Increasing Cortisol Rather than Thyroid Hormone During Stress

[Guest guest]

Dr. C. Lowe - http://www.drlowe.com/

January 2, 2008Question: I am a naturopathic doctor and have hypothyroidism and adrenal insufficiency. I’ve been taking medication for these conditions over the past several years. Despite experimenting with different dosages and combinations, I am yet to find the correct doses. I did feel well and stable for 18 months while on a combination of 50 mcg T3 and 15 mg of hydrocortisone.

After a large stress, however, I developed hypothyroid symptoms again. I increased by T3 to 70 mcg, but all that did was keep me awake and not relieve my symptoms. My doctor tested me and said that my TSH levels showed that I was hyperthyroid. Because of this, he lowered my dosage to 30 mcg of T3 and added 25 mcg of T4. I became severely ill on this and my health declined drastically over six months. My doctor refused to change the medication because now my TSH level was back to normal.

On my own, I added two grains of Armour per day and improved very quickly. Under the care of another doctor, I’m now on 4 grains of Armour per day and 15 mg of hydrocortisone. I’m fairly stable on this combination, but my weight is a problem, and I’m concerned about it. When I was on 50 mcg of T3, my other symptoms (depression, anxiety, fatigue, muscle pain, hair falling out, poor concentration, insomnia) cleared up. My weight also fell back to normal, and I maintained the lower weight. But this time, after my episode of hypothyroidism, my weight hasn't come back down. This is troubling because I follow an excellent health program. I eat a perfect diet, take nutritional supplements, and I’ve done practically every healing regimen in the natural medicine world. I exercise very hard with weights and cardio—one hour in the morning four-to-five days a week. Then I do a very brisk walk for an hour most evenings. Despite this regimen, I’m in constant pain. And my weight has stayed higher than normal. I have a layer of fluidy, fatty, flabby, cellulite type of fat over my arms, belly, thighs, and butt. It doesn't seem to shift no matter how hard I exercise. Is it possible that I need more T3 to get rid of the pain and flab? I love your work. Thank you in anticipation of your reply.

Dr. Lowe: I am sorry you’ve had the health problems you describe. Whenever I hear from a clinician such as you, I regret even more the confusion that reigns in the field of clinical thyroidology. You’re by far not the only clinician perplexed about how to use thyroid hormone effectively to alleviate problems such as your pain and fat.

When you went through the severally stressful time you mentioned, you most likely needed to temporarily increase your cortisol dosage rather than your T3 dosage. And by increasing your T3 dosage, you may have worsened the cortisol deficiency induced by the stress.

When the adrenal cortices are functioning well, stress causes them to substantially increase their secretion of cortisol. In my opinion, during stress, the person on physiologic cortisol therapy, as you’re on, should mimic what the adrenal cortices do during stress. The person should take more cortisol than during tranquil times.

During the stressful time you experienced, it’s highly likely that your need for cortisol markedly increased. By increasing your T3 dosage, you may have sped up the clearance of cortisol through your liver. This would have decreased the cortisol available to your cells at a time when you needed much more than usual. You said that at this time, you again developed symptoms of hypothyroidism. It’s possible that the symptoms were actually those of a cortisol deficiency. That’s likely if the hypothyroid-like symptoms included fatigue, muscle weakness, lower tolerance of stress, and low blood pressure upon standing up.

Armour works well when the patient takes a high-enough dosage. It’s possible, however, that you aren’t taking enough. On your dosage of 4 grains, you’re getting 36 mcg of T3. This is only 4 mcg less than when you felt well and stable on 50 mcg. However, the difference may be substantial for you as an individual.

The problem I see in cases such as yours is a black hole of sorts: how much of the T4 in the Armour (152 mcg in the 4 grains) do you absorb and convert to T3? We don’t know. Some studies indicate that while we absorb almost 100% of T3, we absorb variable amounts of T4, for example 80% or 85%. But how much of it ends up converted to T3 and bound to T3-receptors is a mystery. Because we never know how much T4 is effectively used by one’s body, I believe that using T3 is preferable. The relationship between symptoms or symptom relief and the T3 dosage is far clearer than with T4. More T3 dosage might also reduce or relieve your pain by inhibiting substance P production, by repressing the preprotachykinin-A gene, which codes for both substance P and its receptor.[1,p.732]

I hope, doctor, that you’re soon able to relieve your pain and lose your excess fat. I suspect that you can do so by raising your T3 dosage a small amount. Also, if you experience any prolonged or intense stress, I hope you’ll consider that temporarily increasing your cortisol dosage is the proper course of action