Recently I was asked by a thyroid patient whether I had an article on low cortisol symptoms.
As I discuss cortisol extensively in my books, I had not previously written a general blog post on the many symptoms arising from low cortisol, high cortisol, or aldosterone problems.
So, I have created this article based on a few extracts from Chapter 5 of my Thyroid Patient’s Manual book. Please see the book for a more complete description of the adrenal glands, adrenal hormones, and issues that can arise in connection with these.
Note: I am not going to discuss treatment options for low cortisol in this article. I do discuss this in my book The Thyroid Patient’s Manual. I also describe how to tackle low cortisol in my other two books, Recovering with T3 and The CT3M Handbook.
Low cortisol often goes hand in hand with thyroid problems, as it is often induced due to hypothyroidism, or incorrectly treated hypothyroidism.
This article will focus on the symptoms that can be caused by severe, moderate, or mild levels of low cortisol.
It will also briefly cover the symptoms of high cortisol and both low and high aldosterone.
People vary in the number of these symptoms that they experience and the severity of the symptoms.
Let me first cover the most severe type of low cortisol caused by adrenal gland failure (Addison’s disease).
Addison’s disease is a life-threatening condition. Proceeding with thyroid treatment without diagnosing and treating Addison’s disease could risk an Addisonian crisis and death.
In Addison’s disease, the adrenal cortices are destroyed. This is usually caused by an autoimmune attack. In this case, ACTH from the pituitary is not effective in producing sufficient cortisol.
Sufficient cortisol is required to maintain health and quality of life. In states of physiological stress, particularly caused by infection or physical exertion, the body produces significantly more cortisol – sometimes even by a factor of 10. Consequently, in Addison’s disease, the body cannot meet the demand for higher cortisol, and an Addisonian crisis can result, which can be life-threatening.
Sufficient aldosterone is required to maintain blood pressure and sodium/potassium balance. Many deaths from Addisonian crisis, or adrenal crisis, are caused by the nearly complete absence of aldosterone, which is necessary to maintain blood pressure and sodium/potassium levels and balance. Potassium levels become very high and can cause cardiac arrhythmias.
Note: in central adrenal insufficiency (little or no ACTH stimulation), the cortices will continue to produce sufficient aldosterone in most individuals. They will also produce a little cortisol – even with no ACTH secretion at all.
Addison’s disease is extremely serious and must be ruled out before proceeding with thyroid treatment if there is any evidence for it being present. To begin thyroid treatment in the presence of undiagnosed Addison’s would risk causing an Addisonian crisis. Addison’s disease symptoms usually develop slowly over many months.
The symptoms of Addison’s disease include:
- Extreme fatigue.
- Weight loss and decreased appetite.
- Darkening of your skin (hyperpigmentation).
- Low blood pressure, fainting, worse on standing.
- Salt craving.
- Low blood sugar (hypoglycaemia).
- Nausea, diarrhoea or vomiting.
- Abdominal pain.
- Muscle or joint pains.
- Irritability.
- Low mood, mild depression.
- Body hair loss or sexual dysfunction.
- Frequent urination.
- Drowsiness.
- Increased thirst.
- Dehydration.
If some or all of these symptoms are not responded to, the situation can worsen over time. These symptoms typically worsen when even a mild illness like a cold occurs.
Acute adrenal failure/Addisonian crisis symptoms:
- Pain in your lower back, abdomen or legs.
- Severe vomiting/diarrhoea.
- Low blood pressure, worse when standing up.
- Severe drowsiness or loss of consciousness.
- High potassium and low sodium.
- Muscle cramps.
- Severe dehydration.
- Pale, cold and clammy skin.
- Sweating.
- Rapid, shallow breathing.
- Severe muscle weakness.
- Headache.
If the above is not promptly attended to, the risk of death through an Addisonian crisis is significantly higher.
Addison’s disease needs to be diagnosed and treated by an endocrinologist, as it can be life-threatening as I have said many times now. Extremely low cortisol in Addison’s disease is treated with hydrocortisone (HC), which is bio-identical cortisol.
Once on HC treatment, the individual needs to be aware that there are situations where a higher HC dosage needs to be used. The reason for this is that the HC an Addison’s patient requires will suppress any remaining ability to make cortisol. So, in the event of higher physiological stress, the body cannot respond to it by making more cortisol. The need has to be met by using more HC medication.
If your doctor suspects severe hypocortisolism, or adrenal gland damage or low aldosterone you need to be referred to an endocrinologist for further investigation.
Severe hypocortisolism may also prompt the doctor to consider low aldosterone as a possible problem, as this is often also present in Addison’s disease.
What about less severe low cortisol that is not caused by Addison’s disease?
Many thyroid patients experience milder levels of low cortisol, sometimes known as partial adrenal insufficiency, or adrenal fatigue. Both of these terms are misleading, as I will discuss soon.
Some of the symptoms of hypothyroidism may be confused with some of the symptoms of low cortisol since both can lower metabolic rate. Low cortisol may interfere with the conversion of T4 to T3 and result in lower FT3 and elevated rT3. Low cortisol also reduces T3-effect in the cells. When cortisol is low, blood sugar may also be low. Insufficient blood sugar will slow down the mitochondria – thus slowing down metabolism.
The mechanism that most frequently causes low cortisol is hypothalamic-pituitary (HP) dysfunction. This means that for some reason the HP system is not controlling one or more endocrine glands correctly, even though there may be no damage or disease in either the hypothalamus or pituitary.
Contrary to what many alternative medicine practitioners claim, the adrenal glands do not become ‘fatigued’ or ‘tired’. They can continue to make and secrete cortisol in large amounts as long as they are stimulated to do so by sufficient ACTH from the pituitary gland. For instance, cortisol levels remain very high indefinitely in Cushing’s disease – when a tumour produces excessive ACTH. So, even in the state of constant and prolonged excessive cortisol production, the adrenals just keep making cortisol. The adrenals can continue to make all the steroid hormones as long as there is sufficient cholesterol in the blood.
The rate-limiting step in cortisol production is the amount of ACTH-stimulation of the adrenal cortices. Hence, the terms ‘adrenal fatigue’ or ‘tired adrenals’ are misleading. The term ‘partial adrenal insufficiency’ tends to imply that the adrenals are ‘partially insufficient’. It is a vague term, but it is misleading too, as the adrenals themselves are usually not the issue.
The cause of most cases of low cortisol is inadequate secretion of ACTH by the HP system. It is a dysfunctional state, not a ‘disease’ state, i.e. there is usually nothing at all wrong with the adrenal glands themselves.
Often the cause of this HP dysfunction is unknown, although many studies have shown that it can result from extreme or prolonged stress. The net effect of this is that cortisol and DHEA eventually fall. Dysfunction of the hypothalamic-pituitary-adrenal axis (HPA axis) is thought by some doctors to be the number 1 cause of low cortisol problems.
Genetic mutations can also cause adrenal cortex dysfunction. Mutations can reduce the function of the enzymes needed to make cortisol, resulting in a condition known as congenital adrenal hyperplasia (CAH). Milder versions of this disorder occur in adults – where it is known as non-classical CAH. In CAH, DHEAS levels are high as more ACTH is secreted to super- stimulate the cortices to make enough cortisol.
Mild to moderate low cortisol problems are far more common than the severe cortisol insufficiency of Addison’s disease. Unfortunately, most doctors do not test, recognise, or treat moderate to mild low cortisol.
I prefer to use the term ‘hypocortisolism’ versus ‘low cortisol’. Low cortisol is better defined as the sub-optimal effect of cortisol within some or all of the cells. This definition includes all the possible causes, e.g. HP dysfunction, adrenal gland disease, and even cortisol resistance. It includes everything that stops cortisol from optimally operating within the cells. Consequently, I use the terms hypocortisolism and low aldosterone – which are far more specific.
Some of the main symptoms of hypocortisolism include:
- Low blood sugar – dizziness, unwell, hunger.
- Severe fatigue, tiredness.
- Dizziness (even when sitting down).
- Low blood pressure.
- Intolerance to even low dose thyroid medication.
- Poor response to thyroid treatment or dose raises.
- Anxiety or inability to cope with stress.
- Irritability or anger or panic feelings.
- Feeling cold.
- Low body temperature as thyroid hormone action is not as effective.
- Fluctuating body temperature.
- Aches and pains.
- Pale skin or slight darkening of the skin.
- Skin appears thinner.
- Digestive upsets – may include diarrhoea.
- Nausea.
- Weight loss if cortisol very low.
- Worsening allergies.
- Trembling, shakiness or jittery/hyper feeling.
- Rapid heartbeat especially after thyroid meds.
- Insomnia – difficulty sleeping.
- Flu-like symptoms.
- Dark rings under the eyes.
- Low back pain (where adrenal glands are).
- Hair loss.
- Worsening symptoms in presence of stress.
- Clumsiness.
- Fatigue in the morning but better in the evening.
Some of the main symptoms of low aldosterone include:
- Low blood pressure.
- Postural hypotension (lower BP on standing).
- Craving for salty foods.
- Thirst.
- Light headedness on standing.
- Frequent urination (esp. during the night).
- Excessive sweating.
- Slightly higher body temperature than usual.
- High heart rate/palpitations.
- Cognitive fuzziness.
- Dizziness or fainting.
- Low sodium and high potassium.
Note: low aldosterone can occur with or without Addison’s disease. It can also occur with or without hypocortisolism. So, your doctor should be aware of this and be on the lookout for any tell tale indications of it, even if you do not have Addison’s disease.
Low levels of thyroid hormone can cause several symptoms of hypocortisolism
This can obviously make recognising hypocortisolism a bit of a challenge. If someone has been hypothyroid for a considerable time before diagnosis and treatment, it is possible that there will be hypocortisolism present. Therefore, hypocortisolism is something that a family doctor or endocrinologist should either check for, or at the very least, be on the lookout for.
Let me now briefly discuss high cortisol.
These are some of the clues when high cortisol is present:
- High blood pressure.
- Vasoconstriction causing pain in the chest, similar to angina.
- The latter can also cause arrhythmia – changes in heart rate, missing beats, extra beats, high heart rate.
- Heart rate variations including pounding heart, high heart rate – see the previous point.
- Bruising easily.
- Fluid retention.
- Weight gain, obesity, or moon-shaped face.
- Increased belly fat, fat on the back of the neck.
- Fatigue.
- Weak muscles and muscle loss.
- Facial flushing.
- Bile acid indigestion – burning in stomach.
- Excess stomach acidity – this can be severe.
- Mood swings – anxiety, depression, irritability.
- Increased anxiety is particularly common in high cortisol.
- Note: gut issues including diarrhoea are usually linked with low cortisol. But the effect of the stress hormone cortisol within the brain can cause it to send signals to the large intestine and cause mild diarrhoea (getting the body ready for flight or fight). Also chemicals released due to stress/anxiety/possible depression etc. can cause the chemicals released by this to disrupt the gut flora and also cause gut symptoms.
- Hair loss.
- Reduced TSH.
- Reduced FT3, increased rT3.
These are some of the clues when high aldosterone is present:
- High blood pressure.
- Low potassium (weakness/muscle spasms).
- Numbness or tingling in the extremities.
- Frequent urination.
If you suspect low or excess adrenal hormones then please ask your doctor to run lab tests for cortisol, aldosterone, renin, potassium and sodium, in order to get a more complete picture.
For a more full description of the adrenal glands, adrenal hormones, disease states, and treatment options please see The Thyroid Patient’s Manual book.
This blog post now complements one that I did in March 2020 which covers the symptoms of hypothyroidism. Together these two articles provide good information on the symptoms of both types of conditions:
https://paulrobinsonthyroid.com/symptoms-of-hypothyroidism/
Best wishes,
Paul
Hi,
Thank you for sharing your knowledge, I always appreciate that! You said in your post “The mechanism that most frequently causes low cortisol is hypothalamic-pituitary (HP) dysfunction.” So I am wondering if you cover how to “fix” this process in any of your books or posts? I really have not found any information on that to date. After going through significant stressors in a short period of time, I was pretty much at deaths door and it has taken me years to come to a place where I can mostly function. I am not totally well however even at this point. After all my searching and experimenting with different methodologies this has always been what I seem to come back to (the HP axis) but have been unable to find clear ways to mend this. Thanks in advance for your thoughts.
Hi Rayann,
All three of my books discuss this. I introduced the Circadian T3 Method (CT3M) in Recovering with T3 and discuss it further in The CT3M Handbook. CT3M is all about ensuring that the pituitary has enough T3 to function. The pituitary gland effectively runs on T3 and if for any reason it is low then you can get HP dysfunction – often presenting with low cortisol.
You can also search my website blog for CT3M or use one of the tags to find posts on it (Circadian T3 Method). I don’t go into the detail on my website that is needed to implement CT3M but it is covered in Recovering with T3 and The CT3M Handbook.
CT3M works in many cases. However, be aware that in some cases the cause of any HP dysfunction is simply not known. Having said that my success rate with CT3M is high.
Good luck!
Paul
Hi Paul Robinson!
I am currently waiting on further testing, everything is pointing to non-classical CAH (event molecular testing).
Is this something to take into consideration when using thyroid supplementation?
Is this something you cover in your books?
Have you seen this in your encounters with strange diseases and hypothyroid states?
Thank you
No, Congenital Adrenal Hypoplasia (CAH) is too specific a condition for me to cover it in my books. I have not encountered patients with this.
You need to work with an expert in this area.
Best wishes to you, Paul
Thanks!
The endocrinologist that recognizes CAH doesn’t recognize hypothyroidism because TSH is within the lab range … even though temps and heart rate (and symptoms!) do reflect it. What a mess! I don’t think they look at the thyroid at all in CAH.
Thank you –
They need to be looking at FT3 and FT4 levels. It is not uncommon to have low TSH output from the pituitary gland. All organs in the body can have faults. The pituitary gland is no exception to this – it often surprises me that endocrinologists and doctors think that the pituitary can have no failings.
I would find a more open-minded doctor and have a trial of thyroid hormone. What type of hormone or combo depends on FT4 and FT3 and reverse T3 levels.
Good luck MK!
Best wishes, Paul
Thank you!
Paul Robinson, Keep on truckin’
🙂
What about high renin?
Thanks –
Hi G,
That is more unusual and needs a physician to investigate. It can indicate a more serious condition e.g. kidney disease, Addison’s disease, severe adrenal insufficiency, cirrhosis, or serious hypertension amongst others. It does need investigating. I tend to focus on the more common situations and not the unusual ones.
If this is you then do have it investigated by a medical professional.
Best wishes, Paul
That could explain why I don’t quite fit with the low aldosterone and low cortisol picture, even though I have them low when tested.
Thank you!
Have it investigated by the right type of specialist G.
Your doctor ought to refer you to someone who would have the right knowledge and competence.
Best wishes, Paul
i have loe ACTH challenge and low cortisol. I was admitted when i drove myself to the ER with very low blood pressure that started to affect my kidneys re high creatine. In the hospital they gave me injections of hydrocortisone and i received i was anemic and my electrolytes were off all better when i left the hospital, Now i was weaned down to 20mg a day of hydrocortisone, close to what the body produces and continue to feel cold like someone put ice water in my extremities very uncomfortable can’t get warm comes and goes , sneezing, severe burning eyes inflammatory along with some weezng . a runny nose and weight gain re maybe low metabolic rate. Blood work is not sig , i have a pulmonitis and have asthma, and have had it for years poor spirometry Fev1 low lung volumes, Feels like i have a daily cold or allergy but i don’t, No cover it feels viral but they don’t know. No temp but weight gain. I wonder how much of this is from low acth and may not improve with cortisol regarding my symptoms. Any thoughts? Thanks Dave
Hi Dave, you’ve been going through it haven’t you – it sounds like a very rough time.
I would definitely check TSH, FT4 and FT3 also. If the pituitary is involved you may also have low FT3 (the most important thyroid hormone). This alone can cause some of the symptoms.
As for the cortisol, 20mg is sometimes not nearly enough. Some people have glucocorticoid resistance and need more. So, even testing cortisol levels at trough times from any HC dosing may not reveal much.
In your shoes, I would get the full thyroid panel done before investigating whether higher HC doses work better. Are you splitting the HC?
Normally, people on HC replacement take 3 doses per day. The largest is first thing in the morning, the second largest is around noon and the third/smallest is around 4-5 pm. This is a physiological replacement pattern.
I hope this is of some help.
Best wishes, Paul
Thanks for all your knowledge. My brother’s got AHO (albrights hereditary osteodystrophy) and I myself was never tested. But got some of the same symptoms. I was just wondering, i’ve got chronic low blood pressure and glucose levels. Not to go on with a list of symptoms, got positive p-ANCA, postive ANA, postive anti-tpo and a bunch of doctors not looking beyond their islands of expertice . Anyway, my dog was diagnosed with addisons, and I myself could see myself fit some of the discription/criteria. So as a former law student have read all the “manuals” sort of speak and as an experement tried taking cortisonacetaat for 4 weeks to see how it would effect me. And it was like day and night difference. Like life had returned to me. My question, would taking cortison have any effect on peopel whom don’t need it? Does the fact that it has such a profound difference for me be a clue?
Hi Lieneke, I would test cortisol with multiple tests to actually see if you do need hydrocortisone. It sounds to me like you may do but doing the testing is the best way.
I would test cortisol in 3 ways:
1) An 8:00 am morning blood cortisol test. A family doctor can do this.
2) A 4 point cortisol saliva test (ideally which includes dhea sulfate – but not essential). Can be done at home and returned to the lab through the mail or a courier company.
3) An acth stimulation test (Synacthen test) to rule out Addison’s Disease. This test needs to be done in a hospital situation and under the supervision of an endocrinologist.
My The Thyroid Patient’s Manual book explains how to interpret the test results. But it ought to be clear if there is a big issue.
Hydrocortisone if ‘not needed’ for low cortisol could also have a positive impact on inflammation – so it might improve symptoms if no other treatment is working. But it is best not to be on steroids if the need isn’t clear cut.
You should be working with a doctor on this.
Best wishes, Paul
Hello Paul, I have Hashimoto, on T4 (112mg)only since 3 years. I have very low cortisol all day long especially on the afternoon and the evening ( out of range), low T3 , middle T4. I can’t raise any meds at all, nor T4 nor even 1 mcg of any kind of T3… hyper and ill reaction. I am very worried about my futur because I don’t know what else to try ( my minerals and vitamines are ok, my tracks are quite low now, my iron was à litle low so I take supplements from prescription.
I tried HC, adrenal extract ( makes me crazy like T3). So, i am wondering if I take my T3 at 3am, will it do the trick? I really looking for some comfort there is some kind of solution for me.
Thank you your work !
Hi Aurélia, have you had a Synacthen test (ACTH stimulation test) to rule out Addison’s disease. I think that ought to be done before any further attempts to fix cortisol. CT3M won’t work if the person has Addison’s or true Hypopituitarism. A Synacthen test is a hospital-based test supervised by an endocrinologist. If your cortisol jumps up during the test due to the ACTH-like drug that they give you, then you know that your adrenals are capable of making enough cortisol.
If you fail a Synacthen test, then you would need some type of steroid, e.g. HC or prednisolone. Some Addison’s patients find that they cannot cope with HC and have had success using a cortisol pump (read about that by searching for ‘cortisol pump’ on my website).
If you pass a Synacthen test easily then it may be prudent to rule out hypopituitarism. There are a couple of good tests for this (hospital-based again), e.g. an insulin tolerance test.
Have you also tested 8:00 am morning blood cortisol rather than just a free cortisol test in saliva – sometimes blood cortisol can be normal and free cortisol can still be low: https://paulrobinsonthyroid.com/cortisol-results-inconsistent-between-saliva-testing-and-blood-testing/
CT3M might help but I would try to rule out the more serious issues first.
I would also want to look beyond thyroid and cortisol – have B12 checked (when not had any B12 of any form for several months), folate, vitamin D, serum iron, serum ferritin. Some of these can cause issues too, as can low blood sugar and related issues.
I hope this helps.
Best wishes, Paul
Thank you very much for your answer,
I’am waiting for my appointment for an acth stim test, it could take months here in Quebec with the pandemic. I will ask for the hypopituarism and insulin resistance tests, thank you for your advice. I just checked my labs again and my blood cortisol is ok on the morning ( never been tested on the afternoon), CBG is 54 (35-50), my acth and dhea are bottom range ( dhea as dropped in a year). Folate serum B9 is 29 Nmol/L , serum ferritin was 31 so I’ve started supplements ( I need to check iron serum, thank you). My B12 is on the upper quarter but I stopped my supplements just 5 days before testing. My zinc was very low so I take supplements now.
Would pituary adenoma could be responsible for both my hashimoto and cortisol problems?
Sorry for all the intell and thank you very much. I miss a good doctor here I’m fighting my own battle 🙂
Aurélia
p.s. The hypopituitarism test is an ‘insulin tolerance test’ – insulin resistance is entirely different.
You also have to be off B12 supplements for 4 – 6 months to test it – otherwise, it always looks high.
See my blog on ‘B12’. Be careful with zinc – it is a cortisol suppressant.
Unlikely to be a pituitary adenoma. If blood cortisol is ok then also unlikely to be Addison’s.
If FT3 is low then can cause low cortisol – read my books. Low FT3 is a huge issue.
Best wishes, Paul
I have had Hashimotos for almost 30 years. I have never had resolution of my symptoms. My TSH is always low, not matter what my Free T’s are. I now have diastolic heart failure, and I literally feel like I am dying. I have been to doctor after doctor after doctor….. I have tried many combos and brands and types of thyroid meds, but never T3 only, or mostly T3. I am wondering if this might help?. But, how do I find a doctor that would try this?
Hi Lynn,
I am so sorry to hear of your situation. Trying T3 mostly/only when you have heart failure is not really the best situation.
It could be done but it would have to be slow, step by small step, and with careful measurements including BP, heart rate and regular heart checks.
I suspect that you won’t find a doctor who is willing to try this given your heart condition.
As for low TSH – sometimes this happens and it does not mean that the person is over-replaced on thyroid hormone. It is a great pity that the low TSH was not ignored many years ago.
I am honestly not sure what else to say.
My very best wishes to you, Paul
Hi Paul,
I would like to ask about high aldosterone and if you seen any link with it and not optimized thyroid/suppressed TSH/keto diet?
I’ve decided to check my aldosterone levels as I’m looking for the root cause of my low blood pressure that haven’t improved that significantly despite T3 treatment. I was expecting a low value, but instead my labs showed high aldosterone:
476,49 pg/ml [norm: 13,37-233,55 pg/ml sitting].
My symptoms though are not exactly typical for hyperaldosteronism – my BP tends to be around 101/59, pulse around 70. I’ve never had problems with sodium or potassium levels. I do have some water retention, tend to drink lots of water during the day and do have frequent urination. I used to have frequent migraines that are now less frequent and less severe.
I’ve read that Keto can cause high levels of aldosterone – I returned to keto diet 2 weeks before doing my labs. I’ve also read that suppressed TSH is linked with high aldosterone. Do you have any experience with that?
My thyroid background – I’ve had Hashimoto’s for 20 years and since February have been transitioning from T4 only to T3/T4 and finally T3 only. I am now on 95 mcg of T3 and still not optimal – recent labs:
FT3 2,44 pg/ml [1,58-3,91] 19hrs without meds.
I will appreciate your advice.
Weronika,
Not really. Low cortisol is what I’ve mainly seen as the main cause of low BP. This is usually linked to low FT3 (poorly treated thyroid conditions).
If someone is having issues then I also don’t like special diets as these can have some bearing. Better to be on a balanced diet and work on the core issues.
I’d definitely not start to consider treating the aldosterone, but rather work on the core issue of treating the hypothyroidism.
Sorry if this isn’t really helpful.
Your FT3 is quite low given the dosage – makes me wonder if gut is a problem and absorption is a problem.
Best wishes, Paul
Paul, thank you for your advice, it’s more helpful than you can imagine. I am also wondering why my FT3 is not going up and the gut may be indeed the answer. I’ve been battling SIBO for a few years now. I thought that it will get better with my thyroid getting better but it seems like it’s too serious to go away just with that. I also have issues with low iron, despite supplementing – methanogenic bacteria tend to steal it. I’m now on Elemental Diet as nothing else worked. Hopefully once the SIBO is gone, the body will finally be able to reboot.
Thanks again and all the best to you,
Weronika
Weronika,
Another reason for FT3 not going up is that the addition of T3 is also matched by worse T4 to T3 conversion.
See:https://paulrobinsonthyroid.com/more-t4-t3-thyroid-medication-might-not-always-raise-patients-ft3-levels-in-thyroid-hormone-treatment/
This is a complex post because it is a complicated area – but worth reading a few times. This is an issue I see a LOT. The post explains how to tackle it if this is what is going on.
Best wishes, Paul
Thank you Paul, however I don’t think this issue applies to me, as I am on T3 only. I’ve tried T3+T4 in different combinations as I did have quite a high rT3 of 34, adding T3 made it almost a 0. The first time I’ve tried T3 only was not that life-changing, however after I tried adding some T4 back, I’ve felt a difference – it was like a burden on my body. Since then I dropped T4 completely and have been gradually increasing T3 to find my sweet spot. I started my journey in February but since then only some of my hypothyroid symptoms subsided. I am less tired, my gut works better as per motility, but I am still weight loss resistant and feel like I can keep increasing my dose with no side effects. My thyroid is almost non-existent (atrophy). I am wondering if the other factor is that it just takes time for the body to fully utilize the T3 after so many years without it (20 years of Hashimoto’s and T4 only). Do you see in any of your clients such a slow progression?
Best regards,
Weronika
Weronika,
In that case, you may not be on enough T3 OR you may be missing another factor.
Cortisol needs to be tested – a 9:00 am morning blood cortisol and a 4-point saliva test
B12, folate (no B12 ought to have been taken in the 4-6 months prior – yes, months)
vitamin D
iron, ferritin
If cortisol is sub-optimal (use the books) then try CT3M – this can suddenly help the T3 to work as T3 needs cortisol as a partner:https://paulrobinsonthyroid.com/t3-thyroid-hormone-and-cortisol-relationships-summary/
Best wishes, Paul
Hi, Paul!
Thank you for this post. I thought it was very interesting to know that hypothyroidism symptoms and low cortisol symptoms can be confused with each other. This is just one more reason people should not try to self-diagnose themselves and go to a doctor if they are feeling unwell.
Hi Jackie, not really. Doctors don’t really understand how cortisol and thyroid hormone interact and they almost never suspect high or low cortisol issues when the symptoms aren’t catastrophically obvious.
I conclude exactly the opposite actually. I think patients are aware of their own bodies and symptoms far more sensitively than doctors can assess. With the right knowledge the thyroid patient is in a far better position to ask for the right tests and work with their doctor, rather than just turning up and expecting great insight from them.
Best wishes, Paul
p.s. I’ve not encountered a doctor or endocrinologist yet who was really interested in low cortisol symptoms or anything to do with cortisol that was not a completely clear failure of a Synacthen test, i.e. overt Addison’s disease.