Gail's Thyroid Tips
ADRENAL-THYROID CONNECTION:

Now let’s move on to the adrenal issue. This is vitally
important to thyroid patients for 2 big reasons.

First of all, the job of the adrenal gland is to produce
adrenal hormones. One of these hormones is cortisol. This
is the hormone your body demands when it is faced with
any kind of stress. Stress does not just mean having your
dog die or flunking a test. Stress is as simple as going
outside on a hot (or cold) day, or eating lunch.
Menstruation is a stress to the body. The adrenal gland
reacts the same way when you eat lunch as when your
dog dies. It’s all the same to your adrenals.

Another thing produced by the adrenals is DHEA. DHEA is
a hormone precursor; in a healthy body it is converted into
the sex hormones (testosterone, progesterone, estrogen,
etc). DHEA is absolutely vital to our health. Here is a very
brief link about DHEA (this isn’t my best one since it talks
only about sexual and mental health, but it’s something! I’ll
get the others set up later). DHEA is important to prevent
Alzheimer’s, heart disease, diabetes, cancer, skin
problems, and about a million other things. Testosterone,
as you may know, is what gives us our sex drive. Men
have tons more testosterone than women (which is the
main reason why their minds always seem to be in the
gutter!). Where does testosterone come from? It is made
by the body from DHEA. DHEA is made by the adrenals
and is turned into all the sex hormones (estrogen,
progesterone, etc). So, are you suffering from no sex
drive? You probably have low testosterone which means
you probably have low DHEA and why would you have low
DHEA? If your adrenals aren’t working well. If you are a
lactating hypothyroid woman (but aren’t pregnant or
nursing a baby), you probably need DHEA because DHEA
turns into testosterone. If you have had your prolactin
measured and the test came back normal but you lactate
anyway, you may very well be deficient in testosterone. In
order to not lactate, the ratio between testosterone and
prolactin must be correct. If you have "normal" prolactin
but very low testosterone, it is just like having high
prolactin. http://www.wholehealthmd.com/print/view/1,1560,
AR_955,00.html

Decreased libido, galactorrhea, obesity, increase in
abdominal fat, pubic hair loss, decreased muscle mass
and strength, clitoral atrophy, increased risk of breast
cancer, lack of motivation, premature ovarian failure,
osteoporosis, decreased memory, increased risk of
Alzheimer’s, increased risk of diabetes, decreased feeling
of well-being, depression, and fatigue are more symptoms
of low testosterone. Read through these links and see if
you recognize yourself there.

http://www.mja.com.au/public/issues/jun7/davis/davis.html

http://www.stenlake.com.au/showdocument.asp?
DocumentID=152 In this article, a chemist has found that
testosterone can protect against Lupus.

Here is another article with some really great information
about testosterone.  Take note of where the author says
that both free and bound testosterone are the components
of total serum testosterone (TST).  Free testosterone is
what your body can use.  Bound testosterone cannot be
used until it is unbound.  So you see, your TST might be a
nice healthy number, and yet you may have all the signs of
low testosterone because all of your testosterone is
bound.  What binds it?  Sex Hormone Binding Globulin
(SHBG).  If you have too much SHBG, it can bind up all
your sex hormones so you cannot use them.
http://www.digitalnaturopath.com/treat/T12321.html

Another possibility is that you are making DHEA but that
your body simply isn’t converting it into the various sex
hormones.

Here is an article on galactorrhea (chronic lactation): http:
//www.uspharmacist.com/NewLook/DisplayArticle.cfm?
item_num=141

http://www.nal.usda.
gov/ttic/tektran/data/000009/42/0000094260.html This
study may be of little interest to you unless you are
lactating for no reason (or if you are a dairy farmer!). This
is a study done on cows showing that changes in their
deiodinase activity plays a role in their lactation. My
husband found this study as he researched lactation
because the one thyroid problem I have that has not gone
away is lactation. I weaned my last baby in Nov ’98 and
STILL lactate! Hasn’t ever stopped in all that time (but I
least I feel great!). So we’re still researching this one. If it
turns out that changes in your deiodinase activity affects
lactation that sure would explain what’s going on in a lot of
us hypo women!

And here is a natural remedy to stop lactation. http://www.
herb.co.za/herbal/sage.htm

You can get DHEA in the vitamin section of nearly any
store (Wal-Mart has it). Notice in the link above that it took
up to 4 months for the patients to see results (http://www.
wholehealthmd.com/print/view/1,1560,AR_955,00.html).
Also, you do not want to take too much. My doctor has me
take 25 mg daily Monday through Friday with a break on
the weekends (the dose for men is 50 mg daily). If you
start taking DHEA and notice that you are getting acne like
a teenager, you don’t need that much. Quit taking it
altogether until the acne clears up and then you can try
taking a half-dose 3 days/week instead. If the acne comes
back, your DHEA levels are probably just fine. I’m not
getting any acne at all on my dose, but I am not surprised
considering that I had a lab test showing that my adrenals
don’t work (and by the way, if DHEA gives you acne, that
does not mean your cortisol levels are OK).

Here is another article that concerns osteoporosis, but on
page 4 you will see a discussion of DHEA and the role it
plays in bone density. http://www.thorne.
com/altmedrev/fulltext/osteo2-1.html

Now, the first reason why hypothyroid women should be
concerned about their adrenals is that the adrenal gland is
highly dependent upon thyroid hormone. It cannot function
properly if you become hypothyroid. I have a study (I’ve
got to find it again) which shows that almost 100% of
women with thyroid disease are deficient in DHEA. Yep,
that’s right! If you’ve got thyroid disease, you are probably
facing an adrenal insufficiency. This is especially true if you
were hypothyroid for a long time and denied treatment (I
was denied treatment for more than 5 years). Also, if you
spend years on incomplete thyroid therapy (such as the
synthetic thyroid hormones), you are more likely to have
weak adrenals. The adrenals just can’t do their job if they’
re getting only T4.

And the thyroid gland cannot do its job without the
adrenals. I have a great article discussing this:
Peatfield_Suggest.htm (if you print nothing else, print this
article). The amazing Dr. Barry Durrant-Peatfield of Great
Britain has found repeatedly that if a woman on thyroid
therapy continues to exhibit symptoms, if he treats her
adrenals, her symptoms go away. Without the adrenal
hormones, the body cannot use the thyroid hormones.
Treatment of the adrenals results in the thyroid hormone
finally making it into the cells and tissues. This usually
results in the patient being able to lower her thyroid
medication. In addition, over time the adrenal support will
help heal the damaged cell receptor sites so that thyroid
hormone can pass into the cell to the mitochondria again.
In other words, proper adrenal support means the
difference between a life of good health and a life full of
nagging, miserable, painful hypo symptoms.

Now, this is a really radical and unusual approach to
thyroid disease! But it shouldn’t be! Notice I said that he
treats the adrenals of his patients. What a concept; did
you know that actually, all hypothyroid women are
supposed to have their adrenals tested BEFORE getting
any kind of thyroid hormone? Yep! If you read the inserts
which accompany thyroid medications, you will find that the
contra-indication for the use of thyroid hormone is
"uncorrected adrenal insufficiency." And you do NOT know
if a patient has adrenal insufficiency if you do not test for it.
Here are the links to the cytomel and synthroid inserts, but
you will find this to be true on the insert of EVERY thyroid
medication.

http://www.rxmed.com/monographs/cytomel.html

http://www.druginfonet.com/synthrod.htm

This should make you pretty mad. Why? Because if your
adrenals have become weakened by your thyroid disease
and aren’t functioning well, when you are put on thyroid
hormone it can cause an adrenal crisis. If the situation is
very bad, it can KILL you. That’s right---death. But are the
doctors testing our adrenals ahead of time? No, they are
not, even though it clearly states that they must do so in
the Physicians Desk Reference. Every doctor who
prescribes thyroid hormone without testing the patient’s
adrenals first is putting the patient’s life at risk (in other
words, almost every doctor on this planet).

Here is an article by a doctor discussing the treatment of
hypothyroidism. On page 4, you will see a section entitled
"Special Cases: Recent Heart Attacks and Weak Adrenal
Function." The paragraph about the adrenals describes me
perfectly! That is me all over and a lot of women I know.
Go to the very next section on page 5 entitled "Problems in
Converting T4 to the T3 Hormone." Reading that
paragraph you will see that cortisol is necessary for the
body to convert T4 into T3. Thus we must have our
adrenals working in order to utilize the oral thyroid
hormone we take. http://www.healthy.
net/asp/templates/article.asp?PageType=Article&ID=528

So you see, if the body has poor thyroid function, poor
adrenal function will result. And then the doctor will start to
give you thyroid hormone but you won’t feel better because
your body simply can’t use the thyroid without cortisol. You
must address adrenal function. And you are supposed to
address it FIRST. Yet I was on synthroid for a whole year
before I got my first adrenal test. And the only reason I got
the test then was because my husband went to my doctor
and demanded it, not because the doctor thought of it
himself. Meanwhile, by that time my adrenals were so
weakened and non-functional that I was near death---all
because no doctor had bothered to check them before
giving me synthroid. Then the pure T4 weakened my
adrenals even further so they shut down almost
completely; it nearly killed me.

Are you a woman who is hypothyroid and yet any tiny
amount of oral hormone gives you hyPERthyroid
symptoms? When I read these articles about adrenal
function and how oral thyroid taken by a hypoadrenal
person can cause hyPERthyroid symptoms, I have to
wonder if perhaps you need an adrenal test.

Read these next two articles and take especial note of
"Table 1" in each of these articles. Notice the list of
symptoms hypoadrenal people experience. See how they
sound almost exactly like hypothyroid symptoms? Makes
you wonder which came first, low adrenal or low thyroid….
Chicken and the egg. And you must fix both to be healthy.

Dean_Adrenal.htm

http://www.advancedhealing.com/articles/articlestress-001.
htm

The first article, just above Table 1, points out that you
must check adrenals before giving thyroid hormone. He
also points out that none of the doctors in this world are
doing so even though it is clearly stated in the Physician’s
Desk Reference. He even quotes the Physician’s Desk
Reference.

This next article also discusses adrenal insufficiency. The
big thing that stands out to me in this article is where the
writer mentions that body temperature may be below
normal. That’s true for hypothyroid patients also. Have you
read articles in which the Barnes method is discussed and
the writer often says it can take up to a year after thyroid
hormone is begun for the patient’s body temperature to
come up to normal? Well, I suspect that’s because the
patient’s adrenals have not been addressed! If you
address both the adrenals and the thyroid together, the
patient will feel much better much sooner. Without cortisol,
she cannot use thyroid hormone properly and without
thyroid she will not make cortisol. Neither the thyroid nor
the adrenal can correct without the other. You must treat
both together! http://www.merck.
com/pubs/mmanual/section2/chapter9/9b.htm

And here is an interview with the Drs. Shames, who
specialize in thyroid disorders and the adrenal connection.
In this interview you will note that they say you can actually
diagnose adrenal weakness by default if your thyroid
patient experiences a WORSENING of symptoms when
she is given thyroid hormone. Now, I greatly admire the
Drs. Shames and if I lived in Boca-Raton FL I’d choose
them to treat my disease. But what angers me about this
interview is how they completely ignore the adrenal issue
until AFTER they treat a patient for her thyroid. They say
"oh, if you are on thyroid drugs and still don’t feel well,
maybe it’s your adrenals." This is WRONG! The adrenals
are supposed to be treated FIRST. Go back and read
those thyroid drug inserts; they clearly state that doctors
must not prescribe thyroid meds if there is adrenal
insufficiency. And yet the doctors---even the great Drs.
Shames---keep giving us thyroid meds and waiting until we
collapse before checking adrenals (if they bother to check
them at all). This bit of malpractice on the part of doctors
can KILL you. http://thyroid.about.
com/health/thyroid/library/weekly/aa052801a.htm

So, what is an adrenal test? WATCH OUT! My husband
found all this wonderful information about adrenal function
and how you must address this issue in thyroid patients,
but we had a hard time convincing the doctors to do so. I
was sent to an endocrinologist because all the GPs who
had seen me couldn’t figure out why I still wasn’t feeling
well even with a low TSH. They decided there must be
further endocrine imbalances (adrenals are part of the
endocrine system) and a specialist was needed. So I went
to the local Endo and got her to admit that there is an
adrenal-thyroid connection, but she refused to run tests. I
went back to the GP and told him what had happened. I
was so upset that he immediately ordered an 8 AM serum
cortisol test. See, the way that cortisol works is your levels
are much higher in the morning and they fall throughout the
day. In addition, cortisol is not stored anywhere; the body
makes it as it needs it. So I got an 8 AM cortisol test and I
had 6.7 with the normal range being 6.2 to 29. In spite of
this very low number, the doctor said "Well, it’s normal"
and sent me home. And a morning serum cortisol is the
only test most doctors will run.

I changed doctors and got myself put on Armour. I
immediately began to feel better but still had many
unresolved symptoms because this man was afraid to give
me enough medication! (it has T3 in it, after all, so must be
bad…..). So I changed to a Top Doc (http://www.thyroid.
about.com/health/thyroid/library/weekly/bldoc1.htm I drive
2 hours to get to his office and then 2 hours back) and he
just about died when he saw my cortisol test! He said that
clearly I was in bad shape since I was at the very bottom
of normal range and the levels only fall off from there. He
likes to see your morning number between 12 and 15 for
optimum health.

So he ran an all-day adrenal test on me. THIS IS VITAL!!!!
Even if your insurance won’t pay for it, get this test! What
you do is spit in test-tubes at 8 AM, noon, 4 PM, and
midnight. I got the test and it showed that I was still
starting off in the low normal range at 8 AM, but it was
better than it had been back on synthroid. Armour is not
only better for your body but also better for your adrenals;
my 8 AM cortisol level had come up to 11 after 2 months
on Armour. But it also showed that I was even farther
down in the normal range at noon, was below normal by 4
PM, and had no adrenal function at all by midnight. So you
see, had my new doctor given me only an 8 AM cortisol
test like the last guy did, it would have showed that I was
just fine, and yet the all day test proved conclusively that I
was close to death by the end of the day, every day. One
of the symptoms I had at this time which hadn’t improved
from the Armour was aching feet and breathing problems
while sleeping (I would either snore or have sleep apnea or
chokes where I would stop breathing completely).
However, the same day that the doctor started me on oral
cortisol, my feet quit hurting, I had enormous energy, and
all my sleep problems disappeared. I feel more rested and
energetic than I have felt in years! It totally alleviated every
single remaining "thyroid" symptom I was dealing with.
While Armour did great things for me and nearly restored
me to normal (on synthroid, I was actually dying; my new
doctor told me it is just a miracle I did not actually DIE at
some point over the last few years while my health was so
mismanaged), the oral cortisol turned back the clock 10
years. I went from feeling like a decrepit 90-yr-old to a 25-
yr-old (and I’m 34, by the way). Go back and read again
the "Table 1" on those adrenal links I listed above. Those
symptoms, especially the aching and pain, are always
written off as hypothyroid symptoms and fibromyalgia. But
if your adrenals are weak, then even T3 isn’t going to cure
all your ills. You must begin taking cortisol and then you will
feel like new. I want to reiterate how much my adrenal
function improved after a couple months on Armour. On
synthroid my 8 AM cortisol level was only 6.7. After 2
months on a too-low dose of Armour, my 8 AM level
moved up to 11. I would argue that the adrenals need
more than just synthroid to function well; these glands
probably require either T2 or T3 or both for good function.

You can get this all day adrenal test for only $106 dollars
from the Great Smokies Diagnostic Laboratory (www.gsdl.
com). They are in North Carolina but they will overnight
mail to you a special test kit (at their expense) and give
you a prepaid mailer to overnight it back to them. The
phone number of Great Smokies is 800-522-4762 and they
are worth every penny because very few labs do this test
at all. They take insurance payments, or you can pay up
front and file the insurance yourself, which costs less. Your
doctor has to order the test, but all he has to do is call that
toll-free number and they will set up an account with his
medical license to authorize your lab work. (and in the
meantime, you may want to peruse their website to see
what all you can learn from them too!)

Some of you have told me that you had an ACTH test,
which is supposed to tell you if your adrenals are working
properly. And the doctor told you that your test was normal
so you don’t need adrenal support. Well, an ACTH test is
similar to a TSH test; ACTH is the hormone which tells the
adrenals to get busy and make cortisol. So if your ACTH is
elevated, then your adrenals aren’t working, right?

I had an ACTH test too, when I first told a doctor that I had
concerns about my adrenal function. My results were
perfectly normal so he decided that I did not have adrenal
problems. I changed doctors not long after that and was
given the all-day cortisol test. This test showed that I had
almost no adrenal function by evening and that by midnight,
my adrenals were nearly completely shut down. So as you
can see, that ACTH test was worthless.

There is another type of "all day" adrenal test your doctor
may offer you. This is a test in which you collect all of your
urine in the same jug for a full 24 hours. This test is pretty
worthless too; don’t get excited if your doctor orders it.
The type of day-long cortisol test that you must request is
an exam that takes individual measurements of your
cortisol levels at least 4 times throughout the day. This test
is usually referred to as an "Adrenocortex Stress Profile."
For further information on the types of tests which are
good and those which are worthless, go back to the
interview with the Drs. Shames. http://thyroid.about.
com/health/thyroid/library/weekly/aa052801a.htm

I offer this to you as further emphasis on the importance of
having an ALL DAY cortisol stress index to determine if
your adrenals really are ok. My 8 AM cortisol test was
fine. My ACTH test was fine. And yet the all day cortisol
test showed adrenal shut-down by evening, which nearly
killed me. Every night in my sleep I wasn’t breathing much
of the time. Go back to that article by Dr. Durrant-
Peatfield; he has an explanation for this. Peatfield_Suggest.
htm  It is because your thyroid disease has weakened your
entire body so much (since every cell you have depends on
thyroid hormone) that even your poor little pituitary gland
can no longer produce ACTH in proper amounts to
stimulate your adrenals. So the ACTH test is worthless; if
the number is low the doctor will believe your adrenals are
fine (just like a low TSH means you must have lots of
thyroid hormone in your body, right?). When really that low
ACTH may mean your body is so weakened by thyroid
disease that your pituitary is unable to do its job either.
Keep this in mind; Dr. Durrant-Peatfield also points out that
this very same thing can be true about low TSH. If you are
hypo from head to toe and your TSH isn’t real high, your
doctor will usually send you home. But if you are really low
in thyroid, your pituitary may be so weakened by that fact
that it can’t even produce TSH.

Another point I’d like to make: if your all day adrenal test
comes back showing that you are somewhere in the
normal range all day, even at midnight, but the numbers
are rock-bottom, that’s not good enough. My doctor wasn’t
satisfied even with that 11 I had at 8 AM. He wants your 8
AM level between 12 and 15 for optimum health. That’s
right at mid-range and this is where you will feel best. Too
much is not good for you but too little is bad also. You
need to be right in the middle throughout the day for the
best health. So if you are scraping along the bottom of the
reference range all day long, it’s no wonder you aren’t
feeling good. Your doctor should not look at this and say
"OK, it’s still in normal range so go home and take some
Prozac." He should say "No wonder you feel dragged out
and exhausted and achy. You are barely scraping along
with hardly any cortisol at all! Clearly you will feel better if
you had a little more."

Several women have posted me and said that their adrenal
tests showed yo-yo levels, with a high at 4 PM or
something wacky like that.  Today I got a note from a lady
who just got her Great Smokies saliva results, and she too
had that same phenomenon.  Here are her test results,
with the reference range in parenthesis:

DHEA at 8 AM:   1.3  (.75-2.5)

Cortisol:

8 AM:   28.6  (5-23)

12 noon:   2.39  (1.8-11)

4 PM:   6.22   (1-6.5)

12 midnight:   0.56  (.8-4.7)

As you can see, her cortisol was very high at 8 AM and 4
PM but much too low at noon and nearly non-existent at
midnight.  Included with her results is a "Conclusions"
paragraph from the laboratory.  It says:

"A pattern showing both elevated and decreased cortisol
levels in the presence of normal DHEA is clinically
significant. The presence of cortisol fluctuations suggests
an underlying hypofunction that is interrupted by episodic
hyperfunction. This may be seen in adrenal fatigue with
hyper-reactivity, such as physiological or psychological
stress induction of cortisol in an otherwise hypofunction
state. DHEA within the refernce range suggests there is no
evidence of zona reticularis hypofunction at this time. In
this pattern there is increased probability of poorly
regulated blood glucose, presenting as hypo or
hyperglycemia. This pattern represents a degree of
adrenal hypofunction and has been noted in fatigue
disorders, physiological or psychological stress and
hypertension."

I asked her when she took her thyroid medication.  She
took the morning dose at 7:30 and the second half of her
Armour in the afternoon.  This could very well be the
"physiological stress induction of cortisol!"  This woman
has the classic clinical symptoms of adrenal hypofunction,
including a worsening of her thyroid symptoms 2-3 days
after she increases her Armour dosage.

I include this for the people who have posted me saying
that they, too, have yo-yo cortisol levels which are high at
the wrong times or go up and down throughout the day.  
The Great Smokies Lab states this IS significant and seen
in adrenal fatigue.  If your doctor refuses to address this,
perhaps you need a different doctor.

Now, here is the second huge reason why adrenal function
is so important to thyroid patients. The first reason was
that hypothyroid people are usually hypoadrenal. The
second reason is that every time you switch thyroid
medications or change your dose, you are stressing your
body (the same as going outside on a hot day stresses
your body too). I have found—and so have many other
women—that every time I had my dosage changed or my
medication switched, I’d go on a "crash." I’d feel ok the
first day or 2 but then my symptoms would come back
even worse than before. I’d be a wreck for 3-5 days and
then slowly I’d improve and end up feeling better than I had
felt before the change. I always thought this crash must be
because my thyroid gland was putting out some amount of
hormone and the increase in my oral dose caused my TSH
to go down so my thyroid gland shut down too, and then it
recovered after a few days. But I kept researching and
found out that actually, it is because my adrenals were in
such horrible shape from spending 5 years with untreated
thyroid disease. My adrenals simply couldn’t handle the
stress of changing medications. This is exactly the problem
described in those links I listed above Dean_Adrenal.htm
and http://www.healthy.net/asp/templates/article.asp?
PageType=Article&ID=528). And this is true for almost
everyone with thyroid disease; they always feel bad when
changing thyroid meds because of the stress to their
adrenals. By the way, I have a theory that this is why so
many women will say "Oh I tried _____ medication and it
just didn’t work for me." And actually, the change in thyroid
medication might have been a good idea but the adrenal
crash made the patient believe that she was much worse
off with this different medication.  Re-read that interview
with the Drs. Shames.  They say exactly the same thing.

Why don't you get a big adrenal crash on synthroid like you
might get when you try Armour? Because synthroid is pure
T4 and so metabolically inactive that it barely moves
through your system and does nothing to you. Armour on
the other hand, increases metabolic activity so effectively
that the adrenals can't handle the sudden return to health
so they crash. Knoll Pharmaceuticals would have you
believe that this proves Synthroid is better than Armour. In
actual fact, the adrenals crash because Armour is so much
better than synthroid! Synthroid limits the body and keeps
the metabolism sluggish and barely functioning (which
means no adrenal stress). Armour, on the other hand,
gives back to you the nice healthy metabolism you had
before your thyroid gland got sick, and it does so quickly
and effectively. But if you were hypothyroid for quite a
while without getting treatment or if you spent a long time
on just synthroid, your adrenals will be weaker. The
sudden return of your normal metabolism when you start
Armour sends these weak adrenals into a crash. This is
why Armour must be given to a patient in a small initial
dose (1/2 grain) which is then increased little by little (1/4
grain every 2 weeks); this dosage schedule is printed on
the Armour package insert. Armour is much better for your
adrenals and they will begin to heal when you switch from
synthroid. But this takes time, which is why you should
increase the Armour slowly. If you take more Armour too
quickly, your adrenals may crash and you will feel much
worse for several days or even a couple weeks. And if
your adrenals fall off too seriously, you could end up in the
hospital. [NOTE: women who have strong adrenal function
will be able to increase their Armour doses more quickly
than indicated on the package insert.]

So you see, the reason you feel worse when you start
Armour is because it is better for you than synthroid, not
worse for you! But there is an easy solution to the adrenal
weakness that every doctor should be giving his patients:
oral adrenal support. Used in conjunction with Armour, the
patient will feel much better much sooner. And her Armour
doses can be increased at a faster pace so she will not
have to lie around the house being hypo on a half-grain for
2 weeks. The oral adrenal support allows the patient's
adrenal glands to heal while supporting the other systems
in her body so she can safely take her thyroid medication
and restore a healthy metabolism.

So, what do you do about weak adrenals? Well, my doctor
cured mine by putting me on a physiologic dose of daily
cortisol and DHEA. I took 25 mg DHEA daily 5 days/week,
and 20 mg cortisol daily, which is the amount your body
should make on its own. Cortisol is not stored anywhere;
your body makes it as it needs it. Some people make too
much and it just runs around their bloodstream, which is
bad for them and leads to heart disease. But if you are
making too little, it is just as bad for you and will lead to
early death. So you take 20 mg daily (5 mg at each meal
and 5 mg at bedtime). My doctor had me on oral cortisol
for 3 months so that my own adrenal glands could take a
nice big rest and recover from the terrible stress they’ve
been under all these years. It worked.  I began taking
these doses as soon as I got home from his office so I
ingested 15 mg before bedtime that first day. That night,
for the first time in years, I could breathe normally while I
slept; I had been suffering from sleep apnea and had also
developed "chokes"---each night when I first fell asleep,
my saliva would run down and fill my windpipe and I’d
wake up drowning on my own spit, coughing and sputtering
for 10-15 minutes before my windpipe would fully clear,
gasping for air the entire time. The Cortef cured this
problem on the first day!  My constant foot pain was gone
in 2 days.  About a month later, I forgot to take my
suppertime and bedtime cortef doses; that night I choked
again for the first time since I started Cortef.  I made sure
not to forget my doses anymore!  After 3 months, I quit
taking the Cortef completely and am feeling great.  My
adrenals rested and healed and are doing the job on their
own again.  No chokes, no foot pain, no symptoms at all.  
I'm healthy as a horse again.

If you start to come down with a cold or flu, you take
more. I found that out; the nurse forgot to give me the
cortisol instruction sheet (which describes how you take
more in those instances), so between appts I got a bad
cold and all my "thyroid" symptoms came back! That
happened right on top of my menstrual cycle too. Suddenly
my feet hurt so bad I couldn’t even walk when I first got up
in the morning. My body ached, I was snoring and
constipated, etc. I thought maybe the body demands more
thyroid during menstruation and illness, so I started taking
3.5 grains each day but it didn’t help. When I went back to
my Top Doc the following week, he explained to me that
the body demands more CORTISOL during illness and
menstruation due to the stress on the body. He felt real
bad he no one had given me the handout describing how
you should take more during colds….. You need more
when sick because illness is a stress; people with normal
adrenals always make more cortisol when sick. And by the
way, the immune system cannot work properly without
cortisol. This explains why a major symptom of
hypothyroidism is frequent colds and sinus problems.
Because hypothyroid women are hypoadrenal and their
bodies can’t fight disease without cortisol. The body
demands twice as much cortisol when sick as when
healthy; if you have weak adrenals, they just can’t handle
the workload. This is why your illnesses drag on and you
feel like you are in a hypothyroid fog.

Oral cortisol is a prescription medication. In addition, it can
cause constant hunger and rapid weight gain. It can also
reduce the secretion of melatonin. I experienced some of
these side effects; while on Cortef I was very eager for my
dinner and also stayed up late every night. But does this
mean that we should all avoid taking any oral cortisol? No.
If your adrenals are very weak, you will not be getting
enough cortisol, and you must have cortisol for life.  To
counter the side effects of Cortef, I took 3 mg melatonin
every night 1 hour before bedtime and it worked.  You can
buy melatonin in any vitamin store.

But there are other alternatives to oral cortisol. Here are a
few links describing things you can eat and things you can
do to help bolster your adrenals naturally. I recommend
you start doing these things immediately but if your body
pain is severe or the slightest stress sends you on a
hypothyroid crash, you most likely are going to need
cortisol tablets to optimize your health.

http://health4her.com/library/concerns/adrenal_conditions.
cfm

http://www.angelfire.com/ca/HerbalDoc/licorice.html

http://www.merck.
com/pubs/mmanual/section2/chapter9/9b.htm

These links are about the herb maca, which is also
supposed to boost your adrenal function and prevent sugar
cravings. I have corresponded with women who are using
it and say it is great.  One woman told me it cured her
chocolate cravings! Now that I've completed my 3 months
on cortef, I am taking maca too and am feeling wonderful.

http://www.nzhealth.net.nz/products/macca.html

http://www.alternativemedicine.com/digest/issue38/38100.
shtml

http://www.imperialgoldmaca.com/maca.htm