Hypotyreose og binyreproblemer - informasjonstråd.

[kris]

Tenkte jeg skulle samle litt av den informasjonen jeg har lett fram om binyreproblemer kombinert med lavt stoffskifte. Flott hvis andre også kan bidra!

P.S. Jeg har oversatt teksten til norsk lenger ned i tråden!


1. SYMPTOMER

Først noen sitater fra Mary Shomon's bok "Living Well with Hypothyroidism" (HarperResource, New York 2005 (2. utg.) - ISBN 0-06-074095-7 - paperback):

- The Adrenal Connection (side 240-43)
One common condition that frequently accompanies hypothyroidism - and may even prevent proper treatment if it is not addressed itself - is adrenal exhaustion, also known as adrenal fatigue.

(...)

Adrenal fatigue often develops after periods of intense or lengthy physical or emotional stress, when overstimulation of the glands leaves them unable to meet your body's needs. (...) Symptoms include:

• Excessive fatigue and exhaustion
  Nonrefreshing sleep (you get sufficient hours of sleep, but wake fatigued)
  A feeling of not being restored after a full night's sleep or having sleep disturbances
  Feeling overwhelmed by or unable to cope with stressors
  Feeling run down or overwhelmed
  Craving salty or sweet foods
  Feeling most energetic in the evening
  Low stamina, slow to recover from exercise
  Slow recovery from injury, illness, or stress
  Difficulty concentrating, brain fog
  Poor digestion
  Low immune function
  Food or environmental allergies
  Premenstrual syndrome or difficulties that develop during menopause
  Consistent low blood pressure
  Extreme sensitivity to cold
  Lack of sex drive
  Dark circles under the eyes
  Lines of dark pigment in the nails
  Startling easily
  No stamina for confrontation

Interestingly, one of the most common symptoms, according to some practitoners, is a lack of response to thyroid hormone replacement in people with hypothyroidism.

At his website - www.drrind.com - Dr. Bruce Rind, an expert on the thyroid-adrenal connection, has a helpful chart called the Metabolic Scorecard: Symptom Matrix with more information on adrenal symptoms. Dr. Rind feels that hypothyroidism and adrenal problems are very interrelated. Says Rind:

I've found that one of the strongest stressors to the adrenals is thyroid hormone (specifically T3). The body is designed so that under normal conditions, one organ will not destroy another. The thyroid energy is allowed to rise only to a level that will not harm the adrenals. Thus, in a stress situation, the tolerance of the adrenals usually drops and we see a corresponding drop in T3. Conversely, if fatigued adrenals just started to receive support (e.g., nutrients favorable to adrenal health, drastic reduction in stress, or even a very joyful situation) we see a rapid rise in T3. I find that most people with history of Grave's disease or Hashimoto's Thyroiditis demonstrate weakened adrenals. Thus, the success of the thyroid therapy is limited by the health of the adrenals.

(...)

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Her er det som står om det samme temaet i Richard L. Shames og Karilee Halo Shames' bok "Thyroid Power - 10 Steps to Total Health" (HarperResource, New York, 2002 (2. utg.) - ISBN 0-06-008222-4 - paperback):

The Thyroid-Adrenal Connection (s. 132)
A major connection exists between low thyroid and low adrenal. Low adrenal, also called adrenal insufficiency, can actually cause someone's thyroid problem to be much worse than it would be otherwise.

Crucial Reasons for Knowing Your Adrenal Levels (s. 133-134)
Adrenal insufficiency symptoms include: weakness, lack of libido, allergies, dark circles under the eyes, muscle and joint pain, dizziness, low blood pressure, low blood sugar, food and salt cravings, poor sleep, dry skin, cystic breasts, lines of dark pigment in the nails, difficulty recuperating from stresses such as colds or jet lag, no stamina for confrontation, tendency to startle easily, lowered immune function, anxiety, depression, and premature aging. Some of these symptoms are similar to those of low thyroid.

If low thyroid people with these symptoms are put on thyroid hormone alone, they sometimes respond negatively. They may have coexistent but hidden low adrenal. If they take thyroid hormone by itself, the resultant increased metabolism may accelerate the low adrenal problem. The proper approach in this case is to treat the patient with thyroid and adrenal support simultaneously.

Adrenal insufficiency, especially when unmasked by the addition of thyroid hormone, is unpleasant and uncomfortable. To compound the problem, the doctor and patient then may wrongly assume that thyroid replacement has been a mistake. A tremendous opportunity for better health has now been missed.

While uncomfortable, this dilemma can become a diagnostic tool. The doctor could then gradually add thyroid and adrenal hormone together, with the patient eventually taking optimal levels of both. This careful attention and delicate calibration are demanding on the practitioner and patient. Nevertheless, we have seen patient after patient dramatically improve with such dedication.

Also, interactions among your hormones are sometimes as important as the direct action of the hormone itself. Some adrenal hormones assist in the conversion of T-4 to T-3 and perhaps assist in the final effect of T-3 on the tissues. Some scientists believe that even the entrance of thyroid hormone into our cells is under the influence of adrenal hormones. Thus, if your adrenal level is high enough, you might do well to take both adrenal and thyroid hormone together.

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(Her er et intervju Mary Shomon har gjort på www.thyroid-info.com med 'Drs. Shames' om dette temaet.)


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Her har jeg klippet fra en artikkel online;

ADRENAL PROBLEMS (Replacement Cortisone Therapy)

By Dr Barry Durrant-Peatfield MB, BS, LRCP, MRCS (forfatter av boken "The Great Thyroid Scandal" - se link lenger ned).


The adrenals sit just above the kidneys and most of us have heard that these are responsible for the “fight or flight” reaction to stress. Briefly, there is a rapid increase of the glucocorticoids, to enable the body to cope. It is the failure of this mechanism to work properly, in the presence of general stress, or the stress of illness, that we are concerned with in the use of replacement cortisone therapy. We call this condition Low Adrenal Reserve, or simply, Adrenal Insufficiency.

The most severe form of the syndrome is called "Addisons Disease", after the great Guys Physician, Thomas Addison, who was the first to describe it in 1855. It was then usually due to tuberculosis destroying the glands. Patients were dusky coloured, with terrible weakness, malnutrition, collapse and coldness, and the illness ran a fatal course. It is pretty rarely seen in clinical practice. But we are concerned with the mild form of deficiency, where the patient may be well, until subjected to stress and/or illness. Then, many of the symptoms may appear with prostration and collapse; or there may be level of insufficiency present all the time, with varying degrees of weakness, muscle and joint pains, and general ill health.

So what do we look for in the way of symptoms? It is rarely clear cut, because the deficiency is so often part of another illness, and may therefore have something of the symptoms of both. We are particularly concerned with thyroid deficiency, which, if of longstanding, or fairly severe in degree, is most often associated with adrenal insufficiency, as well as a direct result of the stress on the system low thyroid function will cause.

The patient will complain of weakness and episodes of prostration, frequently feeling quite unwell without being able to pinpoint the cause. Episodes of dizziness, sometimes cold sweats, caused by the blood sugar becoming abnormally low, are not uncommon. Often, an odd internal shivering is described. Aches and pains of a rheumatic nature are other frequent complaints. The patient often complains of the cold, and is likely to be cold to the touch. The subject does not feel well, and may look ill, with dark rings under the eyes, and a general pallor. There are likely to be digestive problems, with excessive wind and bloating, and bowel disturbances. The menstrual cycle may be disturbed, or absent and libido low. Depression and anxiety may also be a feature. Some of the symptoms complained of by patients with M.E. -- Myalgic Encephalitis -- are very similar, leading to the well-grounded suspicion that M.E. is associated with low adrenal reserve. Certainly, frequent minor illnesses are common, with an overlong course of quite minor infections, which may also have an unusually severe effect on the patient.

Low thyroid function has some of these features, and it may be difficult to distinguish one from the other; In fact it should not be necessary because, as I pointed out above, as the two are often together, so too must the treatment overlap and be designed to relieve both.

The complications of treating hypothyroid or underactive thyroid patients, is that their consequent poor adrenal reserve may become suddenly obvious, as soon as the thyroid is treated. The thyroid supplementation may, at worst, precipitate the adrenal problem; but what usually happens, is that the thyroid replacement may either not apparently work at all, or the patient may have thyroid over dosage symptoms on quite a low level of replacement. Hence, where low adrenal reserve is suspected, it is possibly dangerous, and certainly ill advised, to treat the patient without supplementation of the adrenals, in the manner explained further below.

[kris]

NB! Jeg har oversatt teksten til norsk lenger ned i tråden.


2. DIAGNOSTISERING

Jeg siterer videre fra Mary Shomons bok:


- Evaluating Adrenal Fatigue (s. 244-245)

Conventional endocrinologists and tests cannot diagnose adrenal fatigue because they are prepared only to diagnose extreme dysfunction in the adrenals, such as Addison's disease, a potentially fatal condition where the adrenals essentially shut down.

Your holistic or integrative practitioner, however, can do a number of tests to evaluate your adrenal function, and diagnose adrenal fatigue or other subtle dysfunctions in your adrenal glands. These tests include:

• - 24-hour urine test, looking at multiple samples over 24 hours
  - Saliva testing for cortisol levels, usually done at several points over a 24-hour period
  - DHEA - since DHEA is a precursor to almost all the other adrenal hormones, low DHEA levels can often signal adrenal fatigue
  - Pregnenolone, like DHEA, is a precursor to adrenal hormones. Blood and saliva testing of pregnenolone may provide information on low adrenal function

Dr. Kate Lemmerman tests adrenal function in her hypothyroid patients and frequently finds signs of adrenal stress, often with low DHEA-sulfate levels. Says Lemmerman:

Often if patients are still fatigued after having idealized their thyroid functioning with appropriate thyroid replacement I find that their DHEA-S levels are less than ideal and their fatigue can be ameliorated with supplementation. I use DHEA-S levels rather than serum DHEA as I find that, as the sulfonated molecule is the active version, it is like testing for Free T-3, rather than total T-3.

Dr. Kent Holtorf typically diagnoses adrenal insufficiency using a combination of symptoms, plus blood sugar, free cortisol, and hemoglobin A1C testing. Says Holtorf:

One must have a high clinical suspicion and not just think in terms of normal and abnormal. These normal levels are determined for healthy individuals, not the chronically ill, so the cortisol levels should be higher with this illness. 24-hour urine and saliva tests can be done, but these can also result in false positive and false negative results. Some doctors who treat these disorders have reported that cortisol is not helpful; this is totally opposite to my experience. I have found this adrenal hormone to be very helpful.

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Fra Shames' bok:

How to Determine If You Are Low Adrenal (s. 141-147)
It would be wonderful to have a simple, reliable method of assessing a person's adrenal function. Many tests are available but none is widely used. One reason is that most medical doctors consider that the adrenal system is always functioning smoothly, except in two very severe and rare circumstances. One is caused by overproduction of cortisol called Cushing's Syndrome. Underproduction of cortisol is called Addison's Disease. When it is clear to a physician that you do not have either Cushing's or Addison's, the topic of adrenal metabolism all too often is shoved aside.

(...), normal adrenal metabolism is essential to good health, and problems can arise even when you do not have either of these two rare illnesses. The truth may well be that there is a continuum between these two extremes. Problems may occur at various points along this spectrum of adrenal dysfunction, rather than as rare illnesses that occur only at either extreme. (Ref: A. Kasperlik-Zaluska, "High Prevalence of Thyroid Autoimmunity in Idiopathic Addison's Disease", Autoimmunity 18, no. 3 (1994): 213-216.)

Why Aren't Adrenal Tests Ordered More Often?
Another reason doctors may not be sufficiently involved in this topic is that adrenal tests are even more challenging to interpret than thyroid tests. The biochemistry is extremely complex and, until recently, the testing technology had not been widely useful except to diagnose Cushing's and Addison's. Now the measurements are more sophisticated. Current technology can be divided into roughly two camps: conventional medical evaluation; and the more recently developed alternative adrenal tests.

What Are the Standard Options?
The conventional medical evaluation for adrenal function includes measurements of ACTH (adrenocorticotropic hormone) from the pituitary, as well as cortisol (hydrocortisone) from the adrenal glands themselves. Both of these are simple blood tests.

In addition, doctors will sometimes obtain a 24-hour urine sample for cortisol and related cortex hormones. (...) One drawback with this measurement is that it is not illustrative of variations within the 24-hour period, because the whole day's worth of urine is mixed together in one bottle. The level of adrenal hormone is naturally high in the morning, progressively diminishes through the afternoon, and reaches its lowest levels in the evening. In the case of the 24-hour urine sample, the doctor can determine if the total amount of hormone is high or low for the whole day, but will not know at what time of day major variations occured. (...)

In much the same manner, a blood cortisol level is meaningless by itself. You need to know what time of day the sample was taken. Thus, the patient's blood is drawn at a standard time of day, when there is a large sample of normal values for comparison. (...)

Complicating this test is the fact that the blood cortisol level is dependent on the red blood cell protein molecules that carry it in the bloodstream. The amount of this protein carrier can change for a variety of reasons, which changes the level of cortisol that is measured. Abnormal estrogen levels and liver trouble also can lower the amount of this carrier protein, which will alter your test result. In addition to all this, one's level of activity can change the result of the test. Moreover, commonly used blood tests do not distinguish between protein-bound cortisol, and the unbound free form, which is more readily bioavailable. The new test for free cortisol is clearly preferable.

Stress level has a significant impact, too. Someone may have rushed to get to the lab or come from a stressful meeting at work. That would yield a different level than that of a patient who was calmly sitting in the waiting room for half an hour before the test. In addition, the conventional tests have a normal range that is very wide, so that only the most severe, out-of-range abnormalities qualify as being diagnostic of abnormal adrenal function (sound familiar?).

For these reasons, many doctors do not order adrenal tests at all. If they do, they generally focus not on cortisol, but on evaluating adrenaline levels (...). Since adrenaline and its related compounds are known as catecholamines, testing for levels of adrenaline is also known as testing for catecholamines. It was once thought that a person who was overly stressed would display very high levels of these compounds. But the tests are hard to interpret. The phase of adrenal depletion might be adaptive (high levels), or exhaustive (low levels).

In addition, just as with the cortisol tests, the time of day, the patient's level of activity, and the exact timing of the samples during a 24-hour period have sometimes proved to be daunting to the lab, the patient, and the doctor interpreting the test. Even low blood sugar triggers catecholamine release. The same difficulties for measuring 24-hours' worth of urinary adrenal cortex hormones would apply to measuring 24 hours worth of urinary catecholamines.

The evaluation of primary adrenal insufficiency, therefore, is best performed by giving the person a medication to stimulate the release of cortisol. The goal of this type of "challenge testing" is to measure adrenal reserve. Long before a failing adrenal gland reveals definite abnormal levels of hormone, it will go through a period of low reserve.

The way to determine the amount of adrenal reserve is to measure gland output after ACTH stimulation. The adrenal is stimulated into increased production with a quarter milligram of Cortrosyn (or some other synthetic version of ACTH), given by injection. The baseline blood cortisol is measured just prior to this injection, and the increased result is measured at the end of an hour. We believe that an increase of less than 10 micrograms, or a peak result of less than 25 micrograms, is a lowered response, thus indicating an inadequate adrenal reserve. There is not full agreement among the experts, however, about proper interpretation of either the incremental increase or the peak result.

This complicated stimulation test is much more expensive and invasive than an ordinary blood test. Moreover, it still may not tell us much at all about mild adrenal insufficiency, which could be affecting your thyroid hormone function.

Are the Alternative Options Any Better?
If conventional medicine is stymied by the adrenal system's subtleties, what do the alternative practitioners have to offer? They have chosen laboratories that try to assess adrenal function somewhat differently. A number of labs will do urinary measurements as described above, but instead of using 24-hour's worth of urine, they use four separate samples collected at (08.00), (12.00), (16.00), and midnight. Testing four different samples taken throughout the day is an attempt to obtain a more complete adrenal profile than one sample would provide. This allows a more detailed picture of the patient's daily cyclic adrenal function, and better distinguishes between the alarm phase and the exhaustion phase.

In addition to increased determinations per day, the new test measures more than cortisol levels. Also commonly tested is DHEA, a precursor to some of the other adrenal hormones. (...) The resulting set of numbers, which some labs call the Adrenal Stress Index or ASI, can then be used to initiate and monitor therapy.

Saliva measurement is another type of test not yet considered part of a conventional adrenal workup. The determination of hormonal levels in saliva is, however, being researched for its effectiveness in assessing glandular health and balance. (Ref: M. Laudat et al., "Salivary Cortisol Measurement: A Practical Approach to Assess Pituitary-Adrenal Function", Journal of Clinical Endocrinology and Metabolism 66, no. 2 (1988): 343.) One such saliva test is similar to the urinary ASI above. It tests four saliva samples, collected at four specific times of day (...). Like the urinary tests just mentioned, more than cortisol levels are measured. Some saliva labs will check cortisol, DHEA, and pregnenolone. Pregnenolone, like DHEA, is a chemical precursor to many of the important adrenal hormones. The saliva measurement is a good choice because of its ease of collection and affordability, but its degree of reliability remains to be fully evaluated. It is potentially much more accurate than blood testing, because saliva tests measure only the free (bioavailable) form of the hormone.




TEST DEG SELV!

(Fra Shames' bok - "A Self-Assessment" (s. 149-150).)


To explore whether there might be an adrenal component to your low thyroid function, ask yourself the following questions.

Do you have:

• - Low stamina for stress, easy irritability?
  - Excess mood responses after eating carbohydrates such as pasta, breads, and sugars, or marked low blood sugar or hypoglycemia?
  - Chronic infections (bacterial, viral, fungal, or yeast)?
  - Low blood pressure, fainting, or feeling of momentary light-headedness upon standing up?
  - Chronic allergy/sensitivity to common items in environment?
  - Arthritis or other chronic inflammatory response?
  - "Tired but wired" feeling? Poor sleep?
  - Having your best energy when others are winding down and sleeping?
  - Cravings for sweets, intolerance to alcohol?
  - Especially poor resistance to respiratory infections (getting them more often and being depleted when you have them)?
  - Dry unhealthy skin with excess pigmentation?
  - Cystic breasts (chronic cystic mastitis)?
  - Difficulty recuperating from jet lag?
  - Significant anxiety with depression?
  - A sense of aging prematurely?

If you answered yes to four or more of these, and if you have experienced some of the difficulties outlined in this chapter, you might want to consider adrenal testing to evaluate your condition further.



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Videre fra artikkelen til dr. Durrant-Peatfield:


If a high index of suspicion of adrenal insufficiency is raised by the history given by the patient, then what are the signs the doctor looks for to establish the diagnosis? Actually, it is sometimes difficult where the problem is not particularly severe; but there are some pointers. The blood pressure is usually quite low, often very strikingly so. The difference between the lying, (or sitting) blood pressure, and the standing one, may be very important. Normally, it rises when the patient stands. In low adrenal reserve, it either does not change at all, or lowers further. The pupil reflex is slow, or unstable, or even reversed, to bright light. Reflexes may be abnormal, especially the Achilles reflex -- in the heel. The heart sound is characteristically altered.

It is satisfactory to confirm the clinical impression by blood tests; but these sometimes are unhelpful. The level of cortisone in the blood may be measured, but it is widely variable. However, DHEA, mentioned above, is quite a good indicator of adrenal cortex function. The urinary excretion of adrenal hormones is an excellent indicator -- but the practical problems, (it has to be over 24 hours), and the expense of really good laboratory analysis, tend to limit this test to hospital in-patients.

It is, in our view, perfectly practical and reasonable, to establish the diagnosis on clinical grounds, and because the therapy given is of very low -- physiological -- doses, there is no possible risk to the patient, however long it is needed. In a very large number of cases, the adrenal insufficiency may right itself over two or three months, making further supplementation unnecessary.

[kris]

NB! Jeg har oversatt teksten til norsk lenger ned i tråden.


3. BEHANDLING



Fra Mary Shomon:


- Treatments (s. 245-247)

If you are suffering from adrenal fatigue, what can you do? Here are a few tips that can help.

Physiologic Replacement Dose of Hydrocortisone - Some people with adrenal fatigue or unresponsive hypothyriodism have found that low-dose hydrocortisone at physiologic doses can help their immune system and resolve many symptoms of adrenal fatigue. According to Drs. Richard and Karilee Shames:

What we are talking about is the use of small amounts of natural adrenal hormone (hydrocortisone) to bring slightly low adrenal function up to its proper normal daily range. This is in stark contrast to the high doses of powerful synthetic adrenal hormones commonly used to treat severe health problems, or to assist in building muscles.

(Se under for mer fra boken deres.)
You will need a more open-minded, aware doctor to obtain this sort of treatment.

Adrenal Glandulars - Desiccated adrenal gland can be helpful to some people in supporting the gland, and in replacing some missing adrenal hormones. If your practitioner recommends this treatment, be sure to get at reputable brand from a reputable supplier, to ensure quality, potency, and safety.

Hormones - Pregnenolone and DHEA are hormones that can help resolve adrenal fatigue. Use of these hormones is recommended only under the guidance of your practitioner.

Dr. Kate Lemmerman uses DHEA with her patients whose test results show low levels:

I aim for supplementation to restore values in the mid-level of a healthy 30-year-old which is about 175-250 mg/dl in our lab. I usually start with 5-10 mg in the morning for women and 10-25 mg for men and recheck after 6-8 weeks along with recheck of the thyroid values. Once the DHEA-S levels become more ideal I have seen some patients need to decrease their thyroid supplementation. I DO NOT recommend that people just take DHEA without checking their levels, as excess DHEA can also be a problem with excess hair growth, acne and agitation. And because DHEA is not regulated by the FDA it is important to recheck levels because I have seen patients hardly raise their levels with certain brands, while overshooting their target level with other brands.

Natural Support - There are a variety of herbal treatments that can help support the adrenal system, including licorice and ginseng, among many.

Avoiding Stimulants - As much as you may want them, stimulants are the equivalent of giving a car too much gas and "flooding the engine". They put additional stress on the adrenals to work harder and produce more energy, and end up further depleting the adrenal glands. Things to avoid include caffeine, ephedra, guarana, kola nut, and prescription stimulants.

Balance Your Blood Sugar with Your Diet - To minimize stress on the adrenal system, and ensure maximum energy, you should consider a low-glycemic (low-sugar) diet, consisting of sufficient protein and fat; low-glycemic carbohydrates; eaten in smaller more frequent meals throughout the day. Sugar and simple carbohydrates put stress on the adrenal glands by rapidly shifting blood sugar levels. By switching to vegetables, fruits, proteins, and high-fiber carbohydrates, blood sugar remains more stable, providing less strain on the adrenal glands.


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Fra Shames' bok:

The Thyroid-Adrenal Connection

(...)

Correction of low adrenal is similar to correction of low thyroid. You merely take a pill that contains some of the hormone you are lacking. The purpose of this chapter is to assure that doing so, when appropriate, is not only safe and effective but can change your life for the better.

Cortisol is in the category of medicines called steroids, a class of body substances built upon the structure of the common cholestereol molecule. Both health practitioners and the lay public have great concern about the safety of taking oral steroids. We would like to address this issue directly by making a distinction between high-dose steroid therapy and low-dose adrenal supplementation.

What we are talking about in this book is the use of very small amounts of natural adrenal hormone (hydrocortisone) to bring slightly low adrenal function up to its proper normal daily range. This is in stark contrast to the high doses of powerful synthetic adrenal hormones commonly used to treat other health problems or to assist in building muscles.

The Best Treatment for Low Adrenal Function (s. 147-149)
Where does all this leave us? Fortunately, the news is good. Although adrenal testing is quite complex, adrenal treatment can be quite simple.

Imagine that you have an inordinate level of anger, fear, anxiety, and stress. Suppose that you have been able to get at doctor to test you properly, and you do have mild adrenal insufficiency. One good thing to do is identify the causes of your stress and see what can be done to eliminate and/or manage them. Another is to take a small daily amount of hydrocortisone (brand name Cortef). This comes in 5 milligram tablets, and many low thyroid sufferers will find their situation improved with the simple addition of one pill daily in the morning with breakfast.

Other people with a slightly worse adrenal condition might find better improvement with one pill at breakfast and one pill at lunch. Still other people might require slightly more hormone. For them, the best way to take this kind of adrenal hormone may be four times daily, one pill at breakfast, lunch, dinner, and one at bedtime with a small snack.

You need not increase to four times a day if a lower dose adequately improves your adrenal function. Improvement in your status can be confirmed by retesting, once you have been on medication for a month or two. You may need to taken an extra dose or two of adrenal hormone temporarily, for a few days, if sudden unusual stress causes you undue fatigue. You will need even more adrenal supplement if a respiratory infection severely diminishes your energy.

The addition of adrenal hormone to your regimen could easily result in your getting more mileage out of your thyroid hormone. In fact, many people are thereby able to reduce a high thyroid intake to a more appropriate dose.

As with thyroid hormone replacement, the literature on the subject has overemphasized the hazards of mild supplementation and minimized the enormous benefits. We want to make it clear that taking these very modest amounts of mild natural adrenal hormone, when needed, will not cause an excess of adrenal hormones in your body. Nor will you experience the side effects commonly attributed to steroids (puffy face, weakened bones and skin, high blood pressure, water retention). We're suggesting 5 milligrams of natural hydrocortisone (Cortef) one to four times per day, as opposed to 100-200 milligrams per day for treatment of severe disease. If you notice any intestinal side effects, simply stop this medicine and try something else.

Most people who are treated for inflammatory conditions of the skin, lungs, or joints are not given natural hormone. Instead, they are prescribed the much more potent, and side-effect-provoking, synthetic analogue of hydrocortisone, called prednisone. Under no circumstances are we recommending that any mildly low thyroid or low adrenal person take synthetic chemicals such as prednisone for the kind of hormone balancing we are discussing in this book.

There are also a number of nutritional products available over the counter that can be supportive or even curative of mild low adrenal function. A discussion of which natural products are most useful will be found in the next step, along with our best thoughts for other nutritional and alternative therapies to optimize your thyroid. For now, we wish you good luck for your adrenal balance.

(Det neste kapittelet i Shames-boken handler mest om alternativ behandling av stoffskifteproblemer, lite om binyrer. Anbefaler de som er interessert å kjøpe boken for å lese dette!) ;)


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Dr. Durrant-Peatfields artikkel:


You will be given hydrocortisone 10mgm, which is the natural form, to take in a dose appropriate to your needs. Half a tablet three or four times a day is usual, later to be increased, if required. Hydrocortisone has the problem of very rapid uptake by the system, and it needs to be given every four hours, at least. This creates practical problems for many patients, and we use more often, Deltacortril, or Prednisolone. 2.5mgm is usually given to start with, increasing to 5mgm after a few days. Rarely, a total dose of 7.5mgm may be required.

Most patients feel benefit within a few days. You will be asked to ring the surgery if you are in the slightest doubt about how you feel, or how things are going. A report by phone after a week is pretty important, and then we see you in two or three further weeks to assess matters. You will probably have been asked to keep a diary of events. If you have a thyroid problem, the thyroid replacement will start after a week, at a very low dose, working slowly upwards.

It sometimes takes many weeks for all the benefits to come through, but some improvement is clear within a week or so. Adrenal insufficiency related to low thyroid function corrects itself, as the thyroid levels improve, and usually after, two, three or four months, have recovered sufficiently for the cortisone therapy to be stopped.

The question is often asked. Will the cortisone replacement suppress my adrenals? The answer is that in physiological dose it does not at all; and in any event, the adrenal activity is curtailed anyway, making the options quite clear. Suppression occurs in the super-pharmalogical doses, which do not concern us in this context. Even then, the adrenals are able to recover, if the primary illness is dealt with, and the dose reduced gradually.

Low adrenal reserve means that under a state of challenge, the problem is going to show. While on replacement treatment therefore, any further illness and stress is best dealt with be a temporary increase of dose. Influenza, heavy colds, dental extraction, injury and the like, require, for example, the 5mgm Deltacortril to be doubled, just for a few days. (I find that a 5mgm dose almost completely prevents jet lag; and influenza is over in one or two days.)

We have now a considerable fund of practical experience in the treatment of the adrenal deficiency syndrome, and are very much aware of its great benefit.

It should not be considered in isolation, however, any may well be part of the management of other deficiencies. The aging process is the result of deficiency in a number of different aspects of the system, so that full benefit may not be gained until both nutritional and hormonal imbalances are looked for and corrected.

[nora]

Shames har en ny bok om emnet hypo+binyrer. Omtale på thyroid.about.com.
I england har Dr.Durrant-Peatfield en bok som heter the great thyroid scandal og han har mye om binyrer, han sier at man må behandle begge deler.
nora

[kris]

Nå har jeg oppdatert tråden med utdrag fra Shames' bok ("Thyroid Power") - i blå (og rød) skrift. Den boken av Shames & Shames som du viser til, nora, kommer ut snart - den heter "Feeling Fat, Fuzzy, or Frazzled".

Og her er Amazons infoside om "The Great Thyroid Scandal and How to Survive It".

[nora]

Slenger inn noen fler linker med det samme (mest om addison siden "weak adrenals" er så lite beskrevet

http://www.fred.net/slowup/hai96.html
http://www.medscape.com/viewarticle/406491_print
http://jcem.endojournals.org/cgi/content/full/86/7/2909 bra oversiktsartikkel hvor hum skriver om de fire stadiene
http://www.dld-diagnostika.de/diseas...-addison_e.htm
http://www.pdamed.dk/instrukser/Hypofyse/21.html
http://www.adshg.org.uk/info/addisons/page1.html
http://www.niddk.nih.gov/health/endo...on/addison.htm
http://ist-socrates.berkeley.edu/~jmp/JeremyLO2.html
http://www.endocrinology.med.ucla.edu/adrenal_axis.htm
http://www.chemicalbalance.com/kevin...st_results.htm
http://author.emedicine.com/PED/topic47.htm
http://www.drkaslow.com/html/adrenal_insufficiency.html
http://www.aalrl.com/testinfo/aldosterone.htm
http://bmj.bmjjournals.com/cgi/conte.../312/7038/1085
http://bmj.bmjjournals.com/cgi/conte...313/7054/426/c
http://bmj.bmjjournals.com/cgi/conte...l/321/7261/645
http://bmj.bmjjournals.com/cgi/conte...8/7433/215?eaf
http://www.globalrph.com/corticocalc.htm
http://www.emedicine.com/med/topic65.htm
http://edrv.endojournals.org/cgi/con...tract/23/3/327
http://jcem.endojournals.org/cgi/con...ract/89/5/2228
http://www.endotext.org/
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract Det var Winquist som oppdaget 21-OH antistoffene
http://www.mc.vanderbilt.edu/pituita...site/test3.php
http://www.macses.ucsf.edu/Research/...ivarycort.html
http://www.macses.ucsf.edu/Research/...ivarycort.html
http://www.merck.com/mrkshared/mmanu...hapter9/9b.jsp
http://www.cushings-help.com/911.htm
http://www.addisons.org.nz/
http://www.addison.no


http://www.chronicfatigue.org/History.html
http://www.drdebe.com/DHEA.htm
http://www.chronicfatigue.org/ASI.html
http://users.bestweb.net/~om/thyroid/

og en bok av Jeffries http://members.aol.com/jefferiesw/index.html Safe uses of cortisone
http://members.aol.com/jefferiesw/articles/1994.html
"Excerpts from a 1994 article which describes the diagnosis of mild adrenocortical deficiency and its safe and effective treatment with small, physiologic dosages of cortisol, as well as factors that have led to the bad reputation of this normal hormone. "
Mange har brukt hans anvisninger og brukt lavdose- terapi for mild adrenal insufficiency

[kris]

Og nå har jeg lagt til klipp fra en nett-publisert artikkel av dr. Durrant-Peatfield (grønn tekst).

Det var en imponerende samling linker, nora...! Det hadde vært flott om du med tid og stunder kunne skrevet noen få ord om hva hver av dem handler om - som du allerede har gjort på noen!

[nora]

Den fra Durrant-Peatfield er kjempebra og er om den binyresvaktheten som kommer av langvarig hypothyreose.
Jeg vet om noen som har tatt cortison lavdose i ett år eller så og så kunne stoppe.
Andre har fortsatt på en lav dose.
nora

[kris]

Jeg har bladd litt i håndboken til Laboratoriene her vestpå, og funnet fram til de prøvene som er mest aktuelle i forhold til binyreproblematikken. Denne håndboken har greie forklaringer på hva de ulike prøvene kan vise.

(ep=EDTA-plasma, s=serum.)

ep - ACTH

s - 21-Hydroksylaseantistoff

s - DHEA-sulfat

s - Kortisol

spytt - Kortisol

pasient - Synacthentest

[nora]

Det som er spennende her at spyttprøven er ikke bare for cushings, men også for lavt cortisol.

Limer innnoe fra thyroid.about.com forumet som viser at lavt cortisol er ikke så sjeldent:

From: carol45ailie Jun-19 5:46 am
To: jimnmnj (jimnmnj1) 2 of 4

68184.2 in reply to 68184.1


Hello,

I am pretty familiar with adrenal issues since I have two daughters who are hypoadrenal. I used to believe in the adrenal fatigue diagnosis...now I am not so sure.. I do believe we can stress our adrenals and with the right rest and eating practices etc we can feel better though...

I think one needs to do proper testing of the adrenals. You should do a serum am reading..an ATCH stimulation test to see if the adrenals are responding...and I know there are other tests.

Adrenal issues are seroius.

I have a daughter who is 21 now , but was 17 when she "crashed"...It was almost impossible to get help...She had every syptom of hyperthyroid, but since her labs didn't show that no one believed me. She also had other weird symptoms...that I now know were from low cortisol....being hyperthyroid is a nightmare if you are low adrenal..and believe me..my daughter suffered!

I took her to a NP who did his meridian thing on her ( I thought it was wacky at the time..but he was right on with everything) and it showed her adrenals where "shot"...he gave her adrenal supplements..it didn't help...she did okay for a while...tired..etc..but she was functioning. I think the thyroid finally burned out and then she was exhausted..

She did a 24 hour saliva cortisol and it showed she was 2 on a scale of 1-8...that's pretty low. She also had had an ATCH challenge test that showed her cortisol levels didn't raise like they should when stimulated...her serum cortisol was also low.. In spite of all of that..doctors didn't want to give her cortisol...she was really sick...she could hardly keep her eyes open..she woke up with horrible headaches..she was "puffy"...it goes on and on.

Anyway...a doctor finally let her have some cortisol...it made her feel much better...not perfect, but better. She also has the thyroid issues so it gets confusing as to what is what.

I had hoped she would eventually be able to get off the cortisol but the opposite has happened..she has had to increase it. We have tried several times to lower it , but shefeels awful when we do....has a hard time breathing...acidy stomach..etc..

She takes 20mg SR cortisol...when she is stressed she takes more. She also uses a lot of salt! She looks great... Now we are trying to deal with her thyroid...she is feeling achy and extremely tired again..probably time to raise the thyroid! ARgh..

So, just to know...adrenal issues are not something to be taken lightly.....and most doctors are inept at dealing with them.

I also have a younger daughter who is on 10mg of cortisol.. She can miss a dose and not suffer...she could go off and be fine perhaps..but..she is soo low also..We think she has suffered from having celiacs and not being diagnosed until this past summer...she is improving...gaining weight...etc...so, it might take awhile to recover..

Sorry I went on and on...just know that you need to educate yourself about adrenals..the doctors are pretty clueless...and you will need to be aggressive to get help...

Good luck!
Carol

nora