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“Hi Dr. Roz, My doctor said I have problems with my thyroid and my adrenals and I don’t know which one to treat first. Some say it must be the adrenals, others say it should be the thyroid. I’m afraid to do it wrong”
Great question! The short answer is both are important but the order may not be.
Would you believe that as many as 20 million Americans have some form of thyroid disease? (1) It could be an underactive thyroid, also known as hypothyroidism—or hyperthyroidism, an overactive thyroid.
Many people discover they have thyroid disease when they begin to experience fatigue or some of the other most common symptoms associated with the disease and go to their doctor to have their problem diagnosed.
But what if there was another cause behind it all that we missed?
The Adrenal Connection
The adrenal glands sit on top of the kidneys and produce over 100 different hormones, one of which is cortisol, otherwise known as the “stress hormone”.
Cortisol literally gets us up in the morning and allows us to go about our day while accomplishing necessary tasks. Often, we can see it made out to be a villain, but life simply cannot go on without it.
The main reason that the adrenals can’t make cortisol is an autoimmune disease called Addison’s disease. In some places, the rates of it have doubled since the 1960s, affecting the lives of between 93-144 cases per million1. Typically, it affects people between the ages of 30 and 502.
Key Insight: A related condition, adrenal dysfunction, is even more poorly understood. And yet, one recent study showed that 57.9% of people in one sector of the working population may be fatigued due to problems with their adrenal glands3.
Other experts argue that the prevalence of chronic fatigue is now coming to the forefront, but many skilled doctors haven’t had the opportunity to learn about it and its importance to their practice.
The Link Between Your Thyroid and Adrenals
A possible link between the thyroid and adrenal glands has begun to be explored in recent years. Because of the fact that so many people are affected by thyroid disease, a link could literally affect millions of people in America (and worldwide).
In fact, it could affect you if you suffer from:
- Weight gain
- High levels of stress
Or, if any of the other symptoms associated with thyroid disease and adrenal dysfunction, like the ones we will cover below.
Bottom Line: A connection is also important because untreated adrenal problems can only lead to more fatigue and other health issues related to the adrenals and the thyroid.
Thyroid Disease & Adrenal Dysfunction: Symptoms
When the thyroid is underactive, it often leads to the following symptoms:
- Increased sensitivity to cold
- Dry skin
- Weight gain (2)
- Puffy face
- Muscle weakness
- Elevated blood cholesterol level
- Muscle aches, tenderness, and stiffness
- Pain, stiffness or swelling in your joints
- Heavier than normal or irregular menstrual periods
- Thinning hair
- Slowed heart rate
- Impaired memory
And when the thyroid is overactive, it can lead to:
- Sudden weight loss, even when your appetite and the amount and type of food you eat haven’t changed
- Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of the heart (palpitations)
- Nervousness, anxiety, and irritability
- An increased appetite
- Tremor — usually a fine trembling in your hands and fingers
- Menstrual changes
- An increased sensitivity to heat
- Changes in bowel patterns, especially more frequent bowel movements
- An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
- Fatigue, muscle weakness
- Difficulty sleeping
- Thinning of the skin
- Fine, brittle hair
When the adrenals are not producing enough cortisol, it can cause:
- High levels of fatigue every day
- Inability to handle stress
- Salt and sugar cravings
- Difficulty getting up in the morning
- A weak immune system
- Asthma, allergies or respiratory complaints
- Hard to concentrate
- Mid-body weight gain
- Loss of muscle tone
- Low blood pressure
- Low blood sugar
- Low sex drive
Can you see the similarities? Many symptoms of adrenal fatigue actually mirror those of thyroid disease (3).
Evidence Of The Thyroid-Adrenal Connection
Studies suggest that problems with the hypothalamus-pituitary-adrenal (HPA) axis—which connects various glands and organs in the body and controls the secretion and effect of many hormones—may contribute to thyroid-type symptoms, especially for people with thyroid conditions4.
However, there are a number of elements to take into account and watch out for when treating and diagnosing you.
Your Cortisol Levels Can Affect Your Thyroid
One of cortisol’s main roles is to work in concert with thyroid hormone, too.
In fact, cortisol is needed for the thyroid to carry out its job properly. Precise amounts of cortisol are essential for normal thyroid function, so it’s important that there isn’t either too little or too much circulating in your bloodstream at any one time.
Cortisol also plays a key role in converting T4 into T3 (active thyroid hormone) outside the thyroid gland.
Producing The Wrong Amount Of Cortisol At The Wrong Time
If you have hypothyroidism or hyperthyroidism, it can make your body produce too much or too little cortisol, potentially disrupting the usual ebb and flow that helps you get up in the morning and fall asleep at night.
For example, hypothyroidism can raise cortisol levels generally because this disease causes cortisol’s half-life to go up, and your overall metabolic rate to go down5.
Hyperthyroidism can also overstimulate the adrenal glands, making cortisol levels rise for a period of weeks or months, before dropping when the adrenals cannot keep producing so much5.
You may not have heard about this connection before because conventional endocrinology training doesn’t explore the link between thyroid and adrenal function.
At Integrative Health, we prefer to err on the side of caution and ensure that there’s no way you might suffer from the negative consequences of the link.
Key Insight: Not only can the symptoms of low-thyroid function very easily look like an adrenal imbalance, if thyroid medication is given to someone with an adrenal problem who has normal thyroid hormone levels, the medication can actually worsen the person’s symptoms instead of improving them.
This is why it’s important to look at both your cortisol levels and thyroid hormone levels before initiating treatment, and why we always double check to ensure your adrenal levels and all your thyroid hormone levels are healthy.
The Best Way To Find Out If This Might Be Affecting You
One of the best ways to find out if your cortisol levels might be affecting your thyroid function is to test and investigate both.
To test for cortisol, a cortisol salivary test or “adrenal stress index” is performed over 12 hours to ensure you’re producing enough cortisol when you need it (4), and that you’re not producing too much when your levels should actually be lower.
To test for thyroid function abnormalities, it’s important to look at:
- TSH, or thyroid stimulating hormone levels
- FT4, or free thyroxine levels
- FT3, or free triiodothyronine levels
- Thyroid antibody tests, to rule out related autoimmune diseases (Hashimoto’s or Graves disease)
Action Steps: Supporting Your Adrenals At Home
Your lifestyle and diet can really affect your adrenal glands. Here are some ways to support your adrenal glands and help get cortisol levels back in balance.
- Take the Adrenal Quiz (5)
- Consider testing for adrenal function
- Stop working as many hours
- Minimize stress through daily meditation and breathing exercise
- Try the adrenal reset diet and eat foods that will stabilize blood sugar levels
- Nutritional IV therapy
Interested in doing right by your body, every day? Consider this…
Action Steps: Supporting Your Thyroid At Home
You can support your thyroid at home, too. Try:
- Taking the Thyroid Quiz (6)
- Getting plenty of sleep: at least 7-9 hours per night
- Avoid too much iodine and stay under 300 mcg per day. Be sure to avoid sources from supplements, iodized salt, and sea vegetables
- Nourishing your thyroid and replete nutrients with high-quality supplements to help your body produce and metabolize hormones more efficiently, including selenium, B vitamins, zinc, copper, vitamin E, vitamin D, and iron
- Getting your ferritin (the storage form of iron) optimized. Suboptimal ferritin impacts the conversion of T4 to T3, which is the form that your body absorbs
- Improving your gut health and consider IgG4 food intolerance testing
If your body is struggling to metabolize synthetic thyroid hormones, you might also like to explore using natural desiccated thyroid (NDT), which includes both T3 & T4.
Interested in a comprehensive program? Here’s something worth your time…
Your Adrenals & Your Thyroid
The adrenal glands and thyroid may be connected in such a way that it profoundly affects your ability to enjoy optimum health. If you have even a slight issue with your thyroid, at IH, we recommend exploring your adrenal health. Doing so may also allow for a reduction in medication overall.
Written by Dr. Roz Ranon of Integrative Health. Dr. Roz Ranon, NMD is an Arizona board-certified Naturopathic Physician practicing with Dr. C at Integrative Health with a focus on Hashimoto’s Thyroiditis.
Learn more about Dr. Ranon here