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Dr. Andrew Rynne

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Suggest remedy for high BP while on Prednisone for bronchial infection

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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Posted on Fri, 30 Oct 2015 in Thyroid Problem and Hormonal Problems
Question: I have been on Prednisone for the last 3 weeks for a bronchial infection. 60mg per day. I had my thyroid removed and take 2 grains of Armour thyroid. I also have adrenal insufficiency.

My heart has been pounding, BP high @147/79 (usually 120/70), shaking, weak, sweating profusely. Very agitated. Temp normal.

Serious? Should I stop my thyroid medication for a few days?
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Answered by Dr. Shehzad Topiwala 43 minutes later
Brief Answer:
Thyroid/ adrenal

Detailed Answer:
It appears you have had adrenal insufficiency even prior to starting the prednisone course for the bronchial infection.

Now if that is the case, then prednisone needs to be tapered even more gradually than for a person without pre-existing adrenal insufficiency.

When I see someone like you in my practice, I suggest they reduce prednisone by 5 mg every 1 to 2 weeks and see how it goes. Sometimes even slower taper is necessary.
The rate of tapering and the dosing will largely depend on your symptoms. So I suggest you see an endocrinologist in-person and under careful supervision and follow up, go about weaning the prednisone.

The symptoms you are experiencing at the moment are suggestive of adrenal insufficiency except for the high blood pressure.

In such cases and even otherwise it is not advisable to take armour thyroid. Most endocrinologists worldwide prescribe levo thyroxine for the treatment of an under active thyroid.

This can become an emergency if matters are not handled properly by a qualified expert. And at the present time too, the ideal thing would be to go to the emergency.
For example, taking thyroxine in the presence of adrenal insufficiency (that is worsened by inappropriately rapid taper following 3 weeks of high dose prednisone course). can precipitate an 'adrenal crisis'.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala 8 hours later
Thank you for your quick reply. Yes, you are correct in that I have had Adrenal Insufficiency for about 10 years now. My symptoms started when I was on 60mg of Presnisone per day in terms of rapid heart rate, feeing hot, shaky, weak and agitated. As I began the tapering 60mg for 3 days, 40mg for 3 days, 20mg for 3 days and then nothing (I am in the 20mg for 3 days now), I have been sweating profusely (like hair dripping wet) and I live in NY (cool here).

Given that additional information, any additional recommendations/thoughts?

Thanks for your help. Nice to triangulate on this to be sure I'm dealing with it right.
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Answered by Dr. Shehzad Topiwala 2 hours later
Brief Answer:
Follow up

Detailed Answer:
The taper was too quick in my opinion.

I am sorry I will not be able guide you specifically how to go about managing this dangerous situation on an online forum like this. You must seek prompt medical care from an expert who will treat you under close direct supervision.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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