Why Isn’t My Thyroid Medication Working?

PATIENT>>But other doctors don’t make me wear
this ridiculous costume. DOCTOR>>That’s because other doctors don’t
understand the delicate doctor patient relationship like I do. [fart] Now, do you have any other
questions? PATIENT>>Yes. I got frustrated with my continuing
hypothyroid symptoms and increased my thyroid medicine. It did nothing. I am still cold,
tired, and have all the other symptoms. I don’t understand. DOCTOR>>Your inability to metabolise more
thyroid medicine suggests adrenal fatigue. This is even more likely if you have allergies,
frequent respiratory infections, faintness upon standing, palpitations or trouble sleeping.
However, your blood test showed your cortisol is normal, so we will just check you again
in 6 months. Go in peace. PATIENT>>But my thyroid medication is not
working. It’s not right. I have all those problems you mentioned. Are you sure that
a single blood test is enough to detect low cortisol? DOCTOR>>Technically, a saliva-test better
measures bio-available cortisol, but that test is generally unnecessary. PATIENT>>Why? DOCTOR>>Because adrenal failure is fairly
easy to detect. You fall down and die. That is called Addison’s disease and is the only
degree of adrenal failure officially recognized by The Church of Modern Medicine. PATIENT>>But what about adrenal glands that
are simply underperforming? DOCTOR>>Weak adrenals are not recognized by
modern medicine. We assume that adrenals either work or fail completely. When they work, you
live. When they fail, you fall down and die. There is no in-between. PATIENT>>You want me to believe that there
is no such thing as weak adrenals? DOCTOR>>If I want to stay a member of the
Church of Modern Medicine, then yes, that is what I must ask you to believe. PATIENT>>Are you serious? DOCTOR>>Listen, we must keep our voices down.
Technically, you’re right. Your adrenals can fail gradually just like your thyroid or pancreas.
But it’s a delicate subject. Adrenal fatigue would have to be treated with cortisol, which
is a steroid and therefore the Work of Satan. PATIENT>>But how can cortisol be the Work
of Satan if it is produced naturally in the adrenals? DOCTOR>>Because when cortisol was first isolated,
doctors found it so helpful that they injected people with huge doses of the stuff. This
caused terrible side-effects so we declared it the Work of Satan. PATIENT>>But aren’t most medicines like that?
Helpful in small amounts but dangerous in large ones? DOCTOR>>That’s true, but cortisol hurt our
feelings so we ignored the subsequent studies showing that low doses were safe and effective.
It is too late now. Once doctors make up their collective mind, they can not change it without
admitting that they might have been under treating patients for fifty years. As a result,
most doctors today won’t treat you for adrenal fatigue until you fall down and die. PATIENT>>But clearly you understand this better
than other doctors and will help me, right? DOCTOR>>It’s not that simple. Cortisol is
no longer patented and has become very cheap. As a result, pharmaceutical companies have
no incentive to spend the money to have cortisol approved as a low dose therapy. PATIENT>>I don’t even understand why that
matters. DOCTOR>>Nowadays, unless pharmaceutical companies
are pushing the treatment, the disease falls through the cracks. You might not believe
this, but if I diagnose you with hypoadrenalism, there is no such box for me to check on the
diagnosis form. Insurance companies don’t pay for treating unclassified diseases, and
doctors who make uncategorized diagnoses face professional scrutiny. PATIENT>>But didn’t you say that weak adrenals
could be why my thyroid treatment isn’t working? DOCTOR>>Absolutely. Cortisol is a critical
co-factor for thyroid receptor activation. Your body can not utilize thyroid hormone
without enough cortisol to match. That is why we suspect weak adrenals when your thyroid
medication doesn’t raise your metabolism like it should. PATIENT>>So how do we fix it? DOCTOR>>You can try adrenal supplements, but
it’s rarely so simple. The hypothalamus, pituitary, genetically weak adrenals or even a genetically
missing hydroxylase enzyme can all be to blame. Low dose cortisol treatment supports the adrenals
and even enables them to heal in some cases if they are the problem. But just like your
thyroid medication, you might simply need some extra cortisol indefinitely. PATIENT>>So how does cortisol supplementation
work? DOCTOR>>In a perfect world, we would start
you on a trial of low dose hydrocortisone. The body normally produces the equivalent
of about 40 milligrams per day, so if we only give you between 20 and 30 milligrams, your
body can lower its own production to keep your serum levels exactly the same. PATIENT>>I’m not sure I understand. Did you
just say my serum cortisol levels could stay the same, even with supplementation? DOCTOR>>Exactly. That is why this approach
is pretty safe. In a healthy person, a small dose of cortisol just replaces part of what
the adrenals were already making naturally. In such people, the pituitary simply down
regulates ACTH to keep total serum cortisol levels the same as before. A person with healthy
adrenals will therefore not notice any difference and can simply stop taking it. PATIENT>>But if I do need the cortisol? DOCTOR>>If you have weak adrenals and your
cortisol is below normal, your pituitary will not down regulate but will instead gladly
allow your serum levels of cortisol to rise. This will then activate your dormant thyroid
receptors. Thyroid hormone will finally enter your cells, your temperature and energy levels
will quickly improve, and it will become quite obvious that this was your problem all along. PATIENT>>That sounds wonderful. When do I
start? DOCTOR>>I said that is what we would do in
a perfect world. This is not that world. Hypoadrenalism is actually very common and treatment provides
great relief to those who need it. But we refuse to diagnose it because the treatment
requires the use of a steroid that we scared ourselves with a half century ago. You are
more likely to rob a bank successfully than to find a doctor to help you. PATIENT>>So there is nothing you can do? DOCTOR>>Of course there is. If I can not fix
the real problem perhaps I can at least distract you. The pharmaceutical rep dropped off their
latest antidepressant this morning. I’ll go get you some samples. [cash register ringing]