Now Low Cortisol? Already Hypothyroid And Low Hormones. What To Do?

[CaliforniaKat]

Hi,
So I got my most recent 24 hr saliva cortisol and dhea back. Cortisol was high and dhea was low 8 months ago, now dhea is still low (but better) and adrenal function is low. I posted my result here.

I posted my bloodwork in the bloodwork section, and I'm not sure how to link it here.

What do I do now? I'm exhausted all the time and I don't know whether the low cortisol is because thyroid isn't optimal yet (tsh says yes, but T3 and T4 still in bottom of range and temps have dropped again) or due to something else. I'm so lost and frustrated, and I know I have already asked a ton of newbie questions.

Waking temp is consistently 97.0
Afternoon temps are 98.2, but both waking and afternoon temps were good 4 weeks ago.

I know if I go back to NMD he will add adrenal support in the form of dessicated adrenal cortex, but Peat idea is that it isn't necessary? I'm confused (again) I feel like every step forward is followed by two steps back...

 

[theLaw]

You might consider trying to improve liver health.

Surrogates For Thyroid Hormone

Dietary Stearic Acid Reduces Visceral Fat By 70% And Increases Lean Mass

Improving Liver Function With Caffeine/K2/Taurine/Glycine And Haidut's Advice/supps

I noticed that using Orange Juice as a sugar source had a significantly different effect on my blood sugar than sugar, soda, or even Apple Juice - all of which led to a rise in stress hormones, especially during sleep (never considered that I might literally need to refuel each and every time I woke up).

Also, salt (1 Tbsp/day = 1/4t per hour every waking hour) has been a complete game-changer for me, and I've A/B tested it many times with great results.

 

[Jackrabbit]

You definitely could boost your progesterone levels, the best way is with bio identical hormones that you can buy otc, but mainly online. The ones dissolve in e or absorbed in the skin. Progesterone and cortisol have a weird relationship, they seem to go hand in hand. When you’re stressed it can go up along with cortisol, almost like the body’s natural way of balancing the cortisol response. Dhea has more to do with testosterone.

 

[Frankdee20]

B 5 boosts cortisol

 

[CaliforniaKat]

I noticed that using Orange Juice as a sugar source had a significantly different effect on my blood sugar than sugar, soda, or even Apple Juice - all of which led to a rise in stress hormones, especially during sleep (never considered that I might literally need to refuel each and every time I woke up

I don't do a lot of straight sugar right now. No soda, no caffeine (decaf coffee) and table sugar is only added to fruit I'm cooking. I use fruit and some OJ, occasionally fruit-veggies. Starches are only a couple days a week, if that. I take an 81 mg aspirin in the morning, supplement d, k2, and some b vitamins. My calcium to phosphate ratio is usually a little more than 1 to 1, with calcium being higher. I use CO and cocoa butter daily. Gelatin in coffee and added to cooked fruit. Only been eating this way about 2 months, though the gelatin, cocoa butter and CO have been in my diet for much, much longer.

 

[CaliforniaKat]

You definitely could boost your progesterone levels, the best way is with bio identical hormones that you can buy otc, but mainly online. The ones dissolve in e or absorbed in the skin. Progesterone and cortisol have a weird relationship, they seem to go hand in hand. When you’re stressed it can go up along with cortisol, almost like the body’s natural way of balancing the cortisol response. Dhea has more to do with testosterone.

That's interesting, because I thought progesterone was supposed to lower cortisol? All my hormones are low in most recent bloodwork, though didn't test prolactin or testosterone. And converting to similar units I thought my estrogen to progesterone ratio was okay, even though both were low overall.

Blood pressure is low too, even though I am supplementing with salt.

 

[Jackrabbit]

That's interesting, because I thought progesterone was supposed to lower cortisol? All my hormones are low in most recent bloodwork, though didn't test prolactin or testosterone. And converting to similar units I thought my estrogen to progesterone ratio was okay, even though both were low overall.

Blood pressure is low too, even though I am supplementing with salt.

I think progesterone ratio is supposed to be 30:1 according to Ray Peat, but someone correct me if I’m wrong. Since it’s such a simple thing to supplement it seems like a no-brainer. I would follow up about the low cortisol with an endocrinologist and have them do whatever testing they need to to determine how to fix your cortisol/thyroid levels.

 

[Jon]

Low cortisol is a sign of a long standing chronic fatigue. As I understand it, in early stages of chronic stress you see a spike in serum cortisol, but as time goes on your body has trouble making such a high amount all the time and becomes depleted of resources to do so.

Vitamin C is helpful, I believe it vies the adrenals with raw materials to produce stress hormones. I would tend to thing getting in natural vitamin c (5oomg worth) through food and drink is a good place to start, then if you feel like you can tolerate more (no changes in urination or digestive tract; burning sensation) then you could think about supplementation to further up your intake.

Although, I have also heard that with cortisol (like thyroid hormone) sometimes all the natural interventions and therapies in the world won't kick start your body's production of cortisol and a hormonal replacement is needed. I do believe just like thyroid hormone, cortisol replacement therapy is one that you do not have to stay on for life. Once your body is given a boost, it tends to take over production (unless its from something like Addison's disease).

 

[CaliforniaKat]

Low cortisol is a sign of a long standing chronic fatigue. As I understand it, in early stages of chronic stress you see a spike in serum cortisol, but as time goes on your body has trouble making such a high amount all the time and becomes depleted of resources to do so.

Vitamin C is helpful, I believe it vies the adrenals with raw materials to produce stress hormones. I would tend to thing getting in natural vitamin c (5oomg worth) through food and drink is a good place to start, then if you feel like you can tolerate more (no changes in urination or digestive tract; burning sensation) then you could think about supplementation to further up your intake.

Although, I have also heard that with cortisol (like thyroid hormone) sometimes all the natural interventions and therapies in the world won't kick start your body's production of cortisol and a hormonal replacement is needed. I do believe just like thyroid hormone, cortisol replacement therapy is one that you do not have to stay on for life. Once your body is given a boost, it tends to take over production (unless its from something like Addison's disease).

I have heard the same thing. I had uneven daytime cortisol 2 years ago, then seemed okay. Then high cortisol much of last year. I felt good a month ago and temps seemed to fall in line with that. Now feel awful. So what do I use to raise cortisol back to 'normal'? My progesterone to estrogen ratio (according to bloodwork) is 31, but all are in the post-menopausal range in day 21 of my cycle.

My NMD will say to try adrenal cortex supplements while continuing to try to optimize thyroid. Brimeyer, and others in the more Peatish community say that T3 will raise cortisol eventually...

I am a single parent and have to work, so I can't afford to get sicker...

Pregnolone, progesterone, dhea, T3? Help!!

 

[Jon]

Goodness, to be real with you I'm not the greatest with the pro hormone pathways, but I believe pregnenalone is probably the most likely to be converted to the hormones you're in need of.

There's an adaptogen called Gynostemma that Russians used to help the lagging hpa axis of athletes who had diminished cortisol responses to exercise. Apparently the herb gave them back full cortisol response, but had the opposite effect in people with too high of serum cortisol (lowered it). I've tried Gynostemma powder, I just added it to hot water and drank it as a tea. It tastes good actually :) but I didn't have blood work done so I'm not sure of its effect on me.

@tara want to give some more informed lay advice? (Since obviously I'm a noob lol)

 

[alywest]

I have heard the same thing. I had uneven daytime cortisol 2 years ago, then seemed okay. Then high cortisol much of last year. I felt good a month ago and temps seemed to fall in line with that. Now feel awful. So what do I use to raise cortisol back to 'normal'? My progesterone to estrogen ratio (according to bloodwork) is 31, but all are in the post-menopausal range in day 21 of my cycle.

My NMD will say to try adrenal cortex supplements while continuing to try to optimize thyroid. Brimeyer, and others in the more Peatish community say that T3 will raise cortisol eventually...

I am a single parent and have to work, so I can't afford to get sicker...

Pregnolone, progesterone, dhea, T3? Help!!

You should get a cortisol response test, where they inject you with cortisol and then they take your blood work after 30 then 60 minutes. This is ordered by an endocrinologist. Then if you have low cortisol response, that means your adrenals are struggling. If you have a normal response but with low baseline cortisol, they will most likely prescribe you something like prednisone. In my experience, handling low cortisol is not something that you should do alone. It is actually a serious issue and can definitely explain why you feel so bad. Unfortunately thyroid alone won't fix the problem.

 

[HDD]

Have you read through these email exchanges on cortisol?

Ray Peat Email Exchanges - Ray Peat Forum Wiki

 

[Jon]

You should get a cortisol response test, where they inject you with cortisol and then they take your blood work after 30 then 60 minutes. This is ordered by an endocrinologist. Then if you have low cortisol response, that means your adrenals are struggling. If you have a normal response but with low baseline cortisol, they will most likely prescribe you something like prednisone. In my experience, handling low cortisol is not something that you should do alone. It is actually a serious issue and can definitely explain why you feel so bad. Unfortunately thyroid alone won't fix the problem.

+1 @CaliforniaKat

 

[sweetpeat]

That's interesting, because I thought progesterone was supposed to lower cortisol?

I think it depends on the dosage.

I have a similar hormone profile as you, except I have "optimal" (according to lab work) thyroid levels. T3 at top of range but all other hormones still low. I was trying to see if optimizing my thyroid would improve my other hormones. Unfortunately no. So I tried experimenting with pregnenolone and it helped some. But since adding progesterone, it has increased progesterone levels as well as estrogen and cortisol. This was with taking 12-15mg (4-5 drops Simply Progesterone). I take the bulk of it at night. Sometimes I take 3 mg (1 drop) mid morning. I'm still experimenting to find the best dose, but wanted to share my experience.

Peat says progesterone knocks estrogen out of tissues and into blood, which explains the rise in estrogen. Not sure how to explain the rise in cortisol. In another place on the forum, haidut says that pregnenolone will normalize cortisol (make it lower if high, make it higher if low). Maybe progesterone has a similar function? But again, it probably depends on the dose. Too much might be suppressive to cortisol. That's why I've been experimenting very cautiously. I started with just one drop for a few days.

 

[Jon]

When I take T3 the same thing happens - tired, cold, depressed, lower heart rate, etc. T4 works better for me but only at 200 mcg (high dose) and then I still have high rT3. I have low cortisol and take replacement. That may be why T3 doesn't work - it requires more cortisol than I can generate. T4 also requires more cortisol but seems to work better with my dose regimen.
All endocrinology textbooks say that cortisol should be evaluated before adding thyroid. Low cortisol is probably the primary reason thyroid meds aren't tolerated. You can take a saliva cortisol test - they give much better info than serum cortisol. A saliva test (ZRT labs is one) takes 4 samples throughout the day to give you a profile of your cortisol production. I don't know if they're available outside the US.
You can get prednisone from Mexico. Try 5mg in early morning. That's enough to mimic your own cortisol production. Don't take too much prednisone - dangerous side effects (muscle wasting, skin thinning, diabetes, osteoporosis, cataracts, etc). Thyroid and cortisol interact. Low thyroid will slow your liver function and you won't process or clear drugs quickly so they can build up in your body. Prednisone has to be converted in the liver to the bioactive form, so you may find it slow to work (2 hours +_) . But it's easier to get than cortef or prednisolone (bioidentical).

This from another thread where a member was talking about how t3 was dropping his temps. Thought it might add something for you to consider. @CaliforniaKat

I'm not saying just take drugs on your own whim though, more suggesting things to run by an endocrinologist when you go in.

 

[Lucas]

I have hypothyroidism and cannot take t3, when I take it I fell more fatigued, more hypo.

Also I can’t increase my T4 dose. Maybe my problem is low cortisol. Should prednisone 5 mg a day helps it? For how much time should I take it?

 

[alywest]

I have hypothyroidism and cannot take t3, when I take it I fell more fatigued, more hypo.

Also I can’t increase my T4 dose. Maybe my problem is low cortisol. Should prednisone 5 mg a day helps it? For how much time should I take it?

I wouldn't do that without proper testing. I think Dr. Peat says that the bad reaction to thyroid is because of poor liver function. If you have low cortisol you are going to have a really hard time functioning in general. It might be better to focus on liver health until you get your cortisol levels checked and even then go through a professional for treatment. I'm all for DIY health and all that, but in that case I would say you need to be monitored. I agree that prednisone should only be taken in 5mg doses. Dr. Broda Barnes wrote a book called "Hope for Hypoglycemia: It's Not Your Mind, It's Your Liver" that I obtained used for like $3. It's an interesting read. He talks about using thyroid for hypoglycemia and does say that 5mg of prednisone could be required for adrenal issues as well.
I notice when I take t3 and night I sleep better, especially if I've had enough sugar. Maybe try taking the t3 at night and still take your t4. Once you start sleeping better you might start being able to tolerate taking it during the day in very small amounts. I usually nibble cynomel and then take my t4 in one dose since it's time released.

@CaliforniaKat, perhaps pregnenolone would be good for you as you seem to be short in all of the hormones except estrogen. I also noticed on your image that you are using iodine: This was cut and pasted off of the email thread that @HDD posted:

Iodine
Lugol's solution is sometimes helpful for an inflammation, but it's risky when there might be a thyroid problem.

Short term use of iodide is safe at a few milligrams per day, but chronic intake of even one mg. per day increases the risk of thyroiditis.

 

[CaliforniaKat]

I think it depends on the dosage.

I have a similar hormone profile as you, except I have "optimal" (according to lab work) thyroid levels. T3 at top of range but all other hormones still low. I was trying to see if optimizing my thyroid would improve my other hormones. Unfortunately no. So I tried experimenting with pregnenolone and it helped some. But since adding progesterone, it has increased progesterone levels as well as estrogen and cortisol. This was with taking 12-15mg (4-5 drops Simply Progesterone). I take the bulk of it at night. Sometimes I take 3 mg (1 drop) mid morning. I'm still experimenting to find the best dose, but wanted to share my experience.

Peat says progesterone knocks estrogen out of tissues and into blood, which explains the rise in estrogen. Not sure how to explain the rise in cortisol. In another place on the forum, haidut says that pregnenolone will normalize cortisol (make it lower if high, make it higher if low). Maybe progesterone has a similar function? But again, it probably depends on the dose. Too much might be suppressive to cortisol. That's why I've been experimenting very cautiously. I started with just one drop for a few days.

This is great to know. I have a lot going on and it sucks. HMO docs have been kinda useless because I don't fall out of the 'normal' range and according to them I am overmedicated for thyroid even though my T4 and T3 are still in the bottom of the range.

I paid for the recent bloodwork and salivary cortisol. I don't know if the salivary cortisol test will even matter to my HMO. When I asked for a reverse T3 test I was told it is unreliable and not a test they do.

I do pay privately for a naturopathic doctor about thyroid. I have an appointment Monday. But I don't know that he knows Peat's work at all. Would anybody be able to recommend a Peat friendly doc in Southern Cal or one that does reasonably priced phone consults?

 

[Blossom]

I thought you might like to read this from the email depository.

Cortisol/Cortisone_ Dr. Ray Peat

Question: Have very hypothyroid friend who says she has low cortisol
because her pituitary doesn't work. She says the low cortisol was
confirmed by saliva and blood tests.

Ray Peat: Addison's disease, with adrenal cortex degeneration, can
cause cortisol deficiency, in which case progesterone would
compensate, but doctors often tell people they "don't have enough
cortisol" without proper confirmation.

Question: Would pregnenolone correct this?

Peat: Pregnenolone should usually do it, but progesterone is more
certain if the adrenals are really destroyed.

Question: What do you think of using Cortef?

Peat: I think William Jefferies' book created a lot of interest in
that. Since ACTH can interfere with ovarian function, cortisol can
sometimes help the ovaries to make progesterone, by suppressing ACTH.
But I knew people who followed his prescription and got Cushing's
symptoms. Pregnenolone is something that can always be used with
thyroid, to guarantee an easy adrenal response.

Cortisol vs Cortisone vs Cortef

Cortisol works in the body although the body can convert cortisol to
cortisone. Synthetic cortisol-like drugs, such as prednisone are more
like cortisol. Also, hydrocortisone is a drug that acts like
cortisol. The body makes 20 mg of cortisol daily. Taking 10 mg of
prednisone is equivalent to about 50 mg of cortisol or 2.5 times the
daily amount made in-vitro. Cortef is Hydrocortisone which acts like
cortisol.

Cortisol and weak adrenals

Cortisol is a little more water soluble than progesterone, and a
diurnal cycle can be seen in the saliva, but the absolute amounts
aren't as meaningful as in the serum. Thyroid is needed for the
adrenals to function
well, and adequate cholesterol, as raw material. It's popular to talk
about "weak adrenals," but the adrenal cortex regenerates very well.
Animal experimenters can make animals that lack the adrenal medulla by
scooping out everything inside the adrenal capsule, and the remaining
cells quickly regenerate the steroid producing tissues, the cortex. So
I think the "low adrenal" people are simply low thyroid, or deficient
in cholesterol or nutrients.

Question: If prednisone suppresses adrenal function, how does it
cause diabetes? This guy's diabetes is out of control. He is
spilling lots of sugar in his urine. So the cortisone isn't fixing
him at all. Do you think it would be possible to get him off the
cortisone, insulin and testosterone?

Peat: The doses they prescribe as "replacement" are much more than
the adrenals would produce, so they in themselves are diabetogenic.
William Jefferies told people that, since the adrenals produce 20 mg
of cortisol per day, they should take 30 or 40 mg, as a replacement
dose, because only half of it is absorbed. They got fat faces quickly.
Using pregnenolone, they were able to taper off the cortisol in a
month or two.

Source

 

[CaliforniaKat]

I notice when I take t3 and night I sleep better, especially if I've had enough sugar. Maybe try taking the t3 at night and still take your t4. Once you start sleeping better you might start being able to tolerate taking it during the day in very small amounts. I usually nibble cynomel and then take my t4 in one dose since it's time released.

@CaliforniaKat, perhaps pregnenolone would be good for you as you seem to be short in all of the hormones except estrogen. I also noticed on your image that you are using iodine: This was cut and pasted off of the email thread that @HDD posted:

Iodine
Lugol's solution is sometimes helpful for an inflammation, but it's risky when there might be a thyroid problem.

Short term use of iodide is safe at a few milligrams per day, but chronic intake of even one mg. per day increases the risk of thyroiditis.

I take KI in pill form. I can't remember dose on the bottle right now, but it says one pill is 150% of RDA. I take one pill and do not use iodized salt. It is something I will bring up with Doc on Monday, though he isn't an endo (see my last response above) and may cut it as I go forward.

Right now my T3 and T4 are not separate pills. I am taking 2 grains of NDT. The brand name is Acella. Two grains contains 76 mcg T4 and 18 mcg of T3. I have cynomel from Mexico (Grossman brand) that I took for years without a Doc, but then it become unavailable and Tyromel and Thiroyd didn't work for me. I was unmedicated for a while, which is when cortisol started to get wonky. My TSH currently is 0.03, which is below the range for TSH, but my actual T4 and T3 are bottom of range. STTM website would say I am still undermedicated, but that adrenals need to be addressed before going up on NDT. I really want to go back to T3 only but not sure my adrenals will handle it.

I agree that possibly, and slowly, adding pregnenolone and possibly progesterone, would help. I am bringing that up to Doc on Monday too. I am hesitant to venture back out on my own with hormones, but I know a lot of this is N=1 experimenting.