Re: Latest labs your thoughts ?

[Guest guest]

Was on 100 T3 45mg HC 0.2 Florinef when the labs were done, non taken the morningbefore the test.Sodium 148 (133-146)Potassium 3.6 (3.5-5.1)Ferritin 53 (20-300)Transferin 2.5 (2-3.6)Iron 29 (11-28)Saturation 46% (23-53)TSH - not detectedFT4 4.0 (10-25)Total T3 - 12.1 (dont know the range for this one atm)So i am going to start a potassium supplement, but was just wondering yourthoughts on why there is still 4.0 for FT4 when im on 100mg of t3, do you thinkthere may still be some RT3 going on even tho ive been on T3 only since octoberas shouldnt my FT4 be 0 ?

Hi,

May I ask – do you suffer from primary 's or severe adrenal insufficiency - and

are you under the care of a doctor - or are you self medicating? – If you were self medicating, I would urgently recommend for you to find a doctor who will take you under his or her wing.

Florinef is an extremely potent mineralcorticoid and it should only be taken by patients with primary 's disease or salt-losing adrenogenital syndrome. It can be very dangerous to take for anybody else, because it pushes up Na and suppresses potassium. Your Na is above the range, which in itself is bad, but your potassium has fallen too low.... since you say you had not taken any of the medication on the day of the blood draw this is doubly worrying, because the day before (when you had taken Florinef) - and presumably the days after - the Na would have been even higher and the K (potassium) even lower .... and this is a dangerous combination.

You say you want to start potassium supplementation – Why ? - that – IMHO – would just mess things up more ... then you'd finish up with high Na and higher K – which will lead to fluid retention and kidney problems ... your Na has to come down to the middle of the ref range and K has to go up to about 4 – 4.5 .... and the way to achieve that is to either reduce or stop the Florinef - if you do suffer from primary 's or you have been diagnosed with serious salt-losing, then you'd have to fine-tune and reduce the Florinef very carefully and keep re-testing the electrolytes until you've got the Na:K ratio spot on – but if you do not have either of those diseases, then what is your reason for taking Florinef? If to take Florinef has been recommended to you by somebody from some forum and not by a doctor, then that was dangerous advice. Florinef should only be taken under the close direction of a physician. It is very easy to get the electrolytes out of kilter by taking too much or too little and you could land yourself in very serious trouble. I really cannot stress this enough.

You also take 45 mg of HC, which is a therapeutic amount of steroids.... again, I do hope that you are under the care of a competent doctor, because this kind of medication really does need very close monitoring.

Your Na:K ratio is out of kilter – the Na is too high and the K (potassium) too low (so you need to gently reduce the Florinef –not add extra potassium)

Your iron is a bit too high but your ferritin still too low.... you still need to supplement iron to get the ferritin reading up to around the 90 – 100 mark to optimize thyroid hormone utilization.

Your TFTs - why has the TT3 been measured and not the FT3 ?? this is very odd – but without knowing the ref range there is no way of seeing where you stand with your T3 medication – your FT4 is presumably still measuring something, because your own thyroid gland might still be pushing out some minimal amount of hormones. This can happen even when true hypothyroidism has been reached and the gland is basically non-functioning. Some people produce the odd hormone even after a thyroidectomy, I have read, presumably from some thyroid tissue that's left behind. I don't think there is any way of knowing if you still have an rT3 issue just from looking at the FT4; you would have to re-test rT3.

With very best wishes,

[Guest guest]

Thanks for your time and reply are you a doctor or just a suffer aswell?

> Hi,

>

> May I ask – do you suffer from primary 's or severe

> adrenal insufficiency - and

>

> are you under the care of a doctor - or are you self medicating? –

> If you were self medicating, I would urgently recommend for you to find

> a doctor who will take you under his or her wing.

I had adrenal insuffciceny as per genova 24 saliva test and yeh im under the

care of two doctors at the minute but i like to educate myself and get other

peoples opinons on things aswell.

>

>

>

> Florinef is an extremely potent mineralcorticoid and it should only be

> taken by patients with primary 's disease or salt-losing

> adrenogenital syndrome. It can be very dangerous to take for anybody

> else, because it pushes up Na and suppresses potassium. Your Na is above

> the range, which in itself is bad, but your potassium has fallen too

> low.... since you say you had not taken any of the medication on the day

> of the blood draw this is doubly worrying, because the day before (when

> you had taken Florinef) - and presumably the days after - the Na would

> have been even higher and the K (potassium) even lower .... and this is

> a dangerous combination.

>

> You say you want to start potassium supplementation – Why ?

I thought the general thing with florinef was that it " uses " up potassium, when

i was on a low dose of florinef 0.1 my potassium was 5.3 it actually raised,

then since going to 0.2 its gone to 3.6 so i was thinking and this also from the

adrenals group is that supplement potassium so it doesnt drop too low and

stay on the same amount of florinef but to keep monitoring electoryltes every

2weeks.

- that

> – IMHO – would just mess things up more ... then you'd

> finish up with high Na and higher K – which will lead to fluid

> retention and kidney problems ... your Na has to come down to the middle

> of the ref range and K has to go up to about 4 – 4.5 .... and the

> way to achieve that is to either reduce or stop the Florinef - if you

> do suffer from primary 's or you have been diagnosed with

> serious salt-losing, then you'd have to fine-tune and reduce the

> Florinef very carefully and keep re-testing the electrolytes until

> you've got the Na:K ratio spot on – but if you do not have

> either of those diseases, then what is your reason for taking Florinef?

There are a couple of reasons, first one being that i needed a really high dose

of HC which is a sign " Another clue that your aldosterone may be too low is

being on high amounts of HC, such as 30-40 mg, and not getting good results. "

And also i pee quite alot.

> If to take Florinef has been recommended to you by somebody from some

> forum and not by a doctor, then that was dangerous advice. Florinef

> should only be taken under the close direction of a physician. It is

> very easy to get the electrolytes out of kilter by taking too much or

> too little and you could land yourself in very serious trouble. I really

> cannot stress this enough.

It was reccommended by val on the adrenals group which i then checked over with

dr P.

>

>

>

Steve

[Guest guest]

Hello Steve,

Thanks for your time and reply are you a doctor or just a suffer as well?

Neither J – but I have done a lot of research into 's disease.

I had adrenal insuffciceny as per genova 24 saliva test and yeh im under thecare of two doctors at the minute but i like to educate myself and get otherpeoples opinons on things aswell....nothing wrong with that J But please realize that even a flat-lined adrenal salivary result would not necessarily represent 's disease... in fact, it rarely does. It even states on the Genova commentary that when you have reached the adrenal `exhaustion stage', it should not be taken for confirmation of 's disease - please see....

Exhaustion Stage: This is generally a state of insufficient production of adrenal hormones after multiple years of persistent stressors with insufficient coping mechanisms. Patients usually present with fatigue poor energy and immune system hypofunction. They may exhibit chronic anxiety. In some patients this

represents impaired response to shorter-term stressors (i.e. overreactivity to short term stress). Adrenal support and restoration measures, as well as identification and balancing of major stressors are indicated. This state should not be confused with 's disease, which is a near absence of adrenal hormones, and is a medical emergency.

There is a huge difference between fatigued adrenals and 's disease. Fatigued adrenals are just that – knackered adrenals, but with TLC, glandulars, vitamin- and mineral supplementation (or- in extreme cases- a physiological dose of HC) you can in most cases coax them back into functioning normally in time, because the adrenals – although tired and worn out – will not have been destroyed by an autoimmune disease, as they are in 's.

Primary 's is a potentially life threatening condition. The outer layer of the adrenal glands would have been destroyed by an autoimmune condition and the outer layer of the adrenals is the one that produces the mineralcorticoids – mainly aldosterone - and aldosterone regulates the fluid- and electrolyte balance in the body by promoting the retention of sodium and the loss of potassium in the bloodstream.... - and this is where Florinef comes in. Florinef is a mineralcorticoid which takes over the role of Aldosterone when the outer adrenal layer has been destroyed. It works just like the body's own aldosterone – it regulates the electrolytes and the overall fluid balance in the body.

Now – when somebody without suffering from 's disease takes Florinef, then the adrenals become confused. In a non-addisonian person the outer adrenal layer works ... it does produce aldosterone; perhaps not as much as it should, due to general exhaustion of the adrenals, but it will produce some mineralcorticoid. So when there now is an influx of Florinef on top of the natural production of aldosterone, it is extremely easy to mess up the electrolyte balance ... and messing up the electrolytes can be life threatening.

If the potassium levels get too high, it can stop the heart; if the sodium levels get too high, it will mess up the kidney function. People who take Florinef need, IMHO, regular electrolyte checks to make sure that Na and K are kept in the right proportions – if the Na goes too low and the K too high for any length of time, it can trigger an addisonian crisis (which is life threatening and needs immediate medical intervention). Without re-hydration an adrenal crash can kill a person within hours. If the balance goes the other way – high Na and low K – it can damage the kidneys.

Those are the reasons why Florinef should never be taken without close monitoring by a doctor; until a maintenance dosage is established you need regular (perhaps weekly) electrolyte checks to make sure that the Na:K ratio is correct... and that means Na should be in the middle of the re range and K (ideally) between 4.0 – 4.5.

> You say you want to start potassium supplementation – Why ?I thought the general thing with florinef was that it "uses" up potassium, wheni was on a low dose of florinef 0.1 my potassium was 5.3 it actually raised,then since going to 0.2 its gone to 3.6 so i was thinking and this also from the adrenals group is that supplement potassium so it doesnt drop too low andstay on the same amount of florinef but to keep monitoring electoryltes every2weeks.The term to `use up' potassium is one way of putting it <g>.... Florinef suppresses potassium whilst at the same time elevating sodium. The drug works extremely efficiently and quickly and tiny alterations in dosage can make a huge difference in the levels, as you have experienced. You have to bear in mind that unless you actually have primary 's, your own adrenals are the other players in the game.... they will produce aldosterone too, even if it might be a reduced amount (which is probably why your K initially rose, despite the attempts of Florinef to reduce it).... it is awfully difficult to judge how much Aldosterone is naturally produced and how much you have to add without constantly checking the electrolytes. Our Na and K are not static parameters, they change all the time depending on what we eat and drink and do. This is what makes taking Florinef so risky. It is a steroid designed to take over the function of a defunct outer adrenal layer. When this layer is not defunct, then you are basically playing Russian Roulette and 'blindly' supplementing a hormone that might or might not be naturally produced to some degree. It is a different story when you know that you have primary 's and your outer layer is as dead as a dodo – you then have to replace what the adrenals can no longer produce.

The only definitive way to find out if you might have primary 's disease is to undergo an SST (short synacthen test). If the outer layer of the adrenal glands had been destroyed, an ACTH injection will not raise the cortisol level or only raise it minimally. – but you can't do that test for now, because once you have taken any kind of steroids it is no longer possible to achieve a valid result. You would have to stay off all steroids for about 6 weeks before an SST result would become valid again.

There are a couple of reasons, first one being that i needed a really high doseof HC which is a sign "Another clue that your aldosterone may be too low isbeing on high amounts of HC, such as 30-40 mg, and not getting good results."And also i pee quite alot.

It may be a sign, but I take it that you had not actually tested your Aldosterone level – and you are guessing. Peeing a large amount could have other reasons, like diabetes or diabetes insipidus for example. The way HC works is by amounts and by duration. As Dr. Peatfield says – physiological amounts of HC up to 30 mg are safe; in extraordinary circumstances even up to 40 mg HC may be needed, when a patient is near addisonian levels. But the rub is – once you venture into therapeutic levels (which you have done) your adrenal function will (for the duration of the HC supplementation) significantly reduce or even totally shut down its own cortisol production.

And this means in plain English.... once you exceed those safe physiological levels of HC your adrenals will rely on you to supplement what is needed. The higher you go with the dose, the less your own adrenals will produce in an attempt to prevent swamping the body with cortisol. They will simply shut down and to eventually get them working again can take months, even years, of frustrating HC withdrawal attempts, not to speak of the debilitating side effects of glucocorticoids, which you might experience.

I do not know you, Steve, and I do not know anything about your history, so please do not think I am judging you or am saying what you are doing is wrong – I would not have a clue about that. All I am saying is that it would be unwise – even dangerous – to supplement glucocorticoids and mineralcorticoids at therapeutic levels without being closely monitored by a doctor. But since you have Dr. Peatfield's support and the support and care of another doctor, I am sure everything is under control J - just be careful with supplementing extra potassium; I think this might backfire. Your sodium level at last count was high and your potassium low.... so the logical way IMO to go is to reduce the Florinef by a smidgen and then Na and K should hopefully level out.

With best wishes,