Low Thyroid - Adrenal Burnout - Help Wanted!

[Mr.Mesmer]

Hi,

I'm a 44 year old male, - just this website as a member, but have been reading stuff here for several years now. I'm not on a 100% Peatarian diet, but have combined several of the princibles with a primarilly paleo-but-with-some-occasional-sugar-and-darkchocolate-diet.

Anyway, - I really, really need some advise, since I'm dealing with some issues that are over my head, and I'm feeling completely lost in this pharmaceuitical-endocrino - jungle!

Some background;

I've trained my whole life. Primarily in the martial arts, but also running and lifting weights. The last 10 years my training has consisted of a lot kettlebells, bodyweight and crossfit type training as well.
I dont drink or smoke( only some cannabis, now and then ) and have always had a pretty clean and healthy diet, no soda pops and junkfood. I've have always used supplements when necessary - herbs, vitamins etc.

In the last ten years I have suffered from joint issues, that have gotten progressively worse, year by year.
This has been accompanied by extreme fatique, which is also getting worse and worse.

It's so bad that I dont feel like getting out of bed some days. Some days I litteraly feel as if I'm 180 years old, with lead running through my veins!

I have bad mood swings, brain fog, and just a achy, heavy body.
Naturally my training, and my life in general is suffering badly.

Recently I've been suffering from weeklong headaches. Feels like my eyeballs are rotting in my skull.

I live in Scandinavia, and I have seen tons of doctors here, they have done countless bloodtests, etc. - and nothing has come up.
Except very recently - my doc found that I had borderline low thyroid levels, which he thought could explain some of my symptoms.

So he wanted to start me on T4 only, which I declined, having heard all the horror stories. And since the endo's in my country are a complete joke, - I instead opted to go to one of the leading endocrinologists in Europe.

They did some blood and urinanalisys and quickly came to the conclusion, that my adrenals weren't working properly and my thyroid was low.

So.... they threw everything, but the kitchensink, at me!

This is the protocol they want me to follow:

Each morning:

Erfa thyroid:
15 mg (quater of a grain) for 10 days
Then 30 mg for 10 days
Then 45 mg for 10 days
Then 60 mg for 10 days
Then 75 mg for ten days

Hydrocortisone:
20 mg followed by 10 mg at lunch

DHEA:
35 mg a day

Pregnenolone:
100 mg a day

Testosterone Liposomal gel 10%:
1 1/2 gram a day on neck and shoulders

Arimidex:
2 X 0.25 mg tabs a week

Furthermore supplements:

Vitamin A:
100.000 iu a day

Vitamin D:
5.000 iu a day

Well, I'm no expert on any of this, but I've always been wary of medications, and tried to stay as far away from it as possible. So for me, this protocol seems excessive?

So far I've tried the Erfa - up to 30 mg, which made me feel a little drunk and dizzy. So I've stopped it again.

Hydrocortisone scares the ***t out of me, so I haven't started that yet.

The preg I tried - gave me a terrible headache, that lasted for two days.

DHEA seems to work a little better, done it on and off now - to try to get a feel for it.

Testosterone - haven't done it yet.

I'm posting my labwork - and I will be grateful if anyone has any helpful input as I am totally lost!

 

[haidut]

post 118919 Hi,

I'm a 44 year old male, - just this website as a member, but have been reading stuff here for several years now. I'm not on a 100% Peatarian diet, but have combined several of the princibles with a primarilly paleo-but-with-some-occasional-sugar-and-darkchocolate-diet.

Anyway, - I really, really need some advise, since I'm dealing with some issues that are over my head, and I'm feeling completely lost in this pharmaceuitical-endocrino - jungle!

Some background;

I've trained my whole life. Primarily in the martial arts, but also running and lifting weights. The last 10 years my training has consisted of a lot kettlebells, bodyweight and crossfit type training as well.
I dont drink or smoke( only some cannabis, now and then ) and have always had a pretty clean and healthy diet, no soda pops and junkfood. I've have always used supplements when necessary - herbs, vitamins etc.

In the last ten years I have suffered from joint issues, that have gotten progressively worse, year by year.
This has been accompanied by extreme fatique, which is also getting worse and worse.

It's so bad that I dont feel like getting out of bed some days. Some days I litteraly feel as if I'm 180 years old, with lead running through my veins!

I have bad mood swings, brain fog, and just a achy, heavy body.
Naturally my training, and my life in general is suffering badly.

Recently I've been suffering from weeklong headaches. Feels like my eyeballs are rotting in my skull.

I live in Scandinavia, and I have seen tons of doctors here, they have done countless bloodtests, etc. - and nothing has come up.
Except very recently - my doc found that I had borderline low thyroid levels, which he thought could explain some of my symptoms.

So he wanted to start me on T4 only, which I declined, having heard all the horror stories. And since the endo's in my country are a complete joke, - I instead opted to go to one of the leading endocrinologists in Europe.

They did some blood and urinanalisys and quickly came to the conclusion, that my adrenals weren't working properly and my thyroid was low.

So.... they threw everything, but the kitchensink, at me!

This is the protocol they want me to follow:

Each morning:

Erfa thyroid:
15 mg (quater of a grain) for 10 days
Then 30 mg for 10 days
Then 45 mg for 10 days
Then 60 mg for 10 days
Then 75 mg for ten days

Hydrocortisone:
20 mg followed by 10 mg at lunch

DHEA:
35 mg a day

Pregnenolone:
100 mg a day

Testosterone Liposomal gel 10%:
1 1/2 gram a day on neck and shoulders

Arimidex:
2 X 0.25 mg tabs a week

Furthermore supplements:

Vitamin A:
100.000 iu a day

Vitamin D:
5.000 iu a day

Well, I'm no expert on any of this, but I've always been wary of medications, and tried to stay as far away from it as possible. So for me, this protocol seems excessive?

So far I've tried the Erfa - up to 30 mg, which made me feel a little drunk and dizzy. So I've stopped it again.

Hydrocortisone scares the s*** out of me, so I haven't started that yet.

The preg I tried - gave me a terrible headache, that lasted for two days.

DHEA seems to work a little better, done it on and off now - to try to get a feel for it.

Testosterone - haven't done it yet.

I'm posting my labwork - and I will be grateful if anyone has any helpful input as I am tatally lost!
- especially input from KSman is welcomed!!!

The protocol they put you on is not bad, so I am encouraged to see some doctors are actually trying to help their patients. The only things I would change is ask them to drop the cortisone. When they ask why tell them that if cortisol is low taking 100mg pregnenolone will probably boost cortisol production to normal. Second thing I would change is lower the DHEA dose to 15mg daily, so I'd take it in divided doses of 5mg three times a day. Anything more than 15mg DHEA start really raising your estrogen and estrogen irritates the adrenals and prevents them from stopping the burnout.
The arimidex is not optimal but it is OK for now. If possible, ask them to prescribe you exemestane which should have less side effects.
Btw, how did they determine you have adrenal burnout? What are the tests they ran and what are the results? It would help us guide you more effectively on what to discuss with your doctors.

 

[Westside PUFAs]

post 118919 Vitamin A:
100.000 iu a day

 

[Mr.Mesmer]

Yeah, the 100.000 iu's of Vitamin A sounds pretty crazy doesn't it?! :) I've mostly just done around 50.000 IU's - sometimes going up to the 100.000, and I haven't experienced any discomfort from this yet.

 

[Mr.Mesmer]

Here's my labwork.
Most of this is from a while back.
In these tests, my D vitamin is very low - around 28, - i've since been able to raise it to 120.
Homocysteine is also high, and it has been lowered and is now within normal limits.

 

[Mr.Mesmer]

And Haidut - what you are saying about the Hydrocortisone, are my thoughts exactly!

It seems to be such a potent drug, with such a wide variety of potential sideeffects, that it's really not something to be messed around with, unless absolutely necessary.
Does anyone here have personal experiences with going on HC, and later getting completely off it again??? Is this really an option?

As far as the pregnenolone, I did that for a couple of days - but got awful headaches, and stopped it again.
Any ideas why?
It also seemed to be messing with my libido.
Maaaaaaaaan, - hormones are such a b**** to be dealing with!

 

[sweetpeat]

I looked over your labs, and here is my take on it, FWIW. :)

Your t3 is low in relation to your t4. What this usually means it that you have conversion problems. Selenium is something that can help with that if you don't eat much seafood. Also the vitamin A helps, but I think the main culprit is high estrogen. Your prolactin is high for a male (Peat likes to see it between 4-7 for males) and this indicates high tissue estrogen. High estrogen will interfere with the t4-to-t3 conversion process. Lowering your estrogen and increasing t3 should help raise cortisol as well as help your body produce its own DHEA and pregnenolone. The arimidex (or exemestane that haidut suggested) should help with the estrogen. Vitamin E is also good for this. Maybe hold off on the thyroid until you get estrogen under control and then see where you stand? It appears at this point you have a decent amount of t4 output from your thyroid, but it could also be backed up because it hasn't been converting well to t3.

 

[Mr.Mesmer]

Thanks for your input - much appreciated!

Thats an interesting point you got in regards to my estrogen levels, but as far as I know - you won't really bring down prolactin, by inhibiting estrogen by itself.
According to various steroidsites you need cabergoline or something similar to do that...

 

[tara]

Welcome Mr Mesmer.

I'm not dr or expert, just read a bit here and elsewhere. Neither I nor others can give you personal medical advice. But here are some thoughts.

The thyroid dosing may be reasonable, but I'd like to see you monitor waking temps and heartrate so you can see the effect it's having on base metabolism and notice when you have enough. And maybe slow it down a little. The T4 component can take more than 10 days to reach stable blood levels. Maybe leave it at least 14 days, maybe 21 days between increments?
I don't see a TSH number - am I missing it or is it missing?

If the pregnenolone gives you a bad headache, you could try a much smaller dose - like 10mg - and see if that is better. Or drop it altogether for now, and maybe try it again once you've got the thyroid function up a bit. A few of us have reacted badly to it, and one possible explanation seems to be that we were running on stress hormones because thyroid was low, and the pregnenolone lowered the stress hormones, leaving us with inadequate energy.

Peat suggests having total cholesterol of at least 160, but better 200 before supplementing thyroid - thyroid supps ay result in using it up faster to produce otehr hormones that you need, and this can lower it. So this might be one to keep an eye on in future tests.

I agree about holding off on the cortisone. If none of these other things helps after a while, you can reconsider it.

The vit-A dose seems high. SOme people seem to need that much, but many don't. Too much may not be great. Maybe you can experiment with doses and see if you can tell what is helping you?

I may have missed vit-D levels. If your levels are low, maybe supplementing 5000IU makes sense. Other wise it is pretty high. Are you getting redgular sunshine on your skin? This helps with more than just vit-D.

I'm female, but my cautious approach would be to leave out the testosterone to start with, and see what improvements you can get with the other stuff first.

I'd go with Haidut's suggestion on DHEA.

I'm not on a 100% Peatarian diet, but have combined several of the princibles with a primarilly paleo-but-with-some-occasional-sugar-and-darkchocolate-diet.

I'd also be interested in your diet - I'm not sure what you mean by either paleo or peatarian diet, since people seem to have various ways of doing it. Low sugar doesn't seem particularly 'peatarian', but maybe you are meaning low sucrose, and actually getting lots of carbs from other sources? I think it's important to ensure good nutrition before starting thyroid supps - if there is not enough there to support it, thyroid supps can sometimes cause more stress than help. Peat's ideas on nutrition are quite different from some other common ones.

There are several things needed to convert T4 to the active T3. Selenium as mentioned. Glucose. Adequate protein (I'm guessing you are getting enough of this). Other micronutrients. Overexercise can reduce the conversion.

If you are training hard and frequent, that might be one of the stresses that has been undermining you. Especially if you have been doing some kind of low-carb diet. Can you space out your work outs a bit, and avoid pushing to failure to often etc?

Have you read some of Peat's articles? Eg starting with ones on thyroid and on sugar? I'd recommend if you haven't yet.

Good luck.

 

[jaguar43]

I agree with others that you should not take the Hydrocortisone but my honest opinion is to stay away from arimidex and exemestane. I am not sure if Hadiut knows this, but someone on the ray peat Facebook page ask Ray Peat about exemestane. He doesn't recommend it and believes that there isn't much data on its long term effects.

I also don't agree with taking the Testosterone right away. Lower the dose of DHEA 10 to 15 mg per day.

If you consider yourself as a "beginner" to Ray Peat's recommendations. Then I suggest you take it slow. You got a lot going on and it would be hard to tell what is working and what isn't. Your symptoms with headaches is hard to pinpoint directly on one substance because you are taking more than one. You need to work your way up.

Usually Ray Peat states that one should try Pregnenolone first. And if you are not responding well, then DHEA. Especially with your adrenals not working.

 

[tara]

I agree with others that you should not take the Hydrocortisone but my honest opinion is to stay away from arimidex and exemestane. I am not sure if Hadiut knows this, but someone on the ray peat Facebook page ask Ray Peat about exemestane. He doesn't recommend it and believes that there isn't much data on its long term effects.

I'm no expert on those substances, but that seems like a suitably cautious approach.

If you consider yourself as a "beginner" to Ray Peat's recommendations. Then I suggest you take it slow. You got a lot going on and it would be hard to tell what is working and what isn't. Your symptoms with headaches is hard to pinpoint directly on one substance because you are taking more than one. You need to work your way up.

I agree.

Pregnenolone might have contributed to headache. (I had a bad week or so when I tried it, but I had other possible factors too.) Another possibility is that you have raised your metabolism a little and thereby run out of sugar faster. No doubt there could be other factors.

 

[toddw]

You will not get better without the hydrocortisone. If you are waking up with low cortisol levels, your body is in a compromised state. Until you fix that with hydrocortisone, taking the thyroid or anything else that pushes the body will make you feel worse. Pushing your body when cortisol levels are low is about the same a trying to lift weights with a cold.

The 10 and 20 mgs dose seems excessive. 5mg is the most that should be taken at once. Around 7-8am is the most important time to take hydrocortisone because normal cortisol levels are the highest at that time. You can add another 5mg around 11am and then 2.5mg (if possible) once or twice between 12-5p. If 5mg at 7-8am doesn't seem like enough, then take another 5mg an hour later.

Hydrocortisone is an anti-inflammatory so it will help with the body aches.

Your headaches (pain above the eyeballs) may be referred pain from tightness in the neck and shoulders. Massage the muscles that are on each side, near the back of the neck, running to the back of the shoulder.

On the DHEA, Pregnenolone, Testosterone, and Arimidex, I would wait until you can see where you are once you get to 75mg of thyroid with the hydrocortisone. If you take too much of any of those it will cause more stress and make it difficult to know how much hydrocotisone to take.

 

[tara]

I live in Scandinavia

Since you are probably not getting any sun at this time of year, you might consider finding a way to get some extra red light (orange through near-infrared spectrum) - red light restores the cytocrome C oxidase enzyme, a crucial factor for good mitochondrial energy production.) Strong incandescents are one way. Some people use red LEDs or other methods. There are threads with (a lot of :) ) detail.

 

[tara]

You will not get better without the hydrocortisone. If you are waking up with low cortisol levels, your body is in a compromised state. Until you fix that with hydrocortisone, taking the thyroid or anything else that pushes the body will make you feel worse. Pushing your body when cortisol levels are low is about the same a trying to lift weights with a cold.

The 10 and 20 mgs dose seems excessive. 5mg is the most that should be taken at once. Around 7-8am is the most important time to take hydrocortisone because normal cortisol levels are the highest at that time. You can add another 5mg around 11am and then 2.5mg (if possible) once or twice between 12-5p. If 5mg at 7-8am doesn't seem like enough, then take another 5mg an hour later.

Hydrocortisone is an anti-inflammatory so it will help with the body aches.

Your headaches (pain above the eyeballs) may be referred pain from tightness in the neck and shoulders. Massage the muscles that are on each side, near the back of the neck, running to the back of the shoulder.

On the DHEA, Pregnenolone, Testosterone, and Arimidex, I would wait until you can see where you are once you get to 75mg of thyroid with the hydrocortisone. If you take too much of any of those it will cause more stress and make it difficult to know how much hydrocotisone to take.

I don't know enough to say there is never a case for supplementing hydrocortisone. But I know enough to be cautious.

My rudimentary picture is that chronic high stress contributes to fatigue and catabolism, and this can include joint cartilage. Ie more demands on the body from any causes, including overexercise, undereating, unresolved physical or psychological trauma than it can meet with basic thyroid metabolism and good nutrition. High stress puts high demands on adrenals to produce stress hormones like adrenaline and corticosteroids.

If OP has been heavily restricting all sugars including fruit, and maybe also restricting more starchy foods like grains and tubers, then this could cause a fair bit of stress and presumably catabolism.

If you increase thyroid hormones that are low, reduce the stress, and supply adequate nutrition, the demand for the cortico-steroids decreases, the adrenal cortex may have more of a chance to recover from whatever damage it may have incurred, if any, and the body is more likely to get into a more anabolic mode in which the joint damage can at least slow, if not start to reverse. Peat has said that even very damaged adrenal glands can often recover quite quickly given the right conditions.
Someone else might be able to explain this better, or correct me where I'm wrong.

If OP decides to try the hydrocortisone at some stage, your suggestion to use lower doses looks like a good idea to me.

There are other anti-inflammatories too, besides hydrocortisone. Eg. aspirin, if it agrees (with vit-K, if you take it regularly).

 

[tara]

Your headaches (pain above the eyeballs) may be referred pain from tightness in the neck and shoulders. Massage the muscles that are on each side, near the back of the neck, running to the back of the shoulder.

Lots of things can cause headaches, and this is one of them - certainly worth a go.

 

[Emstar1892]

Hi,

I'm a 44 year old male, - just this website as a member, but have been reading stuff here for several years now. I'm not on a 100% Peatarian diet, but have combined several of the princibles with a primarilly paleo-but-with-some-occasional-sugar-and-darkchocolate-diet.

Anyway, - I really, really need some advise, since I'm dealing with some issues that are over my head, and I'm feeling completely lost in this pharmaceuitical-endocrino - jungle!

Some background;

I've trained my whole life. Primarily in the martial arts, but also running and lifting weights. The last 10 years my training has consisted of a lot kettlebells, bodyweight and crossfit type training as well.
I dont drink or smoke( only some cannabis, now and then ) and have always had a pretty clean and healthy diet, no soda pops and junkfood. I've have always used supplements when necessary - herbs, vitamins etc.

In the last ten years I have suffered from joint issues, that have gotten progressively worse, year by year.
This has been accompanied by extreme fatique, which is also getting worse and worse.

It's so bad that I dont feel like getting out of bed some days. Some days I litteraly feel as if I'm 180 years old, with lead running through my veins!

I have bad mood swings, brain fog, and just a achy, heavy body.
Naturally my training, and my life in general is suffering badly.

Recently I've been suffering from weeklong headaches. Feels like my eyeballs are rotting in my skull.

I live in Scandinavia, and I have seen tons of doctors here, they have done countless bloodtests, etc. - and nothing has come up.
Except very recently - my doc found that I had borderline low thyroid levels, which he thought could explain some of my symptoms.

So he wanted to start me on T4 only, which I declined, having heard all the horror stories. And since the endo's in my country are a complete joke, - I instead opted to go to one of the leading endocrinologists in Europe.

They did some blood and urinanalisys and quickly came to the conclusion, that my adrenals weren't working properly and my thyroid was low.

So.... they threw everything, but the kitchensink, at me!

This is the protocol they want me to follow:

Each morning:

Erfa thyroid:
15 mg (quater of a grain) for 10 days
Then 30 mg for 10 days
Then 45 mg for 10 days
Then 60 mg for 10 days
Then 75 mg for ten days

Hydrocortisone:
20 mg followed by 10 mg at lunch

DHEA:
35 mg a day

Pregnenolone:
100 mg a day

Testosterone Liposomal gel 10%:
1 1/2 gram a day on neck and shoulders

Arimidex:
2 X 0.25 mg tabs a week

Furthermore supplements:

Vitamin A:
100.000 iu a day

Vitamin D:
5.000 iu a day

Well, I'm no expert on any of this, but I've always been wary of medications, and tried to stay as far away from it as possible. So for me, this protocol seems excessive?

So far I've tried the Erfa - up to 30 mg, which made me feel a little drunk and dizzy. So I've stopped it again.

Hydrocortisone scares the ***t out of me, so I haven't started that yet.

The preg I tried - gave me a terrible headache, that lasted for two days.

DHEA seems to work a little better, done it on and off now - to try to get a feel for it.

Testosterone - haven't done it yet.

I'm posting my labwork - and I will be grateful if anyone has any helpful input as I am totally lost!

Hey MrMesmer, how are you doing now? Did you find a way to raise your cortisol levels?

 

[kranum]

I live in Denmark, and if you are thinking about getting a lamp to increase your light exposure in the wintertime you might be able to get it where i bought mine: El-artikler I think it is crucial for staying in good health in the long Scandinavian winters.

 

[skycop00]

And Haidut - what you are saying about the Hydrocortisone, are my thoughts exactly!

It seems to be such a potent drug, with such a wide variety of potential sideeffects, that it's really not something to be messed around with, unless absolutely necessary.
Does anyone here have personal experiences with going on HC, and later getting completely off it again??? Is this really an option?

As far as the pregnenolone, I did that for a couple of days - but got awful headaches, and stopped it again.
Any ideas why?
It also seemed to be messing with my libido.
Maaaaaaaaan, - hormones are such a b**** to be dealing with!

Quite possible that the pregnenolone raised blood pressure. Happened to me on 50mg daily. Went to low dose 2x per week and BP normalized. Just be sure BP is monitored as it may be causing headaches

 

[Koveras]

Quite possible that the pregnenolone raised blood pressure. Happened to me on 50mg daily. Went to low dose 2x per week and BP normalized. Just be sure BP is monitored as it may be causing headaches

Found this recently:

Pregnenolone sulfate modulates angiotensin II-induced inositol 1,4,5-trisphosphate changes in the anterior pituitary of female rat. - PubMed - NCBI

"The present study was designed to test whether pregnenolone sulfate can influence the angiotensin II (AngII) action in the anterior pituitary. Female rats were ovariectomized and 10 days after operation were treated with either 50 or 250 microg per animal in one of the following substances: oil (control), pregnenolone sulfate (PREG-S), estradiol benzoate (E(2),) progesterone (P), or dehydroepiandrosterone sulfate (DHEA-S), given in single intraperitoneal injection. Because AngII is known to act in the anterior pituitary through the phosphatidiloinositol breakdown, thus increasing the level of inositol-1,4,5-trisphosphate (IP(3)), the IP(3) concentration was determined 24 h after the injection in the anterior pituitary homogenate after in vitro exposure to AngII. Among the tested steroids only PREG-S enhanced the basal (without AngII) and AngII-induced level of IP(3) in both doses used. There was no difference between the effect of a high and low dose of PREG-S. These results show that PREG-S may modulate AngII action in the anterior pituitary, regardless of the presence of ovary."

"Angiotensin II increases blood pressure by stimulating the Gq protein in vascular smooth muscle cells (which in turn activates an IP3-dependent mechanism leading to a rise in intracellular calcium levels and ultimately causing contraction. " (From Wikipedia)

 

[skycop00]

Very good find above!!!