Doctors Lounge - Endocrinology Answers
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Forum Name: Endocrinology Topics
Question: Hormone Imbalance, Adrenal Fatigue
|rhea187 - Tue Sep 08, 2009 9:07 pm||
Ever since my daughter was born 4.5 years ago I have had problems. As time has progressed it has gotten much worse.
Daughter was born & I went on patch, I had an allergic reaction & had a horrible rash on my skin, next I went on Depo Shot. This caused horrendous bleeding, I bled from March until November, daily, non-stop. Then the dr's insisted I should go on Nuva Ring, I did & went off of that in February when my husband deployed & was off of it for about 7 months. When he returned I went back on the ring for about 3 months & I hated it. Husband had a Vasectomy in March of 2007, I have been birth control free since January of 2007.
One of my main problems are inability to lose weight, despite a good diet (well a good one before) & exercise. I exercised 5x's a day & ate right for 5 months straight & didn't lose a single pound. It was horrible. I was so tired, I had to drag myself to the gym & after spending an hour there I would come home & nap for at least 3 hours during the day, on top of getting at least 12 hours of sleep each night.
I have been to different dr's numerous times & always was told nothing was wrong & I should go on the pill due to irregular & very painful periods. I refused. My main symptoms when I went to that dr were fatigue, inability to lose weight & the horrible periods. I was in so much pain I would cry, their answer was the pill.
We moved to our new home in October of last year, in November I got in with a new dr. She gave me the same answers as every dr I have seen before. I refused to believe NOTHING was wrong with me & saw another dr in the practice. He has been working with me, but I don't know if what he is saying is working the way I think things should be.
I am a 26 y/o female. Seemingly healthy through out life. Never overweight, about 5'2" & usually about 115-125 lbs, even after the birth of my son, then I had my daughter & now I hover around 145-155 lbs.
I had Thyroid Testing done in December of 08, January of 09 & May of 09. Hormone Saliva Testing done in June of 09. The results are as follows.
Thyroid December 08 -
TSH 0.295 (Preference Interval .450-4.5)
T4, Free (Direct) 1.09 (Preference Interval .61-1.76)
Thyroid January 09-
Thyroid Peroxidase Antibodies <10 (Preference Interval <35)
T-4 Free .9 (Preference Interval .8-1.8)
TSH 3rd Generation .63 (Preference Interval .4-4.5)
Thyroid May 09-
T4 Free Direct .99 (Preference Interval .61-1.76)
TSH .663 (Preference Interval .45-4.5)
Triiodothyronine, Free, Serum 2.9 (Preference Interval 2.3-4.2)
Thyroid Peroxidase <10 (Preference Interval 0-34)
Saliva Testing June 09-
Estradiol (Saliva) 2.8 (Reference Range 1.3-3.3)
Progesterone 25L (Reference Range 75-270)
Ratio: Pg/E2 9L (Reference Range Optimal 100-500 when E2 1.3-3.3 pg/ml)
Testosterone 14L (Reference Range 16-55, Age Dependent)
DHEAS 13.2 (Reference Range 2-23, Age Dependent)
All of the above were in units of pg/ml accept Ratio Pg/E2.
The following are in units of ng/ml
Cortisol Morning 3.6L (Reference Range 3.7-9.5)
Cortisol Noon 1.0L (Reference Range 1.2-3.0)
Cortisol Evening 1.4 (Reference Range .6-1.9)
Coritsol Night .5 (Reference Range .4-1.0)
I had to fill out a none, mild, moderate, severe symptom list for with the hormone testing. I will include my moderate to severe symptoms.
Vaginal Dryness, Incontinence, Foggy Thinking, Tearful, Sleep Disturbed, Headaches, Aches & Pains, Morning Fatigues, Evening Fatigue, Cold Body Temperature, Sugar Craving, Weight Gain -Waist & Hips mostly, Decreased Libido, Loss of Scalp Hair, Mood Swings, Tender Breasts, Bleeding Changes, Irritable, Anxious, Decreased Stamina, Dry & Brittle Hair, Constipation, Increased Urinary Urge (often feel like I have a mild UTI), Low Blood sugar
The results I have with the hormone testing is that I am pre-menopausal, estrogen dominance during the luteal phase & that may interfere with thyroid function (dr's refuse to believe anything is wrong with my thyroid), testosterone level is too low for my age, adrenal fatigue - adrenals are pretty much shut down.
I have been on Prometrium to up my progesterone levels since the beginning of August. I am taking 25mgs days 14-28. Haven't seen much of a difference, it made my period very long the last time I had it & I am sleeping better at night on it.
Dr just added Zoloft (25mg daily) to my meds last Thursday. He thinks I am clinically depressed, but I guess anyone going through what I am going through would be depressed too. I don't feel like I am depressed, I feel like I just want these problems solved & can't figure out how to do it.
On a normal day I need to nap after I get my son from school for about an hour & then I am recharged until bed at 9/9:30 at night. Now with being on the zoloft I am completely tired all day & have no motivation or desire to get off the couch. I go back to the dr in 9 days to see how the Zoloft is working. it isn't working, it is making me feel worse.
I normally see a D.O. I think it is time I ask to see a specialist to fix these problems. What kind of specialist do I need to see & what kind of information do I need to go into the appointment with?
|Debbie Miller, RN - Sun Nov 15, 2009 1:41 am||
I would recommend seeing an endocrinologist if in spite of a good trial of treatment you don't feel improvement but first I would discuss the concerns with your current doctor who may have good reasons for the current course of action. Before seeking a specialist, I would want to be sure I understood where this doctor is coming from. If your situation is sub-clinical and labs don't make it clear, an endocrinologist may not be willing to find other answers and may rely on the lab tests for confirmation. If you do seek another opinion, the most helpful information to take would be your lab results and a journal that outlines your symptoms. Include when you take your medication and the effects you notice. thyroid-info.com can help you determine this.
Neurotransmitters can affect many body systems and people benefit from the SSRI antidepressants such as Zoloft beyond major depression. They are often used for other conditions as well. But, dosing regulation can be tricky. It takes a while for the drugs to show their effects as your body adjusts and often after a couple of weeks or so a dosage adjustment is needed or try taking it at the opposite time of day. Sometimes a different form of SSRI or similar medication is needed. It's a trial and error thing. If you find after a few weeks that you still feel worse on the Zoloft, perhaps a different medication will work better for you. It takes a lot of patience to get the regulation that works for you.
There is a condition called subclinical hypothyroidism - a kind of borderline condition and there is controversy about treating it. It may progress to overt hypothyroidism. When labwork does not reveal clear answers, there is always debate about treatment and how effective it might be and whether or not the potential benefits would outweigh the side effects that might result from treating it with medication. Often the best thing to do is continue to monitor for changes in the levels.
The body's endocrine system with its many hormones is very complex and it can take a long time to figure out the problem as well as the solution. The progesterone should help balance out the estrogen and help with the adrenal dysfunction so that is a good treatment. Often oral contraceptives are tried because they tend to deliver a more predictable and stable rate of hormones. It is usually seen as a fairly easy treatment to try with few risks if you are not a smoker or have no history of blood clots. But, they certainly are not a cure-all so if you don't want to take them, I would not see a problem with refusal.
A few other lifestyle changes that might help with adrenal insufficiency include:
• Stress reduction. Chronic stress repeatedly forces the adrenal glands to sustain high levels of cortisol. Take more time for yourself and exercise daily.
• Sleep 7-9 hours a night. The hormone seems to be helping this now so that's good. Lack of sleep can be caused by stress, hormonal imbalance, by physical, emotional and psychological factors.
• Eat a diet rich in healthy whole foods, fresh fruits, vegetables, nuts, legumes and fiber.
• Take a daily multivitamin.
• Add essential fatty acids from fish oil to your diet.
• Since sugar stimulates the adrenals, reduce or eliminate sugar and alcohol from your diet.
Other conditions such as diabetes and hypoglycemia can also cause generalized symptoms so you may want to ask the doctor about those.
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