List members,
I have new autoimmune issues to address (antibodies have popped up to
positivity for SSA (Ro), SSB (La), anticardiolipin IgM, etc., and recently
low positive for anti U1 RNP).
On July 2, went to ER with pleurisy-like inflammation. (This just after the
anti RNP positivity...) Having Addison's disease, I had to double steroids
just for the inflammation/infection. Still problems with the pleuritic
pain, and rheumatologist raised dose to 10 mg. extra prednisone (above my
replacement dose for addison's). Then secondary infection, antibiotic very
helpful. Steroids still up, for 6 days. Now tapering them. See questions
I asked endo below, and his response below that. (sorry for the caps,
format change would not allow me to fix)
If anyone deals with thyroid hormone intolerance issues, or adrenal/thyroid
interaction issues, these are quite important for polyglandular syndrome
esp. in my case. I believe low thyroid binding globulin may be important
here, though we have no way of knowing for sure. It has taken weeks to get
sorted out, unfortunately.
Also, I would like to know if anyone is dealing with rheumatologic issues
along with thyroid. We know hypoT is more prevalent in any other autoimmune
disease. But more than that, How does hypo and hyerT states influence our
immune system, especially Autoimmune activity in the body? IF I need to
suppress antibodies, does a slightly hypo or hyperT state facilitate this?
Your thoughts, thyroid listers, are welcome~
Holly
QUESTIONS I asked--
Present concern: Tapering extra steroids by 2 mg. prednisone at a time, now
is causing pulse to rise and bp to fall. This occurred in evening for two
nights— heart rate in 99 to 105 range for three to four hours.
- Why does this occur when it was prednisone I had dropped, not florinef?
Does tapering prednisone affect vascular resistance, or something that
affects bp and therefore heart rate?
- [Could lower prednisone have caused a change in my free thyroid hormone
levels? (Extra free thyroid hormone has caused mineralocorticoid
insufficiency before on several occasions, it has tended to occur a few days
after the rise.)]
Another main concern is to remain as adequately replaced as possible so as
not to flare any possible autoimmune-caused inflammation. At this time, it
is fairly clear to me that I feel just barely at replacement level right
now. [I do hesitate to try to taper very quickly, until whatever is using up
cortisol is resolved further. (inflammation? Infection? Some sort of ongoing
problem somewhere in my body?)]
I have been on increased baseline steroids (pleurisy, inflammation,
infection, etc.) since 7/4/08, for almost 3 weeks. Does body have a new set
point after this long, which means slower more gradual taper necessary? (As
we have discussed in the past, much of the reduction for Addison’s taper is
symptom-based, and with a short term increase I have in the past tapered
rapidly back to normal.)
-Would changing the extra prednisone back to a Cortef/prednisone
combination, or to ALL Cortef, help in tapering process?
-Would alternate-day dosing give more gradual tapering with less symptoms?
ENDOCRINOLOGIST's RESPONSE:
IF I HAVE BEEN ON THE NEW HIGHER STEROID DOSE FOR LESS THAN ONE MONTH, AND
IF BACKGROUND SITUATION IS NOT CHANGED—IS NOT INCREASING CORTISOL
REQUIREMENTS—THEN A TAPER BACK TO FORMER DOSE WOULD BE EASILY ACCOMPLISHED
OVER 10 DAYS TO 2 WEEKS. LONGER THAN ONE MONTH, OTHER FACTORS COME INTO
PLAY.
I ASKED BY HOW MUCH TO TAPER AT ANY ONE TIME, AND HE SAID THAT I WOULD NEED
TO CUSTOMIZE THE TAPER ACCORDING TO MY SYMPTOMS.
WHEN ON COMBINATION THERAPY, HE SAID THE CONCEPT IS TO DECREASE PREDNISONE
BACK TO FORMER BASELINE FIRST, DUE TO ITS LONGER HALFLIFE, AND THEN TO BEGIN
TO TAPER BACK THE HYDROCORTISONE.
REGARDING AFFECT ON THYROID HORMONE, IT IS IMPOSSIBLE TO KNOW, HOWEVER
THEORETICALLY LOWERING STEROIDS WILL HAVE AN AFFECT ON THYROID HORMONE
LEVELS IN THE BODY. (SAID I COULD MAKE MYSELF CRAZY TRYING TO FIGURE IT OUT…
)
REGARDING HIGH PULSE RATE AND ESPECIALLY 109 READING ON THURSDAY, Dr. SAYS
HE WOULD ORDINARILY NOT BE COMFORTABLE WITH A PATIENT WITH PULSE AT THAT
LEVEL.
I TOLD HIM THAT LOOKING BACK, ON THURSDAY, I HAD MISSED LUNCH ALTOGETHER,
AND TOOK ALL MEDICATIONS ON EMPTY STOMACH—INCLUDING ARMOUR THYROID. IT WAS
THAT DAY, LATER AFTERNOON AND EVENING, THAT I HAD THE MOST PRONOUNCED
EPISODE OF HIGH HR.
HE DID SAY, YES, FOOD INTAKE WILL CUT ABSORPTION OF THYROID HORMONE IN
ARMOUR. HOWEVER, WITH ARMOUR IF THIS HAPPENS, IT IS FOR SHORT TERM AND CAN
BE CORRECTED FAIRLY QUICKLY. IF YOU EXPECT NOT TO EAT NORMALLY, YOU CAN TAKE
½ THE NORMAL DOSE AT THAT TIME.
I DID NOTE THAT ON FRIDAY, ATE LARGER NOON MEAL AND HAD NO PROBLEMS WITH
HEART RATE REST OF DAY.
YES, HE SAID IT IS QUITE POSSIBLE THAT HIGHER THYROID HORMONE IS THE CULPRIT
OF MY RAISED PULSE SINCE STARTING TO TAPER, INFLUENCED BY STEROID REDUCTION
AND EATING LESS FOOD AT NOON MEAL WITH ARMOUR DOSE.
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