Adrenal Fatigue vs. Hypothyroidism

Michael Lam, MD, MPH
www.DrLam.com

The following table outlines the key differences in the signs and symptoms between adrenal fatigue and hypothyroidism.

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. Conventional medicine tends to miss this due to ignorance on adrenal fatigue. Those who were 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 alone is not helping.

Those who have poor body temperature regulation are more prone to have mixed presentation. This group of people may present a steady low body temperature from low 90's 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.

Low Thyroid Function Due to Adrenal Fatigue

Hypothyroidism can be primary or secondary. Primary hypothyroidism can easily be cured with administration of thyroid replacement therapy. If hypothyroid symptoms such as low body temperature, fatigue, dry skin and weight gain persist despite thyroid replacement therapy regardless of laboratory values, one must look elsewhere for the cause of the low thyroid function.

Secondary hypothyroidism is low thyroid function caused by malfunction of another organ system. One of the most frequently overlooked causes is adrenal fatigue. Adrenal fatigue is perhaps the most common cause of secondary low thyroid function, both clinically and sub-clinically. Low adrenal function often leads to low thyroid function, classically evidenced by high levels of thyroid binding globulin (TBG), low free T4, low free T3, high TSH, slow ankle reflex and low body temperature. Few physicians are trained to detect this connection. Fortunately, secondary hypothyroidism can be reversed when the underlying root problem (such as adrenal fatigue) is resolved.

When the adrenals are exhausted, the ability of the adrenals to handle the stress associated with normal bodily functions and energy requirements is often compromised. To enhance survival, the adrenals force a down-regulation of energy production. In other words, the body is being metabolic 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 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. This leads to reduced free T4 and free T3 levels in the blood if 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 and 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 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) is diametrically opposed to one another.

Administering thyroid medication in cases of advanced adrenal fatigue without concurrent attention to adrenal recovery will often fail. In many cases, it 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. Thyroid medication administered under such circumstances 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 mentioned earlier, 70% of those who are diagnosed with hypothyroidism and are treated, continues to complain of unresolved symptoms with repeat visits to physician's office. 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. They 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 mentioned earlier. 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, this overshadows the benefit such medication may have on the thyroid glands. 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. The patient continues with unresolved symptoms with low body temperature that refuses to normalize while the classic signs of hypothyroidism persist despite medication.

Those who have hypothyroidism but fail to improve with thyroid replacement medication should therefore always investigate adrenal fatigue as a possible etiology for their thyroid problem. Normalization of the adrenal 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. This can happen in a matter of weeks. Those who are on thyroid replacement will invariably find that less medication is needed as their adrenal function normalizes. In fact, one can become overmedicated and thus run the risk of hyperthyroidism if one's 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 function suppression is lifted, leading to normalization of the thyroid 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 function during this adrenal focused thyroid recovery strategy, will continue to show low thyroid 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. However, 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.

Weak adrenals and thyroid, when present concurrently and not attended to properly, start an adverse reinforcing vicious downward spiral of adrenal dysfunction. Those 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. 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 worse 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.

For detailed discussion, read article called "Ovarian Adrenal Thyroid Axis Imbalance" at www.DrLam.com

About The Author

Michael Lam, M.D., M.P.H., A.B.A.A.M. is a specialist in Preventive and Anti-Aging Medicine. He received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from Loma Linda University School of Medicine, California. He also holds a Masters of Public Health degree and is Board Certification in Anti-aging Medicine by the American Board of Anti-Aging Medicine. He has authored numerous articles and the following books: The Five Proven Secrets to Longevity, How to Stay Young and Live Longer, Estrogen Dominance - Hormonal Imbalance of the 21st Century, and Beating Cancer with Natural Medicine.

For More Information

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©2009  Michael Lam, M.D. All Rights Reserved.

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