being Tired, Depressed, Constipated,
Sleep or Think?
Depression, Hair Loss, Vertigo, & Infertility Correlate
Low Thyroid Levels
Levels Fluctuate and often
Gum Disease &
not from Low TSH
High Blood Sugar & Insulin
Resistance Correlate with High T3
to Diagnose a
Thyroid Lab Results
by the Time of your Last
Reference Ranges are
too Broad; What is Healthy / Optimal?
T4, T3, or Desiccated (T4 + T3)
Iron, Cortisol, Selenium, Iodine
Symptoms (Anxiety, Tachycardia), Hypothyroid
Low Cortisol: Hydrocortisone (HC)
T3: Side Effects
you need T4 too)
Dryness Resolve with BHRT
Testosterone in Aging Men:
Palmetto, Stinging Nettle, and OTC Men’s Supplements
and Yellow #5 (Tartrazine)
Altitude Sickness: Headache, Insomnia,
Books I Recommend
Who Writes TiredThyroid?
to defray web hosting costs appreciated.
Adrenal Fatigue or Low Cortisol:
Hydrocortisone (HC) Side Effects
Adrenal fatigue, adrenal
insufficiency, adrenal dysfunction, or hypoadrenia is
co-existing problem for
those who’ve been hypothyroid for years. Adrenal fatigue
is the term most commonly used by patients, though it is not recognized
by the medical profession and has no insurance billing code. When
thyroid energy is low, the adrenals (a small gland above the kidneys)
with cortisol and
adrenaline to give the body energy. This
can make one feel both tired and wired at the same time.
Sleeping problems are common. In
disease, the adrenals produce little to no cortisol, so one must
cortisol, or they would die. Those
Addison’s are usually quite thin.
Cushing’s is the opposite state, where one
overproduces cortisol. Cushing’s
patients are usually quite heavy,
with a moon face and buffalo hump (hump on the backside of their neck).
Adrenal fatigue refers to a
broad range of adrenal dysfunction.
In the same way that thyroid dysfunction
can range from
myxedema coma on the hypothyroid end to thyrotoxicosis on the
end, so can adrenal fatigue range from Addison's on one end (cortisol
close to zero) to high or dysfunctional daily cortisol rhythms
the other end. If one has Addison’s, then there is
one must be on hydrocortisone
for life. And
if saliva cortisol labs
show a flat-lined pattern at the bottom of the range all day, then one
to supplement with hydrocortisone too.
others, supporting the adrenals with adaptogens and slowly
raising thyroid levels can also work.
because thyroid and corticosteroid binding globulin (CBG) have an
thyroid levels come
up, CBG goes down, leaving more cortisol free.
is also released from CBG as body temperature rises, and body
temperature correlates positively with thyroid levels. So raising
thyroid can naturally raise cortisol levels. [1,13]
But any increases must be
done slowly--weekly thyroid increases are too much too soon and
do not give the body time to adjust. I have read of people
are so sensitive that they can only raise 1/4 grain of desiccated
thyroid or 12.5
mcg of T4 every 12 weeks. If one has poor T4 to T3
conversion, then taking smaller amounts of T3 throughout
the day (including bedtime), instead of once a day, will also give all
organs, including the adrenals, a more steady supply of energy to
perform their function.
cortisol can have a primary cause; that is, the adrenals
not produce cortisol. But it can also have a secondary
pituitary does not send out an adequate ACTH (AdrenoCorticoTropic Hormone) signal, which tells
the adrenals to produce the cortisol. If the
hypothalamus does not send out
hormone (CRH), which sends the signal to the pituitary to produce ACTH,
that is considered a tertiary cause. If
damaged pituitary or hypothalamus and low ACTH are the cause of the low
cortisol, then cortisol must be taken for life to replace the essential
missing hormone. Cortisol that goes to zero is considered an
adrenal crisis and is life-threatening, so steps must be taken to avoid
this situation. A medical alert bracelet/necklace/card should
carried at all times if one is on cortisol replacement, because the
ACTH feedback loop does not work in this situation.
fatigue seems common in
those with thyroid problems. Are the adrenals somehow
to the thyroid? Apparently they are, because without adequate
thyroid levels, the adrenals themselves
atrophy. Rats were given anti-thyroid drugs like
methimazole; these drugs are used to lower thyroid levels in Graves'
patients.  Their adrenals atrophied when
and the adrenal cortex actually shrank in size, especially
the zona fasciculata, which is where cortisol is produced. As
expected, blood cortisol levels were lower in the hypothyroid rats.
Interestingly, Brewer's yeast, which is high in B vitamins
selenium, appeared to have a protective effect on the adrenal gland,
somewhat offsetting the methimazole-induced atrophy. 
Thyroidectomized dogs exhibited the same
effect--their cortisol levels dropped significantly only seven days
post-thyroidectomy. Their adrenocortical function was
restored after they were given levothyroxine. 
to treat adrenal fatigue has side effects many are not aware of,
and should be, so they can make an informed decision if they choose to
part of their protocol. People
using hydrocortisone on thyroid internet forums have reported
side effects, and there are medical journal references that support the
, glaucoma, which can lead to
blindness , weight gain and “buddha belly” , immune suppression
lead to fungal infections and resistance to some cancer treatments
cardiovascular disease/ hypertension , diabetes , insomnia, and
to tolerate any stress, which can lead to a fatal
. Someone on the
hydrocortisone protocol must
learn how to “stress dose,” or manually provide the hydrocortisone
needed for any
since the body becomes completely dependent on external dosing. If one
cannot provide the
required increased hydrocortisone for the stress, it can be fatal. More
than one has ended up in the ER while on this protocol.
In the same way that T3-type medications
suppress TSH, taking hydrocortisone suppresses the ACTH feedback loop,
stimulate natural cortisol production.
One can have low cortisol symptoms in
conjunction with physical signs of high cortisol because
manual dosing creates high cortisol levels shortly after a dose, but
low cortisol levels just before the next dose. It is
difficult to replicate natural cortisol production, or to
automatic ACTH feedback loop. One
should be aware of the risks before embarking on
doesn't cause these side
effects at physiological doses, only at excessive
doses, say the proponents of this protocol.
But how does one define physiological?
Maybe what is
physiological for one person is an overdose for another.
In one study of primary or secondary adrenal insufficient
patients, those on hydrocortisone doses greater than 30 mg/day had a
lower Quality of Life score than those on lower daily
doses.  In another study of primary or secondary
adrenal insufficient patients, the dosing schedule that brought the
highest proportion of simulated patients within physiological cortisol
targets was 10 + 5 + 5 mg at 0730, 1200 and 1630 h,
respectively. However, even with this regimen, about 54%, 44% and 32%
of patients would remain over- or under-treated when compared to the
physiological ranges at 0800, 1600 and 2400 h, respectively. 
These high percentages of being over or underdosed on what is
considered a physiological dose confirm what many patients on
report--that it is extremely difficult to manually dose hydrocortisone.
This may explain the side effects many report.
a study of 12 Addison's and 20 hypopituitary patients on replacement
glucocorticoid therapy, 75% of the patients were found to be taking
excessive doses when serum cortisol levels were correlated
with 24-hour urine free cortisol excretion. Their mean daily
of hydrocortisone was reduced from 29.5 to 20.8 mg.
This caused median osteocalcin (a protein involved with bone
formation) to increase (which is good) from 16.7 to
Another 56% had their dosing regimen or drug changed.
Osteoporosis is a serious side
effect of any glucocorticoid therapy, so
it is imperative that one is not overmedicated. 
Hydrocortisone is used
to suppress the HPA (hypothalamus-
transrepression (which it does very well), but side effects like
diabetes are from a different mechanism called transactivation. Other side effects like
osteoporosis seem to
involve both transrepression and transactivation.
So while one may get the intended HPA effect of
may also unknowingly be putting oneself at risk for serious side
seem to work as it should when
one is on other pharmaceutical drugs like benzodiazepines, or any
that treats anxiety and depression.
These drugs probably work at some level on
the HPA axis and cortisol levels, creating unintended, conflicting
Also, if Lyme disease or some
other underlying medical
condition is present, taking hydrocortisone can exacerbate the
condition because of
suppressive effect on the immune system.
Hydrocortisone treatment should not be entered into
lightly. Some have
ended up worse
than before they
started any treatment.
Thoughts on thyroid internet groups.
Read patient experiences with hydrocortisone use.
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