Hydrocortisone (HC) Treatment

From: http://tiredthyroid.com/hc.html

Just like there are stages of thyroid dysfunction, from myxedema coma on the hypothyroid end, to thyrotoxicosis on the hyperthyroid end, there are ranges of adrenal dysfunction.  If one has Addison’s, then there is no question that one must be on HC for life.   And if saliva cortisol labs show a flat-lined pattern at the bottom of the range all day, then one may need to supplement with HC too.  But for most others, supporting the adrenals with adaptogens and slowly raising thyroid levels can also work.  This is because thyroid and corticosteroid binding globulin (CBG) have an inverse relationship.  As thyroid levels come up, CBG goes down, leaving more cortisol free.  So raising thyroid will raise cortisol levels. [1]  But any increases must be done slowly–weekly thyroid increases are too much too soon and do not give the body time to adjust.

Are you on supplemental HC because of flat-lined saliva cortisol labs?  Is it working for you or not?  Please state your daily HC dosing schedule and any positive or negative changes you’ve experienced.


34 thoughts on “Hydrocortisone (HC) Treatment

  1. For years I had what I thought were classic low cortisol symptoms-lightheaded when standing, orthostatic intolerance, fatigue, inability to handle stress, exercise intolerance, heat intolerance, salt cravings etc. It seemed to make so much “sense” to me, so I started to pursue natural doctors who were willing to test/treat me. I had a saliva cortisol test and it was very bad. My AM result was half of the lowest level and it did not go any higher throughout the day. I then also had some other testing done (ACTH, serum cortisol), which were both elevated. It did not make sense to me, but decided to try out HC any way since my symptoms seemed so much like Addison’s.

    After trying varying amounts of HC/florinef over the course of a 2 years, I now know that most of my symptoms were not actually low cortisol at all. Sure my labs indicated suboptimal cortisol, but raising those levels to an optimal range did not resolve symptoms. I still have heat, exercise and orthostatic intolerance. I still have a tough time handling stress and often times feel “wired, but tired”.

    For me personally, HC was not this amazing, cure-all drug. It does help with some random symptoms I used to have, but I am still mostly disabled and unable to work outside of the house. I know now that I have POTS (postural orthostatic tachycardia syndrome) which mimics LOTS of “low adrenal” symptoms. However it is important to understand that they are 2 distinct conditions. POTS is not just adrenal fatigue which is evident by everything I have gone through and tried over the past 2 years.

    I regret not having a stim test done in the beginning because now I do not really know what was wrong with me. I was under the pretense that I would see significant improvements on HC and I did not. Now I am unable to wean off of it and have essentially made myself Addison’s due to the suppression from the HC itself.

    If I could go back in time, I’d have gone to an endo and got a proper stim test done rather than rely on a saliva cortisol test for treatment.

    • Hypo and stage 3D diagnosis 18 months of treatments, supps including adaptogens and cortex, far worse and doc said no to Cortef -no otc here and cannot import it. Waiting for second saliva cortisol and acth blood test. Would an acth-stim test have been more useful?

    • Hi Dana

      Did you at sometime before your pots symptom startet, get a hpv vaccine ?
      My daughter has pots and is very poorly, and we think it is the vaccine that made her sick;(
      I was searching pots, because we heard that you in the states often give cortisone and florinef to pots patients, but I can not find anything about this on the net.

  2. While taking 30 mg HC daily, I developed pre-glaucoma. I weaned off and eye pressure has gone back to normal, but there is still some residual damage. Saliva labs were not flat-lined, just low at noon. HC is not for everyone and was a royal PITA the whole time I was on it.

  3. I worked my way up to 37.5mg of HC daily plus 1mg of prednisolone, all towards the goal of being able to increase my dose of Armour to the “magic” dose of 3-5 grains which, I was told, most normal adults who need thyroid supplementation should be on. I was miserable the entire 7-8 mos that I was on HC and while weaning off (cost me my marriage too) but at least I was able to wean off. My adrenal status is still pretty lousy (saliva labs have always showed low normal in the AM and noon, normal for the rest), but it’s no worse than it was before I took HC and now I try to manage it with vits and supps like high doses of vit C, vit D, vit B50, sea salt, and coconut oil.

      • I am taking 100mcg of T4 and 20mcg of SRT3 in 3 doses, 8 hours apart. I don’t know if I could have done without the thyroid if I had started out with adrenals first, but after years of taking thyroid meds, I have never felt comfortable quitting as I don’t think that my thyroid could produce enough hormone on its own. I am sleeping without RX aids now, but it took two years to wean off of all of the sleep aids after HC destroyed my sleep patterns.


  4. Wonderfully informative site. Thank you.
    Since HC may not be the answer & has serious side effects, what are alternative treatments to HC?

    • If you have Addison’s and no adrenal function, or have pituitary or hypothalamus damage, then you MUST be on HC. But if your adrenal function is low because your thyroid levels are low, then SOMETIMES, raising thyroid hormone very slowly, like 1/8 grain raises held for 6 weeks+ at a time, with lots of adrenal vitamin supplements for support, can work. But this doesn’t work for everyone (adrenal atrophy over time?), nor do most people have the patience. I think people should get definitive testing to determine whether they really are primary or secondary before starting on HC, and unfortunately, that’s not always done. It seems like it’s recommended on some forums as a “simple” remedy, but its effects are so complex, that people have found out the hard way that they’ve only traded being sick for being sick in a different way. *sigh*

      • Thanks, Barb. Appreciate your recommendations. I’m hypothyroid (Hashimoto’s) & am going to have adrenal testing. My doctor isn’t in favor (big surprise), so I’ll have to pay for it myself. All I’ve had is serum cortisol, which was low. Is saliva the best route? I’ve read conflicting info about this. What are the best supplements for adrenal support?

    • Try Six Flavor teapills or straight Rehmannia to boost adrenal output (not just cortisol, but all adrenal hormones/steroids). It has helped me tremendously.



  5. I have just started taking 25mg HC for fatigue. The fatigue occurs when working around the house etc. basically within an hour of gardening or manual labor. Worse in hot weather.
    Golfing even became a problem. HC seems to be helping with the fatigue somewhat but really concerned about the 25mg long term. Like to wean off a little. Does anyone have comments about this. Currently taking 15mg AM and 10mg at 4PM.

  6. I’ve been on HC for 3 weeks now and I feel way worse now than before. My cortisol levels were on the low end of the range, like 4.2 or something like that, and my ACTH was 52, 2 points over the range. My endo has me taking 15 mg in the am and 5 mg in the afternoon. I have had stomach problems like pain and burning. My PC has now put me on nexium to help with that. I have sleep problems, and now a metallic bitter taste in mouth. I feel toxic. I’ve had a lot of other side effects as well.

    I just sent a message to my endo asking if she thinks I may be getting to much. I went to my chiro today for an adjustment and told her my recent diagnosis. She said I should go on a Paleo diet for several months, and meanwhile hopefully get my dose of HC adjusted right, then come back in for a nutritional and wellness assessment and they can figure out what foods I should be eating and supplements to boost/support my adrenals and hopefully get off of the HC.

    Is this actually possible? I wish I had never started the HC, and had consulted my chiro sooner, as my endo has been watching my adrenal numbers for 3 years now. I don’t know why I never thought to try to turn it around before it got too bad, because I had heard of supplements to boost the adrenals. I think maybe I was leary of it and afraid it might make things worse. I think I had heard that it could be dangerous. What kind of experience has anyone else had with doing this? I also had no idea that being on the HC would cause me too feel worse!

  7. I’ve been hypo for decades and still untreated. saliva cortisol done 11 months ago was high normal a.m., rest almost zero. I tried hc cream for the first time the other day and it stopped me from going to Emerg, still is. Picked up my cortisol results yesterday, all 4x so high it couldn’t be measured. How is this possible, and why is hc cream bringing me immediate relief?

    • When you take HC, you suppress your own pituitary hormone, ACTH, which tells your adrenal glands to make cortisol. So by manually taking HC, you may be suppressing your own function, which in your particular case is good, because your normal levels are too high.

  8. I’ve been on HC for 3 weeks and I’m very fatigued! I had low, low, high on my saliva cortisol test and Dr treated me with taking HC 2x a day at a mere 2.5 mg each occurance. I’m more tired than ever. I’ve asked to raise the dose but he refuses. Any advice I can get would be helpful!

  9. I just spent the last 2 years trying everything to heal my adrenals. In 2013 it was so bad, couldn’t get out of bed and lost weight down to 113 and I’m 5-6. I was on GAPS diet, went gluten free and took truck loads of vitamins and herbal remedies. Spent thousands of dollars at a wholistic clinic. Last Fall did a saliva tests and still all lows. My am result was a 5. Still felt terrible and had been trying all along to treat my hypothyroidism. I tried different thyroid meds and different doses, I just was getting worse and couldn’t tolerate 1/4 grain of armour twice a day. I was having high blood pressure and bad headaches. My cholesterol has shot up to 273. I couldn’t stand it any longer and got some hydrocortisone from overseas. I had quit the thyroid meds and started taking the HC by itself. I can really tell….that if you are hypothyroid, taking HC by itself will make your hypothyroidism feel worse! So if you feel worse on HC, it’s probably you need thyroid meds or an increase in dose. I started back on thyroid meds just recently, using some T3-only I had, but waiting for some NDT to come in the mail. I can’t wait, my free T3 has been below normal range for years. Sad I’m doing this all myself, but will not be made afraid. I’ve read “Safe Uses of Cortisol” and “Thyroid Guardian of Health” recently. I actually have a library of books now from all these years of trying to figure this out.

    • Hello,
      I know this post is a couple of years old; however, I was wondering if you found a solution? I have been struggling the past couple of years with my energy level. I’m on NDT for my thyroid, but only had temporary relief. I’ve been considering HC. I’m just not sure. I really can’t find a doctor who gives a flip either.

    • Hi Jennifer!
      You post the exact my story, i can’t believe it.
      I ordered HC from overseas also and today I was forced to take 5mg because I felt I’m dyeing because of fatigue at 11am
      I’m on 25mcg of Levothiroxyn (T4)
      I’ve tried Natural Thyroid half a grain and second day my heart beat was so fast and I felt all hot and sweaty. I stopped it and continued on T4 only.
      Should I stop T4 at morning for some time because I start HC?
      How are you feel now?

  10. My saliva cortisol results were flatline low. My wise doctor started me on just 5mg slow release HC each morning… with wonderful relief of exhaustion, depression, confusion, muscle weakness, tachycardia and palpitations, hypoglycaemia, and other symptoms. I am now also taking pregnanelone, and as I increase it, have reduced the SR HC to 2.5mg, still feeling better. Pregnanelone is the precursor to dhea and cortisol, so possibly a good choice for adrenal exhaustion for some people.

  11. HC revolutionized my life. I was under treated hypothyroid for a long time. At 28, after pulling the plug on a hellish marriage, I slowly began the journey of shifting to Desiccated Thyroid after twelve years of T4. But I could not withstand it. 3 months later, I got my first 24 hour salivary cortisol and I was low, low, low, low. Started off on HC at 37.5 mg per day. I felt so different. I immediately had energy. I was stress dosing thanks to bad marriage. I have Hashi’s, so I reduced the glutens in my diet. Included fish oils and CLA. Have stabilized at 1.5 grain desiccated thyroid. I gained weight on HC, but I feel alive now. I am now at 25mg tapered HC per day. I don’t get sinus infections anymore. It’s miraculous what HC has done for me. Thanks to desiccated thyroid and HC, my migraines are gone. I can sleep well most days and get out of bed by 7:30 am even after a bad night. I still have a long way to go for complete recovery. People who are not doing well on HC need further investigations and a doctor who knows his way around thyroid, hormonal and adrenal problems. Lifestyle and diet changes are also necessary for success. Stressful life with bad diet is will not help.

  12. BTW, if you have stage 4 adrenal fatigue like I do and are on HC, stay away from Vit C and Zinc. Or adaptogens in general. They did weird things to me and made my initial intolerance to desiccated thyroid much worse. And no guesswork with Adrenal fatigue. Get the 24 hour salivary cortisol and find out what stage of AF you have. I was on Vit C and zinc for months, reducing my already low cortisol levels. Turns out I needed the HC. So find a physician who knows how to tread this minefield.

  13. 10 days now on HC 10 mg. At first I was agitated and insomnia set in. Now I have a more balanced day. My diagnosis from ND is secondary adrenal fatigue. Also, I’m balancing sleep apnea, chronic pain from spinal stenosis, fibro and chronic fatigue, psoriasis, osteo, and bunions. I have hope!

  14. Hello, I have been researching about Hydrocortisone Treatment. On 11/18/15 I had an emergency C-section at 29 weeks pregnant due to a severe case of Pre-eclampsia. After surgery I was diagnosed with Pituitary Apoplexy, I bled into my Pituitary Gland. Due to this now my Adrenal glands do not produce Cortisol and I am on Hydrocortisone 50mg twice a day. I have been trying to learn more about my condition and get informed at least until I am able to follow-up with my doctors which have not seen me yet being I just got out of the hospital. I read that this limits my ability to handle stress, can anyone tell me what type of stress? Is it stress to the body physically as in an injury, or does it include mental stress, such as arguing and being upset? I am so lost right now, how can I not be stressed with all that I have been through with in a day and my baby still in the NICU until February 2016. I went from taking just prenatal vitamins and medicine for heartburn, to taking medications for cortisone, diabetes, high blood pressure, and headache and nausea medicine, total of 8 medications, all due to this incident of bleeding into my Pituitary gland. I need advice, feedback, how to cope with this, someone that understands where I am coming from. This is a scary situation, specially for the fact that I keep reading things that says if I don’t take this medicine it can be fatal. I have 2 other children besides my newborn. Anyone knows of any support groups or more resources for my condition, it would be helpful. Thank you.

    • Loraine, I’m so sorry to hear about your medical problems. I don’t know enough about pituitary apoplexy to advise you, but I can tell you that people who don’t produce cortisol are said to have Addison’s disease. You can google for support groups on that who may offer more information. And yes, stress can be either physical or mental, because they’re inter-related.

    • I hope you are much better at this point. I had the start of my symptoms right after the birth of my child too. You do have to take medicine for the rest of your life but it only needs to be increased with physical stress. Having said that, it takes time to figure out how much to take and when to take it. If needed, jot down when you take your meds and when you feel exhausted. This will give you a better idea of how much you can do with each dose. If you notice you can do more than you may be able to cut down. If you notice you can do less either you are about to get sick or the dose needs to go up. Good luck to you and your baby!

  15. Do you have an Endocronolgist? He / she help will set up your meds. Also: Discuss the stress factors.
    Also: The necessary precautions you have to take if you get serious health condition. Such as a bad cold .
    He will also talk to you about stress dosages.

    • I see him for the 1st time next Friday of next week. I will have to weite down what stresses me. Its difficult, i think that besides all of this worrisome i might be affected by post partum depression.

  16. I have been on HC for three weeks and I feel amazing! I found out through my saliva test that I am very low in cortisol. I also was high estrogen. I just started progesterone(Biodentical) hormone creme a week ago. That has helped too. I just cant believe this is working for me. I have tried so many different things! Everyday I walk up and down two flights of stairs from my condo and everyday before I got this treatment it was like my legs were lead and I would have daily dread of the stairs. It hit me yesterday for the first time in forever I walked up and down my stairs with ease! I hope this keeps up! My husband cant believe the change in me. I am so hopeful now! :)

  17. I have most of the symptoms of secondary Addisons disease. Crave salty foods, low sex drive, chronic fatigue, dark pigment knuckles elbows and knees, hair loss off the top of my thoughts. What lab test should I ask the doctor for. Thank you so much I hate to go to the doctor and I cannot find a good one

  18. I’ve been hypothyroid for a few years and then found to have adrenal fatigue – somewhat low cortisol throughout the day. My Dr put me on 15 mg hydrocortisone. Having energy again has been amazing, although I notice my body seems a little swollen and I’ve had some trouble sleeping. There have been a few times when I’ve felt excessively angry or irritated or sad, especially if I wake up in the middle of the night. For a while I thought HC was this miracle cure. I’m sad it’s not.

  19. I take 5 mg of Prednisolone, 100 mcg T4 and 1/2 grain Thyroid-S, and 25 mg DHEA (to balance the cortisol). I’m male, 34, 195 lbs muscular. It’s been two months, I feel better every day and this is the only thing that ever worked.

    I don’t think I should have been a very difficult case. I probably have natural subclinical thyroid levels and over time it brought down my adrenal function. Trying to add a ‘little’ T3 or NDT only made things worse – both thyroid and adrenals – I believe.

    Learning T4 isn’t only a ‘prohormone’ was critical (you were another voice there – thank you!) and thinking about the ratio also helped. 100 / 6 * absorption ( ~95% T3 / ~60% T4 ) = ~25 to 1.

    I go to double check the test in a few months, so we’ll see. Just adding myself here as a data point. ymmv.

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