Between 2016 and 2024 I lived through the most horrendous work related stress (bullying) which had a catastrophic impact on my employment and income.
After nearly 9 months I’m out the other side - settled in a new job and started a Masters degree - but feel really, really flat and tired. I sleep but it’s erratic and I’m always tired in the mornings. I feel better as the day goes on.
I’m wondering if my adrenals have taken a hammering and if I should do a test.
I’m still on 90mcg T3.
McMurtagh - There's no harm in doing a test, other than to your pocket if doing it privately. However, if you have adrenal insufficiency, I would expect you to have listed a number of symptoms beyond what you listed in your post, so it's unlikely based on just what you posted.
Cortisol seems to be the latest "in thing" - I even had an ad pop up on Facebook yesterday for some junior doctor/public speaker/wannabe MP selling tickets for a talk he is giving nearby with cortisol in big bold letters at the top of the ad. Endocrinology isn't even his area of medicine. Just seems to be one more person trying to make a buck out of people who are being misled into thinking they might have a cortisol problem when most of them won't. There are only about 9000 cases of primary adrenal insufficiency in the UK, about twice that for secondary adrenal insufficiency, and an unknown number for tertiary (the one caused by long courses of steroids). The numbers are so small that many GPs will never knowingly see a case.
If you really think you might have adrenal insufficiency, then see your GP and see if they will do an early morning (8-9am) cortisol blood test. If they won't, but you really want to get it done, get the blood test done privately. Don't waste your money on saliva-based tests, as your GP will likely ignore the results if you put them in front of him/her. You have to prepare for cortisol tests, avoiding various things and stopping certain medications etc., so don't just get the test without checking first, otherwise the result will be unreliable.
Whatever you do, don't start taking over-the-counter adrenal cortex/adrenal glandular/adrenal supplements thinking that they might help and that they cannot do any harm. Messing with cortisol levels can do harm.
After a work experience that sounds like yours, I did talking therapy, available free from the NHS without GP referral (just Google NHS talking therapy to find how to apply). I found it very useful - had an excellent therapist (to whom I can go back again if I need to again in future), and no waiting list. I had never considered doing therapy until that work experience, health diagnosis and a few other things all came together. It definitely helped me.
(For info, I have a diagnosis of tertiary adrenal insufficiency)
Thank you.
Don't waste your money on saliva-based tests, as your GP will likely ignore the results if you put them in front of him/her.
I have a different view of saliva tests. I did them a couple of times and found that my cortisol was very high (over the range in 3 out of 4 of the saliva samples, and in the one that wasn't over the range the result was 90% through the range).
At the time, I was finding it hard to tolerate thyroid hormones in any form and at any time of day, and after I got the saliva tests done I was convinced that my high cortisol was to blame.
I used the saliva test results to help me find the best timing for taking T3. I split my T3 and took the highest portion of my dose at the time when my cortisol was lowest and it improved my tolerance a lot. When I was taking T4 I also took that at the time when my cortisol was lowest.
Eventually I was able to very slowly shift dosing to first thing in the morning and now I take all my T4 and T3 first thing in the morning. I've never been able to tolerate thyroid hormones in the evening or at bedtime. As someone who has suffered almost life long insomnia, taking thyroid hormones at night makes it worse.
I've never shown my saliva test results to a doctor. I've just used them for my own benefit.
I was surprised to hear that people take T4 at bedtime - seems contradictory to me; thanks for confirming 😱
Its personal preference, T4 does very little until its converted into T3 and there is evidence that taken at night its better absorbed and utilised, plus there is no worrying about food, drink or other meds interfering. I take mine in the small hours when I get up for the loo. I've taken it in the morning as well and it makes no difference, except I have to delay having a coffee.
Ahhh, that’s what I do too - usually 3-5 AM - I get up 6-7AM so can have my coffee right away 👍🏼
I'm not one social media like Insta or FB but I heard recently there 's a trend on there about " cortisol face". When you wake in the morning and your face is puffy and dull looking. The usual weird and wacky remedies from so called influencers trying to make a quick buck and of course no science behind it whatsover.
I don’t suffer from a puffy face - so that’s helpful indicator.
Would be good to know your ferritin levels too - this can give you the walking through sludge feeling too.
Plus - have you had any counselling for your trauma, you could well have some PTSD, anxiety and depression symptoms. The local council run mental health services have a Triage system, ours is called Healthy Minds, I called them when I was struggling a few years back and after a 12 week wait with stop gap advice I had 12 weeks amazing counselling with a highly qualified psychotherapist who was re-training in CBT. Life changing.
PS - Well done getting out and getting on with things! Kudos to you.
Thank you.
I’m due a blood test soon and the GP checks me for iron and most other things.
I’ve had counselling and coaching and don’t think I’ll gain any benefit from any more of that. I just wondered whether the physiological impact of such a prolonged period of stress might explain the flat feeling. I was running on stress for so long.
Ah good, glad you have had that option.
100% agree, you are definitely onto something, the recovery after prolonged stress is quite noticeable. Post exertional malaise (PEM) flatness etc.
the GP checks me for iron
From personal experience several years ago I found out that my surgery only thinks someone needs iron supplements if their ferritin is below range and they are anaemic i.e. haemoglobin is below range. Haemoglobin is tested as part of a Full Blood Count (FBC).
After finding out (by accident thanks to an informative pharmacist) that I could buy prescription-strength iron supplements without a prescription and get iron panels done privately with finger-prick blood samples I was able to raise my ferritin, haemoglobin, and eventually my serum iron, to optimal by myself without having to beg and plead for a prescription.
So, always make sure that you get copies of your results for iron panels, ferritin, and FBC to find out if your iron and ferritin levels are optimal. Don't rely on a doctor to tell you that your results are "fine". Get copies of results and prove it to yourself. Having a below range serum iron, and bottom of range ferritin and haemoglobin was NOT fine for me at all even though my doctor thought they were.
(sorry long reply, don’t have the time to make it shorter 😀)
I just wondered whether the physiological impact of such a prolonged period of stress might explain the flat feeling. I was running on stress for so long.
Hi, years ago I went through similar work stress I’d say 2012-2022 (my hands get kinda sweaty just thinking about those people)… it can get SO BAD, can’t it, and it is existential when you and/or your family rely on your income. No words can describe just how horrible it is.
I would have said it was the most stressful thing I ever went through.
Until.
A few months ago when I experienced the stress of a near-death family illness.
|
During that time I looked into my symptoms and tried to detangle the cause - thyroid, perimenopause, stress, etc.
It gave me comfort at the time that stress CAN cause symptoms & block so many of our body functions.
I am a huge fan of frequent blood tests at various way points in our symptom journey. If you can get them and/or afford them. Definitely figure out what your feeling correlate to.
As for myself - it was as simple as me being on a continuing hypo/peri-menopause journey that was very severely and significantly disrupted for about 3 very intense months. And now 2 months later I have returned to where I was before it all started in the fall. (Which is near optimal thyroid, and emerging perimenopause).
|
When I researched the impact of stress, here are the things I learned that helped me understand what was happening in my body/cells. That stress did play a role, and that it can mess with your bloods/cells/symptoms.
For me, it helped me be patient … I took a blood test or two during that time, but I did not change my meds until the impact of that acute stress dissipated.
|
Sharing my experience and the below are some of the notes I took.
- Chronic stress suppresses the hypothalamic-pituitary-thyroid (HPT) axis, reducing T3 and T4 production.
- Elevated cortisol reduces TSH and T4-to-T3 conversion.
- Cortisol increases cellular resistance to thyroid hormones. This means that despite consistent blood test results, it can explain symptoms. High cortisol - 1) reduces thyroid hormone receptors on cells so they are less responsive to T3 and T4. 2) reduces thyroid hormone transport proteins so less reach your cells. 3) and of course it leads to some additional inflammation.
|
Lastly - for me, I test morning cortisol every couple months and did a 5 point saliva earlier this year. It’s always near top (but not over) range for me, but nothing drastically stands out for me, and so I continue focus on my free Ts.
But yes both high and low cortisol disrupt thyroid function, and managing stress and rest is key to balancing thyroid and adrenals, as they are so interconnected in the body's stress response system.
That’s so helpful, FallingInReverse - thank you!
I’ll read more into that x
Adrenal insufficiency 
adrenal insufficiency
Could this be adrenal insufficiency?
Adrenal insufficiency 
