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ACTH Stimulation test and adrenals
Posted by: Mary
Date: February 15, 2001 7:10 AM

I'm a 39 yr old mother of 3 small children, diagnosed with Hashimoto's thyroiditis 3 years ago, right before conceiving our third child. I began on Armour thyroid, and was pregnant w/in a month! About 2 months after her birth, my TSH was almost non-existent, so was told to stop my thyroid med, but this past August I began to feel very bad...it's been a long 6 months...in Sept. my former GP wanted to send me in for an MRI to rule out MS! My main symptoms were dizziness, and then weakness overall, and shakiness, then later shortness of breath, and many other symptoms - low blood pressure, hands falling asleep in the night, diarrhea, etc. etc. My T3 and T4 levels just below or near low on the normal range, but TSH still 'normal' (2.8 or so). I managed to find a holistic MD recently...my DHEA was low in Sept., so she prescribed 10 mg. DHEA/day. Also she agreed to let me go back on my Armour just 3 weeks ago, but I started to feel worse! Just last week, I had a ACTH stimulation test done. Here are the results: at 9am, after fasting, level was 10.1 (norm. 16-24), at 30 min.,12.5, and at 60 min.,17.9. She diagnosed me with "adrenal fatigue", and said that perhaps part of why I've been feeling worse lately is that I started to treat my thyroid before addressing the adrenals.....but I'm wondering-- now what do I do? I am really nervous about steroids, but Cortef seems to be somehow safer from the research I've been doing on the web. She prescribed up to 20mg/day, but said to start out at 5mg/day. Based on these numbers, what do you all think? Also, I'm nursing a 22 month old. Would this pose any real danger? And, I work in my darkroom once a week, w/ chemicals. Would Cortef stress out my liver? She also told me about licorice.

RE: just got cort. stim. test results...
Posted by: Ron Kennedy, M.D.
Date: February 15, 2001 2:56 PM

I prefer to use Free T3 along with TSH as a lab test for thyroid function as this is the form of thyroid hormone actually available to do the job. I prefer to prescribe all natural hormones in the 12 hour time release form to be taken every 12 hours; for example: Time Release T3, Time Release Cortisol. I think it does not matter much which gland you treat first, preferably both simultaneously if you know both are in need. Of course, there can always be other problems which are as yet undiagnosed and this should always be kept in mind.

RE: ACTH Stimulation test and adrenals
Posted by: Mary
Date: February 16, 2001 7:45 PM

I've been doing a great deal of research on the web the last few days re: adrenal fatigue and Cortef...from what I can tell, a physiological dose of this drug should be safe re: effects on immune system, nursing, liver, and withdrawal...But, I also read that this drug could supress estrogen levels - one other component my doctor wanted me to have checked out, but she told me to wait until day 21 of my cycle to have these drawn, and I'm only on day 8, so since I didn't want to wait 2 weeks to try this drug and (finally) start to feel better, I decided to go and have the strogen/progesterone/testosterone/prolactine/sex binding hormone drawn yesterday, so we'd have a baseline before starting on the Cortef - thinking that they could be viewed knowing which day in my cycle they were drawn on...I'm still a little nervous to start taking a 'steroid', since even taking a Motrin is fairly unusual for me (I tend to try more 'natural' approaches first). I guess I'll be staying on the Armour 15mg, while we see what the Cortef does...Also, one well-researched thyroid patient recommend I look into the possibility of having Celiac's Disease, based on having some digestive problems over the years...a few months of IBS a couple of years before being diagnosed w/ Hashimoto's, etc. She told me that Celiac's can be at the root of Hashimoto's and adrenal problems....do you have any thoughts on that? Can't find too much info on this subject. Can you tell me how is it diagnosed? I'm wondering if having good magnesium, potassium, folate, iron and cholesterol levels would tend to be a sign of NOT having celiacs? Any thoughts on this?

RE: ACTH Stimulation test and adrenals
Posted by: Ron Kennedy, M.D.
Date: February 16, 2001 11:01 PM

It is a clinical diagnosis made more solid by serum gluten antibodies and confirmed beyond doubt by biopsy of the gut. The symptoms of diarrhea, bloating, weight loss, anemia, chronic fatigue, weakness, bone pain, muscle cramps, constipation, or constipation alternating with diarrhea show up reliably in some combinaiton when gluten is ingested. The main source of gluten is wheat. As far at that being the root of Hashimoto's, it is true that diseases involving autoantibodies (like Hashimoto's thyroiditis) are set in motion by leaky gut and a leaky gut is surely possible with celiac disease.



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