Thoughts on adrenal suport

[munch520]

Hello all, I'm a recent newbie here and super appreciative for all the guidance. My intro thread is here (https://www.excelmale.com/forum/showthread.php?8671-New-guy-from-Ohio) with ALL results, but basically I have been diagnosed with Hashimotos thyroiditis and also have low/irregular cortisol.

The thyroid treatment has been underway for 2 mos (100mcg synthroid), and recently I got back the saliva cortisol results, which are below. Basically, OK during AM, low rest of the day, and up at night...which explains the insomnia (waking abruptly, unable to go back to sleep) and pounding heartbeat (not rapid) I'm experiencing.

5am: 6.2ng/mL (range 3.7-9.5)
Noon: 1.9ng/mL (range 1.2-3.0)
6pm: 0.9ng/mL (range 0.6-1.9)
9:30pm: 3.1ng/mL (range 0.4-1.0)

Current protocol for the adrenal insufficiency is:
Standard process: desiccated adrenal 3x/day, symplex m 5x/day, hypothalamus pmg 2x/day
Natural Factors Sensoril ashwagandha (250mg) at night

I did get better sleep for 7-10 days after implementing the above, but have been having more insomnia the last night or two.

I understand that I'm trying to support the adrenals with the above treatment, I'm wondering though if the ashwaghanda is fighting against that support. I get that I want to lower my cortisol at night, but I also want to raise it during the day. I know ashwagandha falls into the apaptogen family, but I have read many studies where in test subjects it reduced cortisol by up to 25% after 60 days...I've also cut out caffeine/stims and now workout ONLY in the AM.

Despite great help from my DO/DC, I am on the books to see an endo in early 2017 for more guidance. In the meantime, I thank you in advance for your thoughts!

 

[Nelson Vergel]

I would not do anything right now except trying to get more sleep. I would start thyroid treatment and wait until your TSH and antibodies are normalized, then retest your saliva cortisol.

In the meanwhile, you can read the following:

http://www.stopthethyroidmadness.com/adrenal-info/faq/

 

[Vince]

Hashimotos Thyroiditis and Selenium Part One by Jeffrey Dach MD
http://jeffreydach.com/hashimotos-thyroiditis-and-selenium-part-one-by-jeffrey-dach-md/?ref=rss

 

[munch520]

I would not do anything right now except trying to get more sleep. I would start thyroid treatment and wait until your TSH and antibodies are normalized, then retest your saliva cortisol.

In the meanwhile, you can read the following:

http://www.stopthethyroidmadness.com/adrenal-info/faq/

Thanks! Unfortunately the sleep for me was never a huge issue until starting thyroid meds about 1.5-2mos ago. I actually read on that STTM site that adrenal issues are commonly exposed once starting thyroid treatment. Which is why the doc then did saliva test and confirmed the adrenal
Issue, he said the thyroid meds just further exacerbts it and bring more symptoms to the surface.

 

[munch520]

Hashimotos Thyroiditis and Selenium Part One by Jeffrey Dach MD
http://jeffreydach.com/hashimotos-thyroiditis-and-selenium-part-one-by-jeffrey-dach-md/?ref=rss

Thanks! Thankfully I was helped out with that day one, and take 200-400mcg of selenium per day (in Pure Encapsulations Ultranutrient multivitamin)

I haven't had TPOab run since starting treatment but the thyroid med and supplementation has lowered my TSH from almost 8 to 3.66. FT3 actually went down a bit and FT4 is unchanged.

 

[munch520]

To help with sleep (since we know my night time cortisol is too high) doc suggested Phosphatidylserine at 10PM or so, beginning with 100mg to see if that helps.

Anyone had success with that? I know it's been studied more extensively as a workout supplement...

The main thing I need is sleep, and my body seems to be working against me to get it. Prior to all these issues, I was always a sound sleeper, out as soon as I hit the pillow and usually hitting my 'snooze' button at least a couple times!

 

[munch520]

Update - cutting out thyroid protocol until adrenals can handle it, as the insomnia when I started thyroid meds. I did feel good for a few days after starting thyroid med or adjusting dose, but that was short-lived.

Will continue to support adrenals and hopefully things stabilize. Heck, TSH could be elevated due to adrenal issues from what I read and my FT3 and FT3 were good so I'm wondering if the thyroid is to blame at all.

I'll update back after a few days or a week, I know T4 has a longer half life so we'll see how this goes.

 

[Vettester Chris]

There's probably umpteen talking points here, but I'll keep it to minimum ...

On your cortisol test, did you also get a DHEA correlation lab taken? Any discussion with the doctor (or anyone) on the various stages of Adrenal Fatigue/Exhaustion? Elevated PM cortisol is usually found in the earlier stages of fatigue; Stage 2 adapted w/DHEA Slump, Stage 3 -Maladapted Phase 1 ... Not saying this is your exact situation, as other variables could/might be in play with the cortex, axis, etc., but it gives you something to research and get familiar with.

Your mid-range cortisol values are good IMO, obviously the AM & PM are off. AM 'should' be right at the top of the reference, PM should be towards the middle-to-mid lower end of reference range, which that one is really high. So yes, it would make sense why sleep is problematic, and I agree with backing off the thyroid meds until things are squared with the adrenals. T3 pooling will usually result in a higher conversion rate of conversion to Reverse T3, which can explain some of symptoms you felt when on the thyroid medication.

On the thyroid ... Did you get your Reverse T3 along side the Free T3 and Free T4? Do you have the lab numbers for these labs plus TPO? How did the TgAb antibodies look?

I'll conclude on this, and just keep in mind it's one guy's opinion ... Take a look at the NDT side of thyroid meds, like Armour, ERFA if in Canada, and even compounded NDT's with most hormone pharmacies. Your 100mcg of Syntyroid T4 only synthetic is equal only to about 1 grain of NDT. Usually 1 grain of anything when having Hashi's will just aggravate the situation. Since you're already familiar with STTM, you can find all sorts of info there about effective ways to go about treatments with Hashi's.

 

[Vettester Chris]

Also, forgot to mention that adding DHEA at night helped me tremendously with some of the cortisol imbalances I was experiencing. The whole pregnenolone steal topic makes since when continuous stress demand is put on Adrenals-> Cortisol, thus the initial stage where there's an evident slump of DHEA ...

 

[munch520]

There's probably umpteen talking points here, but I'll keep it to minimum ...

On your cortisol test, did you also get a DHEA correlation lab taken? Any discussion with the doctor (or anyone) on the various stages of Adrenal Fatigue/Exhaustion? Elevated PM cortisol is usually found in the earlier stages of fatigue; Stage 2 adapted w/DHEA Slump, Stage 3 -Maladapted Phase 1 ... Not saying this is your exact situation, as other variables could/might be in play with the cortex, axis, etc., but it gives you something to research and get familiar with.

Your mid-range cortisol values are good IMO, obviously the AM & PM are off. AM 'should' be right at the top of the reference, PM should be towards the middle-to-mid lower end of reference range, which that one is really high. So yes, it would make sense why sleep is problematic, and I agree with backing off the thyroid meds until things are squared with the adrenals. T3 pooling will usually result in a higher conversion rate of conversion to Reverse T3, which can explain some of symptoms you felt when on the thyroid medication.

On the thyroid ... Did you get your Reverse T3 along side the Free T3 and Free T4? Do you have the lab numbers for these labs plus TPO? How did the TgAb antibodies look?

I'll conclude on this, and just keep in mind it's one guy's opinion ... Take a look at the NDT side of thyroid meds, like Armour, ERFA if in Canada, and even compounded NDT's with most hormone pharmacies. Your 100mcg of Syntyroid T4 only synthetic is equal only to about 1 grain of NDT. Usually 1 grain of anything when having Hashi's will just aggravate the situation. Since you're already familiar with STTM, you can find all sorts of info there about effective ways to go about treatments with Hashi's.

Thank you so much for your help! I'll answer your paragraphs by bullets...

-they didn't do DHEA with saliva cortisol labs BUT I have a serum number of: 386 ug/dL (ref 138.5-475.2 ug/dL Roche ECLIA method) which seemed to be good! That's good insight thanks, I've been dabbling with how to supplement the adrenal desiccated and based on my levels, I might focus more on morning and not be supplementing 3x/day like I am now (7am, 12pm, 4pm)

-Here are the thyroid labs I have so far, TgAb has never been run that I can see:
PRE-TREATMENT
TPO/Thyroid Peroxidase: 220 IU/mL (0-34 IU/mL)
TSH: 7.89ulU/mL (.450-4.5 ulU/mL)
T3 free: 3.6 pg/ml (2.0-4.4 pg/mL)
T4 free: 1.21 ng/ml(0.82-1.77 ng/ml)
rT3: 18.9 ng/dL (9.2-24.1 ng/dL)
TSH index: 8.05 (HAP) [1.3 - 4.1] (PI)

Looking back the actual Ft3 and Ft4 look pretty good to me. And the more reading I do the more I see how adrenals can affect TSH and Rt3 especially...

thyroid labs AFTER 2 weeks on 65mg WP Thyroid, then 3 weeks on 97.5mg...same ref ranges as above (pdoc didn't run TPOab, Rt3)
FT4: 1.24
FT3: 3.1
TSH: 2.78

-Thanks for the suggestion, sorry I didn't mention it but I actually started with 65mg/1 grain WP Thyroid and then upped the dose from there (multi dosing 2x/day). We thought this was too stimulating, so that's why we tried 100mcg Synthroid. I think any thyroid hormone is really messing with my adrenals, like you said. Unfortunately with the half life of T4, I'll have to wait a week or so to see how I feel stopping the thyroid meds, yesterday morning was my last dose.

 

[munch520]

Also, forgot to mention that adding DHEA at night helped me tremendously with some of the cortisol imbalances I was experiencing. The whole pregnenolone steal topic makes since when continuous stress demand is put on Adrenals-> Cortisol, thus the initial stage where there's an evident slump of DHEA ...

OK I have sublingual DHEA so I'll try to see if that helps. My serum # didn't look too bad so I hadn't considered it.

My sleep is the HUGE issue right now. When I have these episodes, without fail, I wake up a couple hours after going to sleep, usually fall back to sleep, and then wake again at 3-4am and then can't go back to sleep. I've read high AND low cortisol can cause these abrupt/panicked wakings so I don't know if something like phosphatidyl serine before bed will help lower that high level around 9-10pm, or if my coritsol tanks after that (around midnight-2am) and maybe I'm doing more harm than good taking a supp that tries to lower it...

I did cave and take some trazedone last night (50mg) which took a few hours to kick in but thankfully I got 7 hours or so which is an improvement.

Sucks that the first thing people say to heal adrenals is "get sleep"...haha much easier said than done, they're causing the insomnia!

 

[ERO]

To help with sleep (since we know my night time cortisol is too high) doc suggested Phosphatidylserine at 10PM or so, beginning with 100mg to see if that helps.

Anyone had success with that? I know it's been studied more extensively as a workout supplement...

The main thing I need is sleep, and my body seems to be working against me to get it. Prior to all these issues, I was always a sound sleeper, out as soon as I hit the pillow and usually hitting my 'snooze' button at least a couple times!

I have had limited success with Phosphatidylserine as I too have had issues with night-time cortisol. Phosphorylated Serine works far better and it used to be available in a product called Seriphos, but it has been re-formulated with Phosphatidylserine and now previous users (myself included) find it next to usueless. If anyone knows a source of Phosphorylated Serine, please let me know!

 

[munch520]

Hey guys, back with an update for ya after seeing new endo (Dr. Ravi Dhawale) and adjusting thyroid protocol. This is an odd situation so bear with me...

PRE-TREATMENT (Sept 2016)
TPO/Thyroid Peroxidase: 220 IU/mL (0-34 IU/mL)
TSH: 7.89ulU/mL (.450-4.5 ulU/mL)
T3 free: 3.6 pg/ml (2.0-4.4 pg/mL)
T4 free: 1.21 ng/ml(0.82-1.77 ng/ml)
rT3: 18.9 ng/dL (9.2-24.1 ng/dL)
TSH index: 8.05 (HAP) [1.3 - 4.1] (PI)


After trying 65mg NDT then 100mcg synthroid
FT4: 1.24 (0.82-1.77 ng/ml)
FT3: 3.1 (2.0-4.4 pg/mL)
TSH: 2.78 (doc also found 2012 labs and my TSH was around 3 then, I may have had this issue for a while)


QUIT all thyroid support 12/23
Cortisol normal on 1/11/17

labs from 1/20/17:
TPO: 205 IU/mL (0-34 IU/mL) [note reference ranges changed]
TSH: 7.89 MIU/mL (.50-6.00 MIU/mL) [note reference ranges changed]
T3 Free: 286 pg/dL(200-490 pg/mL) [note reference ranges changed]
T4 Free: 1.2 ng/ml(0.7-1.8ng/ml)

At this point was feeling pretty good, sleeping well a little tired but back to almost feeling 'good'. The endo thought I was WAY overmedicated before, and started me on only 25mcg of Synthroid. Here's labs after 6 weeks of that

TSH: 3.59 MIU/mL (.50-6.00 MIU/mL)
T4 Free: 1.2 ng/ml(0.7-1.8ng/ml)

Felt great when those labs were taken, a little tired in evenings but who isn't (we have 2 young kids too). So it's curious to me that both doses suppressed the TSH well and pretty quickly, seems that I am both super sensitive to the meds and maybe don't require much or need to be titrated up very slowly to tolerate the meds well.

This hypothesis was contributed to by their suggesting a double dose (50mcg) of Synthroid 1x/week to try to tweak dosage up a bit. Unfortunately 3 days after doing that, I was back to the same side effects (albeit not as bad as when I was on 100mcg) persistent fever, panic, insomnia, etc.

So I'm now not taking the meds for a couple days then restarting 25mcg and staying there, will retest in late April to see if TSH has been further suppressed/see how I feel. What do you guys think of this protocol? I've tried both NDT (WP Thyroid) and Synthroid and the Synthroid seems to agree with me best, and at low doses.

 

[munch520]

EDITED,New thread started