Re: Trying to understand labs and fatigue

Your results are intriguing. Cortisol and DHEA has a relationship to one another.
Normally, at the first signs of adrenal function going hay-wire due to stress is HIGH DHEA to match HIGH cortisol levels.
Then as stress progresses - lower DHEA and high cortisol.
Severe Chronic Stress - Low DHEA and normal cortisol.
Exhaustion stage - Low DHEA and low cortisol.

Those are the general patterns observed during stress states and effects on adrenal function over time. Dr Lam describes it very well.

Most MD's will say it's not possible for there to be 'grey' areas of function of the adrenals, they either work or they don't. It's akin to saying that hair-loss doesn't happen...either you've a full head of hair or you're completely bald. Yet ironically for every other organ and system of the body they recognise there are varying degrees of function.
Extra-ironically government studies and independent government-funded studies show hypertrophy of adrenals coupled with high cortisol, and atrophy of adrenals with low cortisol.

Of course there are scenarios where function is abruptly affected, like in cases of certain infections can cause acute adrenal insufficiency, and chemotherapy can cause sudden hair loss.

Logic and rational thought dictates to go from normal to enlarged adrenals does not occur in a split second. They gradually become enlarged hyper-cortisol or gradually atrophy coupled with lower cortisol output. Hence the model of transition mentioned above.

It's normal for high cortisol output with stress - that's the job of that gland, the problems arise and subsequently symptoms, when that stressor (in whatever form be it emotional, viral, bacterial, parasitical, auto-immune, toxicity, heavy metals etc)is chronic..unrelenting stress on a gland which, like any other system, become depleted when working around the clock. The real answer to adrenal problems is figuring out the stressor. There are MANY...not just emotional as often discussed.

The liver is renowned for it's rejeuvenating capabilities - hence why we can chop a portion off a healthy individual and transplant it...knowing it'll regenerate back to normal in a handful of months.
An alcoholic often destroys their liver. The stress of constant alcohol deteriorates the function slowly over time and then liver failure occurs. It's not an overnight process. Symptoms don't even show for years. This is an organ that is amazingly rejeuvenative.

There's been much heated discussion about "adrenal fatigue" online and it's a semantic ploy, once again, of the medical institution to shirk from its responsibility to providing excellent health care, by not embracing preventative health care before extreme diseased states like Adrenal Insufficiency or Cushing's manifests.

In you, DHEA is low and your cortisol is within range - actually quite a good reading of cortisol on the face of it.
If your DHEA was higher it would certainly seem to suggest that adrenal health is good but the DHEA and cortisol are calculated as a ratio. This needs to be factored in to better see how the adrenals are coping with stressors.

See here:

http://metabolichealing.com/key-integrated-functions-of-your-body/hormone-and...


http://articles.mercola.com/sites/articles/archive/2000/08/27/adrenals.aspx


http://www.anti-agingmd.com/dhea.html


http://www.metametrix.com/test-menu/profiles/hormones/adrenal-stress


So as your DHEA is low, despite being in range, with apparent normal cortisol output suggests adrenal stress and the body is using up DHEA stores to counter cortisol production which would be high if you had enough 'building blocks' to make as much cortisol as your body would want to, (as i said before everyone has their own optimum levels of hormones and the ranges serve as a generous wide guide of 'normal')

Supplementing with DHEA looks like an obvious solution and could help symptoms (if estrogen and testosterone are not high) but really you need to find out the underlying cause of adrenal dysfunction.

As you said you were diagnosed Hashi's and have not been treated for it - except with T3 which you didn't react well to, it could suggest your adrenals have down-graded to match your thyroid production. Adrenal/thyroid and ovaries are intrinsically tied homronally in their functioning.
You've had your fair share of severe emotional stress from what you've said which also would impact on 'down-graded due to thyroid issues' adrenal functioning.

It seems like a catch 22 because DHEA helps the immune function while cortisol suppresses it (hence why the ratio is important - these functions of DHEA and cortisol generally oppose oneanother)...with your low DHEA and not high cortisol your immune function isn't being supported or suppressed...perhaps this is the reason for the Hashi's?...worth pondering.

Have you tried Dessicated Natural Thyroid? 'Stop the Thyroid Madness' book talks of hundreds of people who don't do well on T3 only medication and found much improvement on thyroid glandular because it contains T2, T3, T4, and calcitonin. All the active ingredients for BALANCED thyroid health, rather than gun-shot approach with just T3.

It's quite concerning you've had Hashi's untreated for years. It could easily be the reason for everything swinging out of balance.


I'd recommend that book highly to you if you have Hashi's as it's a wealth of info summerised from hundreds of people who have been down the road of thyroid issuses coupled with adrenal issues. The website is very useful too.
Many times with thyroid issues there are D3, Iron, selenium, Calcium imbalances too. That book would be an enlightening read if you've had un-treated Hashi's for years.

I'm a believer in searching for the underlying cause, yet sometimes symptoms are so severe we are barely functioning so i also believe it's wise to treat them to help live from day to day a little better, enabling our bodies and minds to function better in order to figure out the under-lying cause if nothing else!

When you know the other sex hormone levels you could consider DHEA supplementation. I wouldn't recommend it for high estrogen or testosterone though as DHEA converts to these.
You're only 37 and from my recent researches DHEA levels in the 30's should be higher than 4.4 on average, as studies show. I'm 34 and my DHEA is even lower.

It's interesting you felt better for the night-time cortisol. I find that really intriguing. You felt better with lower levels of cortisol. It seems to suggest that the other levels, despite being normal, *could* be a stress for your body to produce. So in reality it's like your body isn't stressed with low levels, but to produce normal levels it's really working hard...does that make sense? Like you say - it makes you *feel* as if it's artificially high. (We are actually our own best doctors but to really figure out what we instinctively know is hard!)
A healthy person has no symptoms and normal cortisol and DHEA values.
A person (you) with chronic symptoms has normal cortisol values and low DHEA. Your body is working hard to produce normal values and the DHEA levels are showing this.

Have you tried an adrenal-health type protocol? Vitamin C, B5 (pantethine form), general good quality B complex (B-right from Jarrow's has many of the B's in the bio-available form, not synthetic cheap, useless B complex that most are). There are many protocols, some more extensive than others. I would start with C and the B's and see how you feel.
Some use adrenal glandulars and herbs too.
Licorice could be helpful to help maintain cortisol levels and boost BP.
'Omo' poster on here has posted a lot of info about licorice which is really interesting.


For more info on adrenal health it's worth reading through Dr Lam's website (scroll down for articles):
http://www.drlam.com/index.php


You should find a good doctor - and don't stop until you do! They are out there. Look for online recommendations perhaps of doctors in your area. It's important to find one who will work WITH you. And most of all be happy to!
You're barely functioning and are considering giving up a second career due to chronic health issues so diagnostics alongside symptoms can help pin-point the underlying imbalance/cause.
If you do start on Dessicated natural thyroid for the Hashi's you'll want thyroid labs to monitor progress.
As you are working full-time and have children it's not like you can spend all your time online researching the intricacies of endocrinology to self-navigate and heal yourself. There's a lot you can do yourself nutritionally, supplementally, and really try to de-stress your life emotionally, get plenty of rest...sounds fickle but it's essential.

Wishing you luck to you on your healing journey :-)









Tweet