By: Michael Lam, MD, MPH

Read Part 2 Now!

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

Characteristics Adrenal Fatigue Hypothyroidism
Body Measurements
Weight Early: gain weight; severe – cannot gain weight Generalized weight gain
Body Temp 97.8 or lower Low 90s to 98.6
Temp regulation fluctuating and exaggerated Steady
Mental Function
Mental Function Brain Fog Slow thinking
Depression Sometimes Frequent
Physical Looks
Eyebrows Full sparse outer 1/3
Hair Thin, sparse on extremities Coarse and sparse
Hair loss Sometimes Common
Nails Thin, brittle Normal to thick
Peri-orbital Tissue Sunken Puffy
Skin Thin Normal
Skin tone Dry Oily or moist
Internal feeling
Ligaments Flexibility Good Poor
Fluid retention No Yes
Pain Headache, muscular, migraines Joints, muscles
Reactivity Heightened and hyper-reactive Hypo-reactive
Medical condition
History of Infections Common Occasional
Chronic Fatigue Yes Yes
Orthostatic Hypotension Frequent No
Blood Sugar Tendency toward hypoglycemia Normal to hyperglycemia
Heart Palpitation Frequent No
GI function Irritable or hyperactive Constipation and hypoactive
Mal absorption Yes No
Sensitive to Medications Frequent Normal
Personality Traits
Personality Type Type A Type A or B
Obsessive Compulsive Frequent Mixed
Sleep Pattern Wake up 2-4 am Sleepy
Temperature Tolerance Intolerance to Cold Intolerance to Heat
Food Craving Craving for sweet and salty Craving for Fats

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

Thyroid location for Hypothyroidism

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.


© Copyright 2013 Michael Lam, M.D. All Rights Reserved.

Read Part 2 Now!
5 stars - "Hello Dr. Lam-" Hello Dr. Lam-

Reading your website has brought a lot of things together for me. The triad described struck a note with me- beginning stages adrenal fatigue.

Thank you so much for your efforts in helping people like me.

I look forward to your reply.

Leave a Reply

Your email address will not be published.


Sarah Morris

I have felt unwell for 3 years and no doctor could tell me what was wrong. Finally, I had tests one year ago showing very low adrenal (cortisol and DHEA levels) and low free T4 and high T4:T3 ratio. I am a teacher and find the job very stressful. I plan to leave my job in the next 9 months. I am a Type A personality and had unexplained health problems when I was at school (now I think the same issue – due to exam stress). I saw Dr. Peatfield (UK) but have been on Nutri Adrenal Extra (4-6 tab daily) for 1 year and T3 for 4 months. I feel more tired than ever. I just had thyroid tests today which came up with: very low TSH, normal T3 and free T3 and low T4 and free T4. I live in Kenya and don’t have access to good endocrinologists (that I know of), though I will be in the UK for 2 weeks in December. Would you have any advice on what I should be doing? I’d like to find a good endocrinologist to see in the UK if possible. I would appreciate your help as I have been self-medicating for the last few months (based on Dr. Peatfield’s book) and really don’t know what I am doing.

Dr. Lam

When you feel more tired than ever with thyroid replacement, your body is telling you it does not like what you are doing. Seeing an endocrinologist is good, but do not expect them to really trace it to the root level. Most conventional endo will give you more thyroid to “force their way in” to the thyroid if you complaint more, as that is the standard protocol. You need to alert your endo of the adrenal component so he has a more comprehensive perspective. Print out my papers or let them read my book . Its not about good or not good endo because the training are all the same and most will be on the same track. Our worldwide telephone based nutritional coaching program deals with this type of issues. You can call my office for more information.

Dr Lam.

Neset Fehmi Sezgin

How about my wife Demet, she is turning 50 and having dry skin, dryness and gaining weight. I think she is being affected by low thyroid

Dr. Lam

You need to see your doctor and have the thyroid checked as the first step. If there is an adrenal component to the problem, you need to alert the doctor. Do not be surprised if your doctor is not educated on this. Print out my article for your doc if needed to help the educational process. You may have to go through a few doctors to find someone who really knows.

Dr Lam.


I was diagnosed with medullary thyroid cancer in 2009. Since then my calcitonin levels have been always under 2 – classified undetectable. Recently I have become heat intolerant and my calcitonin is 2.5. My Tsh had swung from above normal range to below normal range with my T4 within normal range throughout. With a total thyroidectomy my throxine levels are supplemented with Levothyroxine. My daily dosage was increased in order to decrease the TSH as a result my TSH is not below normal range. My concern – until now all thyroid related hormones have been stable – they are now unstable with raised calcitonin and heat intolerable. My worry is that this situation is indicating a dysfunction within the pituitary hypothalamus axis and maybe due to metastatic disease. Am I on the right track or could there be another explanation? Thank you

Dr. Lam

Something is going on that is unsettling the hormonal axis. I am not sure what it is from what you described, and a full workup will be needed. See your endocrinologist for that.

Dr Lam

Clark Norile

My wife has been diagnosed as hypothyroid, she has been on medicine for over 20yrs, slowly increasing the dosage. Her thyroid is still functioning. Is is still possible after all these years to try nourishing her foundation and weening off the meds slowly ?


It is possible, if done slowly and properly under doctor supervision. Generally speaking, the longer you are on meds, the harder to wean off. But that is not the main issue. The key is first to find out why she is on it in the first place. if there is a primary thyroid issue, then weaning off is not a good idea . Many people have low thyroid symptoms that is mistakenly taken as hypothyroid, and over time, developed resistance, thus dosage have to be increased. Read Adrenal Fatigue versus Hypothyroidism for more information as it will give you the major difference that you can see.

Dr Lam