Even in the best of hands, many find thyroid replacement a challenging exercise that often ends with stagnant or worsening thyroid gland function and symptoms over time. When this happens, one needs to look outside the box. Various other conditions can present with symptoms very similar to low thyroid gland function or hypothyroidism. The most common of which is Adrenal Fatigue Syndrome (AFS).
Let us look at this in more detail.
Primary vs. Secondary Hypothyroidism
Hypothyroidism, or low thyroid gland function, can be primary, which means first in order of development, or secondary, which develops as a result of changing conditions in other parts of the body.
Primary hypothyroidism means that the thyroid cannot make the hormones T3 and T4 because of a problem with the gland itself. One of the most common causes is the destruction of the thyroid gland by the immune system. This condition is called Hashimoto’s thyroiditis and is by far the most common diagnosis given for people with low thyroid gland function. Treatment usually involves thyroid replacement therapy. Primary hypothyroidism can also be caused by surgical removal of the thyroid gland, which is then followed by inadequate thyroid replacement therapy. In primary hypothyroidism, TSH is usually high. However, if hypothyroid symptoms, such as low body temperature, fatigue, dry skin, and weight gain persist, despite thyroid replacement therapy and regardless of laboratory test results, we must look elsewhere for the cause of low thyroid gland function.
Secondary hypothyroidism is commonly thought to be linked with issues involving the pituitary gland, hypothalamus, and/or medications such as dopamine and lithium. In recent decades, we also include what is known as non-thyroid illness syndrome (NTIS). In this situation, patients have physical signs of hypothyroidism but do not have structural problems with the thyroid gland function, and the TSH is normal.
For example, in those suffering from anorexia nervosa (an eating disorder), low thyroid gland function has metabolic causes that do not fit the criteria for classic hypothyroidism as defined by endocrinologists. Treatment is usually directed toward the underlying cause, and steroid replacement is usually employed in addition to surgery, as needed.
Who Is Most at Risk of Developing Hypothyroidism?
There are many risk factors when it comes down to ‘who is most at risk’. These include the following:
- Those who are over sixty years of age
- Females in general
- A family history of thyroid issues
- A family history where autoimmune diseases are common
- If you already have an autoimmune disease
- Having experienced hormonal changes, e.g. due to pregnancy, childbirth, or menopause
- Those with chromosomal abnormalities, e.g. as is the case of those with Turner’s syndrome or Down Syndrome
- When you take certain medications, e.g. some of those prescribed for bipolar disorder
- Previous thyroid surgery
- When you have been exposed to radiation in your neck area
- Those who are of Asian and Caucasian descent
Adrenal Fatigue Syndrome (AFS)
Adrenal Fatigue Syndrome is a common but frequently overlooked condition, closely associated with and possibly a cause of secondary clinical and subclinical hypothyroidism.
We can see the everyday consequences of Adrenal Fatigue Syndrome in the following statements:
- I’m tired all the time – I manage to keep going on my job, but I drink coffee every few hours to get through the day.
- I used to merely gripe and complain about feeling tired, but now the fatigue is so overwhelming and debilitating, I’m underperforming on my job.
- I’m anxious and fearful much of the time.
- I seem to catch every cold or flu that comes around.
- My joints ache, and my doctor said I probably have arthritis, even though I just turned forty.
- I’m depressed and can’t think straight—I feel like I walk around with brain fog.
- I’ve tried every diet in the book, but I can’t lose weight.
- Last year I lost my job, and shortly after those emotional and financial blows, I became chronically tired and depressed.
- I wake up at 3:00 AM and toss and turn for hours and cannot fall asleep again.
- I used to have great energy, but now a short walk wears me out.
These statements personalize some of the typical — and persistent — signs and symptoms of Adrenal Fatigue Syndrome. You might have described these same things to your doctor, or you may have noted these changes in your health or know someone who has these complaints, but you don’t know what to make of them. If you’re over age forty-five or fifty, you might even be told to attribute your symptoms to “normal” aging!
Below, you’ll find an expanded list of the signs and symptoms of AFS. As you can see, many of these symptoms are also related to other conditions including thyroid gland function like primary hypothyroidism, and they match the statements listed above:
- Progressively increasing lethargy and lack of energy.
- Increased effort needed just to perform daily tasks.
- Decreased ability to handle stress.
- Tendency to gain weight, coupled with an inability to lose it, especially settling around the waist.
- Frequent bouts of influenza and other respiratory diseases, with symptoms lasting longer than usual.
- Trembling under pressure.
- Reduced sex drive.
- Tendency to feel light-headed especially when rising from a horizontal position.
- Inability to remember things.
- Lack of energy in the morning and in the afternoon between 3:00 and 5:00 PM.
- Tendency to feel better suddenly for a brief period after a meal.
- Often feels tired between 9:00 and 10:00 PM, but resists going to bed.
- Difficulty getting out of bed in the morning.
- Once out of bed, has a need for coffee or other stimulants to get going.
- Cravings for salty, fatty, and high protein food such as meat or cheese.
- For women, increased symptoms of PMS and irregular menstrual bleeding, with days of heavy flow that stops (or nearly stops) on day 4, only to resume on days 5 or 6 of the menstrual cycle.
- Pain in the upper back or neck for no apparent reason.
- Tendency to feel better on vacation and when stress is relieved.
- Mild depression.
- Food and or inhalant (airborne) allergies.
- Dry and thin skin.
- Low body temperature.
- Heart palpitations.
- Unexplained hair loss.
- Alternating constipation and diarrhea.
- Dyspepsia (indigestion).
Addison’s Disease and Adrenal Fatigue Syndrome
Addison’s disease, also called adrenal insufficiency, is a rare but recognized disease in which the adrenal hormonal output falls below a level that meets established clinical parameters. It affects about four out of 100,000 people and is diagnosed with blood testing. In this case, if blood tests results are abnormal we know the adrenal glands are structurally dysfunctional and the patient needs lifelong steroid replacement.
Addison’s disease is often caused by an autoimmune dysfunction, whereas stress, either physical or emotional, is the primary culprits of Adrenal Fatigue Syndrome. The symptoms of Addison’s disease include low energy, joint and abdominal pain, weight loss, diarrhea, fever, and electrolyte imbalances. Some Adrenal Fatigue Syndrome sufferers report these symptoms too, but they are usually much less intense unless in advance stages.
At its core, symptoms of AFS represent the body’s internal neuro-endocrinological response when overwhelmed by stress. To survive, the body starts to down-regulate all organs in order to maintain homeostasis. This is one of the most effective way to conserve valuable energy, the currency of life. Low thyroid gland function is a result of such effort. The thyroid gland function itself is working properly from a pathological perspective. Under the command of the adrenal system telling us to slow down, a clinical state of hypothyroidism is the result. If you are under a stress, either physically or emotionally, be on the alert for Adrenal Fatigue Syndrome.
Adrenal Fatigue Syndrome and You
Many adults are puzzled when they first hear about Adrenal Fatigue Syndrome because they generally have little knowledge of the adrenal glands and their function. They’ve simply never considered that their adrenal glands could be linked to a cascade of symptoms, such as mild to extreme fatigue, lowered immunity, thyroid disease, low libido, menstrual disorders, metabolic disorders, mild to moderate depression, and so on. Yet, AFS is neither rare nor mysterious. Research suggests 11.9 percent of adult population in the United States suffer from severe fatigue, extreme tiredness, or exhaustion lasting more than one month. Many times more of the population suffers mild to moderate fatigue, with less debilitating symptoms. This number is growing exponentially as stress of living in the modern world takes its toll on our body. AFS is therefore one of the most prevalent health conditions, afflicting most adults at one time or another at varying degrees. It is a silent epidemic. Who hasn’t experienced stressful events or even periods of prolonged stress? However, the situation is seldom seen as a serious threat to health and is therefore seldom identified.
Even when identified, many healthcare professionals believe that no recovery protocols exist and perhaps tell their patients to relax and manage their stress. Often, AFS is thought of as a condition of the mind only and doctors prescribe antidepressants. AFS also is commonly tied to thyroid gland function diseases and many doctors order thyroid replacement drugs. Unfortunately, these treatments often leave the root causes unresolved. As a result, the condition worsens over time, sometimes for months but often over years and even decades. With the complex and often convoluted progression of AFS, which admittedly defies conventional medical logic, it’s no wonder that AFS is so often the “victim” of misidentification. Because AFS is not a recognized medical condition, do not be surprised if your physician is not familiar with or rejects the notion.
When considering Adrenal Fatigue Syndrome, it’s important to keep in mind the following principles:
- AFS exists on a continuum of severity, with individually defined stages and phases. The more advanced the stage, the more severe the condition. Stages 1 and 2 are considered mild, and Stages 3 and 4 are considered advanced and increasingly severe in terms of symptoms.
- Adrenal Fatigue Syndrome, particularly in Stage 3 (Adrenal Exhaustion), is related to many recognized diseases, such as hypothyroidism, polycystic ovary syndrome (PCOS), fibroids, hypoglycemia, depression, Lyme disease, irritable bowel syndrome (IBS), autoimmune diseases, and many other defined and regularly diagnosed and treated medical conditions.
AFS and Primary Hypothyroidism – Similarities and Differences
The following table outlines the key differences in the signs and symptoms between Adrenal Fatigue and hypothyroidism.
|Weight||Early: gain weight;|
Severe: cannot gain weight
|Generalized weight gain|
|Body temperature||97.8 or lower||Low 90s to 98.6|
|Temp regulation||Fluctuating and exaggerated||Steady|
|Mental function||Brain fog||Slow thinking|
|Eyebrows||Full||Sparse outer 1/3|
|Hair||Thin, sparse on extremities||Coarse and sparse|
|Nails||Thin, brittle||Normal to thick|
|Skin tone||Dry||Oily or moist|
|Pain||Headache, muscular, migraines||Joints, muscles|
|Reactivity||Heightened and hyper-reactive||Hypo-reactive|
|History of infections||Common||Occasional|
It is not unusual to have concurrent presenting symptoms of both low adrenal and low thyroid gland function. Conventional medicine tends to miss this due to ignorance about Adrenal Fatigue Syndrome. Those who were diagnosed as hypothyroid after a traumatic and stressful event such as pregnancy, accident, infection or an emotional trauma including divorce or death of a loved one, should be especially on the alert if thyroid replacement alone is not helping.
Individuals with poor body temperature regulation are more prone to have mixed presentation as well. They may present a steady low body temperature from the low 90s to a little below 98.6F. They may also present a slight exaggerated response in body temperature as compared to the environmental temperature as characterized by a sensation of feeling hot when it is warm and cold when it is cool outside.
Thyroid test results in AFS sufferers usually show normal or low free T4 and free T3. TSH can be normal or high, but body temperature is generally consistently low. Fortunately, such secondary hypothyroidism can be reversed if indeed AFS is the cause. We see many with Adrenal Fatigue Syndrome who are on thyroid medication reduce their thyroid medicine as their adrenal health improves.
The Thyroid as Part of the NEM Stress Response
The HPA axis, which is directly responsible for the correct functionality of the thyroid, is part of the body’s NeuroEndoMetabolic (NEM) stress response. This stress response is automatic and aimed at survival when stress arrives to our doorstep.
Each organ, gland, or system that is part of the metabolic system is regulated, in some way, by the HPA axis. This axis, in fact, kicks off the process in your body’s reaction system when it encounters stress of any kind. In so doing, it is responsible for the production of all hormones and thus indicates which hormones’ production needs boosting, and which hormones’ production needs to taper off.
Stress, of itself, plays an important role in correct thyroid gland function. When your body encounters stress, whether it is due to psychological, physical, or environmental conditions, the first protocol to follow is its protection. This is done by an increase in cortisol production. Cortisol is the stress hormone. Its increased production is an automatic response to stress.
Cortisol is produced by the two adrenal glands situated on top of your two kidneys. The adrenals are stimulated to produce more cortisol by means of chemical messengers sent from the HPA axis. Cortisol’s role in the body is a vital one, as it readies you for ‘fight or flight’ when presented with a situation perceived as potentially harmful for your survival. During this process, bodily functions not deemed necessary for survival are reduced, and in some cases, shut down. This allows the body to exclusively focus on the problem at hand.
Prolonged stress, however, can lead to adrenal fatigue, a condition not recognized by conventional medicine because it is sub-clinical. Not only may it have a negative impact on optimal thyroid gland function but presents with a list of symptomatic conditions, many of which are concurrent with those present with hypothyroidism.
Low Thyroid Gland Function – A Normal Survival Mechanism
When the body is exhausted, its ability to handle the stress associated with normal bodily functions and energy requirements is often compromised. As mentioned before, to enhance survival, the adrenals force a down-regulation of energy production and thyroid gland function.. In other words, the body is being metabolically down-regulated to slow down in order to conserve energy as the body needs to rest. Lower energy output reduces the workload of the body.
In times of stress, this is exactly what the body wants. As the thyroid down-regulates, production of thyroid hormones T4 and T3 is reduced. The down-regulation in thyroid gland function also leads to an increase in thyroid binding globulin (TBG) level. As a result of increased TBG, more thyroid hormones are bounded on a relative basis and less is released to the body cells where they work. The result – reduced free T4 and free T3 levels in the blood when measured, while total T3 and T4 levels may be normal.
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 (rT3) which acts as a braking system and opposes the function of T3. This reduction in T3, combined with an increase in rT3, may persist even after the stress has passed and cortisol levels have returned to normal. Furthermore, rT3 itself may also inhibit the conversion of T4 to T3 and may perpetuate the production of the inactive rT3.
If the proportion of rT3 dominates, then it will antagonize T3, possibly leading to a state called rT3 dominance. This 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 T4 and T3 may be normal and classic symptoms of Hypothyroid are evident with persistent low body temperature and slow ankle reflex. Alternatively, laboratory test results of free T4 and free T3 may be low while the TSH level is normal or high. In both scenarios, thyroid replacement with T4 and T3 without first considering adrenal fortification is a common mistake and often leads to a worsening state of Adrenal Fatigue over time.
The reason is simple. Thyroid replacements tend to increase metabolic function and energy output. Raising the basal metabolic rate is akin to putting all systems of the body, including thyroid gland function, into overdrive at a time when the body is trying to rest by down-regulation through the many mechanisms described above. The body’s survival mechanism is designed to achieve a reduction of and not the increase in the levels of T4 and T3. What the body wants (to slow down) and what the medications are designed to do (to speed up) are diametrically opposed to one another.
Factors that Influence T4 Production
There are a variety of factors that could influence the thyroid’s production of T4. In most cases, western medicine would not do an in-depth search as to the cause, but rather manage the symptoms. Unfortunately, with hypothyroidism, the cause of the problem is so varied that it is only by finding the root cause that the condition can effectively be overcome or improved. In many cases, hypothyroidism can recover naturally, leaving you with no prolonged side effects or issues.
What may cause your thyroid’s production of T4 production to decrease?
- Certain deficiencies, including zinc, copper, vitamin A, vitamins B2, B3, B6, and B12, vitamin C, iron, selenium, and iodine. Although one may be tempted to supplement these, you may first wish to look at the reason why this deficiency is present.
- Constant stress plays a role. This could lead to adrenal fatigue, which compromises adrenal function (a look at this later).
- Toxicity, due to, for example, lead, mercury, cadmium, fluoride, and pesticides, to name but a few
- Starvation, e.g. anorexia nervosa
- Chronic illness
- Elevated cortisol levels (which may be related to adrenal fatigue)
- Inflammation present in the body
- A decreased kidney or liver function
- A diet high in carbohydrates
- Certain medications, such as estrogen supplements, beta blockers, and others
- Your diet, e.g. one extremely low in proteins, fats, and carbohydrates
- Age plays a role
- Surgery (especially previous thyroid surgery)
- The inadequate production of precursor hormones
In some instances, the body may make T4, but the conversion to T3 is compromised. Under normal conditions, the thyroid processes T4 and T3 according to a 4:1 ratio, in other words, it produces 80 percent T4 hormone and 20 percent T3.
Factors Leading to Decreased T3 Production
T3 is the active form of thyroid hormone, while T4 is the inactive form. It is thus the T2 hormone that plays a role in metabolic function. Sometimes, however, the change from T4 to T3 is compromised. This may be due to various factors, including:
- Exposure to toxic metals
- Chronic inflammation
- Heightened levels of epinephrine, also known as adrenalin. This hormone is released, with cortisol, when the body is subjected to periods of stress.
- A prolonged illness
- When undergoing periods of fasting
- The aging process
- Exposure to free radicals
Some people are genetically predisposed as their primary genes for the thyroid receptors are not functioning properly, thereby hindering thyroid hormones from reaching the mitochondria and nucleus in their cells.
Some people are born with an inherited resistance to the thyroid hormone – this resistance involves the pituitary gland, brain, liver, heart, and bones.
Some people are born with mitochondria that do not function correctly – they may not have the ability to transmit their thyroid hormone needs to the brain.
The Hidden Culprit
Administering thyroid medication to a stressed out body without concurrent attention to optimizing adrenal health and thyroid gland function will often fail over time. In many cases, it is like 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 bought on by thyroid replacement medication. What the adrenals need is rest, not extra work.
Thyroid medication administered under circumstances of weak adrenals may lead to a temporary relief of symptoms and a slight boost in energy at first. 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. Only by increasing the thyroid medication dosage or switching to more powerful thyroid drugs can the worsening fatigue be avoided.
Let us look at this in more detail clinically. Remember that one of the most common presenting complaints to a physician is fatigue. Routine laboratory tests often show higher than normal TSH level. Physicians are more apt to make the diagnosis of Hypothyroidism and start the administration of thyroid medications. While laboratory levels of T4, T3 and TSH may appear improved once the thyroid replacement medication has been administered, the patient clinically continues to show lack of significant improvement and often clinically his condition will get worse over time.
As indicated earlier, many who are diagnosed with Hypothyroidism and are treated, continue to complain of unresolved symptoms with repeat visits to a physician’s office. These well-intentioned physicians can be misled by the “improving” laboratory test results as being “on the right track” and not attuned to possible concurrent underlying adrenal dysfunction that remains to be the main culprit.
Unless FT4, FT3, and rT3 values are factored into the clinical picture, the true cellular delivery of thyroid medication is not known. The body’s cry for help by forcing a persistent low body temperature is often not attended to. The unsuspecting physician may continue to increase thyroid medication dosage in an attempt to relieve the unpleasant and unresolved hypothyroid symptoms such as fatigue. This approach seldom works long term as it unknowingly subjects the patient to the worsening of his overall symptoms which are triggered by the thyroid medication’s un-intended negative effects on the adrenal glands and thyroid gland function. This overshadows the benefit such medication may have on the thyroid gland function. As long as the adrenals are still functioning, the body will continue to down-regulate as much as it can, blunting the body’s response to the thyroid medication.
Over time, despite improving or stabilizing T4, T3, and TSH levels that may be considered within normal range, the patient still needs an ever larger dose of medication clinically in order to keep his symptoms at bay. He continues with complaints of unresolved symptoms with low body temperature that refuses to normalize while the classic signs of hypothyroidism persist despite medication.
The Hidden Gem
Those who have hypothyroidism but fail to improve with thyroid replacement medication should therefore always investigate Adrenal Fatigue Syndrome as a possible etiology for their thyroid problem. Normalization of the adrenal and thyroid gland function in such cases is the key and it often leads to spontaneous resolution of the hypothyroid symptoms.
The faster the sufferer of Adrenal Fatigue recovers, the faster the symptoms of hypothyroidism will be resolved. Those who are on thyroid replacement will invariably find that less medication is needed as their adrenal and thyroid gland function normalizes. In fact, the patient can become over medicated and thus run the risk of hyperthyroidism if the thyroid medication is not reduced as the Adrenal Fatigue condition improves.
This is an important yardstick and gauge of improvement of one’s adrenal function. The credit goes to the adrenal glands and not the thyroid gland. As the adrenals improve, the need for down-regulation subsides and thyroid gland function suppression is lifted, leading to normalization of the thyroid gland function. For those who pursue thyroid recovery by way of first fortifying the adrenals, it comes as no surprise to see the body frequently regaining energy without an increase in thyroid medication after years of relying on such replacement. In fact, thyroid replacement may not be necessary and can be tapered off totally over time as the adrenal function normalizes.
It is important to note that laboratory test results of thyroid gland function during this adrenal focused thyroid recovery strategy will continue to show low thyroid gland function for some time due to a lagging effect. TSH level may continue to be high and out of normal range, while free T3 and free T4 levels will continue to be low. This lagging effect can last for months.
As the adrenals recover, the patient clinically will improve, with rising body temperature back to normal, increased energy, reduced need for thyroid medications and improved weight management. Conventional physicians who are not trained to recognize this adrenal-thyroid connection are pleasantly surprised clinically to see the patient improving despite “abnormal” laboratory studies, but not knowing why. The key, of course, lies in the improved adrenal function.
Wired and Tired
Weak adrenals and thyroid gland function, when present concurrently and not attended to properly, start an adversely reinforcing vicious downward spiral of adrenal dysfunction. Individuals requiring an ever increasing dose of thyroid medication to keep fatigue away may end up becoming dependent not only on the heavy dose of strong thyroid medication, but have to suffer the side-effect symptoms of toxic thyroid (such as heart palpitation) as medication dosage is being increased.
The result is that they feel “wired and tired” as mentioned earlier, with constant fatigue, unable to fall asleep and feeling anxious throughout the day. Internally, their adrenals continue to weaken as the stimulatory properties of thyroid medication are negated by the continued overwhelming rejection of the adrenal glands, resulting in a body that continues to be down-regulated to conserve energy.
This is the worst of both worlds and it happens too frequently and often goes unnoticed. Clinicians and patients alike are baffled by what appears to be clinical contradictions—improving laboratory TSH levels (as a result of increased medications) or high TSH levels that refuse to come down, rising need of thyroid medication to maintain energy and worsening symptoms of Adrenal Fatigue with continued low basal body temperature, metabolic imbalances, weight gain and increased sluggishness.
Conditions Associated with the Occurrence of Hypothyroidism
There are many conditions that coincide with instances of hypothyroidism. These include, among others:
- Insulin resistance (and correspondingly, diabetes)
- Attention-deficit/hyperactivity disorder (ADHD)
- Congestive heart failure
- Cardiovascular problems
- Chronic fatigue syndrome (CFS), also referred to as myalgic encephalomyelitis (ME)
- Ankylosing spondylitis, a type of arthritis that affects the spine
Possible Complications that Might Arise Due to Hypothyroidism
Hypothyroidism could certainly have a negative impact on your quality of life. If left untreated, you run the risk of further complications.
You run the risk of becoming infertile if a woman
Low levels of the thyroid hormone as well as certain hypothyroidism causes an increase in your chances of infertility.
Your child may have birth defects
If gifted with a baby while having untreated hypothyroidism, your child stands a higher risk of having birth defects. Among these defects are included developmental as well as physical problems.
Your mental health may suffer
Hypothyroidism may decrease your mental functioning, or result in depression, which may become more severe in time.
You may develop heart conditions
People with hypothyroidism, especially when left untreated, tend to have higher levels of ‘bad’ cholesterol. The condition may also result in heart failure or an enlarged heart.
You may develop a goiter
When the thyroid gland receives constant stimulation to produce more hormones, it tends to enlarge. A goiter is thus an enlarged thyroid. This condition may, in some people, result in difficulties with regards to breathing or swallowing.
You may develop myxedema
Myxedema may be triggered by infections or certain medications. The condition may be life-threatening and includes symptoms such as drowsiness, an intolerance to low temperatures, lethargy, and falling unconscious.
You may develop peripheral neuropathy
This condition sees your peripheral nerves affected. These nerves include those connecting your brain to the spinal cord, arms, legs, etc. The long term effects include tingling in certain parts of the body, as well as numbness, pain, and muscle problems.
Laboratory Tests Specific for Adrenal Fatigue
Routine serum-based laboratory tests can be useful in the setting of confirming disease, measuring disease burden, and explaining unusual findings in a particular patient. Its use in Adrenal Fatigue Syndrome is severely limited though due to the lack of sensitivity to detect subtle adrenal dysfunction.
Adrenal Fatigue Syndrome is therefore difficult to evaluate with traditional blood tests; those available are designed to detect the severe, absolute deficiencies of adrenal hormones that characterizes Addison’s disease. Blood testing also is useful to detect extreme, excessive levels of adrenal hormones associated with Cushing’s disease. In other words, available blood tests measure adrenal hormones only at the extremes.
What this tells us is that a test result showing so-called normal levels of adrenal hormones does not mean that the patient is free from adrenal imbalance. As long as conventional doctors are not taught the significance of this sub-clinical state of Non-Addison’s Hypoadrenia that is characteristic of Adrenal Fatigue Syndrome, these blood tests lead to misguided interpretations. Patients tested for adrenal function are told the results are well within the normal range, but in reality, their adrenal glands are performing sub-optimally. Meanwhile, clear signs and symptoms continue as the body cries out for help and attention.
Serum laboratory studies of two surrogate markers of adrenal function, cortisol and DHEA (measured in the blood by way of DHEA-S) can, however, reveal a general picture that tells us if the body is in an anabolic state (build up) or catabolic state (breakdown). These blood levels alone do not provide clear evidence that leads to a diagnosis of Adrenal Fatigue Syndrome.
Saliva Cortisol and DHEA
We can also test adrenal health by measuring levels of key adrenal hormones such as cortisol and DHEA in the saliva. A saliva test is far more accurate than serum for cortisol and DHEA as it measures the free and circulating amount of each of these, not the total bounded amount as measured by serum.
DHEA can be measured at any time during the day. Cortisol is different; cortisol levels vary throughout the day—with the highest being in the morning and lowest in the evening before bedtime.
The following are general correlations on how saliva cortisol and DHEA levels relate to Adrenal Fatigue.
- Normal cortisol, normal DHEA does not rule out Adrenal Fatigue.
- Normal cortisol, high DHEA points to early Adrenal Fatigue or excessive DHEA intake.
- High cortisol, normal DHEA points to early Adrenal Fatigue as the body puts out more cortisol relative to DHEA as part of the stress response.
- High cortisol, high DHEA is commonly associated with chronic stress.
- High cortisol, low DHEA usually points to early phases of Adrenal Exhaustion.
- Low cortisol, low DHEA usually is associated with late phases of Adrenal Exhaustion.
The above correlations are very general. There are many exceptions, each requiring paradoxical values are common especially in those who have a sensitive body or in advanced Adrenal Fatigue. Delayed response needs to be factored in as well.
How to Properly Interpret Saliva Cortisol Test?
The recommended tests require four saliva samples: 8 am, Noon, 5 pm, and before bedtime. The multiple samples allow for the ability to map the daily diurnal curve of free cortisol in the body relative to DHEA levels, allowing us to have a much clearer picture of adrenal function.
Like many other tests, the saliva cortisol test has limitations. Results can be confusing and oftentimes defy conventional medical logic. To be useful, saliva cortisol levels must be viewed in the proper context. Keep in mind the following:
- Morning free cortisol level is indicative of peak cortisol output modulated by the HPA axis.
- Lunch cortisol level points more toward cortisol adaptability.
- Mid-afternoon cortisol is highly associated with metabolic issues such as blood sugar imbalances.
- Evening cortisol level refers to baseline adrenal cortisol function. As AFS advances, the daily cortisol diurnal curve changes, as shown in Figure 1.
Remember that AFS consists of a continuum of 4 stages, from mild to severe. As the condition worsens, the cortisol curve will change accordingly. Typically, normal people have a rise in cortisol while we are in deep sleep, reaching peak in morning followed by a gradual decline throughout the day. The low point is at bedtime. Those in mild AFS (Stage 1 and 2) generally see a rise in total cortisol output, especially in the morning, which can linger well into the afternoon as the adrenal cortex is put on overdrive. Those in early phases of advance AFS (Stage 3) will see morning cortisol declining from a high level back to normal, and then as Stage 3 progresses further towards Stage 4, the morning cortisol level becomes quite low. Most in late Stage 3 experience flat cortisol output throughout the day. In other words, the entire 24 hour cortisol curve resembles a flat line.
The following diagram shows the general cortisol curve as AFS progresses from mild to severe.
Many exceptions exist to the above generalizations, so we can’t rely totally on a test result to make clinical decisions. For example, some people who are in Stage 2 show high evening cortisol but low or normal morning cortisol. These individuals tend to have low energy in the morning but are alert as evening arrives. Then, despite high evening cortisol, they often sleep well and don’t have sleep onset insomnia that commonly plagues those with elevated evening cortisol. Even after a night’s rest, though, they tend to be sluggish in the morning. Others may show both high noon and nighttime cortisol levels, with normal morning and afternoon levels. This may be reflective of the body’s erratic response to increase cortisol output during the day when faced with episodic stressor events.
For reasons not well understood, some clinically in Stage 3 may exhibit the Stage 2 Adrenal Fatigue Syndrome cortisol curve pattern. A small number of people can have a totally normal cortisol curve while in late phases of Stage 3. This should alert us to further investigate whether other conditions are the ultimate root cause. It should be clear that proper clinical correlation is critical. Few test results are straightforward. Over-reliance on cortisol values alone as a yardstick of adrenal function can therefore be misleading.
Clinical Correlation is Key
AFS is a complex condition with many causes. Symptoms can be convoluted and confusing. Multiple systems are involved. In advanced stages, the entire neuroendocrine system is dysregulated, not just the adrenal glands. The body is embroiled in a massive effort to re-stabilize internal hormones that are dysregulated. Low cortisol is but one of many parameters to consider.
A Saliva cortisol test as an absolute and sole diagnostic tool for AFS leaves much to be desired and is far from perfect. Over reliance on saliva cortisol level as key clinical focus in an AFS recovery program is a common clinical mistake. Not only can this approach jeopardize the entire recovery effort, but can backfire and make the condition worse.
Proper clinical correlation is critical. Adrenal Fatigue Syndrome symptoms can be numerous and severe while at the same time, laboratory results are normal. The reverse is also true. The test results could show abnormal levels of cortisol and DHEA, but one might not be experiencing symptoms. Furthermore, in advanced Adrenal Fatigue Syndrome, the twenty-four hour saliva cortisol curve invariably becomes flattened most of the time and can stay that way for an extended period, even during recovery. Sometimes we see a delayed response, which means the test results may be confusing and mis-leading and show no meaningful change while symptoms are improving.
As you can see, proper clinical correlation between lab results and symptoms is the key to recovery success. Experienced clinician will rely far more on the clinical presentation than laboratory results. Computerized laboratory interpretations of laboratory tests have limited value. In fact, it can be misleading if we fail to match the different cortisol values with the body’s symptoms throughout the day along with the clinical state.
Saliva testing is not without its virtue, however. It is best used in serial studies performed only as needed for comparative purposes when clinical results are sub-optimal or blunted. Relying on a single hormonal snapshot to draw clinical conclusions is a common mistake in recovery. This is especially common among those who are not under professional guidance. For example, patients may rely on laboratory tests without understanding their limitations. They then embark on a self guided nutritional recovery program that eventually leads to improper use of nutrients, thus making the condition worse. If you are not sure if you have AFS, need a baseline picture, or if you are not recovering from AFS, the saliva cortisol test can be very helpful, provided that it is always properly interpreted by an experienced practitioner in AFS and one who knows your history.
Supplements to Help Thyroid Gland Function
Fortunately there are certain factors that help increase the conversion of T4 to T3. Supplementation is one. Studies have found that supplementation with selenium, potassium, iodine, iron, or zinc, shows an increase in T4 to T3 conversion. The same applies to vitamin supplementation (e.g. vitamins A, B2, and E). Supplementation, however, ought only to be considered where a deficiency is indicated by means of a test.
Other means of increasing the conversion is by following a high protein diet or increasing your fat intake.
Hormone treatments may also prove effective, e.g. growth hormone or testosterone. However, hormones should ideally only be considered where needed. This means in cases where there is a proven deficiency.
The herb ashwagandha shows great promise, according to trials. Studies indicate that not only does it have a positive effect on thyroid gland function, but may help improve memory and play a role in normalizing cortisol levels.
Melatonin may also help if the hypothalamus is indeed the problem. It not only aids with T4 to T3 conversion but also plays a role in heart function and the immune system. Too much melatonin, however, could result in a serotonin decrease, so should be taken under strict supervision by a healthcare professional.
Before any form of treatment is embarked on, one should make sure to have all appropriate lab tests done. This means having a comprehensive thyroid panel of testing in order to get to the root cause of the problem. This includes TSH, free T4, and free T3. Very often treating the root cause can be as simple as a change in diet.
In some cases, a person may have the classic symptoms associated with hypothyroidism, but when tests are done, their laboratory values are normal. It appears that there is nothing wrong with their thyroid gland function, but yet they are symptomatic. Sufferers in such cases have sub-clinical hypothyroidism, often indicating a deeper underlying problem within.
Tips on Hypothyroidism Recovery Naturally
There are a number of medications used by western medicine to treat hypothyroidism. Many of these medications, however, focus on adding more thyroid hormone to the body. They thus attempt to address a hormone shortage. The problem, however, is much more complicated, as the root cause of hypothyroidism differs from one person to the next. Often, the medications do not have the desired effect, with the answer being to up the dosage. The long-term results may be debilitating to the patient’s health, as the cause of the problem may not be thyroid hormone production, or lay with the thyroid gland function per se, but due to something else entirely. Many become “wired and tired” as thyroid replacement dosage goes up.
The functional approach sees the body as an entire organism, with each part playing its own unique role while impacting the function of another. In order to treat hypothyroidism naturally, functional health care professional will delve deeper into your health history, study your symptoms, and ensure that a full panel of tests done. This allows him or her to rule out certain common causes or other issues that could affect thyroid gland function. The aim, with holistic medicine, is to help the body heal hypothyroidism naturally.
What Do You Need to Take into Account when Treating Hypothyroidism Naturally?
Before embarking on the natural approach, all possible causes of the condition need to be taken into account. This means consideration of all symptoms and doing a comprehensive body of tests. If, for some reason, thyroid replacement therapy is decided on as the best route to go, your healthcare professional first needs to take your health into consideration.
A Number of Issues to Look out for before Considering Thyroid Hormone Treatment
If, for example, you have a cortisol imbalance, you first need to work at correcting this, since a person may show symptoms of thyroidism without actually having the condition. The adrenal glands need to be healthy before thyroid hormone replacement therapy is introduced. Lower levels of magnesium may also influence the action of thyroid replacement therapy. It may also result in heart problems.
The gut, which is also influenced by adrenal fatigue and thus cortisol, needs to be healthy, as an unhealthy gut negatively affects thyroid hormone absorption.
Of course, other factors are also involved, such as certain nutrient shortages.
Testing for the Root Cause of Hypothyroidism
There are a number of tests one should consider before coming to any conclusion as to the manifestation of hypothyroidism.
Thyroid stimulating hormone (TSH) test
Tests the levels of your thyroid stimulating hormone as released by the pituitary gland
Free T4 test
Tests the free T4 production levels of the thyroid gland function. A TSH test might present as normal but does not rule out thyroid dysfunction. Rather, it indicates pituitary gland function.
Antithyroid Microsomal Antibodies Test
A test for the presence of anti-thyroid microsomal antibodies. When a blood test comes back positive for these antibodies, it indicates possible damage to the thyroid gland function.
Free T3 test
Measures the T3 levels floating freely as well as those attached to your proteins. A lower concentration of this hormone with normal T4 levels is indicative of a problem regarding the conversion of T4 to T3.
Reverse T3 test
Besides T4 and T3, the thyroid also produces a hormone called reverse T3 (RT3). During times of stress, and in a bid to conserve energy (such as when the body goes into stress mode), higher concentrations of T4 are converted to RT3 instead of T3. Heightened RT3 levels are thus indicative of hypothyroid symptoms due to stress.
Thyroglobulin antibodies test
This test measures the presence of thyroglobulin (a protein) antibodies. Thyroglobulin is present in thyroid cells. The presence of these antibodies indicates possible damage to the thyroid gland function
Other possible tests
Because symptoms of hypothyroidism may be presented by certain nutrient deficiencies (e.g. vitamins, iron, zinc, iodine, etc.), the presence of certain metals and free radicals, and certain toxins, tests should be run in order to rule these out as possible causes.
The Natural Approach And Recovery of The Thyroid Gland Function
Depending on your results, a number of different options are available when treating hypothyroidism naturally.
There are a number of toxins that have an effect on your thyroid gland function These include PCBs, phthalates, heavy metals such as lead, mercury, arsenic, DDT, dioxins, and many more. Detoxification, to a large extent, is a natural treatment for hypothyroidism, as it helps your body get rid of these toxins, often leaving patients much healthier and without needing added treatment.
Improve Gut Health
Another way of treating your hypothyroidism naturally is to see to your gut health. There is a strong link between gut and thyroid health. Many people find their hypothyroid symptoms vastly improve when their gut health is addressed.
Deal With Stress
Constant stress is one of the major influencers when it comes to thyroid health. You need to take measures to either get rid of your stress or to handle it. There are many ways and means of getting a grip on your stress or at the least being able to handle it better. Things to consider are meditation, exercise, enough sleep, and finding a hobby. Exercise, in particular, can be helpful but also can trigger adrenal crashes when the body is weak. Proper supervision is important.
Many people dealing with the symptoms of hypothyroidism have an iodine deficiency. This iodine deficiency may not necessarily be due to diet, but to environmental factors as well – the soil in certain areas simply lacks in iodine levels, which, in turn, is represented in their food. Iodine supplementation may be necessary, as the thyroid needs iodine to manufacture T4. In certain parts of the world, iodine supplements are considered the natural option for the treatment of hypothyroidism. Care must be exercised as one can swing from a hypo state to a hyper state if not properly and closely supervised.
Additionally, it may increase the risk of inflammation and may even increase your risk of contracting thyroid cancer and thyroiditis.
Vitamins and minerals
The modern diet is vastly lacking in many vitamins and minerals. A lack of these vitamins, as previously mentioned, compromises optimal thyroid function and may even present symptoms of hypothyroidism when the body is lacking. It is partly due to what we do or do not eat, but it can also be due to other factors. These include, for example, the use of insecticides and certain inorganic fertilizers. Soil leaching also comes into play. In many cases, your symptoms of hypothyroidism may be treated naturally by means of supplementation and your body’s vitamin and mineral homeostasis restored.
When contemplating supplementation, one needs to be very careful of dosage as overdosage, as with any type of medication, could lead to health problems of their own. When considering any type of medication, it is best taken under the supervision of a health care expert to avoid wrong supplementation which can worsen an existing condition and trigger adrenal crashes. Of course, absorbing these vitamins and minerals into your body by means of your diet is the best natural treatment for hypothyroidism, if a vitamin and mineral deficiency is the problem.
Reversing Thyroid Gland Function by Natural Means at Home – Helping Yourself
If your thyroid itself poses a problem and you are genetically predisposed to the disease, you can, at best, manage the condition. If, however, your hypothyroid symptoms are due to other factors, you can help yourself treat the possibility of contracting hypothyroidism in advance – naturally. It may even help reverse the symptoms if they are only starting to manifest.
Eat more protein
Protein helps with thyroid hormone transportation. Besides protein from animal sources and eggs, you could also consider legumes (e.g. beans), nuts, and quinoa.
When it comes to soy or soy products as a source of protein for the natural treatment of hypothyroidism – it is better to stay away. Soy may cause impediments on your cell receptors and disrupt your endocrine system.
Say no to coffee and sugar
Neither coffee nor sugar is great for optimal adrenal gland function. By eliminating them from your diet, you help restore proper adrenal gland function. Adrenal function and thyroid function are closely linked. By not incorporating these two substances, you are aiding your body’s treatment with regards to the natural recovery from adrenal fatigue and hypothyroidism.
Cruciferous vegetables are not a friend of hypothyroidism
Although generally considered as healthy, raw cruciferous vegetables, e.g. broccoli, cabbage, kale, Brussel sprouts, kale, spinach, and cauliflower, are not conducive to the recovery of hypothyroidism. When raw, these vegetables are goitrogens that interfere with normal thyroid function. Cooking these vegetables, however, renders the goitrogens harmless.
Get enough omega-3 fatty acids
Fish, flax seeds, and walnuts are rich in omega-3 fatty acids. They are essential for immune function, cell growth, thyroid function, and your body’s response to thyroid hormones.
Get enough sunshine
Vitamin D is manufactured by your skin’s response to sunlight. Low vitamin D levels result in the disruption of the hormonal pathway in the body.
Iodine is essential for thyroid function and hormone production. As mentioned above, care must be taken.
Take care of inflammation
Systemic inflammation is often one of the symptoms of autoimmune conditions. When inflammation is addressed, the autoimmune condition often shows improvement.
Practice relaxation techniques
There are many relaxation techniques that help you deal with stress. Adrenal breathing exercise is one such good exercise if the body can tolerate it. Besides the possibility of contracting adrenal fatigue, the thyroid is affected by the NEM stress response.
Manage your adrenal fatigue
There is a close relationship between adrenal and thyroid health. By addressing your adrenal fatigue, you inadvertently address your thyroid problem as well.
Dr. Lam’s Key Questions
What causes the body to be unable to convert T3 to T4?
Organ resistance, metabolic imbalances, and adrenal fatigue are some of the reasons. A detailed history by an experienced provider literate in AFS is needed to decide which is the most probable cause. Unfortunately, labs are not very helpful.
How can I tell if my thyroid is improving without doing a test?
You should start feeling more energetic; your symptoms should slowly improve. Dry skin should improve and a sense of well-being emerges.
What are the functional differences between T3 and T4 hormones?
T4 is what is called a pro-hormone. It is the chemical mother of T3. T3 is the workhorse of the thyroid gland is considered a true hormone. It is stronger than T4 and made in lesser quantity. The two are balanced by the body as both are needed.
I’ve heard iodine helps with the thyroid. What is the physiology behind how that works and would eating seaweed be beneficial?
Iodine is an important mineral in the body to make thyroid hormone. Without adequate iodine, thyroid hormone synthesis is affected, and one could be hypothyroid. Eating seaweed would help boost iodine.