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Treatment Options for Hypocortisolism
The approach that is probably the most common is to do nothing, which can occasionally result in problems during thyroid hormone replacement. However, very frequently when the correct thyroid hormones are provided at the right levels then the cortisol levels quickly recover.
Another approach used by some doctors prior to commencing thyroid hormone treatment, is to do laboratory tests for hypocortisolism and low aldosterone. If the test results indicate a sufficiently low cortisol level then some form of treatment might be administered, prior to prescribing thyroid hormone replacement. Typically, only physiological doses of adrenal hormones are used.
Physiological doses of any naturally occurring hormone are doses that are small and only raise the level of hormone in the body to the normal level and no higher.
An alternative approach is to commence thyroid hormone replacement therapy and watch carefully, to see if any of the tell tale signs of hypocortisolism exist. If there is evidence during thyroid hormone replacement, then laboratory tests for cortisol levels may be done at that time. The doctor can then assess if there is any need to use any form of treatment.
If a doctor concludes that a patient may be suffering from hypocortisolism that is severe enough to prevent the success of thyroid hormone replacement, then it is possible that the patient may be offered a trial of adrenal support.
Adrenal support may involve the use of very small, physiological doses of hydrocortisone, which are designed to only correct a patient's cortisol to normal levels and not above this. In this case, because of the short-lived nature of hydrocortisone in the body, several small doses may be given during the day.
Alternatively, a more natural form of adrenal support may be used, which is likely to contain some level of ground up adrenal glandular.
.Adrenal hormones used incorrectly can cause serious issues and so a patient ought to be working with a suitably experienced and qualified medical doctor.
In the case where some form of adrenal support has been provided, once the correct dosage of thyroid hormone replacement has been established, then any form of adrenal support may usually be reduced gradually and then stopped.
It is also important to be aware that the form of thyroid hormone treatment may directly affect the performance of the adrenal glands.
In my own case, I had hypocortisolism when on T4 replacement therapy but it corrected when I was successfully using T3 replacement therapy.