Slow metabolism and low cortisol

[peaches]

Brief history: Former personal trainer in good shape, began gaining weight to the tune of 40 pounds in 6 months, 5 years later I was diagnosed with Cyclic Cushings. No strong lab evidence other than high 17-ohs and visual symptoms including inability to lose the weight I had gained despite a 1000 calorie carb restricted diet, 40 min fasted cardio 5-6 days a week.

I was approved for surgery after 2 -3mm pituitary tumors showed up.1 year ago I had pituitary surgery . Three tumors were removed non ACTH secreting.
I was placed on 30mgs of Hydrocortisone with noticeable improvement after surgery. I slowly weaned off cortisol over the course of 2 months. No blood work was done at this time due to me not having the best post-op care from my endocrinologist despite request.

I was losing weight on 20mgs of Hydrocortisone QD. Once I dipped below 20mg’s I began gaining weight.
I have read to low of a dose will cause feedback problems and actually cause one to gain weight. Has anyone heard of this?

Fast forward to a year later. I decided to put myself on Cytomel due to the fact I was still unable to lose. I lost 31 pounds in 2 months along with my cardio and diet. However I began to notice Adrenal Insufficiency symptoms after 1 month of use, but I didn’t think anything of it. I mean I had been off hydro for quite some time. I had severe muscle weakness, depression, severe stomach cramps and diarrhea, my cognitive function was little to non. After recognizing my symptoms and putting two and two together I took my BP and it was way low. I took a 5mg hydrocortisone and felt better within 1 hour. I was able to sleep without pain in my joints. I decided to come off Cytomel after reading the thyroid/adrenal relationship and I started on 15mg’s of Hydrocortisone QD.
I feel great physically and mentally. I will be going for blood work next week after withholding hydro for 24 hours and this may give me an idea of whether or not this is secondary adrenal insufficiency. That being said my GP has made it clear he will order the test but he is leaving it up to me to interpret them since he is not an endocrinologist.

My second question is when should I get off the hydro? Since technically I threw my self into AI taking cytomel, could a week of hydro re build my adrenal function?

I feel I need to be on the hydro and thyroid medication (since this is the only way I can lose weight).I am nervous to introduce my system to cytomel again but feel it is the only way I can lose weight.

I need some guidance….

[saltimbanc0]

To try and answer the questions, yes taking low doses that surpress your own acth output and therefore cortisol levels but dont fully replace your needs can cause a relative AI situation.

It is quite likely by increasing your metabolic rate with the cytomel you pushed your adrenal capacity beyond what it wa capable of, ideally it would be better to be more careful with the cytomel than have to use the hc again – its not as simple as a few days to rest the adrenals or anything like that and you are risking complications and further problems taking thyroid meds, especially cytomel (t3).

I would really recommend getting a proper adrenal work up so you know what your body is capable of.

I have been on high dose steroids (pred and hc) in the past and not gained any weight, and then another time gone very cushingoid. Likewise before i was diagnosed but had symptoms of addisons i gained weight being hypoadrenal so both extremes CAN cause both changes in weight.

Often its forgotten/overlooked that without adequate cortisol your body doesnt/wont convert t4 to the active t3 which would also explain why you had good results with supplementing t3 directly but you would be much better long term and healthier to get the adrenals functioning right and not taking thyroid meds rather than having to take both which can eventually cause dependance and further problems.

[peaches]

Thank you for your response.

I had some blood work done and I am waiting on the results. I am slowly tapering off the HC while doing so my thyroid has become inflamed (the doc also did work up for this). So, I am unable to pinpoint but I feel it must be the HC causing the thyroid is suppress. Maybe I am wrong, unfortunately I haven’t gotten my results back. So we will see.

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