Hi Donna,
http://forums.about.com/ab-thyroid/messages?msg=38457.50
Welcome to the forum! You'll find great info and support here!
OK, you're really hypo - what dose of medication did this newby doctor put you on? (Sorry, haven't read through all the posts in this thread).
You said your ACTH was very high - that's the pituitary SCREAMING for more cortisol! What were the results of the cortisol tests you took (please include lab ranges). What time of day was the serum cortisol done? Morning results are ususally higher than afternoon or evening. 24 hour urine cortisol is not good for figuring out the circadian rhythms of cortisol produced by your body.
To give you a simple explanation of the anxiety, panic you're feeling, here goes. When thyroid hormones are very low, such as yours are, the adrenal hormones (adrenalin and noradrenalin) take over some of the functions that the low thyroid hormones can't handle. For example, your heart beats on an average of 72 beats a minute when euthroid. When hypo, the heart rate slows considerably (often below 60 bpm). To get your heart beating faster (your body perceives this as an emergency situation), adrenalin comes to the rescue. Adrenalin and noradrenalin are fast acting hormones, only meant to be used for emergency situations (flight or fight). However, when the heart is beating too slowly (bradycardia) the adrenal kicks in to keep it functioning normally. The side effects of this is that your entire nervous system gets revved up to higher levels.
Adrenalin and noradrenalin not only help to regulate the heart rate but also stimulate the nervous system to be on alert for danger. Danger comes in all forms, like near car crashes or a body that's not up to speed. Your body needs to stay in homeostasis (metabolic balance) in order to survive. So adrenalin comes to the rescue when thyroid hormones are very low.
Adrenalin keeps the mind alert, dialates the pupils (to see better in times of danger), speeds up digestion, makes the muscles tense, raises body temperature and heart rate, increases blood pressure and so much more.
Cortisol, an important adrenal hormone, acts as the feedback system for adrenalin and noradrenalin. When adrenalin and noradrenalin levels are high, cortisol comes in to lower them (through feedback) and bring them back into homeostatsis once the danger is gone. However, if you have adrenal insufficiency and don't produce enough cortisol to control the adrenalin and noradrenalin, guess what levels stay high? Right, adrenalin and noradrenalin. These high levels are what make you feel anxious, just like if a tiger came out of the jungle ready to attack. Your run or fight!
Sufficient cortisol is also needed to convert inactive T4 to active T3. You have very low levels of both, so there's not much action going on (which is the cause of high TSH, inadequate thyroid hormones and hypo symptoms).
All the literature on thyroid disease say that if adrenal insufficiency is present along with hypothyroidism, the adrenal insufficiency must be corrected before starting thyroid medication. This means that you need further testing on your adrenals and replacement therapy with hydrocortisone to make up for what your adrenals can't make. Once the adrenals are addressed, you can begin adding small amounts of thyroid hormones, titrating them up until you get your levels optimized.
Since you're well read about TD, go to the Thyroid Manager and read Chapter 9 on Adult Hypothyroidism. It's a very long chapter (you may need to print in sections) but you can print it out for your newby endo. The Thyroid Manager is written by world class thyroidologists for both doctors and patients alike.
Hope this helps!
Best in health,
Leslie
Maine,