Help: HPA Axis Suppression and Benzodiazapam?...w/Adrenal Issues?

[[Ar...]]

Hi - Well, I joined the other day, and have been trying to figure out my complicated issue.  Things have gotten much worse in my world in the past few days, unfortunately.

 

I have lowish thyroid, RT3 issues, adrenal, lowish ferritin......and I've been on lorazapam and nasal corticosteroid for years.....wondering how the heck to address this bundle of problems. seems like suppressed HPA Axis may be my issue, considering my symptoms and my meds history. Yikes. How can one come off of benzo without pulling rug out from under everything else and crashing the axis? also read that HC suppresses HPA axis so that doesn't sound like good answer, when one is this messed up.  Is this the case?  What to do?

 

I'm 50 y/o woman. My current set of symptoms: EXTREME exhaust/fatigue, foggy brain, daily dizziness/off balance/feeling like on rocking boat/occasional vertigo, weird head feelings, full ear feeling, tinnitus/roaring, dysmenorhea, out of whack period, heart palps, panic attacks/anxiety/agoraphobia (these latter three came on in past 1-2 months), and i'm sure i'm leaving many other symptoms.

 

I've been taking cytomel but cannot tolerate even low dose (10mg a day). i take nasal inhalant for allergies 1 x day. 200 mg progesterone in eve. close to .25 mg lorazapam at night for sleep.

 

i feel that benzo is one of major underlying problems, but how can i come off of it if the HPA axis is suppressed. won't it make it much worse? but also can't be on benzo, because that suppressed HPA axis. I feel trapped in H, E, double chopsticks!

 

I feel like i'm going to die, it's such an awful feeling. I have not been able to work (and I have my own business!). Does anyone know anything about this scenario? I have kaiser unfortunately, so feel like they would not do right thing if i went to hospital. i've had enough trouble with them in dealing with the thyroid, vestibular, and other issues. they don't know what to do with me.  Do I take more benzo now?....get stable....work on adrenals....then titrate?

 

thank you kindly for any ideas, info, support you may be able to offer. below are latest test results. Oh, and I don't have Hashi's. test was negative:

 

CORTISOL

AM: 6.6 (3.7 - 9.5)

Noon: 1.2 (1.2 - 3.0)

Eve: 1.6 (0.6 - 1.9)

Nigh: 0.4 (0.4 - 1.0)

 

FERRITIN

Range:13 - 150 ng/mL

Result: 36.5

 

T4 FREE

Range: 0.81 - 1.54 ng/dL

Result: 0.86

 

FREE T3

Range: 210 - 440 pg/dL

Result: 227

 

REVERSE T3

Range: 11 - 32 ng/dL

Result: 26

 

TPO AB:

Range: <5.6 IU/mL

Result: <3.0

 

IRON

Range 37 - 145 mcg/dL

Result: 80

 

TOTAL IRON BINDING CAPACITY

Range 250 - 420mcg/dL

Result: 271

 

IRON SAT

Range 20 - 50%

Result: 30

 

[[ro...]]

Hi ArtyOne:

 

I am subclinical hypo and the reason I started down the Z/Benzo path in the first place was because my thyroid meds were miscommunicated (from one doc to another) and I was super overdosed with Cytomel.  I also don't have Hashi's.  

 

I'm glad to see you have your free t3 and free t4 tested, but what is your TSH?  I know that cytomel is supposed to be natural synthetic t3 version, but it is very stimulating to the body.  T3 is the active thyroid hormone and t4 is the storage hormone, waiting to be converted to t3, when needed.  

 

I have some concerns here for you -- I am not a MD, so please consult him/her for more direction in your medical issues.  My three concerns are:  First - cytomel -- why not Synthroid (levothyroxine) or even Armor?  Synthroid is only t4 and Armor has 20% t3 and 80% t4.  I think you are getting a major push of active hormone when you ingest the t3 -- I did and I felt better getting off Cytomel and going back to Synthroid.  More t3 is like "pedal to the metal" for the body.  Might be contributing to your interdosing WD sxs bigtime. :tickedoff:  

 

Second, I also tried the Bioidentical hormones.  Progesterone does bind to GABA receptors -- same as ativan.  I felt much better getting off the bio hormones.  Are they really needed right now?  Again, could be contributing to interdosing WD sxs.  

 

Thirdly, I have non-allergic rhinitis.  I get by with a little nasal rinse of salt/water.  Corticosteroids will also ramp up WD sxs for you.  

 

One last question -- how do you know you have the suppressed HPA axis?  Have you had the ACTH thyroid test done in the doctor's office?  You have normal cortisol levels.  I had the ACTH and cortisol tests done too.  But my main problem was the interdosing withdrawals from taking ativan and blood levels dropping would bring on the WD sxs.  

 

I am also with Kaiser.  I think you have several things which may be contributing to your not feeling well.  I wouldn't go up in ativan -- it will only be much more difficult to taper off from down the road.  I'd look at the above three things and see what can be improved.  Diet can also cause interdosing sxs.  I did much better with a low sugar diet.  

Please PM me if you need a buddy.

 

God bless,

Rocko

[[Pe...]]

While on benzos I was sent to a pain clinic and received glucocorticosteroid injections for pain.  It shut down my HPA Axis and I went into adrenal crisis.  I was put on 30 mg of hydrocortisone (20 mg AM/10 mg PM) in the hospital and given a prescription for refills when I was discharged.  It took a month to get into an endocrinologist who literally freaked out at the 30 mg and told me she only gives her patients with Addison's disease 10 mg a day.  She put me on a 7 week taper to come off hydrocortisone (which was quite painful).

 

My GP and I figured out what happened.  Being on benzos set me up for the failure.  Benzos can suppress the HPA axis (You can do an Internet search for "Benzodiazepine HPA Axis" to find related information).  The combination of the two sent me over the edge.

 

Good tests to have your Endocrinologist run:  ACTH checks the function of the HPA Axis.  Fasting AM serum Cortisol, DHEAS, Testosterone, and Estrogen to check Adrenal output.  Serum Vitamin D test.

 

My ACTH test was good but my serum tests were ALL low before I detoxed off benzos.  That was one of the factors in the decision to send me to Detox.  We knew my Adrenals would not recover as long as I was on the benzo.

 

We are going to be rechecking my serum tests soon.

 

You can support your Adrenal function by taking Vitamin C (1000 mg) and B5 (50-100 mg).  Avoid Adrenal glandulars as they may contain naturally occurring cortisol.

 

I hope this information helps!

[[Ar...]]

Hi Rocko - Thanks much for your response.  My responses are below, to follow your questions....

 

I am subclinical hypo and the reason I started down the Z/Benzo path in the first place was because my thyroid meds were miscommunicated (from one doc to another) and I was super overdosed with Cytomel.  I also don't have Hashi's. 

 

I'm glad to see you have your free t3 and free t4 tested, but what is your TSH?  I know that cytomel is supposed to be natural synthetic t3 version, but it is very stimulating to the body.  T3 is the active thyroid hormone and t4 is the storage hormone, waiting to be converted to t3, when needed. 

 

My TSH has always been pretty normal.  I personally believe Free T3 and Free T4 are more important.

 

I have some concerns here for you -- I am not a MD, so please consult him/her for more direction in your medical issues.  My three concerns are:  First - cytomel -- why not Synthroid (levothyroxine) or even Armor?  Synthroid is only t4 and Armor has 20% t3 and 80% t4.  I think you are getting a major push of active hormone when you ingest the t3 -- I did and I felt better getting off Cytomel and going back to Synthroid.  More t3 is like "pedal to the metal" for the body.  Might be contributing to your interdosing WD sxs bigtime. tickedoff tickedoff 

 

I started on Levothroid (same as synthroid).  It was awful for me.  Then switched to Armour.  No good. Then had RT3 test done, and found out my ratio was off, and that I needed to clear T4 out of my system, and should not take any T4 until that is done.  that is why i am on T3 only (tried compounded T3 but it did nothing)....but I cannot tolerate it, likely because low adrenal function and/or low ferritin.

 

Second, I also tried the Bioidentical hormones.  Progesterone does bind to GABA receptors -- same as ativan.  I felt much better getting off the bio hormones.  Are they really needed right now?  Again, could be contributing to interdosing WD sxs. 

 

Interesting.  I actually just read somewhere this week, that progesterone might aggravate the vestibular symptoms.  Hmmm.  I'm taking the Progesterone because I have really painful periods, and it seemed to help with that initially (not so much anymore!) and it does make me sleepy. I'd be interested in hearing more about progesterone's effect on GABA

 

Thirdly, I have non-allergic rhinitis.  I get by with a little nasal rinse of salt/water.  Corticosteroids will also ramp up WD sxs for you. 

 

yep....i did the saline rinsing for many many years and loved it.  BUT.....it was after a rinsing incident, that my vertigo/dizziness symptoms began, very next morning, so as you can imagine, I'm staying the heck away from that for now.  I miss it dearly....

 

One last question -- how do you know you have the suppressed HPA axis?  Have you had the ACTH thyroid test done in the doctor's office?  You have normal cortisol levels.  I had the ACTH and cortisol tests done too.  But my main problem was the interdosing withdrawals from taking ativan and blood levels dropping would bring on the WD sxs. 

 

my endo does not think my numbers are normal, nor does my naturopath.  low in AM, high in eve....which is consistent with how i feel.  I'm conjecturing regarding HPA Axis.  I just feel soooo supressed in general right now.  conversely, i did all three self-test for adrenal, and only one was positive.  I've been waiting to get ACTH.  Not easy with Kaiser in my area, I'm afraid.  can you tell me more about your blood levels dropping? this is all very confusing.  i feel so horrible...like i'm dying! does this stuff really make one feel this bad?

 

thanks again.

 

Icr8me

 

I am also with Kaiser.  I think you have several things which may be contributing to your not feeling well.  I wouldn't go up in ativan -- it will only be much more difficult to taper off from down the road.  I'd look at the above three things and see what can be improved.  Diet can also cause interdosing sxs.  I did much better with a low sugar diet.