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I will quickly summarize 3 years of problems:
I am a 25-year-old female, diagnosed hypoT 3 years ago, finally found a doctor a year ago who gave me HC, as all my saliva tests showed low cortisol, my AM blood cortisol was 11, and my AM ACTH was 17. Peculiarly, my TSH rose with every test. Estrogen dominant.
I got up to 4 grains of armour, and I think I was on about 40-50mg of HC at that point. My RT3 came back really high, like 30 points over the top of the range, and I was not losing any weight, so my doc gave me Cytomel. Besides being unable to lose weight, my tongue has been swollen for at least a year, although it’s probably been longer and I didn’t realize it. I kept having low cortisol symptoms even at 60mg of HC, I guess due to the amount of time I exercise, so my doctor told me to raise.
-1 hour of cardio 7 days a week
-3 hours of aikido/week
-2 hours of weight training/week
-I bike a mile to work and a mile home
-I generally walk 2-3 miles a day
-full-time job
-single, live aloneI could usually tell when my cortisol was getting low because I would get eye aches. If I took 5 or 10mg of HC, the eye ache would go away in about 20 minutes.
I got up to 325mcg of Cytomel and 80mg of HC. I saw a new doctor who was horrified at the amount of HC I was one and wanted to introduce 2 grains of Westhroid into my regimen and drop the Cytomel to 100mcg. I am hesitant to drop the Cytomel that low.
I have lost 14 pounds over the last 4-5 months, and on a normal day I take in about 1800-2000 calories. On a bad day, which usually happens once a week, it’s 2200-2500. Before I was hypoT and running 70 miles a week, I could eat whatever I wanted, and I was 110 pounds. I am currently 150 pounds and would like to be 130. More pleasantly, my tongue swelling has finally gone down, and my tongue scallops are much less pronounced.
I realize now that my HC is too high, and I am bringing it down as quickly as is comfortably possible. I have taken 40mg the last two days and today have experienced minor fatigue and irritability. I have also been shaking a bit, but, quite frankly, I’ve had shakiness for about two months now. I don’t know if it’s due to thyroid or adrenals, although on 80mg of HC, it must be thyroid. My hands are a little trembly, and I feel shaky after exercise. I often get trembling in my calf muscles during and after exercise when I stand still.
Others have suggested that I cut down my exercise routine to just aikido 3x a week because my adrenals cannot handle the stress. I am worried about losing cardiovascular fitness and muscle tone, but I am most worried about gaining back the weight I have lost. I do not trust myself to strictly diet. I was an anorexic teenager and have had a very complicated relationship with food that has gotten much better, but can still be problematic. I was a very severe “exercise bulimic” which is also still something I struggle with. Yes, I have been to therapy many times, and no, it doesn’t help.
Should I cut out exercise? Should I just do less? And if so, how much less? Will 30mg of HC be enough if I continue to remain active? And am I shaking due to too much thyroid?
Every doctor I see tells me something different, and each of them only seems somewhat knowledgeable about hypothyroidism and completely lost when it comes to adrenals. Please help?
Thanks.
-1 hour of cardio 7 days a week
-3 hours of aikido/week
-2 hours of weight training/week
-I bike a mile to work and a mile home
-I generally walk 2-3 miles a dayThis seems to add up to about 2.7 to 3 hours of exercise a day on average.
If one was doing construction work, farm labor, professional sports or some other physically laborious job, I suppose this would not be considered an excessive amount of exercise.
My favorite weight loss exercise is bicycling. One reason is that it is easy to rest while cycling. It isn’t so boring when one is traveling the world at speed. It does not stress the body like running or weight training. The rush of air cools you down. You can listen to a radio or iPod while cycling, keep a GPS device, keep a speedometer on to entertain oneself while bicycling. It is fairly easy to built up to regular weekend 100-120 mile rides. And bicycling burns calories like no other exercise.
At a weight of about 150 pounds, bicycling at an easy, medium, relaxed speed of 16 miles per hour burns over 2100 calories in 3 hours.
Riding at 20 miles per hour (the minimum to keep up with bicycle club cyclists) will burn about 1200 calories an hour, 3600 calories in 3 hours.
If one can ride faster than that – and the semi-pro and serious club cyclists can do close to 30 miles per hour on a flat road – then the caloric expenditure rises exponentially.
It is all a matter of physics. The faster one goes, the more calories expended.
Pro runners usually can’t run a marathon race often. The body breaks down from the stress to the legs. But a pro-cyclist can run the equivalent of 21 marathons in just over 21 days in events like the Tour de France. It is far easier to burn calories while bicycling since it is a non-stress sport compared to running.
Serious bicyclists have to carry food with them since it is easy to burn through one’s glycogen stores and bonk out when cycling. This is why they have pockets for food in the back of their shirts.
The tremendous caloric expenditure is why a professional cyclist can often burn up to 25,000 non-bulimic calories a day yet stay skeletal thin. Look at how thin Lance Armstrong and the other pros are. This is not from dieting. This is from pure calorie burning.
If weight loss is a goal, there is nothing better than serious bicycling to get there. And it is fun and low-stress as well compared to the bone jarring one has from running and the pain one gets from weight training.
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When treating hypothyroidism and when doing an adrenal support treatment, I generally do not like going over physiologic boundaries. This may create more health problems that it solves. Only occasionally would I consider this. I would also consider measures to keep it safe.
Generally, for women, an adrenal support treatment would have at most around 20 mg a day of hydrocortisone.
Sometimes rare cases of hyper-excretion syndrome occur where hydrocortisone is eliminated from the body too quickly. A common cause, for example, is the use of Premarin, which induces excessive activity in many liver enzymes. Jonathan Wright MD in Seattle and his colleagues there would have a better idea of how to diagnose this using a 24-hour urine hormone test. He treats hyper-excretion syndromes with compounded elemental cobalt that his compounding pharmacy makes. Usually a month treatment is all that is needed to calm down liver enzyme production, in addition to removing the inducing substance.
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Hypothalamic-pituitary-adrenal axis dysregulation with low adrenal cortex function has other causes as discussed in other threads in the forum.
Excessive thyroid signaling can also contribute to HPA Axis dysregulation. HPA Axis dysregulation, itself, can promote weight gain. This is one reason the use of thyroid hormone at supra-physiologic doses is not usually done. It works against itself and is not a lasting solution as a result of the physical health risks involved.
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@drgirlfriend 1407 wrote:
I am a 25-year-old female, diagnosed hypoT 3 years ago, finally found a doctor a year ago who gave me HC, as all my saliva tests showed low cortisol, my AM blood cortisol was 11, and my AM ACTH was 17. Peculiarly, my TSH rose with every test. Estrogen dominant.
I got up to 4 grains of armour, and I think I was on about 40-50mg of HC at that point. My RT3 came back really high, like 30 points over the top of the range, and I was not losing any weight, so my doc gave me Cytomel. Besides being unable to lose weight, my tongue has been swollen for at least a year, although it’s probably been longer and I didn’t realize it. I kept having low cortisol symptoms even at 60mg of HC
What are the initial lab results to help diagnose hypothyrodism?
What are the current lab results and the current medication regimen?
I would wonder if there are significant metabolic-nutritional problems occurring when such a high dose of thyroid hormone and hydrocortisone is necessary for function.
What “low cortisol symptoms” are occurring at 60 mg of Hydrocortisone?
Such a dose of hydrocortisone can shut down adrenal cortex function, resulting in a deficit of pregnenolone, progesterone, DHEA, testosterone, estradiol, etc.
The deficit in progesterone that occurs from high dose hydrocortisone can cause a person to become “estrogen dominant” – a term John Lee, M.D. created. See his website: http://www.johnleemd.com/ for more information.
Since low adrenal cortex function includes one or a combination of low cortisol, progesterone, pregnenolone, DHEA, testosterone, estradiol, etc. suppressing cortex output by using excessive hydrocortisone would exacerbate the deficits in the other hormones. This would contribute to the symptoms one would ascribe to low cortisol but are instead due to low production of the other adrenal hormones/signals.
The use of hydrocortisone alone in an adrenal supportive treatment is unbalanced and can cause potential problems including osteoporosis, thinning of the skin, mood and other psychiatric problems, impaired immune system function, etc. This complicates the assessment of what is causing one’s problems.
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Since may of the signs of excessive thyroid hormone signaling (e.g. hyperthyroidism) are similar to low adrenal cortex output (e.g. hypothalamic-pituitary-adrenal axis disregulation, adrenal fatigue, adrenal insufficiency, etc.), the use of supraphysiologic doses of thyroid hormone complicates the assessment of adrenal function or may be a cause of the adrenal problems, itself.
Thank you very much for your comprehensive reply.
My initial TSH was 4.53 (age 22), and only total T3 and T4 were measured. I was running 70 miles a week, a vegetarian eating a lot of processed soy food, and at one point was gaining 2 pounds a week. Over a year and a half, I gained 54 pounds.
My doctor at the time, a standard internist and gynecologist, put me on levoxyl. I felt better for about a week and then felt progressively worse than I did before. Severe muscle aches, fatigue, shakiness, hair loss. I asked to be put on armour, but she refused, saying my T3 was in range.
I went off levoxyl completely and consulted a chiropractor who treated athletes with adrenal fatigue. He put me on 10mg of dhea/day and 50mg of pregnenolone, both sublingually. I had severe insomnia at the time, usually up until 3, 4, or 5am every night. He instructed me not to exercise for a month, only walking where I needed to go. After a month on the dhea/pregnenolone, I was sleeping better and had a bit more energy. He allowed to exercise 45 minutes 4x/week. He did a saliva sex hormone text in which I spit into a tube several days a week for a month. My progesterone/estrogen/testosterone seemed to be cycling correctly and in range. I even had my first natural period in seven years after being amenorrheic for a year.
I had a period two months in a row and then they became sporadic. Around that time, an osteopath started me on armour, after another TSH test came back above 5. It was like I was taking candy. It didn’t seem to make a difference. I think I went up to 3 or 3.5 grains, and then I started having insomnia problems again, and no weight loss. I was also not menstruating.
In October of last year, I saw the doctor who prescribed hydrocortisone. I am part of a rollerblading group that goes out a few days a week to skate on the city streets for a couple hours. It’s fairly low intensity, but it’s a long, sustained effort with a few breaks. I was on 20mg, and I was exhausted the next day. I couldn’t exercise without being extremely fatigued the next day. I think I was on 2 grains of armour at the same time. I was also taking 100mg of progesterone sublingually at night during the last two weeks of my cycle. This induced a period too quickly, so I reduced the progesterone to 50mg during the third week each night and 100mg the fourth.
The symptoms of low cortisol I complained of were: having a very hard time waking up with my alarm in the morning, despite 7 hours of sleep; fatigue after exercise; eye aches with light sensitivity. He encouraged me to continue raising hydrocortisone. He had prescribed me 200mcg of Cytomel, but every couple weeks, I would continue to raise, as I assumed the swollen tongue and non-weight loss were symptoms of hypothyroidism.
But it’s gotten to the point where I’m on a ridiculous dosage, which is unsustainable, and I don’t want to cripple myself for life. I had a number of Armour grains in my refrigerator from about six months ago, so while I wait for my pharmacy to get Westhroid, I am taking two grains of Armour/day and moving quickly down in Cytomel, with 200mcg yesterday and today, and I plan on taking 150mcg + 2 grains of armour today. I actually feel surprisingly good today, despite not getting to bed when I wanted to last night. I took 30mg of HC yesterday.
Another persisting problem is a yeast infection on my back, shoulders, and chest. It’s been there since I went hypo 3 years ago, but I didn’t know what it was at the time. I’ve been treating it for 7 weeks now, with only minor results. I assume this is indicative of my poor immune system and the need to decrease HC.
Simply fall into the same category which most people I deal with. It is called the over training and undereating (which I fell victim too several years ago which blew out my HPTA).
Being a professional trainer and ex bodybuilder I have seen this trend becoming more and more common in todays young men and also women. Please do remember the amount of stress that one was exposed to previous generation has increased significantly. Today we need to factor in cell phone plugged in near our beds at nighttime, computer before bed time, poor economy, lack of being in doors, poor diets which or nutrient depleted and unbalanced. Back 50 years ago our parents did not have any of this to contend with. Childern are being born today with a predispostion to stress which is starting to show in biological difference such as adrenal size. In a study it was noted that americans are being born with 3 times larger adrenals then those in 3rd world countries. The society is a fast paced and always on the go both mentally and physically. People just need to take a good 15-20 minutes 2 -3 times a day and take a few deep breaths to appreciate nature to just relax. Many clients/patience the gas pedal is down and the braking system is screaming or is non existent. This creates an autonomic imbalance which can start a vicious cascade of bodily imbalances which are not positive. When examined a person chosen lifestyle is usually followed by poor nutritional value which does not allow the body to recover properly from stress then on top of working out like a addict. I am not doing a vegetarian lifestyle but >90’% of people do not know how to properly eat according to vegetarian base diet. Most vegetarians are pale skin, look depleted, hair looks nappy and dry ready to crack at any given time. They tend to have a hippy look. There is a book written by a dr that went vegetarian and here health took a dramatic turn for the worse and almost killed her. What one may think is healthy really depends on you genetic and blood type. Most people hypothyroid when asked are type O blood type. In order to regain your well being you need to look at what possilbe caused this. My speculation is that over time your diet was a huge contributing factor because of the high phytate consumption from seeds, nuts, and high fiber foods. Taking a multivitamin in your case probably would not be enough to cover you daily needs. 1800 caloires with hypothyroid is WAY too much. I have guys that are hypo on 1200-1400 calories and they are getting leaner and stronger weekly. As their thyroid improves then food will be increased. For a female with hypothyroidism 1000-1200 caloires should be plenty untill the thyroid regulates. You are on way too much cortef (realthyroid helper i bet). If all other hormones are tuned up then amount of HC can be drastically reduced over time. You need to cut back on the cardio and keep it to 45 minutes a day MAX with combination with weights. Doing all cardio you are going to either be thin fat or be spinning your wheels for a long time. I have read 100 of post of women’s athletes having the same issue. You need to pinpoint the imbalances through proper blood testing. We do 24 vials of blood, saliva, urine testing to see where imbalnaces are occuring. If you are on BC this may be a huge issue as well contributing to the factors of the equation.
You should not stop exercising. You should try alternating days of stressful exercises with days of de-stressing, restorative exercises such as yoga.
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