Adrenal Fatigue versus Hypothyroid Symptoms

By: Michael Lam, MD, MPH


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Laboratory Test for Adrenal Fatigue

Hypothyroid symptoms and Adrenal Fatigue Syndrome

In such cases, laboratory test results of T4 and T3 may be normal and classic hypothyroid symptoms and 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.

Hypothyroid Symptoms

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. 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 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 hypothyroid symptoms persist despite medication.

It is easy to over medicate for Hypothyroid symptoms

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 hypothyroid symptoms 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.

Conclusion

Hypothyroid symptoms may include sleeplessness

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 the article called “Ovarian Adrenal Thyroid Axis Imbalance

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


Dr. Lam’s Key Questions

Many with AFS have symptoms suggestive of low thyroid function subclinically. Laboratory tests continue to be normal.

Supporting the adrenal glands allow the thyroid function to be self-regulating according to the body’s needs 24/7. When adrenal function is low, the body will tend to slow down in metabolism to save energy. This can lead to symptoms of low thyroid.

Feeling cold is most commonly due to a reduced metabolic rate when the body is in a hypothyroid mode. It is akin to a car running at low idle speed at rest. Circulation can be compromised as well.

Yes, but there is usually some kind of triggering factor. It can include stress, electrolyte imbalances, or improper supplementations. This is generally not a common occurrence and happens to those who are already weak and sensitive.


Hypothyroid symptoms

DrLam.com
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Thank you for this coherent definition between primary and secondary hypothyroidism.
I am in full appreciation of the availability of helpful information on your site. It is a wonderful site for those in research for insight into this problem. Thank you so much.




22 Comments

  • Learner says:

    I’m exhausted all the time. I already had celiac and Hashimotos and was treated with T3 for very high rT3 prior to a radical hysterectomy and chemo for stage 3 uterine cancer 2 yrs ago. Then in a major car accident, my sister had a long illness and died, and I chelated a lot of toxicity with IV and oral nutrient replacement. I do all the adrenal support things, organic high vegetable Paleo diet, Vital Nutrients adrenal support, 3g of B5 & C each day in a comprehensive nutrient support program, exercise wisely, and take 30mg of hydrocortisone and 75mcg T3 to function. I’m not getting better and am losing hope, and all these adrenal fatigue websites don’t seem to address the level of adrenal stress my body has gone through… and the cancer survivor websites are useless. Is there anything I can do?

    • Mariella says:

      Read this article, it totally explains why your medications do not help you and instead worsens your condition. Treat your adrenal fatigue first by avoiding stress, having exercise, right diet and meditation. Do this in a matter of 3 weeks to 3 months and your adrenal fatigue will be treated. Treating your adrenals will spontaneously treat your thyroid problems without the need for medication. You can ask for your physician about this for a professional medical advice.

  • Tareah Gray says:

    Thank you for your article, Dr. Lam. I am currently going through a difficult time with my thyroid and am wondering if I should be treated for AFS as well. After having a TSH of .56, I was experiencing overmedication symptoms (insomnia, anxiety, restless limbs, irritable bowels, mood swings). Over the course of about two months, I decreased my Levothryroxine, but the symptoms came on again. I would skip days to relieve them, halve my dose (started at 125), but the same symptoms would come on eventually. My only calm time was being down to 75 mcg for three weeks and feeling just hypothyroid. I was anxious to get back to “normal,” so I upped it to 88. (My doc was involved in these decisions, but she is slow to respond to phone calls and when my symptoms were bad, so I would just skip doses to relieve symptoms, which always began with restless limbs and irritable bowels.) Long story short, there have been a lot of dose changes over the course of 2.5 months. I was down to 50 mcg (another change to Synthroid) and ended up at the weekend clinic because I was only able to fall asleep from 4-6 a.m., grew shaky and anxious, sweaty and hot in addition to the restless limbs and bowel issues. I couldn’t take it any more. My doc wanted me to “push through the symptoms,” but they always grew unbearable. The doc at the weekend clinic let me go off my Levothyroxine for 1-2 months. It’s been almost three weeks, and the only symptoms remaining are that I have trouble falling asleep. I take 25 mg hydroxyzine as an allergy sleep aid, but it only seems to help with allergies. I’ve tried 9 mg Melatonin but with mixed results. My TSH was 61 before I even went off Levothyroxine, so my symptoms seemed to be more of a reaction to the changes in medication than from overmedication/hyperthyroidism at that point. The doc said changes in medication can cause these symptoms and that they should all disappear and I will just experience hypothyroid symptoms and then start on 25 Synthroid for 6 weeks. My worry is that they haven’t considered AFS. I feel very fatigued and other hypo symptoms but can’t fall asleep. How long do the adrenals take to recover (if that’s possible)? I’m relieved to be rid of the other crazy symptoms but so tired from not sleeping despite having true hypo symptoms. Thank you very much!!!

    • Dr.Lam says:

      Difficutly in adjusting to medical dosage can be due to many reasons. you need to focus on the underlying cause. Your doctor can help you. When the thyroid is fragile in its response and becomes like a moving target, it is imperative that you stay with one doctor that you feel comfortable with that can supervise each step along the way. AFS is a deterrant to thyroid recovery and should be considered as well, but with your thyroid not cooperating, medication is usually needed to stabilize , and your doctor will help you.

      Dr Lam

  • T. says:

    “the true delivery of thyroid medication into the cells is not known. The body’s cry for help by forcing a persistent low body temperature is often not attended to…” I read about true delivery of thyroid medication into the cells and was stumped. Adrenal support is the goal but continued use of the thyroid medication(t4 or T4 T3 thyroid medications) seems counter productive after reading this statement. The recovery process is further challenged with thyroid medication, some symptoms show improvement with daily supports but the low body temperature goes up but drop way down on a daily basis. Will there be new topics addressing this issue?
    Thank you for parallel journey support when we are all paving unchartered paths!

  • T. says:

    Thank you for your time. Support the OAT axis and we should have success that is still the big challenge. Who should consider the thyroid support supplements? When would they be considered to be used?

  • T. says:

    Thank you again. I wonder if a person supports their adrenals and is on thyroid medication, does that mean that often times they might need to cut the dose in half or only use a T4 thyroid medication? So then when the adrenals are rested or recovered then consider re-introducing a T4/T3 medication?

    • Dr.Lam says:

      In general, as the body gets stronger, overall metabolism tend to improve. The exact course varies from person to person and must be personalized each step of the way.

      Dr Lam

  • T. says:

    Thank you for your time, concern, skill, understanding input, availability and new products.

  • T. says:

    I am thank you for the bold print statements. I hope to see guidance and articles on how others have found their balance between thyroid medication, adrenals and menopause.

  • Julie Scarsbrook says:

    Fascinating article. I am currently addressing long standing high cortisol after what seemed to be a ‘thyroid collapse’ when the medication does not seem to be working. This article puts a completely different slant on that idea.

  • Melanie says:

    I meant to type adrenaline fatigue

  • Melanie says:

    I have been on A compounded thyroid T3 T4 medication for about eight months now but I also suffer from a drawing fatigue and no matter what I do I can’t seem to get it under control completely. It’s very frustrating my hair is still breaking- getting thinner. I feel tired / exhausted at times also have sleeping problems. I know there is more to what has been told to me all this time, but I just don’t know what else to do or turn to. Can you please help me …

    • Dr.Lam says:

      You should first go back to your doctor for any further adjustment if any or perhaps something else is going on. Loosing hair is common when there is concurrent adrenal weakness that is not dealth with properly. that often spontaneously resolved once adrenals are supported properly from our experience. Unforatuntely, this is not easy for those who are dependent on thyroid.

      Dr Lam

  • tamara says:

    What about those with hashimotos. Enlarged thyroid with inflammation of lymph nodes. 6 months ago I had severe adrenal fatigue. Most likely this has been at the root of my thyroid since 2001. Lowered my levo significantly. My TSH went to 120. Low T3 and T4. I was on a lot of supplements a lot of iodine and herb supplements. I was at 175 mcg went to 75 every other day. And increased it to 75 the last week. Everybody has a different opinion.

    • Dr.Lam says:

      your picture is incomplete unfortunately. there is a lot of history that are critical but missing. when there is AFS and low thyroid concurrently, you should find someone who truly understand both and your confusion will be lifted because it is actually rather simple once you understand the root issue and your doctor will explain to you. Unfortunately, I dont have enough information to give you more input and a detailed history usually takes about 20 minutes to put the pieces together. Remember that Hashimotos is just one form of low thyroid expression that is triggered by low adrenal function in most cases. Do not get thrown off balance. Stay focus on the big picture per my article.

      Dr Lam.

  • Suzy says:

    thank you! I stopped my t3 meds 3 days ago and already notice a huge improvement. I’ve gone from very disruptive 4-5 hours of sleep to 8-9 hours the past two nights, and my edema and pain are greatly reduced and I have more energy. Your website is amazing, full of scientific information that finally makes sense. It’s the best resource I’ve found so far for adrenal fatigue, and I am recommending it to others.

  • Suzy says:

    This article couldn’t have come to me at a better time! My doctor started me on cytomel for free T3 (already taking synthroid for TSH). Ever since then my adrenal fatigue has continued to worsen – to the point that I have a severe electrolyte imbalance and edema. My free T3 has barely moved, despite adjusting meds 3 times. And every time she increases it, my symptoms worsen. On a whim (or maybe just trusting my gut) I stopped taking the cytomel this morning. Then I stumbled across this article. Wow! I feel like the pieces of the puzzle are starting to click in place.

    • Dr.Lam says:

      When AFS is present, the body’s response to thyroid replacement can go through what you are experiencing. its the body’s way of telling you it does not like what you are doing. You are likely to be continually punished if you dont change tracks. we deal with many people like you so nothing unusual from what you are saying.

      Dr Lam.

  • Crowly says:

    Hello, Dr. Lam. I understand why there aren’t any tests for Adrenal Fatigue, but wouldn’t a series of overall work ups taken over time show a trend that would highlight adrenal issues? Thanks for your time, and great website!

    • Dr. Lam says:

      Having multiple snapshots can be helpful provided that there is close clinical correlation. Most professionals, however, get carried away and the focus is distracted to “treating the numbers”, and that is the danger. Remember that you can have normal numbers and still have AFS for a variety of reasons, and laboratory test will not be able to tell us why, no matter how many snap shots taken because it is simply not sensitive and specific enough. I suspect this problem will get closer to being resolved as time and research proceeds but we are still about 20-30 years away. At the meantime, learn to listen to your body. It is never wrong, and if you really pay attention ( and we teach people to do that in our telephone coaching program) , you will learn over time how your body communicates with you. Once you trust your body more, you will understand and truly appreciate and respect your body and will not be so dependent on labs which is population specific but not individual specific. Modern science have us believe that laboratory results are gold standard but when it comes to AFS, it is not at this time. An accurate and detailed history is. Test can help to confirm when used properly, and it can also mislead you. Nothing in life is 100% one way or another.

      Dr Lam