I am a UK resident and have been receiving treatment for my thyroid for two years after I had sub-acute thyroiditis in May 2001.


Q: I am a UK resident and have been receiving treatment for my thyroid for two years after I had sub-acute thyroiditis in May 2001. My GP started me on Levothyroxine in October 2001 and gradually increased the dose to 150 mcg by August 2002. At this point, I asked to see a consultant because I was still having problems, including extreme fatigue, loss of memory, depression, and irregular periods. The worst of it was the fatigue after exercise. I used to be fit, cycling 6 miles to and from work, long walks at the weekend, gardening etc, but found I could no longer do any of these activities. The consultant immediately reduced the dose of Levothyroxine to 100mcg and suggested that the fatigue was due to post-viral fatigue syndrome. Reducing the dose of Levothyroxine normalized my T4 and T3 levels, but I was still feeling ill. I suggested to the consultant that more tests should be done to rule out other causes before the problem could be attributed to post-viral fatigue, so he ordered a short synacthen test. The results were normal. After the test, I had a short period of about three weeks when I felt really good, could do a lot more exercise without feeling tired, and really began to think I was on the road to recovery, but this didn’t last. Having read your web-page on adrenal fatigue and other pages, i.e. Dr Rind, I realize that the synacthen test is not really appropriate for my symptoms. Could you tell me if the test might even have been responsible for the turnaround in my symptoms, i.e. could the chemicals in the test have kick- started my adrenal glands? Do you know of a doctor in the UK who might be a bit more up to date on adrenal fatigue testing?

A: The most important physiological effects of ACTH involve the adrenal cortex and include the maintenance of adrenal weight and the control of adrenal corticosteroid synthesis and release. In its absence, adrenal blood flow is diminished, adrenal atrophy invariably ensues and cortisol secretion is markedly reduced. In addition to controlling corticosteroid secretion, ACTH also increases the synthesis and release of the other adrenal steroids, namely aldosterone and the adrenal androgens. It also has some degree of melanotropic activity and lipolytic effect. Thus the application of the test you received actually gives a little boost to your adrenals. While the test comes back “normal” because it is designed to diagnose adrenal failure or late stage adrenal fatigue, your are not quite there yet, so to say. If you are in the early stages of adrenal fatigue, then the test you have taken will come back “normal” but you are still suffering. To accurately measure your adrenal status, get your doctor to do salivary cortisol and DHEA levels as the best indicator of your adrenal health.