Thyroid/adrenal connection is a question that deserves a large study.
The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones – such as cortisol, epinephrine and norepinephrine – that regulate the stress response. But these hormones play other crucial roles, many of which are directly related to thyroid health. In fact, as we’ll see, proper thyroid function depends on healthy adrenal glands.
Adrenal fatigue is defined by a partial cortisol insufficiency. Adrenal fatigue must not to be confused with Addison's disease, a chronic adrenal insufficiency caused by autoimmune dysfunction, certain infections (including tuberculosis), or various rarer causes. Adrenal fatigue is a condition due to lifestyle problems, generally physical or emotional chronic stress (Click Here).
If physical and/or psychic fatigue is one the most common complain, adrenal fatigue has a broad spectrum of non-specific yet often debilitating symptoms. The onset of this condition is often slow and insidious. Patients are told that they are stressed and need to learn to relax more. Being able to handle stress is a key to survival, and the control center in our bodies is the adrenal glands. Any adrenal fatigue or inability to properly handle stress will lead to physiological disorders and to a myriad of symptoms.
● Signs and Symptoms of Adrenal Fatigue
The list is long, and includes: weakness, lack of energy in the mornings and also in the afternoon between 3 to 5 pm, need of coffee or stimulants to get going in the morning, allergies, high frequency of getting the flu and other respiratory diseases (which tend to last longer than usual), muscle and joint pain, dizziness, low blood pressure, low blood sugar (Click Here), low body temperature, food and salt cravings, poor sleep, dark circles under the eyes, unexplained hair loss, dry and thin skin, lines of dark pigment in nails, increased effort to perform daily tasks, decreased ability to handle stress, tendency to tremble when under pressure, nervousness, anxiety, depression, impair memory, lethargy, increase pre-menstrual symptoms for women, cystic breasts, reduce sex drive, and premature aging.
None of the signs or symptoms by itself can definitively diagnose adrenal fatigue. When taken as a group, these signs and symptoms do form a specific syndrome or picture – that is a person under stress (once other organic pathologies have been ruled out). These signs and symptoms are the end result of acute severe or chronic excessive stress and the inability of the body to reduce such stress.
● Hypothyroidism due to Adrenal Fatigue
What follows is inspired by Dr. Michael Lam's studies. Dr. Lam, MD, is expert in nutritional and anti-aging medicine, California, director at the Lam Adrenal Fatigue Center.
Hypothyroidism as we know can be primary or secondary. Primary hypothyroidism is effectively treated by the administration of thyroid hormone. If hypothyroid symptoms such as low body temperature, fatigue, dry skin, constipation, hair loss and weight gain persist despite thyroid replacement therapy regardless of laboratory values, one must look elsewhere for the cause of the low thyroid function.
Adrenal fatigue is perhaps the most common cause of thyroid failure, both clinically and subclinically, and yet the most frequently overlooked or ignored. It is often responsible for treatment failure. Such a hypothyroidism can be assimilated to a "secondary hypothyroidism" since the low thyroid function is caused by malfunction of another organ system than the thyroid itself. Low adrenal function often leads to low thyroid function, classically evidenced by low free T4, low freeT3, high TSH, and low body temperature. Few physicians are trained to detect adrenal fatigue. Fortunately, this secondary hypothyroidism can be reversed when the underlying root problem, namely adrenal fatigue, is treated and resolved.
When the adrenals glands are weakened or exhausted, the ability of the adrenals to handle the stress associated with normal bodily functions and energy requirements is often compromised. To ensure survival, the adrenals force a down-regulation of energy production, putting the body in a state of catabolism. In other words, the body slows down its metabolism to reduce the workload of a body that needs rest. In times of stress, this is exactly what the body needs. The thyroid gland, which controls metabolism, will then down-regulates its activity by producing less hormones T4 and T3. The down-regulation also leads to an increase in thyroid-binding globulin (TBG), their protein-carrier. As a result of increased TBG (like in case of estrogen dominance), more thyroid hormones are bounded on a relative basis and less active hormones (T3) are released to the body cells where they work. This leads to reduced free T4 and free T3 levels in the blood. In this well-orchestrated systemic down-regulation to enhance survival, the body also shunts some of the available T4 towards the production of the inactive reverse-T3 which acts as a breaking system and opposes the function of T3. The reduction in T3 combined with an increase in reverse-T3 may persist even after the stress has passed and cortisol levels (the adrenal response to the stress) have returned to normal. If the proportion of reverse-T3 dominates, then it will antagonize T3 and possibly leading to a state called reverse-T3 dominance. It results in hypothyroid symptoms despite sufficient circulating levels of T4 and T3. The body therefore has multiple pathways to down-regulate energy production to enhance survival under the direction of the adrenal glands.
In such cases, laboratory test results of free T4 and free T3 may be normal with classic symptoms of hypothyroidism. Alternatively, free T4 and free T3 may be low while the TSH level is normal or high. In both scenarios, thyroid replacement therapy without first considering adrenal fortification is a common mistake and often leads to a worsening state of adrenal fatigue over time. I will explain why.
● Problem: thyroid replacement therapy and adrenal fatigue
According to Dr. Lam, 70% of people taking thyroid replacement medications continue to complain of symptoms. It is not unusual to have concurrent presenting symptoms of both low adrenal and low thyroid functions. Most physicians tend to miss this due to ignorance on adrenal fatigue. Patients who are diagnosed as hypothyroid after a traumatic and stressful event such as pregnancy, accident, infection or an emotional trauma such as divorce or death of a loved one should be especially on the alert if thyroid replacement is not helping. Those who have poor body temperature regulation are more prone to have mixed presentation.
In fact, if low-thyroid people with the symptoms of adrenal fatigue are put on thyroid hormone alone, they sometimes respond negatively. It is true that these people, as I have said, may have coexisting symptomatology, and that this coexistence is misleading, masking adrenal fatigue since some symptoms of adrenal fatigue are similar to those of a low thyroid. If they take thyroid hormone by itself, ignoring the adrenal fatigue, the resultant increased metabolism may accelerate the low adrenal problem.
The reason is simple. Thyroid replacements tend to increase metabolic function and energy output. Raising the basal metabolic rate is like putting all systems of the body into overdrive at a time when the body is trying to rest by down-regulation. The body's survival mechanism is designed to achieve a reduction in the levels of T4 and T3, and not to increase them. "What the body wants (to slow down) and what the medication are designed to do (to speed up) is diametrically opposed to one another", writes Dr. Lam.
"In many cases," says Dr. Lam, "treat hypothyroidism without prior strengthen the adrenal glands, is analogous to pouring oil onto a fire. An already weak adrenal system in a low energy state may not be able to carry the burden of extra energy output. What the adrenals need is rest, not extra work".
Let us look at this in more details. It is true that thyroid medication administered under such circumstances may lead to a temporary relief of symptoms and a slight boost in energy at first. Laboratory levels of T4, T3 and TSH may appear improved. However, this is often short lived. Ultimately, fatigue returns as the thyroid medication further weakens the pre-existing adrenal fatigue condition and often precipitates an adrenal crisis. The overall fatigue level continues to increase well beyond what the medication is trying to combat. "Increasing the thyroid medication dosage to avoid the worsening fatigue is not the best thing to do", says Dr. Lam, "the patients will feel 'wired and tired' with constant fatigue, unable to fall asleep, anxious throughout the day, increased sluggishness, and weigh gain. Adrenal insufficiency, especially when unmasked by addition of thyroid hormone, increases the suffering of these patients. As long as the adrenals are still functioning, the body continues to down-regulate as much as it can, blunting the body's response of the thyroid medication". Over time, despite improving or stabilization T4, T3 and TSH levels that may be considered within normal range, the patient may ask for an even larger dose of medication in order to feel better. With improving laboratory tests, he will not get it, but unresolved symptoms of hypothyroidism persist despite medication. Normalizing of adrenal function in such cases is the key of the problem and often leads to spontaneous resolution of the hypothyroid symptoms. "There is a tremendous opportunity for better health", write Drs. Richard and Karilee Shames, authors of Thyroid Power, "since the proper approach in this case is to treat the patient with thyroid and adrenal support simultaneously". Dr. Lam writes: "The faster the sufferer of adrenal recovers, the faster the symptoms of hypothyroidism will be resolved. This can happen in matter of weeks. Those who are on thyroid replacement will invariably find that less medication is needed as the adrenal function normalizes. In fact, thyroid replacement may not be necessary and can be tapered off totally over time as the adrenal function normalizes".
Those who have hypothyroidism but fail to improve with thyroid replacement medication should therefore always investigate adrenal fatigue as possible etiology of their thyroid problem.
● Laboratory test for Adrenal Fatigue
Adrenal hormones, cortisol and DHEA (dehydroepiandrosterone), are low in case of adrenal fatigue, but still within the "normal" range (and not low enough to warrant the diagnosis of Addison's disease by regular blood tests). In fact, the adrenal hormones can be half of the optimum level and still be labeled "normal". Such "normal" level of adrenal hormones does not mean that the patient is free from adrenal fatigue. As a result, patients tested for adrenal functions are told they are "normal" but in reality, their adrenal glands are performing sub-optimally, with clear signs and symptoms as the body cries out for help and attention.
● Saliva testing
Cortisol and DHEA measurements explore classically adrenal function.
In plasma, any hormone is bound with high affinity to its protein-carrier, but only the free fraction is biologically active, acting through specific intracellular receptors and affecting numerous physiologic systems. For example, in plasma, most cortisol is bound to corticosteroid-binding globulin.
The best way to test the adrenal health is to measure the free level of the key adrenal hormones. Saliva testing is an established effective tool as it measures the amount of free and circulating hormones instead of the bounded hormone commonly measured in blood test. Saliva is a natural ultra-filtrate of blood, and steroids not bound by carrier proteins in the blood freely diffuse into saliva (carrier-proteins are too big molecules to get into saliva). Hormonal saliva testing is a more reliable diagnostic tool than hormonal bound to proteins blood measurements. (Click Here)
Decided on case by case basis, saliva testing is proposed in my clinic. I provide interpretation and hormone-based medications eventually required.