Friend diagnosed with Cushing syndrome but has low cortisol

[Nnik]

Hi!
Wondering if any of you guys can help me interpret this and come up with a plan on where to begin. My good friend is 28, diagnosed with hypothyroidism years ago and over the past few years her health has been deteriorating. She was seeing an ND who had her on armour thyroid at a high dose to no resolve or improvement. She saw an MD who scared her out of thyroid and told her the ND “overdosed” her on thyroid. Of course he switched her to Levothyroxine at 137 which hasn’t improved her weight gain or other symptoms. She has been feeling down and unmotivated - no surprise since she is only getting T4 now. She is very open to diet changes and I’ve already gotten her into some principles from Ray peat.
I have her labs below. Why was she diagnosed with Cushing syndrome with low cortisol? Should she still focus on reducing cortisol or does she need to increase it?
My current ideas for her are to switch to Cynomel/cynoplus - not sure a good dosage for her to start at?
Progesterone
Vitamin D
DHEA?
B vitamins?
Pregnenolone?
What do y’all think
Any advice is greatly appreciated!!

***forgot to mention she’s also on Prozac. Not sure if there’s any connection to cushings disease with that or something that could motivate her to wean off of it

 

[youngsinatra]

I cannot find the cortisol on the blood work?

Her thyroid panel looks great. Low reverse T3, solid free T3 and a desirable TSH level. Is she still on levothyroxine? Some people actually do very well on it.

I think Cushing syndrome & low cortisol cannot happen simultaneously.

Low cortisol can cause low thyroid symptoms tho, even with great thyroid labs.

 

[youngsinatra]

https://thyroidpharmacist.com/articles/addressing-adrenals-must-with-thyroid-problems/

 

[Peater]

I think stopping the Prozac should be the priority... She could be eating the 'ultimate Ray Peat diet' and still show no improvement IMO.

 

[tallglass13]

Where is the Cortisol level??
Does this person have Cushing's Symptoms of Moon Face, Buffalo Hump etc?

 

[Nnik]

Hi!
Wondering if any of you guys can help me interpret this and come up with a plan on where to begin. My good friend is 28, diagnosed with hypothyroidism years ago and over the past few years her health has been deteriorating. She was seeing an ND who had her on armour thyroid at a high dose to no resolve or improvement. She saw an MD who scared her out of thyroid and told her the ND “overdosed” her on thyroid. Of course he switched her to Levothyroxine at 137 which hasn’t improved her weight gain or other symptoms. She has been feeling down and unmotivated - no surprise since she is only getting T4 now. She is very open to diet changes and I’ve already gotten her into some principles from Ray peat.
I have her labs below. Why was she diagnosed with Cushing syndrome with low cortisol? Should she still focus on reducing cortisol or does she need to increase it?
My current ideas for her are to switch to Cynomel/cynoplus - not sure a good dosage for her to start at?
Progesterone
Vitamin D
DHEA?
B vitamins?
Pregnenolone?
What do y’all think
Any advice is greatly appr

I cannot find the cortisol on the blood work?

Her thyroid panel looks great. Low reverse T3, solid free T3 and a desirable TSH level. Is she still on levothyroxine? Some people actually do very well on it.

I think Cushing syndrome & low cortisol cannot happen simultaneously.

Low cortisol can cause low thyroid symptoms tho, even with great thyroid labs.

I cannot find the cortisol on the blood work?

Her thyroid panel looks great. Low reverse T3, solid free T3 and a desirable TSH level. Is she still on levothyroxine? Some people actually do very well on it.

I think Cushing syndrome & low cortisol cannot happen simultaneously.

Low cortisol can cause low thyroid symptoms tho, even with great thyroid labs.

Sorry just added the cortisol test results.
@youngsinatra @tallglass13

She does have kind of the body type of a person with cushings disease. I think a small hump and maybe minimal moon face as well. Nothing crazy noticeable though

 

[youngsinatra]

Thanks for adding that in!

(This is data from Izabella Wentz, PharmD, in all the thyroid patients she has tested)
So low cortisol is actually quite common apparently.

Who has diagnosed her with cushings?

Did she test her serum cortisol aswell?

 

[Nnik]

Thanks for adding that in!

View attachment 59316
(This is data from Izabella Wentz, PharmD, in all the thyroid patients she has tested)
So low cortisol is actually quite common apparently.

Who has diagnosed her with cushings?

Did she test her serum cortisol aswell?

No serum cortisol and this is all coming from her Naturopath. I don’t think Cushing’s disease was an official diagnosis but the ND said she suspects it could be what’s going on. So to make sense of this - her cortisol was probably elevated for so long that this led to adrenal burn out possibly and now she has almost no cortisol left? Not sure if I’m understanding it right. And how would the thyroid come into play with this

 

[Nnik]

Also to mention supposedly her testosterone is elevated and she has acne. I don’t see the testosterone in her labs but the ND had written that in her “plan”

 

[xeliex]

I could be wrong, but the Peaty idea around adrenal fatigue is that the cortisol secreting parts do no relent as the DHEA producing section does dwindle and decline.

This could be a higher problem than the gland itself. Think hypothalamus.

First thing I would do is replete vitamin D and start living Peaty.

 

[Nnik]

I think stopping the Prozac should be the priority... She could be eating the 'ultimate Ray Peat diet' and still show no improvement IMO.

I agree but it’s usually the last thing people feel comfortable with discontinuing. It’s a touchy subject to criticize SSRI’s especially if people have felt that it has really helped them.
I think it can also be an uphill battle with something like that in their system but I don’t think it would be harmful to start trying other things. And maybe if they start making her feel better she will trust that the SSRI should be stopped as well. Or if there is some specific study that I could find that links serotonin to cushings disease that could be a good argument as well.

 

[Peater]

I agree but it’s usually the last thing people feel comfortable with discontinuing. It’s a touchy subject to criticize SSRI’s especially if people have felt that it has really helped them.
I think it can also be an uphill battle with something like that in their system but I don’t think it would be harmful to start trying other things. And maybe if they start making her feel better she will trust that the SSRI should be stopped as well. Or if there is some specific study that I could find that links serotonin to cushings disease that could be a good argument as well.

I'm not your man for studies...I just don't believe there is such a thing as a medication deficiency and that serotonin is a stress hormone, like cortisol.

 

[youngsinatra]

Depending on the person and how long they have been taking it, an SSRI should be tapered off strategically and slow, because it can have severe withdrawal effects.

 

[Peater]

Depending on the person and how long they have been taking it, an SSRI should be tapered off strategically and slow, because it can have severe withdrawal effects.

Good point, even if chemically it would not effect them, incrementally is possible easier to handle psychologically.

 

[youngsinatra]

Good point, even if chemically it would not effect them, incrementally is possible easier to handle psychologically.

Sudden withdrawal can have significant physiological side effects:

„Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating), Insomnia (with vivid dreams or nightmares), Nausea (sometimes vomiting), Imbalance (dizziness, vertigo, light-headedness), Sensory disturbances („tingling” “electric-like” or “shock-like” sensations) and Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness)“

 

[haidut]

Hi!
Wondering if any of you guys can help me interpret this and come up with a plan on where to begin. My good friend is 28, diagnosed with hypothyroidism years ago and over the past few years her health has been deteriorating. She was seeing an ND who had her on armour thyroid at a high dose to no resolve or improvement. She saw an MD who scared her out of thyroid and told her the ND “overdosed” her on thyroid. Of course he switched her to Levothyroxine at 137 which hasn’t improved her weight gain or other symptoms. She has been feeling down and unmotivated - no surprise since she is only getting T4 now. She is very open to diet changes and I’ve already gotten her into some principles from Ray peat.
I have her labs below. Why was she diagnosed with Cushing syndrome with low cortisol? Should she still focus on reducing cortisol or does she need to increase it?
My current ideas for her are to switch to Cynomel/cynoplus - not sure a good dosage for her to start at?
Progesterone
Vitamin D
DHEA?
B vitamins?
Pregnenolone?
What do y’all think
Any advice is greatly appreciated!!

***forgot to mention she’s also on Prozac. Not sure if there’s any connection to cushings disease with that or something that could motivate her to wean off of it

View attachment 59311
View attachment 59312View attachment 59315

Serum and peripheral cortisol are very different animals. One can have very high peripheral cortisol and normal or even low serum cortisol and this is due to the fact that serum cortisol is subject to negative feedback mechanisms, while peripheral one has positive feedback (i.e. it stimulates its own synthesis). This little-known discrepancy is why doctors refuse to consider the role of cortisol in obesity, diabetes, depression, etc as in those people serum cortisol is often normal. However, peripheral (tissue) cortisol in such people is usually very high. Big Pharma knows about this discrepancy and that cortisol causes all such diseases, and this is why it is running clinical trials with 11b-HSD1 inhibitors for such conditions, and why it is quite possible to have all symptoms of Cushing syndrome yet have normal (or even low) serum cortisol. Aspirin/salicylate, emodin, and progesterone are all good 11b-HSD1 inhibitors that can be tried.

Cortisol stimulates its own synthesis (peripherally), drives obesity/diabetes/CVD

Synthetic/bioidentical glucocorticoids (GC) are perhaps the most widely used steroids clinically. In addition, the HPA axis, culminating in cortisol production, is one of the most widely studied mechanisms in regards to many chronic diseases including obesity, diabetes, CVD, mental conditions...

raypeatforum.com

 

[Nnik]

@haidut What would saliva cortisol be considered? That’s how she had it tested. Would that be considered peripheral cortisol? Do you think it would be worth testing her serum cortisol? Not sure how to interpret these saliva tests