""Low Serum AM Cortisol The Cause Of My Problems?""

FitnessMike

Member
Joined
Jan 18, 2020
Messages
303
Hi all,

Wanted to share post i found that might be interesting for peoples who do not tolerate thyroid due to low cortisol, as below:

"""Hello, everyone.

Thought I'd drop back in with a final update as I've managed to fix all of my problems. It turned that whilst my cortisol was high-normal / slightly elevated without medication, even tiny doses of exogenous thyroid were causing it to drop into adrenal crisis territory - three days of 1/8th of a grain of armour caused serum am readings to drop to 100 nmol/l; a week of 1/4 grain of armour caused it to drop to 45 nmol/l. This explains my severe reaction to thyroid I had back in May (which this post was initially based upon), as all of the symptoms are in-line with the onset of adrenal crisis.

When I discovered this, I start with 10mg of hydrocortisone split 5mg upon waking, 2.5mg mid-afternoon and 2.5mg early evening. This has removed all of my side effects from thyroid use and has allowed me to slowly work up the dose to 1.5 grains. Along with this, every single one of my symptoms - freezing cold 24/7, low body temperature and pulse, rapid hair thinning, severe fatigue, brain fog, inability to exercise, palpitations, crippling anxiety and depression, etc - have more or less gone, too.

Feels great to have finally fixed this issue after almost four years of feeling like I was dying. This just goes to show that labs alone cannot be used to determine thyroid and/or adrenal issues, as my TSH was always 2-3, fT3 top of the range, ft4 just below mid-range, rT3 very low and serum am cortisol at the top of the range, yet I had almost every symptom of adrenal insufficiency / low thyroid, and taking NDT + hydrocortisione has fixed them all.

I understand the dangers of hydrocortisone use - even with a dose as low as 10mg per day - so I am hoping to be able to slowly taper off after a few more months of keeping things stable."""


source: https://www.tpauk.com/forum/threads...cause-of-my-problems.19862/page-4#post-209236
 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
I also have low cortisol, which is what I recently discovered. I've been struggling with brain fog, fatigue, lack of motivation, and more for years. A month ago I found my morning salivary cortisol to be 0.068 mcg/dl.
All the supplements I have tried or have helped very little or do nothing for me. When I take NDT, T3 I get the same negative classic set of symptoms that are written in the post and elsewhere, and this comes not only from thyroid supplements, but also from other substances that accelerate the use of T3, so it seems if cortisol is low, then it makes no difference whether you prime T3 exogenously or increase it endogenously - with weak adrenal glands, a collapse will occur. Ray believes that a weak adrenal gland is a not working thyroid, my experience doesn't allow me to agree with him. The thyroid gland depends on the adrenal glands, and the adrenal glands from the thyroid - they are two parts of one whole. Likewise, many here are obsessed with the concept of exceptionally high cortisol and ignore other side.
Since dietary manipulations, pregnenolone, progesterone, dhea (I have normal cholesterol), other supplements and things have not helped for all the years, I probably would not have done this before, now I am desperate, I just exhausted all my theories and there is almost nothing left, all this time I just walked in circles, I was very tired and honestly I had almost no strength left, so I started hydrocortisone as is customary in physiological doses from 5 to 10 mg.
I also wonder if the level of aldosterone, renin, sodium is low, will this not be an obstacle even with the addition of cortisone? I plan to get tested and if it is also low - add Florinef (Fludrocortisone). It is logical to assume if cortisol, aldo are low, then all hormones of adrenal are low, because the gland itself doesn't produce well.
There is a risk of disabling ACTH, atrophying the adrenal glands as some sourses write by exogenous replacement of these hormones, also depend dosage, but it is difficult to say whether it is worse when they no longer work correctly.
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
I also have low cortisol, which is what I recently discovered. I've been struggling with brain fog, fatigue, lack of motivation, and more for years. A month ago I found my morning salivary cortisol to be 0.068 mcg/dl.
All the supplements I have tried or have helped very little or do nothing for me. When I take NDT, T3 I get the same negative classic set of symptoms that are written in the post and elsewhere, and this comes not only from thyroid supplements, but also from other substances that accelerate the use of T3, so it seems if cortisol is low, then it makes no difference whether you prime T3 exogenously or increase it endogenously - with weak adrenal glands, a collapse will occur. Ray believes that a weak adrenal gland is a not working thyroid, my experience doesn't allow me to agree with him. The thyroid gland depends on the adrenal glands, and the adrenal glands from the thyroid - they are two parts of one whole. Likewise, many here are obsessed with the concept of exceptionally high cortisol and ignore other side.
Since dietary manipulations, pregnenolone, progesterone, dhea (I have normal cholesterol), other supplements and things have not helped for all the years, I probably would not have done this before, now I am desperate, I just exhausted all my theories and there is almost nothing left, all this time I just walked in circles, I was very tired and honestly I had almost no strength left, so I started hydrocortisone as is customary in physiological doses from 5 to 10 mg.
I also wonder if the level of aldosterone, renin, sodium is low, will this not be an obstacle even with the addition of cortisone? I plan to get tested and if it is also low - add Florinef (Fludrocortisone). It is logical to assume if cortisol, aldo are low, then all hormones of adrenal are low, because the gland itself doesn't produce well.
There is a risk of disabling ACTH, atrophying the adrenal glands as some sourses write by exogenous replacement of these hormones, also depend dosage, but it is difficult to say whether it is worse when they no longer work correctly.
I am in the same place as you, things like adrenal cortex, pregnenolone, progesterone, rehammnia root(works similarly like liquorice but seems that i don't build tolerance), whether i take NDT or t3(tiny doses) i get the same outcome, muscle twitches and deteriorating insomnia as a result of adrenaline increase, thyroid meds are accumulating in the blood unused if cortisol isn't optimal. I do strongly suspect low aldosterone too, frequent urination long time already, that would further prove an adrenal weakness, im waiting for my second saliva cortisol/dhea test but previous one i had low most of the day except morning. I know that my vot d3/b12/iron/ferritin etc are on good lvl.

I will post more findings on the cortisol/thyroid connection, hope it will sparkle big conversation on the subject as it does not get enough attention.
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303

Lady here says that secondary adrenal insufficiency is reversible/curable in most cases.
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
"""I tried taking up to 25 mg of hydrocortosine in divided doses and paid close attention to ACTH and cortisol levels in the morning. I noticed that, as expected, ACTH levels went from the very high end of normal to the moderate range as cortisol went from the low end of normal to moderate or moderate-high levels. But! I didn't notice anything in terms of symptom relief, or side effects (high blood pressure, etc.). I suspect I simply didn't take enough.

There are a handful of fascinating articles going back a few decades that posit that cortisol is needed for thyroid entry into cells. Other, more plentiful articles, point out that thyroid hormone increases the clearance rate of cortisol, lowering adrenal reserve. Some people with perfectly healthy adrenals and adrenal enzymes would have no problem with this, because as thyroid levels increase, so does ACTH production, leading to higher cortisol. But if you have off-kilter adrenal enzymes (e.g., 11B-hydroxylase downregulation), this can cause the whole hypothalamus-pituitary-adrenal axis to get off-kilter as well, theoretically causing problems with cortisol clearance. This off-kiltering of adrenal enzymes in its full form is called congenital adrenal hyperplasia, and is a fascinating instance of negative feedback loops and hormones. You can have partial and acquired CAH, the latter pretty ironic seeing how "congenital" means, you know, "since birth".

Like you, I take adrenal glandulars in addition to Gaia's adaptogen concoction Adrenal Health, and both give a slight bump in terms of energy and stress management. Other odd details add up, such as my inability to tolerate DHEA, which lowers cortisol, or my downright awful seasonal allergies (cortisol is a mast cell stabilizer). Other supplements or foods I've taken have been shown to reduce enzyme activity for adrenal gland function, ultimately leading to a higher ACTH:cortisol ratio, meaning less cortisol for each "pump" of ACTH (ACTH --> pregnenolone --> progesterone/DHEA/aldosterone/cortisol/etc.).

I'm looking to talk with a doctor about trying hydrocortisone again up to 40 mg while paying close attention to ACTH to make sure I don't shut anything down; it's when ACTH has been shut down for a few weeks or more likely months that corticotroph cells start dying off, which are responsible for ACTH production in the pituitary.

Contrary to what another member said, adrenal glandulars or hydrocortisone don't harm the adrenals; they actually relieve them, because the body can rely on exogenous sources in the form of glandulars or hydrocortisone. What actually happens is you change the feedback mechanism for the hypothalamus-pituitary-adrenal axis: the more exogenous hydrcortisone or adrenal glandular you add, the more cortisol, leading to negative feedback to the hypothalamus, which tells the pituitary turn down ACTH production.

It's the ACTH level that you want to pay most attention to when taking hydrocortisone, prednisone, or glandulars."""


source:
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
3. Provision of adrenal support.

I pointed out that anyone with thyroid deficiency over a period of time, especially if it is more than mild, is likely to have their deficiency accompanied by the Low Adrenal Reserve Syndrome. If this is not dealt with before providing supplementation, response may be disappointing, and there is a risk of a thyroid crisis. This occurs when the system becomes overwhelmed with thyroid replacement from the medication, which it is unable to deal with, and the patient may have violent palpitations, headaches or collapse. The obvious difficulty lies in knowing whether adrenal support is required. Well, the difficulty is more imaginary than real. Firstly, the history of the symptoms, the postural hypotension, the fainting attacks, the digestive upsets and other problems I mentioned in the last chapter, along with possible pointers from a blood test, are likely to make low adrenal reserve a strong possibility. Secondly, if there is any doubt, initial support must be given since there are real problems if it is needed and not given. Thirdly, prescribed in the way I am going to discuss in a few moments, there is no risk, since the amount of adrenal support is physiological (explained below). This means even if it isn’t necessary, no damage is done, no risks are taken, and it can be withdrawn whenever tough appropriate.

The guiding principle is to provide adrenal support physiologically. This means that the amount of supplementation is comparable to the amount actually produced by the body itself in the normal healthy state. The distinction between physiological dosage and therapeutic dosage is crucial to understand. A therapeutic dose is in excess of he natural production (or physiological) dose; and will inevitably suppress the natural production. This point is made clear in the use of hydrocortisone below.

To provide adrenal support, there are a number of options that may be used. The most obvious is to use the manufactured hydrocortisone provided as tablets as hydrocortisone B.P. (British Pharmacopoeia) 10 mg. The natural output of hydrocortisone is actually variable and may be as much as 200 mg. daily under stress and 40 6o mg. in a normal resting state. Obviously then, a dose significantly greater than 40 mg. daily will tend to take over the adrenal production of cortisone, and the adrenals could shut down completely. It must be said at once, so long as this suppression doesn’t last too long, the adrenals will pick themselves up again, and restart producing the necessary cortisone for themselves as before. One spectre that gibbers in the sight of many physicians is this adrenal suppression. It is only temporary unless very prolonged; and the adrenals will resume normal function as far as they are able when supplementation is discontinued. The problem is of course that they may not come back to normal until the thyroid/adrenal deficiency has been adequately treated for long enough. A physiological replacement level would therefore be 15 or 20 mg, daily, required until the patient is making a satisfactory response to the treatment as a whole.

I want to hammer home the distinction between physiological cortisone replacement, which may be quite essential to the overall management of thyroid/adrenal insufficiency, and therapeutic cortisone dosage. It was found as far back as 1948, that supra-normal dosage of cortisone had remarkable benefits on people crippled with rheumatoid arthritis and related collagen disorders systemic sclerosis, systemic erythematosis, and people invalided with intractable asthma, together with other, up to then, untreatable conditions. The downside to the miraculous recoveries cortisone brought to peoples’ lives, were side effects. They were the same as I mentioned with Cushing’s Syndrome; but in addition there was a risk of sudden death after operations or major trauma, with a generally reduced ability to deal with infection. This turned out to be due to adrenal suppression by the high doses of cortisone: when called to respond to a high challenge situation the adrenals were unable to do so; and the patient slipped into irreversible surgical shock and died.

When this became widely known cortisone was used with a great deal more care; doses were less and were given over a limited time interval, and when the cortisone was stopped it was done gradually so that the adrenals could pick up and revert to normal activity. As it does, the pendulum has now swung very far the other way; and in the minds of patients and doctors alike, there is a deep horror and aversion to the use of cortisone in any context whatsoever. This almost hysterical hostility to the use of cortisone, even its very mention, by physicians and their patients, is greatly to be deplored and is one important reason why the management of thyroid insufficiency is in such a parlous state and so misunderstood and misused. I must emphasise again, that the use of low dosage, that is physiological dosage, of cortisone is not only perfectly safe in restoring proper adrenal response, but is absolutely essential. Along with many of my American colleagues, I have seen the subject of much ill informed criticism of this view, based upon a prejudice arising from its previous history of improper use. But facts are facts and it is essential that physicians and patients alike rethink the whole problem. Two quotations from the great physician McCormack Jeffries are really quite relevant.

“Cortisol is a normal hormone, essential for life.”

“Most physicians today are under the impression that any dosage of cortisol can produce side effects that occur without any excessive doses.”

We must return to our theme. It is essential where low adrenal reserve is suspected, or indeed, obvious, that no thyroid supplementation should be considered until adrenal support is in place. Undoubtedly for the physician, the replacement of choice is hydrocortisone, since this though synthetically produced, is identical to naturally produced cortisone. But, the initial approach has to be restrained and cautious, and the lowest possible dose given at the start. I find that 1/4 of a 10 mg. hydrocortisone (that is 2.5 mg) is an excellent starting point. The reason hat it is so low to start with is that patients ill for some time, and perhaps receiving synthetic thyroxine, may have substantially high levels of T4 and T3 which the system cannot use. The adrenal support may kick in quite quickly, causing the T4 -> T3 conversion and receptor uptake to start working quite abruptly. This may cause a sudden overdose situation to occur. The patient may find the pulse rapidly accelerates to give palpitations in the chest or even promote irregularity of the heartbeat. They may feel ill, may collapse, they may have tremors in the limbs as if they were thyrotoxic. With small starter doses of adrenal support the risk of this is avoided. The first two or three days of 2.5 mg. of hydrocortisone given in the morning soon after waking, will be monitored by the patient for any adverse symptoms, checking pulse two or three times a day, and of the course morning basal temperature.

Normally there are no symptoms good or bad; but everyone is different and occasional marked sensitivity occurs. In such a case the hydrocortisone will be stopped for a day or so, and a much lower replacement level will be sought for. The most valuable alternative is the use of an adrenal glandular, such as “Adrenolyph” from Nutri Ltd, or in the USA, Isocort, which being natural adrenal extracts, require no prescription. The amount of cortisone is extremely low, only in trace amounts, but will be sufficient to start the adrenal support going. I shall have more to say about this treatment later on.

Once the hydrocortisone is started the full support dose is now built up to effective levels over 2 or 3 weeks. The 1/4 tablet a day is increased to 1/4 tablet twice a day; then after a few days, three times a day and up to a 1/4 four times a day spread out throughout the waking day. The reason for this is that it is not store by the body and gets rapidly used; 2 or 3 hours will see it pretty well used up completely. Since a smooth level of support is desirable, the dose does need to be spread out. The final dose is usually 20 mg. daily, that is 1/2 tablet four times a day; but careful adjustments relating to the response, may take the dose to 25 or 30 mg. daily, exceptionally even 40 mg. These higher doses are related more to absorption in the stomach, not to deficiency, but low adrenal reserve reaching Addisonian levels may make such doses necessary.

On this regime, the patient may feel considerable improvement after even a few days as thyroid processing of existing thyroid in the bloodstream improves. It sometimes happens that the improvement is so marked, and the hypothyroid symptoms are so much relieved, that supplementary thyroid may only need to be in very small amounts, or even not required at all.

The usual pattern of events, however, is to start thyroid supplementation as soon as the adrenal support has been established. How this may be done, we shall come to shortly. The disadvantage of hydrocortisone is that it needs to be given 4 times a day to be fully effective. Some patients do as well, or better, on he widely used synthetic derivative, prednisolone. The equivalent dose of 20 mg. of hydrocortisone id 5 mg. of prednisolone, which may be increased up to 7.5 mg. and sometimes more. This needs to be given only once a day, most commonly in the morning, since it remains active in the system for about 24 hours. Because prednisolone can irritate the stomach on occasion, it is usually given in an enteric coated version called Deltacortril; and if given with food the risk of gastric irritation is further minimised.

It is sometimes useful to prescribe instead, a mineralocorticoid., and the most useful is fludrocortisone, or Florinef, in doses of 0.1 mg. once or twice a day. This may further improve the adrenal response when given together with the glucocorticoids, hydrocortisone and prednisolone. There are other synthetic cortisones available, but in general they shouldn’t prove necessary.

The length of time necessary to provide adrenal support is really infinitely variable. My normal practice has usually been to obtain the best result with thyroid and adrenal support, and after six or eight weeks, start to tail off the cortisone supplement. If there is no adverse result it may then be stopped taking, say, four weeks in the process. Sometimes the patient starts to lose ground; and it must then be restarted, and in another eight weeks or so another attempt to tail off is made. Sometimes, the adrenals have been so badly hit that the adrenal support may be required for months; and if the adrenals never fully recover, for a more indefinite time. Again I emphasis, that if adrenal support is required, it must be given for as long as it takes; there is no risk to this since one is simply restoring the situation to normal, in the same way, and for the same reason, that thyroid support may have to be given indefinitely.

To summarise the indications for adrenal support we may say:

1 Where an abnormally high or abnormally low DHEA, and/or abnormally low cortisole blood test shows weak adrenal function.

2. Many symptoms, and clinical signs, notably postural hypotension, suggest weak adrenal response.

3. The thyroid deficiency state has been present some considerable time and getting worse.

4. Previous treatment with thyroxine has been unsuccessful or even worsened the situation.

5. There has been thyroid surgery or radioactive iodine ablation.

6. Thyroid blood tests are normal but the patient is clinically hypothyroid.

7. Previous major surgery.

We must now turn our attention to the thyroid deficiency state. Having put in place the adrenal support, it is now safe to provide the thyroid support; and we can be sure that it is actually going to work. Although there are several options available, you are most likely to be offered only one if you can convince the doctor in charge of your need. If you can’t, all is not lost. I have a chapter later explaining how you can help yoursef.


 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
"""The complications of treating hypothyroid or under active thyroid patients, is that their consequent poor adrenal reserve may become suddenly obvious, as soon as the thyroid is treated. The thyroid supplementation may, at worst, precipitate the adrenal problem; but what usually happens, is that the thyroid replacement may either not apparently work at all, or the patient may have thyroid over dosage symptoms on quite a low level of replacement. Hence, where low adrenal reserve is suspected, it is possibly dangerous, and certainly ill advised, to treat the patient without supplementation of the adrenals, in the manner explained further below."""

"""t is satisfactory to confirm the clinical impression by blood tests; but these sometimes are unhelpful. The level of cortisone in the blood may be measured, but it is widely variable. However, DHEA, mentioned above, is quite a good indicator of adrenal cortex function. The most satisfactory test for adrenal hormones is the adrenal stress index; a measure, four times in 24 hours, of Cortisone and DHEA. Measurement of urinary excretion may also be done."""

"""It is, in our view, perfectly practical and reasonable, to establish the diagnosis on clinical grounds, and because the therapy given is of very low == physiological == doses, there is no possible risk to the patient, however long it is needed. In a very large number of cases, the adrenal insufficiency may right itself over two or three months, making further supplementation unnecessary."""

"""
The question is often asked. Will the cortisone replacement suppress my adrenals?

The answer is that in physiological dose it does not at all; and in any event, the adrenal activity is curtailed anyway, making the options quite clear. Suppression occurs in the super-pharmalogical doses, which do not concern us in this context. Even then, the adrenals are able to recover, if the primary illness is dealt with, and the dose reduced gradually."""

 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
@FitnessMike Thank you, a lot of useful information. I've read almost every article on tpauk.com about how I use cortisone according to Dr. Pitfield's scheme. In fact, I have hydrocortisone cream (1%) and Prednisolone, but the cream is inconvenient to dose because it is liquid, and the 5 mg Prednisolone tablet has to be divided by eight, where one piece is equivalent to 2.5 mg of hydrocortisone, so I am thinking of buying Cortef. I seem to feel better from hydrocortisone cream, and one of the differences between cortisone over prednisone is that cortisone has a slightly higher sodium retention activity, but honestly I have not noticed almost any big changes so far from they two, may I expect results too early.
The guy from the reddit link you wrote, that in case of secondary adrenal failure, the safe dose of cortisone will depend on the supply of ACTH, if the ACTH is higher, the more dosage of cortisone you can afford to suppress ACTH, but suppress it not so much that it would be very low. From research on tpauk.com, I have seen that a dosage of 5 mg (possibly up to 10) does not suppress ACTH at all or very little.
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
I have seen that a dosage of 5 mg (possibly up to 10) does not suppress ACTH at all or very little.
That's good to know, anyway dr Peatfield says in the book that its no way to suppress natural cortisol production as long as physiological doses are used, but of course the less you use that allows you to absorb thyroid supplementation the better i would think.

Regards prednisone, i have heard multiple peoples saying that its junk and its more suppressive than HC, HC is closest to what out body produce but correct me if im wrong, well i ordered CH from pharmacy overseas and cortisone acetate from one member, still waiting for both, also still waiting for my second saliva cortisol results just to make sure.

Should me if you want a website from where I ordered HC.
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
"""Daily cortisol production is approx. 5–6 mg / m2 per body surface area.
Based on the calculation above and considering the heterogeneity in metabolism, this would correspond to a daily dose of oral hydrocortisone of approx. 10–12 mg / m2 or 15–25 mg / day.
5 mg of supplemental HC will correspond to a substitution ranging from 1/3 to 1/5 of one’s daily endogenous production which I consider as the safe threshold for HC supplementation without medical supervision and/or regular blood tests surveillance.
Even if HC’s half-life is shorter than other synthetic corticosteroids, I think that this dose, if taken on daily basis, has the potential to become cumulative in a very short period of time.
I am not familiar with cortisol acetate.
I think that the advantage of using hydrocortisone (on a daily basis) in the morning and early afternoon is that, thanks to its shorter half-life, it allows the hypothalamic-pituitary axis not to be exposed to overnight glucocorticoids excess. This chronopharmacology intake of HC is a powerful stimulant to awaken the axis to regain endogenous secretion of CRF, and then physiological ACTH secretion."""
 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
That's good to know, anyway dr Peatfield says in the book that its no way to suppress natural cortisol production as long as physiological doses are used, but of course the less you use that allows you to absorb thyroid supplementation the better i would think.

Regards prednisone, i have heard multiple peoples saying that its junk and its more suppressive than HC, HC is closest to what out body produce but correct me if im wrong, well i ordered CH from pharmacy overseas and cortisone acetate from one member, still waiting for both, also still waiting for my second saliva cortisol results just to make sure.

Should me if you want a website from where I ordered HC.
I have slightly different results from prednisolone and hydrocortisone, the first seems to be a little more stimulating at the equivalent dose (hydrocortisone:prednisolone = 1:4), which is a little annoying, so it seems in this information that you heard is something true, but honestly the difference between them is very blurred for me, prednisolone has longer half-life.
Prednisone and Prednisolone are also different things, prednisolone is a metabolite of prednisone (which is inactive), it is converted from prednisone in the liver through an 11-β-HSD enzyme, so it seems that prednisolone is better if the liver doesn't work optimally, but I don't know about their difference in their effect on ACTH, I would also like to know. Also, hydrocortisone has a slightly higher mineralocorticoid activity in sodium retention (and possibly potassium excretion) and if aldosterone is low, then hydrocortisone is presumably more useful, but very little.
Yes, please write where you ordered it, it’s interesting to see if I’m in Europe.
 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
"Another clue that your aldosterone may be too low?? Never finding stable DATS–you just keep going higher and higher with the HC or Adrenal Cortex and end up on too much!!"
- As I wrote earlier, if this is a confirmation that when hydrocortisone supplements don't work, it means that you also have low aldosterorn and sodium. I think I need to test the tomorrow.

"Hi ********
I started a long mail, got interrupted and when I got back to it, there were so many posts to you on the subject and the all overriding advice from Dr. Peatfield, which is, of course, the one to follow.

However, just to explain a little about Florinef and how it works. So, for what it’s worth, below is what I had written earlier. You might find it helps a little to detangle the confusion you are in at the moment. It’s just a little background info on Florinef from a practical point of view. As I see it, you need to know exactly how Florinef works, in order to determine whether or not it might be what you need.

In my opinion it would be wrong and not without risk to try Florinef without testing.

I don’t know your full story, and without being aware of the full picture it would be wrong, even be dangerous, for me to give any advice. However, in my personal view, it is highly risky to experiment with glucocorticoids and/or mineralcorticoids without the proper guidance of a doctor.

30 mg HC are according to Dr. Peatfield (in his chapter on the adrenal connection) above the physiological replacement dosage of 15-20 mg/day. There is a big distinction between physiological cortisone replacement and therapeutic cortisone dosages and in my view, by going up to 30 mg you might be going into deep waters if you did it off your own accord.

Florinef is a mineralcorticoid (as opposed to a glucocorticoid) and it is the drug that is used for people with primary Addison’s disease or at least it *should* be used, rather than the HC, which most doctors are using instead, because not many endos have hand-on experience with Addison’s. Primary Addison’s in humans is extremely rare – I read that 1 in 100.000 people suffer from it; although I have come across Addison’s in dogs hundreds of times on our forums AD in dogs it is no longer rare at all, although the knowledge of proper treatment for them lags behind with most vets just as much as it lags behind with human endocrinologists.

However, the point of my message is . be very careful if experimenting with Florinef. The function of Florinef is to bring up the sodium and to lower the potassium which is why it is the right drug for Addisonian people. Someone with Addison’s will have very low Sodium levels and very high potassium levels and this is a life threatening condition.

In my view it would make more sense to try and find out what your adrenals are really doing. Since you are having trouble getting an aldosterone test, one very simple way of finding out if something is seriously adrift is to ask your GP for an Electrolyte test that would be checking Sodium (Na) and Potassium (K) and it’s a cheap standard test. I would imagine, that you might have low sodium levels . but the burning question is where is your potassium? You need to know, because if your potassium were low as well as your sodium, and you then took Florinef, you could do damage. The Florinef would lower your potassium even further, whilst your sodium would rise. you might finish up with serious heart and kidney complications.

Just as a guideline for you Lab ref ranges differ slightly, but usually the ref range for Na (sodium) is between 138 160 or thereabouts. The ref range for Potassium (K) is roughly between 3.8 6.0 ==- as I said, the exact figures differ from lab to lab and you’d need to find out the figures your lab is using.

A healthy Na:K ratio would be one that turns out to be in the low to mid thirties, a worrying one is below 27. But I have to stress that one can’t judge by the ratio figure alone. You’d need to look at the whole picture and the relation between sodium and potassium figures.

You get the ratio be dividing the lower figure (Potassium) into the higher figure (Sodium) – for example. lets say for arguments sake that the Na is 140 and the potassium 4.8

140 divided by 4.8 = ~29.2 – which would mean, that the adrenals are not functioning brilliantly (the sodium is too low) but this is not Addison’s disease. If with a reading like that you’d take Florinef, the potassium -which is a good reading with 4.8, and you did not really want it to come down (!) would come down, whilst the sodium goes up. It’s a very fine balance, and if you got it wrong, you could finish up in dire straights.

As a rule of thumb good figures to aim for would be a sodium in the middle of the norm range (around the 145-148 mark) and a potassium figure around 4.5 certainly not above 5 and not below 4."
 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
"""Daily cortisol production is approx. 5–6 mg / m2 per body surface area.
Based on the calculation above and considering the heterogeneity in metabolism, this would correspond to a daily dose of oral hydrocortisone of approx. 10–12 mg / m2 or 15–25 mg / day.
5 mg of supplemental HC will correspond to a substitution ranging from 1/3 to 1/5 of one’s daily endogenous production which I consider as the safe threshold for HC supplementation without medical supervision and/or regular blood tests surveillance.
Even if HC’s half-life is shorter than other synthetic corticosteroids, I think that this dose, if taken on daily basis, has the potential to become cumulative in a very short period of time.
I am not familiar with cortisol acetate.
I think that the advantage of using hydrocortisone (on a daily basis) in the morning and early afternoon is that, thanks to its shorter half-life, it allows the hypothalamic-pituitary axis not to be exposed to overnight glucocorticoids excess. This chronopharmacology intake of HC is a powerful stimulant to awaken the axis to regain endogenous secretion of CRF, and then physiological ACTH secretion."""

Also found it from here:

"30) If I take HC or ACE, will it put my adrenals to sleep?
We are not talking about taking massive doses that would shut down one’s adrenal function. We are talking about taking the amount your body needs, called a physiologic dose. The latter is determined by doing your DATS aka Daily Average Temps, as outlined by Dr. Rind.

And another way to look at it: If the doctor tested the adrenals, he may find that patient is already suffering from low levels of adrenal hormone. They may already be “asleep” to a degree.

In his book “Safe Uses of Cortisol” Dr Jefferies says “It has been demonstrated that when subjects with intact adrenals receive less than full replacement dosages of cortisol, endogenous adrenal function is suppressed only sufficiently to achieve a normal glucocorticoid level. For example, subjects receiving 20 mg (5 mg. four times) daily of cortisol have their endogenous adrenal steroid production decreased by approx. 60%, and subjects receiving 10 mg. (2.5 mg. four times) daily have their adrenal steroid production decreased by approx. 30%.”Endogenous” means “originating within or produced by the body”;”glucocorticoid” means “any of a group of corticosteroids (as cortisol) that are involved especially in carbohydrate, protein, and fat metabolism, that are anti-inflammatory and immunosuppressive, and that are used widely in medicine (as to alleviate the symptoms of rheumatoid arthritis)” (Websters).

But what if you do not HAVE a normal glucocorticoid level? There have been studies on Chronic Fatigue patients taking “hydrocortisone – 25 to 35 mg per day: leads to a 20 to 35% decrease in endogenous ACTH and cortisol production… After stopping, it may take several days to several weeks to recover the previous adrenocortical status.http://www.intlhormonesociety.org/ref_cons/Ref_cons_3_mild_glucocorticoid_deficiency.pdf "
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
Also found it from here:

"30) If I take HC or ACE, will it put my adrenals to sleep?
We are not talking about taking massive doses that would shut down one’s adrenal function. We are talking about taking the amount your body needs, called a physiologic dose. The latter is determined by doing your DATS aka Daily Average Temps, as outlined by Dr. Rind.

And another way to look at it: If the doctor tested the adrenals, he may find that patient is already suffering from low levels of adrenal hormone. They may already be “asleep” to a degree.

In his book “Safe Uses of Cortisol” Dr Jefferies says “It has been demonstrated that when subjects with intact adrenals receive less than full replacement dosages of cortisol, endogenous adrenal function is suppressed only sufficiently to achieve a normal glucocorticoid level. For example, subjects receiving 20 mg (5 mg. four times) daily of cortisol have their endogenous adrenal steroid production decreased by approx. 60%, and subjects receiving 10 mg. (2.5 mg. four times) daily have their adrenal steroid production decreased by approx. 30%.”Endogenous” means “originating within or produced by the body”;”glucocorticoid” means “any of a group of corticosteroids (as cortisol) that are involved especially in carbohydrate, protein, and fat metabolism, that are anti-inflammatory and immunosuppressive, and that are used widely in medicine (as to alleviate the symptoms of rheumatoid arthritis)” (Websters).

But what if you do not HAVE a normal glucocorticoid level? There have been studies on Chronic Fatigue patients taking “hydrocortisone – 25 to 35 mg per day: leads to a 20 to 35% decrease in endogenous ACTH and cortisol production… After stopping, it may take several days to several weeks to recover the previous adrenocortical status.http://www.intlhormonesociety.org/ref_cons/Ref_cons_3_mild_glucocorticoid_deficiency.pdf "

So presuming that one has adrenal insufficiency to some point, not complete insufficiency, if you gradually increase supplementation to the point where you need it to be that should be fine, no permanent suppression. In my case, i need to have enough cortisol to be able to tolerate a decent amount of thyroid, how much thyroid i need i should figure when my symptoms will improving.
 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
So presuming that one has adrenal insufficiency to some point, not complete insufficiency, if you gradually increase supplementation to the point where you need it to be that should be fine, no permanent suppression. In my case, i need to have enough cortisol to be able to tolerate a decent amount of thyroid, how much thyroid i need i should figure when my symptoms will improving.
I think you're right, dosage should up to these time when you can start to tolerate thyroid supp. Probably after some time when thyroid became better, it balanced everything in adrenal and HPA axe.

Do you know what is your serum sodium, potassium, iron, ferritin, copper, ceruloplasmin?
 

Vileplume

Member
Joined
Jun 10, 2020
Messages
460
Do you think supplementing progesterone could replenish cortisol enough to help thyroid work?
 

Ihor

Member
Joined
Feb 25, 2018
Messages
195
Age
27
So, it is my test results, my sodium and aldosterone is well it seems I don't need Florinef, for my case it would be even harm, because florinef up sodium and lower potassium which I have unbalanced. But potassium is looking low on underline borderland, could somebody explain that? Hydrocortisone also has a little potential to excrete potassium and retain sodium, but I didn't take HC three days before this test and my potassium consumption is around not lower 3000 mg/day everytime.


Sodium: 145,6 mmol/l, ref: 135-148
Potassium: 3,5 mmol/l, ref: 3,5-5,5
Aldoserone: 110 pg/ml, ref: 70-300
 
Last edited:

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
Do you think supplementing progesterone could replenish cortisol enough to help thyroid work?
I really dont know, theoretically yes, but i wouldnt think, i wish we could take progesterone or pregnenolone and body would shove it into cortisol but in reality it doesnt help much in my experience, adrenal cortex seemed to work initially but eventually seemed that i build tolerance to it, it most likely depends on how suboptimal your cortisol is.
 

FitnessMike

Member
Thread starter
Joined
Jan 18, 2020
Messages
303
So, it is my test results, my sodium and aldosterone is well it seems I don't need Florinef, for my case it would be even harm, because florinef up sodium and lower potassium which I have unbalanced. But potassium is looking low on underline borderland, could somebody explain that? Hydrocortisone also has a little potential to excrete potassium and retain sodium, but I didn't take HC three days before this test and my potassium consumption is around not lower 3000 mg/day everytime.


Sodium: 145,6 mmol/l, ref: 135-148
Potassium: 3,5 mmol/l, ref: 3,5-5,5
Aldoserone: 110 pg/ml, ref: 70-300
Try maybe upping potassium? i read somewhere that our ancestors were eating way more potassium than were eating now.

Have you done a saliva cortisol test?

Im still waiting for my cortisol/dhea results, as well as my hydrocortisone
 
Similar threads
Thread starter Title Forum Replies Date
V Low Estradiol: Serum, Saliva, Urine Experiments 11
Mito Low Serum Cholesterol Level Among Patients With COVID-19 Infection Scientific Studies 49
GorillaHead What Would Cause Low Zinc Hair Tests But Upper Normal Serum? Hair & Nails 9
yerrag How Is Low Serum Ammonia Related To Hypertension? Heart, Heart Rate, Blood Pressure 23
yerrag High Serum LDH But Low CRP Blood Work, Labs 35
Mito Low Fasting Serum Insulin And Dementia In Nondiabetic Women Followed For 34 Years Articles & Scientific Studies 3
haidut Low Serum Calcium May Increase Risk Of Sudden Cardiac Death Scientific Studies 4
S Low Serum Albumin - How To Raise It? Ask For Help or Advice 14
Doludolu Very LOW Iron , Sufficient Ferritin, Excesivelly high vitamin B12 - Anemia or what is going on? Blood Work, Labs 2
VendettaRed911 Low carb dieters look so much older Diet 116
C Low dose Testosterone Ask For Help or Advice 8
E Low DHT but still losing my hair? Ask For Help or Advice 2
A Need Help - Blood Labs (High TSH, Low T4/T3, Low DHEA) Ask For Help or Advice 0
Doludolu Switching from low carb | keto | carnivore experimentation back to High-carb. Tips for safe metabolic return ? Diet 11
M Low or high stomach acid ? How to tell? Digestion 4
TheBeard Help! Female friend low in Ferritin Ask For Help or Advice 18
A Study says low serotonin causes mice and rabbits to become gay Scientific Studies 3
S High Test but Suddenly Low free Test? Blood Work, Labs 7
Hans Low carb diets shrink the brain and causes brain inflammation Scientific Studies 31
F Too much REM sleep vs too low Deep sleep Insomnia, Sleep Issues 16
M Normal/High Testosterone but low DHEA-S Blood Work, Labs 14
M ******* copper and ceruloplasmin low!! Ask For Help or Advice 32
P Suggestions for low stomach acid, yeast overgrowth? Digestion 20
D Low levels of vitamins B2, B6, B9 in adults with ADHD Mental Issues 2
haidut Keto (low-carb) diet causes heart fibrosis, blocks mitochondrial biogenesis Scientific Studies 16
Hans Low fat diet is equally as effective as Mediterranean diet for fat loss and health Scientific Studies 3
Mito Low Zinc Levels at Admission Associates with Poor Clinical Outcomes in SARS-CoV-2 Infection Miscellaneous Health Discussions 0
IVILA What explains high estrone but low estradiol? Ask For Help or Advice 5
Mauritio Low Dopamine D2 receptor density leads to obesity and insulin resistance , D2 agonism may treat Scientific Studies 28
C Vitamin D, daily low dose or infrequent high dose? Vitamins 11
youngsinatra How To Improve Sexual Indurance (With Low Serotonin) Ask For Help or Advice 78
Hans Excess PUFAs and low saturated fat could contribute to dementia Scientific Studies 1
Hans The pendulum is swinging back - low fat diets are back in business Scientific Studies 18
Luann What have you done to go Slow / Low Tech? Miscellaneous 22
J Best way to deal with hypoglycemia due to low cortisol? Blood Sugar 1
Lokzo Low prolactin levels are associated with visceral adipocyte hypertrophy and insulin resistance in humans - PUBMED 2020 Scientific Studies 6
Mauritio Autism caused by low allopregnenolone , chinese herb can treat Autism 53
V HPA Dysfunction ( Low Dhea-s) Former Anabolics User ( Bloodwork Included) Ask For Help or Advice 20
Jam Applying Peat Principles To Low-Carb High-Saturated Fat: Incredible Results Discussing Dietary Models 136
Twohandsondeck Low body temperature + death in the Bible (1 Kings 1:1) Meditation, Mindfullness, Religion, Spirituality 22
M Low carb high fat (pre T3) VS high carb low fat (taking 3 drops of tyronene upon waking) Logs 7
S Low dose aspirin to treat inflamation induced insulin resisitance? Blood Sugar 1
R Low-dose copper with glycine and proline or gelatin for collagen? Ask For Help or Advice 2
TacoVampire Blood work/ endo/ fatigue / low iron Blood Work, Labs 5
H low stomach acid and low libido issues Digestion 24
M New phone coming this spring with super low sar value Radiation 4
W High DHEA but low testosterone? Blood Work, Labs 3
G Should fructose be minimized if one already has low ATP? Metabolism 12
Frankdee20 Low Fat versus Low Carb for Weight Loss ? Diet 58
P best e ink display? low emf and easy on the eyes. Eyes, Ears, Nose and Headaches/Migraines 14

Similar threads

Top