Recent Adrenal therapy(cortef) and surgery

[raw1973]

I was put on cortef last year(20-30mg a day) to support adrenals during thyroid treatment.
I couldn't take side effects and ended up weaning slowly off completely 6 months ago. Been feeling decent lately, working out often and so on, blood work looked good except TSH is higher then ever. Went on synthetic T-4 + T3 couple weeks back and tolerating it well.

So i was scheduled for surgery in a couple weeks (3-4 hours under General) and figured I would be fine being off the cortef for 6 months. Though, after scheduling, read in a few places that if on corticosteroids for a period of time between last 6-12 months that stress dose steroids must be given intravenously.

I do of course plan to discuss w/ Anesthesiologist but wanted some other opinions in the time being.
I would love to avoid steroids, but adrenal crisis on the surgery table scares the hell out of me. Thanks--Raw

[chilln]

I was put on cortef last year(20-30mg a day) to support adrenals during thyroid treatment.
I couldn't take side effects and ended up weaning slowly off completely 6 months ago. Been feeling decent lately, working out often and so on, blood work looked good except TSH is higher then ever. Went on synthetic T-4 + T3 couple weeks back and tolerating it well.

So i was scheduled for surgery in a couple weeks (3-4 hours under General) and figured I would be fine being off the cortef for 6 months. Though, after scheduling, read in a few places that if on corticosteroids for a period of time between last 6-12 months that stress dose steroids must be given intravenously.

I do of course plan to discuss w/ Anesthesiologist but wanted some other opinions in the time being.
I would love to avoid steroids, but adrenal crisis on the surgery table scares the hell out of me. Thanks--Raw


Well done for researching this facet of the surgery process.

The issue here is whether your adrenals are up to it. The adrenals will release a lot of cortisol once you're cut, because cortisol will suppress the "fix me I'm broken" signals, to a more tolerable level.

You don't want your central nervous system overloaded with "fix me I'm broken" messages.

Since you've been working out, if you've been increasing your maximums, or at least pushing yourself hard, since you've backed off the cortef, then your adrenals are coping reasonably well.

That's what you'll need to discuss with your medical professional advisers - ie: how well have your adrenals been coping with a good hard workout.

If you've been experiencing a few good hard workouts, and you didn't experience any lightheaded symptoms, or any nausea symptoms, then mention that to your medical professional advisers.

Most likely they will either choose to have some adrenal hormones on standby,
or alternatively they will still load you up as a precaution.

Either way, well done for being informed.

###

Incidentally, have you had a bone density scan lately ?

pmgamer was on long term HC supplementation, and his bone density suffered, and this was only discovered just before surgery - and decisions had to be made very quickly, and some less-than-optimal decisions were made.

[raw1973]

Now that you mention it last couple nights after workouts, I was a bit out of it. Though, during workouts I was fine. I thought maybe this was due to my lowering of carbs or thyroid. Blood pressure has been good though a little lower than usual.

I've never checked bone density? Could being on cortisol on and off for a year cause bone density problems at age 35?