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Avatar universal

Adrenal problems?

Hi there, I have been having problems feeling completely well on the T4-only medication I am on (50mcg) and this morning I woke up and had some pain in my lower back over my right kidney area. The pain was at best I can describe as being knife like or like an electric shock and I don't know why this could be.

My doctor has said my thyroid and ferritin results look fine, I'd like to know if I could possibly have an adrenal problem or if it's something else.


!Serum ferritin - Normal - No action needed: 28 (30-400)
TSH - Normal - no action needed: 0.60 (0.2-4.2)
Free T4 - Normal - no action needed: 15 (12-22)
Free T3 - Normal - no action needed: 4 (3.9-6.7)
Anti-TPO antibodies - Elevated level: 166 (<34)
27 Responses
1756321 tn?1547095325
Ferritin - not normal. FT4 and FT3 too low in the range.
Avatar universal
Thanks for reply,

I spoke to my doctor about the ferritin result. He has prescribed me ferrous sulphate 200mg but did so reluctantly because he told me they do not prescribe iron supplements until the ferritin is in single figures.

Re the Levothyroxine - I asked him about the interaction between that and the ferrous sulfate. He had no idea I was on Levothyroxine and has said that this medication is not on my repeat prescription.

The medication review date was meant to have been the start of November and has now been moved to the middle of November. So instead of it being in 6 weeks' time as planned it will now not be done until 10 weeks have passed.
1756321 tn?1547095325
"Ferritin is required for transport of T3 to cell nuclei and for the utilization of the T3 hormone." You want your ferritin in good supply. :)

Dr Mercola has an article Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels...

"In order to optimize the hormone replacement, the Free T3 and Free T4 should be above the median but below the upper end of the laboratory normal reference range. The goal for healthy young adults would be to have numbers close to the upper part of the range, and for cardiace and/or elderly patients, the numbers should be in the middle of its range. The Free T3 and Free T4 levels should be checked every month and the hormone therapy readjusted until the FT3 and FT4 levels are in the therapeutic range described."
Avatar universal
Thanks, the Free T3 and Free T4 need checking every month? :o That's news to me.

My doctor tests it every 6 months if normal, every 6 weeks if not.

I have changed doctors since my current one didn't want to move my medication review to the 6-week interval as planned. I asked the receptionist if I could have it moved and she said "no, the doctor has put it at mid-November on the screen". So I said "thank you" and walked to the other practice next door to them!

If this practice is not keen to have my medication review done as agreed (at the start of November) then I will look to have them done privately although I have done that before and all the doctor has done (when I show them the printout) is copy the results into my records.

They don't like it when I go private because whenever I show them thyroid test results they then say "we could have done that for you, you didn't have to go private and spend money on them." Errr, but you don't test the thyroid hormones when the TSH is normal...
1530171 tn?1448129593
I guess there's a "clash" between NHS and private, so best, ask for the
"non-established" testing, including more frequent testing, through NHS Doctors and once they turn your request down, then going private is your only option other than self-testing*.

Get testing for Reverse T3 ( rT3 )as well, since the fT3/rT3 ratio is probably the most reliable marker for low cellular thyroid function.
Look for a ratio of over 20 for healthy thyroid function. (divide Free T3 by reverse T3, but make sure you are in the same unit measurement for both.)

Red Star is right about your levels being low, however, the best way to gauge it is by the way you feel.

*The golden standard for thyroid testing to my opinion is still Dr. Barnes Basal Temperature in conjunction with your symptoms.
Just look it up online and you can consider trying it for a while and see how it works for you.
Note: You must follow the simple online instructions precisely!
You won't be able to adjust your dosage upwards, since you need a doctor's prescription, but at least you'll know what your thyroid function is,
anytime you wish (except at the very start of your menses).

Hope this helps.

Avatar universal
Thanks for your answer. Wow, this is a lot to take in!

Firstly, I have tried to get my blood test moved for my thyroid and the doctor will not budge from moving it from mid November to start of November. So I think going private for the blood tests is the next best thing

I think the reverse T3 test is expensive. I've looked at a private UK lab and it's about £300 which is money I don't have at the moment but I do hope to start a job in 2 weeks so that might change.

I've tried the bssal temperature graph before. I'll post the readings up if you would like to see them.

I have ordered a 24 saliva test for adrenal stress profile, would that be any good?
Avatar universal
*basal. Aargh, darn autocorrect!
1756321 tn?1547095325
How you feel is of course what you need to look at as well as Lightseeker mentions. Just posting some info from Dr Mercola to show "normal" range doesn't mean you are normal. My thyroid labs are currently optimal but I suffer symptoms due to cellular thyroid resistance. Frustrating~!

One of the obvious differences I could see between Hashimoto's thyroiditis and cellular thyroid resistance to do with the liver. So when thyroid hormone levels changed in the blood due to Hashimoto's thyroiditis, I saw rising liver enzymes, rising cholesterol, sudden weight gain without changing my diet and lower body temperature. But of interest, my body temp dropped to 35 C (95F) and my labs showed subclinical hypothyroidism. Hmmm.

Avatar universal
I see.

Oddly enough I have gained weight on the Levothyroxine but I lose it when I come off so something isn't right. I'll post the basal body temperatures up as Lightseeker suggests I get them done (I have quite a few days' worth of these).

My cholesterol has never been tested even though high cholesterol runs in the family...surely doctors would need to check things like that if they run in the family?
Avatar universal
06/10 SATURDAY - 36.2 degrees Celsius
07/10 SUNDAY - 36.3 degrees Celsius
08/10 MONDAY - 36.1 degrees Celsius
09/10 TUESDAY - 36.1 degrees Celsius
10/10 WEDNESDAY - 36.2 degrees Celsius
11/10 THURSDAY - 36.5 degrees Celsius
12/10 FRIDAY - 36.3 degrees Celsius
13/10 MONDAY - 36.1 degrees Celsius
14/10 TUESDAY - 35.9 degrees Celsius
1756321 tn?1547095325
This is a except from the book Running On Empty by Robyn Koumourou...

"It is not uncommon to start thyroid hormone therapy and find that your symptoms become worse before they get better. When you begin taking thyroxine the areas in the brain that control thyroid hormone production sense the increase in T4 levels within the blood stream.  This feedback system will then cause the thyroid glands natural production of thyroid hormones to slow down.  

Less natural T4 and T3 will then be produced and released and blood levels may remain stagnant or even decrease temporarily.  Less free T3 hormone available to the body will slow down cellular metabolism. The symptoms of hypothyroidism may become worse until an increase in thyroxine is taken or an optimal dose is found.

On the other end of the scale, some people are particularly sensitive to T4 and find that their initial T4 dose produces hyperthyroid symptoms.  In these cases smaller starting doses are required with smaller and slower increases."

1756321 tn?1547095325
Well you aren't hyperthyroid with those body temps!
Avatar universal
Thanks. :) I looked at getting hold of this book via Amazon, it's currently unavailable but it could be because I'm in the UK.

The lowest recorded temperature I've ever, ever, ever had - and this is going back to 2008 when I started to feel very hot despite it being the middle of December - was 34.3 degrees Celsius. I think that might have been the beginning of the Hashimoto's but I can speculate about that all the time which won't change the way things are now.

So -- maybe I need some form of adrenal support? One of my friends bought something called Adrenal Cortex. Not sure if that's very well known at all.

She also recommended I do the saliva test for cortisol (which for me is very hard to do because although I'm only giving a small sample my mouth goes dry really quickly after 1-2 spits)

I bought some T3 a while back (Cytomel) and one tablet equals either 25mcg or 30mcg I'm not sure. My doctor doesn't know I bought it (being in the UK) and so because I know about ferritin needing to be at least 70 for the conversion of T4 to T3 to be optimal I'm not sure what I need to do.
1756321 tn?1547095325
I live in Australia and hired the book out from the library. It's a pretty old book now but the info from the book is 5 years worth of research and endorsed by Thyroid Australia. I've read plenty of other thyroid books as well. You might find a few good books at your local library.

When I started thyroxine, besides a week of hyperthyroid symptoms and another month of worsening hypothyroid symptoms, I had to deal very bad untreated adrenal fatigue (didn't have time to treat the condition first due to severe bradypnea).  My symptoms I had to "ride out" included sleeping 15 + hours a day in a coma/drugged like state and if conscious in bed I could barely move or speak (able to slur a few words out at best), extreme dizziness, numbness.

There are a few home tests for adrenal fatigue if you are interested. I wrote an old answer about this but at the time I didn't have a blood pressure machine to do the first test.


1530171 tn?1448129593
This post was typed  yesterday, but was unable to submit as MedHelp was down for maintenance.

And BTW, your temperature readings are indicative of under-regulated (type one or type 2) hypothyroid and/or primary adrenal fatigue with secondary hypothyroidism.

Reverse rT3 converts from T4, so Levothyroixine- if this is indeed the case -won't serve you well, so  Cytomel would be better suited to address your low thyroid and dosing would be according to symptoms, with ongoing dose adjustments.
This of course barring  the presence of adrenal fatigue, where addressing low thyroid becomes very delicate.

Not sure about attempting to address the adrenal issues on your own, but please read on.

From my saved post of yesterday:

"It would be good -the 24 saliva test for adrenal stress profile-if you have a knowledgeable practitioner to guide you though all this, as it can be rather complex.
In prolonged emotional or physiological stress, your cortisol levels will be dysregulated and excess T4 will likely be converted to rT3 (reverse T3) attempting to put the body in a low energy state for adrenal recovery, so any effort to address the resulting low thyroid state by increasing your thyroid hormone intake, is contra-indicated.

You're welcome to post your basal temp. results any time.
(You already did!)

The rT3 is an expensive test as it is rather complex.
Blue Horizon Labs in the UK (not necessarily a recommendation, just FYI)
charges £111.15, plus single medical fee of £29.95 for the rT3 test."

Hope this helps.
Avatar universal
Ok, will look at this post you linked me to. Thanks. :)
Avatar universal
Thanks Niko for your reply.

I have Cytomel here at home with me. But because of its potency I'm wary about starting it. I think I tried it in the past and I took the whole 25/30mcg dose. Within a few days I was sweating and had a racing heart. I knew the only thing I had done any differently was take the Cytomel and then I stopped. Would I need to cut the tablet up so I don't get much of a hyperthyroid state?

Ah yes, I use Blue Horizon for the private bloods. I have no income and I've been refused the job which I was hoping to use the money for to pay for the blood tests so this might have to wait. I do have the Cytomel for now but I have no knowledgeable practitioner to guide me through the 24 saliva test.

Is it possible that with my earlier blood test results when I was not on Levothyroxine I could have secondary hypothyroidism as my TSH has been suppressed. This has happened twice.

July 2014

TSH: 0.01 (0.2-4.2)
FT3: 7.1 (3.9-6.7)
FT4: 21 (12-22)

August 2014

TSH: 0.10 (0.2-4.2)
FT3: 6.9 (3.1-6.8)
FT4: 26 (12-22)
Avatar universal
Test 1 - Blood pressure

Lying down - 114/72 heart rate: 50

Standing - 126/85 heart rate: 68

Test 2 - Iris contraction test

Iris wavers between contracting and relaxing but manages to open and stay open 30 seconds after.

Test 3 - White line test

Line stays white.
1530171 tn?1448129593
Secondary hypothyroidism can also be experienced along with primary hypothyroidism, should the latter have preceded the  adrenal fatigue
Careful with the cytomel which is all T3 and does not need conversion.
I would try a starting dose of 5 mcg and go from there, if you planning to
attempt self-treatment.

BTW try gluten free/dairy free to see if it helps.
Most Hashimoto's & Hypothyroid sufferers have gluten intolerance and don't even know it!
The gluten molecules-mainly from gmo grains but not excluding non-gmo- resemble the TPO(Thyroid Peroxidase - an enzyme necessary for the signalling Thyroid hormone production) molecules and thus the immune system in its response against gluten, attacks the TPO in the Thyroid also!

Dairy cross reacts with gluten in 50% of patients, meaning that people with
gluten sensitivity will also be sensitive to dairy, as the immune system erroneously responds to dairy (casein is the main culprit) the same as gluten. In other words it can mimic symptoms of gluten sensitivity.
There are many other cross-reactive foods with gluten, but not as common as dairy.

Avatar universal
Thanks for suggesting what dose of Cytomel I need to take. :)

I've ordered a new private blood test as my own doctor will not review my thyroid function at the 6 weeks as planned. He was planning to do it at 10 weeks instead.

How long do I need to eliminate gluten and dairy for?
1756321 tn?1547095325
Not a surprising adrenal result with non optimal thyroid treatment. I don't have any issues with gluten personally not to mention I have no wrinkly fingers which is a sign of gluten intolerance. I do have lactose intolerance although I can eat cheese since it's very low in lactose.
Avatar universal
When I eat cheese it gives me acid reflux - I say acid reflux because I get nausea, a bloated feeling and a tendency to burp after consuming cheese. If I belch that usually gives me a sick taste in my mouth and then I start panicking that I'm going to be sick.

Sticking my head out of the window helps during these episodes.

I don't know about wrinkles in my fingertips but I do get vertical lines in them.
1530171 tn?1448129593
In gluten regards to gluten intolerance FYI
Look into Gliadin test (urine), by Cyrex labs. They test 12 forms-not just the alpha ordered by most doctors- of gliadins regarding gluten intolerance (not necessarily digestive).
Now they can also test which part of the body is affected!
Not everyone experiences gluten sensitivity/intolerance the same.

The effects of gluten can linger around for many months after going gf,
so for testing at least 3 months, but you might experience improvement much sooner.
1756321 tn?1547095325
Those symptoms might be due to lactose perhaps? It depends if you feel the same drinking milk. I eat aged cheddar just to add which lists less than 0.5 grams of lactose. There is an article on this  The Best Cheeses to Eat If You're Lactose Intolerant.

Vertical lines eh?  Sounds like gluten issues. If you want to see pics of this google: "+: wrinkly fingers show gluten intolerance". My fingers are smooth. Even so I don't eat a lot of gluten anyway.

LS, I live in Australia and various labs available in the US aren't available here. And you can't order any test online either. It has to be done through a doctor. I went through the RCPA manual - The Royal College of Pathologists Australasia list of tests available here and the only one close to the test you list is Gliadin antibodies - serum test. I've had that test done a while back since Celiac is one of the diseases linked to Hashi's.  
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