Autoimmune Thyroid Disease

An Unfortunate and Lengthy Adventure in Misdiagnosis

Adrenal insufficiency and hypothyroidism

with 7 comments

Every book I have read on the thyroid so far (admittedly, not a mainstream reading list, but certainly a right-headed one), has warned that hypothyroidism can cause acute adrenal insufficiency. The mainstream endocrinology view is: no, it doesn’t, you’re talking altie nonsense. The view from the patients, the patient advocacy organisations, and the specialist thyroid doctors who treat based on symptoms rather than blood tests, is yes, it can.

It is well known that thyroxine treatment can precipitate an Addisonian crisis in patients with subclinical adrenal insufficiency.

There is, in fact, an autoimmune condition called Polyglandular Autoimmune Syndrome Type II, that causes multiple autoimmune attacks:

Polyglandular autoimmune syndrome type II (PGA-II) is the most common of the immunoendocrinopathy syndromes. It is characterized by the obligatory occurrence of autoimmune Addison’s disease in combination with thyroid autoimmune diseases and/or type 1 diabetes mellitus (also known as insulin-dependent diabetes mellitus, or IDDM). Primary hypogonadism, myasthenia gravis, and celiac disease also are commonly observed in this syndrome.

The specialist thyroid doctors whose books I have been reading suggest that a number of their patients can become sick with a mild/acute adrenal crisis a few weeks after beginning thyroxine treatment, as thyroxine treatment taxes the already very stressed adrenals when treatment is first begun.

I’ve had classic adrenal insufficiency symptoms for a long time, beginning six or seven years ago with reactive hypoglycaemia and afternoon crashes, brain fog, and not being able to wake up and function until after my evening meal. In fact, years ago adrenal insufficiency was one of my many theories, along with hypothyroidism, (and progesterone deficiency), as to what might be wrong with me.

Before I started taking thyroxine, I was a weak, trembling wreak who couldn’t breathe and was in an enormous amount of neuropathic pain. I seemed to have a lot of adrenaline running around. The thyroxine took a few days to start working, and then I began to feel better, and I felt better for a couple of weeks.

For the last few days I have been feeling worse. Very old symptoms I used to have before I went on the failsafe diet have reappeared – brain fog all day, inability to wake up until after my evening meal, apparent hypoglycaemia, and so on. I’ve been experiencing orthostatic hypotension. This has been getting worse. Today I almost fainted on three separate occassions after standing up, and a couple of days ago I had a bad moment in the supermarket that has prompted me to buy a medic alert bracelet. The thought of going to the supermarket actually fills me with dread. That’s how ill I’m feeling.

My basal body temperature has been declining. I’m now back to my starting point of 35.5°C. For the last three days I have been having trouble getting into the 36°C range throughout the day. I didn’t know, but this can also be a sign of adrenal insufficiency. So are the sudden salt and sugar cravings I have.

Doctor Skinner says he has, rarely, diagnosed Addison’s disease in people who present at his consultancy with hypothyroid symptoms, though they have other distinct features too. Most of his patients don’t require adrenal support, they are able to work through the symptoms and eventually begin responding to treatment, however a small number do have a coexisting problem with their adrenals, possibly due to pituitary dysfunction, which makes it rather hard to spot as one of the standard diagnostic tests for spotting adrenal dysfunction is to test that the adrenals respond to the pituitary hormone! Useless if your pituitary is shot. In these cases he will prescribe a small amount of prednisolone for a few weeks.

Doctor Durrant-Peatfield goes much further, suggesting that many patients with hypothyroidism have concurrent adrenal fatigue and should begin an adrenal regimen before even going near thyroid hormone, as he has seen many adverse reactions that are corrected with adrenal gland supplementation, or in more extreme cases, prednisolone. I had no idea, but natural dried adrenal gland and pituitary gland supplements are available as food supplements in the UK (and the US), from Nutri Ltd and Nutri Meds. In the UK, Nutri Ltd sell “Nutri Adrenal”. This is available online from a number of places, including The Nutri Centre, and Sunshine Health Shop.

Today I’ve been very ill – so ill I’m not sure what to do. I’m very restless, which is another symptom of adrenal fatigue, and despite feeling so ill I had to have my partner accompany me to the supermarket in case I fainted, I then decided to take myself off into the city centre to window shop. I wasn’t entirely on the right planet, and I managed to catch the wrong bus home and had to dive out at the critical moment when it veered off down the wrong road. I walked home, took my temperature, which was alarmingly low – 35.3°C – despite sweating, which must be a mistake – and plonked myself in a hot bath until it gave me palpitations – or what felt like palpitations, but was in fact a bpm of 75, the highest reading I’ve had in months.

What does it all mean? I do feel as though I’ve run out of adrenaline. I can’t cope with the simplest things at the moment, like the dog barking at me. The house is a tip as I’m too fatigued and faint to tidy, as bending over and picking things up tends to bring on moments of greying out. In my partner’s words, “it looks like a mad person lives here,” which I don’t suppose is far off the truth. Our central heating boiler has been broken for about a month now, because I simply can’t cope with the thought of facing the phone call to the support team and jumping through all of the hoops to get an engineer out (my partner could do this for me, but he seems to enjoy getting into Mexican standoffs with me over making phone calls in the hopes that it will “socialise” me or teach me to “grow up” or something). It’s not fun living in a cold house when you have a thyroid problem.

I don’t think my allopathic GP is going to take any of this “acute adrenal crisis” nonsense. I’ve bought some dried adrenal gland and some hydrocortisone cream off the interwebs, but they won’t arrive for a few days. I could buy prednisolone perfectly legally, but I’m afeared (sic) to take it without medical supervision. I ended up glugging quite a lot of salt and vitamin C earlier, with my evening meal. I think protein and salt are quite crucial to the sense of feeling better I get. I wondered whether I was hypoglycaemic, but my blood sugar was 5.8 mmol shortly after eating some chicken drumsticks. I rummaged in the medical kit until I found some old, out of date hydrocortisone cream, which I randomly chose to rub into my feet in the hopes the hydrocortisone would do me some good. Normally I have vile, trembling reactions to hydrocortisone, but I just calmed down instead. This evening, I don’t feel too bad.

I don’t know whether to skip my thyroid hormone tomorrow in case I get even worse, but then, if this is simply a thyroid hormone deficiency, I will make it worse. My partner wants me to go and see the doctor on Monday, which would be a week too early, and will make me look like a hypochondriac. I may have to make him come along for moral support. Last week I felt confident and my memory was working better, and I was almost sure I could convince the doctor to refer me to Dr Skinner. Now I wonder what on earth will happen.

I’m feeling pretty down in the dumps about all of this. There was a small book launch I really wanted to go to next week, which is in Nottingham in the evening, and I simply don’t think I’ll be well enough to travel down to it and socialise. I just thought there would be one long happy getting better now I’ve been diagnosed, but there seem to be so many damned obstacles in my way that are designed to stress me out with worry for weeks on end. These obstacles probably look small to an outsider, but right now they feel like mountains to me, and the thought of dealing with it all is just so fatiguing.


Written by alienrobotgirl

7 June, 2009 at 12:02 am

Posted in Thyroid

7 Responses

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  1. “These obstacles probably look small to an outsider, but right now they feel like mountains to me, and the thought of dealing with it all is just so fatiguing.”

    Doesn’t look small to me; I get it. You ARE dealing with mountains right now.

    I sort of avoided/ignored the adrenal stuff for a long time because I didn’t know how much was “woo-woo” and how much was legit and the ones I trusted for my thyroid care “weren’t” into the adrenal fatigue theories. I tend to think it’s legit now, esp as I’ve tuned into the “tired but wired” feeling that is characteristic of adrenal fatigue.

    I took some saliva tests a few years back and was abnormally low on the cortisol, esp in the afternoon, my worst time. But I didn’t know what to do with those results and like you, didn’t want to monkey around with hormonal supplements without guidance I trusted.

    When I have a fast, quick moment of intense stress, like when driving and something nearly happens in traffic, for a split second, I feel a sort of shock through my body that I’m quite sure is adrenaline. I never used to get that feeling from those intense moments. I hate how I feel for a while afterwards, very jittery and nervous.

    The best book I read (that didn’t feel too “out there” on this adrenal-thyroid combo was Stop the Thyroid Madness: A Patient Revolution Against Decades of Inferior Thyroid Treatment, by Janie A. Bowthorpe, M.Ed, copyright 2008. She’s a thyroid patient, too, and compiled a lot of really good resource information for thyroid patients. I know you’re well versed in this, but each resource usually has perspectives the others don’t have, and that can be useful for an individualized approach.


    7 June, 2009 at 4:43 am

  2. Thanks gatg, I have her book on order from the states! 🙂

    The hydrocortisone seems to have made a world of difference to my fatigue/crashing today, and, surprisingly, to my body temperature.


    7 June, 2009 at 1:51 pm

  3. What do you feel about adrenal stress profiles and thyroid tests you can order online? I know they’re quite expensive but it really helps to have something to work with rather than shooting in the dark. : )

    Genova seem to do a few, e.g.

    Feel better soon!


    7 June, 2009 at 5:06 pm

  4. Oh the other thing, I’ve always thought that glandular supps would be aminey? That’s the main reason I’ve never bothered with them.


    7 June, 2009 at 5:30 pm

  5. I’m thinking of ordering one from them actually!


    8 June, 2009 at 1:37 am

  6. Apparently they are made from fresh, de-fatted, freeze-dried glands. I don’t know how inherently aminey they would be as I haven’t tried them yet. I’m desperate to try some armour thyroid, but I have to wait until after my blood test before I can start sneaking stuff!


    8 June, 2009 at 1:39 am

  7. […] Posted in Uncategorized by Alien Robot Girl on 8 June 2009 Well, following on from yesterday, the hydrocortisone cream has made a definite difference. I have been free of brain fog for most of […]

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