taking high dose T3-only....the treatment for RTH which, in the absence of RTH is poentially dngerous

It's rare condition

I think what you are asking is can NDTbe used to treat RTH...and would the NDT result in high rT3.

NDT is not a treatment for RTH!

High doses of NDT will raise FT4.

High levels of FT4 can result in high levels of rT3 which will be metabolised and eventually excreted

High dose T3 is the treatment for RTH

rT3 is the product of excess unconverted T4, it is the metabolically inactive form of T3 it's a way of recycling the hormone components.

To take this reasoning a step further, does it mean that high rT3 causing symptoms cannot be treated with T3 only for 12 weeks

Sorry I have never heard of rT3 being treated with T3 and I don't recognise the question

There appears to be some confusion here.

You appear to be linking RTH with rT3 which suggests a misunderstanding somewhere of RTH and I'm really not clear as to where you are coming from.

Yes patients with RTH need to be on a long term supraphysiological dose of T3....I am one of that number. The high dose is to ensure adequate T3 overcomes resistance and reaches the nuclei of the cells and attaches to T3 receptors where it becomes active

What, in your lab results has caused this question?

Sorry, have to go out now....hope this starts to explain the issue

[Sunflower64 in reply to DippyDame]

My question does not refer to my specific situation but is a more general question. I have not been tested for thyroid hormone resistance and did not even know such testing was possible.

[DippyDame in reply to Sunflower64]

In that case it would help us to help you, if you added some details of your thyroid condition in your profile eg diagnosis, recent labs, medication.

I note you have now deleted your question... and I have wasted a lot of time trying to help you

Please use the forum responsibly

We're all here to help if you have a problem

[Sunflower64 in reply to DippyDame]

I did not ask for help for my symptoms. I asked about Paul R’s article. I did not know that is against forum rules.

[DippyDame in reply to Sunflower64]

It isn't!

I tried to explain RTH and rT3 which you queried in relation to an article by Paul Robinson

But, for reasons best known to yourself, you have now deleted your post so there is nothing left to discuss.

Sorry my response wasn't what you hoped for.

[Sunflower64 in reply to DippyDame]

I felt that the discussion had strayed too far away from the OP and that it would not be helpful for the person who started the thread. I probably should not have posted my question here anyway.