Hashimoto’s: How the Adrenals Cause All Kinds of Problems

Adrenal Collage

The human body, like the planet earth, is made of many ecosystems all interacting and influencing each other. With Hashimoto’s many of these ecosystems are altered and dysfunctional.

And one example of this is the interaction between the adrenal glands and the thyroid.

The Adrenals: Little Gland, Big Trouble

The adrenals are two little glands, about almond size that sit on top of the kidneys.

The one on the right kidney has a triangular shape and the one on the left kidney has a sort of half moon shape.

Each of the adrenals has different inner and outer parts or zones. The inner zone or the medulla is what secretes adrenalin and norepinephrine and just the right amount of dopamine.

These are the stress hormones.

The outer zone……(cue Rod Serling)

You’re traveling through another dimension — a dimension not only of sight and sound but of mind. A journey into a wondrous land whose boundaries are that of the imagination. That’s a signpost up ahead: your next stop……

The outer zone of the adrenal cortex,

this is where 3 different types of hormones are secreted: glucocorticoids, mineralcorticoids and androgens.

These hormones are all made from cholesterol (See? It does do good things.) and are critical to every day function.

Cortisol, the Star of the Show

Of the glucocorticoids, cortisol is the star.

It is stimulated by ACTH from the pituitary. This is very much like the relationship between TSH (also secreted by the pituitary) and T4.

ACTH and cortisol are the analogous hormones of the adrenals.

What does cortisol do?

It regulates blood sugar levels, increases body fat, defends the body against infections and helps the body adapt to stress. It also helps to convert food into energy and is anti-inflammatory.

What doesn’t it do might be a better question.

There are other hormones produced by the adrenals, but let’s not go there right now. Keep your focus here on the cortisol’s reason for being (or raison d’être, as the French would say).

Stress, the Femme Fatale of the Body

Ok, so let’s take a look at few different ways that stress, the femme fatale of the body, causes hypothyroid symptoms.

Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, divorce, losing a job, moving, losing a loved one and the many other emotional and psychological challenges of modern life.

But other things you don’t normally think of, also place just as much of a burden on the adrenal glands.

These include blood sugar swings, gut dysfunction, leaky gut, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation.

All of these conditions sound the alarm and cause the adrenals to pump out more stress hormones.

So really, stress can be thought of as anything that disturbs the body’s natural balance (or if you like, homeostasis).

Adrenal stress is one of the most common problems encountered in modern clinical practice, because nearly everyone is dealing with at least one of the things I just discussed.

Signs and Symptoms of Adrenal Stress

Symptoms of adrenal stress are many, because the adrenals (like its buddy, the thyroid) can affect every system in the body.

Symptoms of Adrenal Stress

Some of the more common symptoms are:

* Fatigue, also a thyroid symptom

* Headaches, splitting headaches especially

* Decreased immunity

* Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep.

* Mood swings

* Sugar and caffeine cravings, (have a hankering for a Red Bull? It could be your adrenals)

* Irritability or lightheadedness between meals, a blood sugar and adrenal problem

* Eating to relieve fatigue, another blood sugar problem

* Dizziness when moving from sitting or lying to standing, it affects your blood pressure

* Gastric ulcers, ulcers in the stomach can be caused by the adrenals

Treat the Adrenals to Heal the Thyroid

Weak adrenals can cause hypothyroid symptoms alone without any problem in the thyroid gland itself.

In such cases, working on the adrenals themselves may be the key to improving thyroid function.

The most significant indirect effect the adrenals have on thyroid function is through their affect on blood sugar.

Low or high cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica, insulin resistance or both.

Blood sugar imbalances cause hypothyroid symptoms in a variety of ways. (More on this in an upcoming post).

But adrenal stress also has more direct impacts on thyroid function. And, (darn the luck!) hypothyroidism has a direct impact on adrenal function. (I feel a vicious cycle coming on!)

Everything Causes Everything

Let’s reflect on non-linearity for a moment, none of this happens in one direction. Hypothyroidism impacts adrenal function and adrenal function, in turn, impacts the thyroid.

First, what happens with the adrenals when the body is in a hypothyroid or functionally hypothyroid state?

There is a very clear link between hypothyroidism and hypoadrenalism. When there is trouble from this, it is often linked to problems in a part of the brain called the hypothalmus.

The Hypothalmus, Boss of the Boss

The hypothalamus is really like the boss of the boss. (The pituitary is the master or boss endocrine gland and the hypothalamus is the pituitary’s boss.)

You know, like when the boss is real arrogant and always doing bossy things and then, all of a sudden, the boss’s boss shows up and he gets put in his place?

Well, the pituitary and the hypothalamus’ relationship is nothing like that. (Just wanted to see if you were paying attention.) 😉

Their relationship is more like, “Hey, we have this amazingly complex, super complicated body to run, do you want to help each other? Cool. Oh and by the way, this is not linear.”

HPA Axis, The Axis of Goodness

With the adrenals, this little benevolent, enlightened dictatorship is called the hypothalmic-pituitary-adrenal axis or the HPA axis. These 3 run the whole show.

The HPA axis plays a major role in regulating immune function, digestion, energy use, mood and thrill of thrills, sexuality.

This HPA axis is controlled by hormones (in a non-linear fashion) and it is totally manipulated by stress.

Stress is like the femme fatale of the HPA axis. It’s the mean wife of the boss’ boss.

Where am I going with all of this?

Well, a dysfunctional HPA axis, like the troubled empire ruled by the mean boss’ wife, can cause all kinds of problems.

With Hashimoto’s, one of the reasons why people continue to feel exhausted even though they are taking thyroid hormones is because of a messed up HPA axis.

And adrenal stress can lead directly to a messed up HPA axis.

Hypothryoidism also impacts the HPA axis. When you are hypothyroid it leads to elevated cortisol due to decreased clearance and a negative feedback loop (The HPA axis doesn’t work properly.)

This, in turn, inhibits thyroid function because cortisol inhibits the enzyme (5’ deodinase) that is responsible for converting T4 to the form the body uses, T3.

It can also inhibit TSH. Hmmmm…..

Thyroxine Treatment Can Cause Adrenal Problems

Something else no one ever tells you is that treatment with T4, like Synthroid or Levothyroxine, can cause adrenal problems.

If someone has adrenal insufficiency, then they are at risk for thyroxine making the problem worse!

Even if the adrenal insufficiency is not that bad, it may have an effect on thyroid conversion, tissue uptake, and thyroid response. And not in a good way.

If the T4 to T3 conversion doesn’t happen as it should, the body can become overloaded with unused T4.

If it is converted, but the T3 cannot enter the cell walls due to adrenal insufficiency or iron deficiency, the T3 cannot be used, and may pool or build up in the blood.

Studies have shown that very high levels of T3 can be toxic to the liver.

Sometimes this T3 pools and then releases or dumps into the blood stream. When this happens, you may suddenly feel all the hyper symptoms like heart palpitations, insomnia, nervousness, etc. This is one of the reasons why some Hashimoto’s people experience hyper to hypo cycles.

In many cases, T4 and TSH blood tests will appear normal, but the patient will feel really lousy.

If a doctor raises the thyroxine dose in this situation, things may become worse. How bad depends on the degree of adrenal insufficiency.

Symptoms may include all the symptoms mentioned above.

And check this out! (This comes from the warning label for Synthroid, but is true of all synthetic T4 drugs.)

“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.

Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”

What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone.

How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?

I put this question to my Facebook support group and 100% of the 85 respondents with Hashimoto’s said they had most of the symptoms of adrenal insufficiency mentioned in the list I posted above. Granted, that’s not a scientific study, but it certainly is emblematic of this problem.

Have you ever heard of a doctor checking for this prior to beginning treatment?

It’s not very common, believe you me. Many doctors dismiss adrenal insufficiency as one of those make believe disorders.

The Flip Side

The other side of this is the many ways that adrenal stress can cause hypothyroidism.

As we discussed above, it messes with the HPA axis and this, in turn, messes with the HPT (hypothamus-pituitary-thyroid) axis. Communication gets all garbled all around.

And we all know how important good communication is. Especially when you have a super complicated body to run.

Adrenal Stress Can Lead to Autoimmunity

The GI tract, lungs and the blood-brain barrier are the main immune barriers in the body.

They prevent the bad guys from entering the bloodstream and the brain.

Adrenal stress weakens these barriers, weakens the immune system in general, and promotes poor immune system regulation.

Cortisol can impact this in both directions. Too little cortisol causes the immune system to rev up and can lead to an over aggressive immune response.

Too much cortisol can weaken the immune system and make you more vulnerable to attacks or unable to defend yourself.

When these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong.

If this happens over and over again, the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s.

Adrenal Stress Leads to Thyroid Hormone Resistance

In order for thyroid hormone circulating in blood to work, it must first activate receptors on cells.

Inflammatory immune cells called cytokines have been shown to make thyroid receptor sites less sensitive.

With insulin resistance, where the cells gradually lose their sensitivity to insulin, we see a similar pattern. There it is insulin, here it is thyroid hormone.

It’s like thyroid hormone is knocking on the cell’s door, but the cells don’t answer.

“I hear you knockin’ but you cain’t come in.”

A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication.

In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.

Adrenal stress reduces conversion of T4 to T3

93% of the hormone produced by the thyroid gland is T4, it is inactive in that form and must be converted into T3 before it can be used by the cells.

The inflammatory cytokines I just mentioned not only disrupt the HPA axis, they also interfere with the conversion of T4 to T3.

The enzyme 5″-deiodinase is responsible for the conversion of T4 into T3 in peripheral tissues such as the liver and the gut.

Both Th1 and Th2 inflammatory cytokines – IL-6, TNF-alpha, IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3.

In patients without thyroid illness, as levels of IL-6 (a marker for inflammation) rise, levels of serum T3 fall.

These inflammatory immune cells make T3 and TSH levels go down and reverse T3 levels go up.

So, adrenal insufficiency leads to poor conversion and adrenal stress due to inflammation can lead to this, as well. Giving us a lovely double whammy.

Adrenal stress causes hormonal imbalances

Cortisol also acts on the liver. When it is high, caused by chronic stress, this decreases the liver’s ability to clear certain hormones, like excess estrogens from the blood.

Excess estrogen increases levels of thyroid binding globulin (TBG), the proteins that thyroid hormone is attached to as it’s transported through the body.

When thyroid hormone is bound to TBG, it is inactive. Meaning it doesn’t work.

It must be taken from TBG to become “free” before it can activate the receptors on cells. (These are the free-fraction thyroid hormones that you see on lab tests as “free T4 [FT4]” and “free T3 [FT3]“.)

When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low T3 uptake and low free T4/T3.

When stress is not the cause, the most common reason for elevated TBG are birth control pills and estrogen replacement (i.e. Premarin).

What To Do?

Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else.

These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.

Sound familiar?

These are also all the things that make Hashimoto’s worse.

You can’t ignore them or pretend like they aren’t there like so many doctors do. We have to deal with all of them.

All of them. Half measures don’t lead to half results, they often lead to no results.

When they exist, these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful.

So much more than a thyroid problem. Hashimoto’s is a multi-system problem.

This is why I created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In it you will discover the complexity and multi-system nature of Hashimoto’s and what you should do about it.

How Do We Support the Adrenals?

This has been a long, exhausting blog post. It’s time to rest (for the sake of our adrenals). In an upcoming post I’ll look at all the things we can do to love our adrenals back to health. 🙂 Stay tuned!

References:

http://www.rxlist.com/synthroid-drug/warnings-precautions.htm

https://cfids-cab.org/cfs-inform/Neuroendocrin/tsigos.chrousos02.pdf – Adrenal stress leads to Hashimoto’s

http://www.karger.com/Article/Abstract/87001 -HPT and HPA responses during repeated stress

The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005

Hashimoto’s Thryoiditis, Izabella Wentz, Wentz LLC publishing, 2013

http://www.holtorfmed.com/blog/adrenal-health-understanding-the-adrenal-and-thyroid-connection/

5 Ways that Stress Causes Hypothyroid Symptoms

http://articles.mercola.com/sites/articles/archive/2000/08/27/adrenals.aspx

http://www.ncbi.nlm.nih.gov/pubmed/3527687

http://www.ncbi.nlm.nih.gov/pubmed/3500324

http://www.ncbi.nlm.nih.gov/pubmed/2500334

http://www.ncbi.nlm.nih.gov/pubmed/17910527/

About the Author Marc Ryan

Leave a Comment:

Jayne says

Interesting read indeed, how do u heal broken adrenals, suppose it’s trial & error 🙂

Reply
    Marc Ryan says

    Hi Jayne,

    You could try trial and error. However, the better approach is to work with someone who has experience with this because they can save you an enormous amount of time, money, energy and effort. I humbly suggest that you get help on this. 🙂

    Best, Marc

    Reply
Lauri says

Awesomeness, as usual!

Reply
Allie Woods says

Question is…and where do we go for help when our Dr’s don’t listen or have no clue about all of this magnificent info? HELP!!!

Reply
    Marc Ryan says

    Hi Allie,

    That’s easy. You come to me or someone like me. If your doctor isn’t getting it done, work with someone who will get it done. There is too much at stake here to be wrangling over nonsense. You need to work with someone who is equal to the task.

    Best,
    Marc

    Reply
Leah says

I’m still trying to heal mine. Emergency surgery in Nov 2011, threw me into Hashi’s a few months later. Then a Dr was giving me prednisone shots in the winter of 2012 for allergies(I didn’t know this was so wrong for my adrenals). I see an osteopath now. So how long will it take for me to heal? I so want to sleep. This is a frustrating journey.

Reply
    Marc Ryan says

    Hi Leah,

    Thank you for your question. It is very difficult to say how long with any certainty. There are so many variables. Generally the more thorough the approach, the better and faster the outcome. If you are not addressing all of the issues I mentioned in the post it will take longer. I have found most people don’t find success because they do too little.

    Best,
    Marc

    Reply
Roopa says

Great post, very informative. I feel like I am starting to understand my issues. Thank you very much!

Reply
Dave Schlottman says

I like your paper. I really buy into your explanation of the disease process because I have an extensive education having been to both pharmacy and dental school and having studied pharmacology, biochemistry, physiology twice….and anatomy and pathology once at the academic level. This is complex stuff. ( I wonder how much the average patient can absorb from your explanation ?) Would you believe that I once met a biochemist who claimed to have worked on the original research of the hypothalamic-pituitary feedback loop in Germany before WW2 ? But I digress.
Anyway, I have totally changed my diet. I am within a few lbs of my ideal BMI number of 24.8 and should reach it in a week at the present rate. I’m getting good exercise. I see my doc for my 6 mo ck-up on Monday. I was diagnosed about 15 yrs ago. I get the shingles too. They told me that I have the Epstein-Barr virus. Blah-blah-blah…. What is the best prognosis I can hope for and do you have any disease management tips for me that help. Mainly I periodically get slammed with an an unpredictable extreme mood swing/ lethargy that lasts about 36 hrs. I even see a psychiatrist but I don’t think the antidepressants do anything. I recently started chewing nicotine gum. That seems to improve my mood. Love my coffee too!

Reply
    Marc Ryan says

    Hi Dave,

    Thanks for your comment. Your prognosis depends on, firstly, getting a proper evaluation and treatment plan. Then secondly, on your willingness and compliance to carry out that plan. I have no idea about either. Personally, I’m not a big fan of coffee, particularly if you are trying to heal the adrenals. It is often counter productive to say the least. Your mod swings and lethargy are important diagnostically and suggest to me that you may not be addressing the problem sufficiently.

    Best of luck and please keep us posted on how things are progressing.

    Best,
    Marc

    Reply
Xavi Iribarren says

In all your complete and brilliant piece of writing, I’ve missed any reference to physical exercise. I agree that stress has bidirectional relationship with adrenals and cortisol. As better as you can manage your adrenals, better you will face up to stress. That’s one big truth.
But, in my own particular experience, when practicing physical exercise in the appropriate way, you can change your cortisol efficiency, and so, your deal with every day stress.

Reply
    Marc Ryan says

    Hi Xavi,

    Great comment! I absolutely agree with you exercise is an important part of the solution. There was just so much to cover in explaining what is happening that I had to first do that with this piece. In an upcoming piece that I’m working on, I’ll be discussing what to do about all of this. And in that discussion I will cover how to use exercise to to reset your cortisol rhythms.

    Best, Marc

    Reply
Melissa 'Spider' Smith says

I am a very low income single mother, and I have no options with my insurance. I can’t afford to see someone else on my own. My insurance won’t cover anything beyond the most basic of services, and my Doctor is NOT interested in digging deeper. My health is deteriorating but my numbers are normal so noone seems to care.

I believe 100% that my problems first began with my adrenals decades ago (I am a child abuse and multiple trauma survivor), but when I try to talk to my Doctor about this she looks at me like I’m crazy. I’ve been working on my emotional health for decades. That is not the problem. I need to work on my physical health, but I don’t know how to get help with this!

Now I’ve been diagnosed with fibromyalgia on top of that, so it feels like every one of my concerns just gets lumped in with that diagnosis. Noone will take me seriously beyond offering me antidepressants. Last time I went in, my Doctor told me to see a counselor without even bothering to find out that I’ve already been seeing one for over two years! Even my counselor believes that my anxiety is primarily physiological at this point, and has offered to consult with my Doctor about this. But my Doctor doesn’t seem interested.

Do you have any suggestions for someone in my situation? Things I could say to my Doctor? Any helpful ideas are very appreciated. Thank you.

Reply
    Marc Ryan says

    Hi Melissa,

    Thank you for reaching out! Firstly, I want you to know that this is not all in your head. There is a very strong link between both thyroid and adrenals issues and psychological issues.

    I can’t tell you how many emails and comments I get where people ask me what to do about their doctors. There’s no easy answer. The first thing to do is to evaluate if your doctor is reasonable and open to suggestion. If they aren’t it’s not worth your wasted time, energy and effort. Find another doctor who will be.

    The second thing is to arm yourself with articles and research. Most doctors want to see things from Pubmed and unless you are a medical professional its hard to decipher some of these studies. But even then you must understand that most doctors use the tools that they have, which are thyroid replacement hormone, glucocorticoids, and antidepressants. That’s pretty much it. They don’t have other tools in their arsenal. As a functional medicine provider, I am familiar with using natural supplements, diet and lifestyle modification. and this is what I write about extensively.

    I also offer a free 30 minute Hashimoto’s Healing Discovery session. In it you can share where you are and where you want to be, I can offer some resources that will help you right away and I can explain how I can help. There is no obligation and I might be able to steer you in the right direction. If that interests you, you can schedule using the button on the home page.

    Best,
    Marc

    Reply
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Liz Suggett says

Hi

This article is so interesting. I was diagnosed with fibromyalgia 2 years ago. Only through my persistence was I finally diagnosed with Hashis. I went down the route of levothyroxin and was brilliant for 2 months and then went downhill. I changed to natural thyroid and once I got the optimal dose, I had lots of energy and was doing well apart from stiffness. I was then put on LDN but the dose was increased too rapidly and my thyroid levels shot dangerously through the roof. it has taken four months to reduce my levels and I am now left fatigued and aching again. I have had my adrenals tested (saliva) and the cortisol is high in the morning, drops below normal at 12 midday, ok at 4pm but then rises again above normal as I go to bed. I have a lot of trouble sleeping, and have had a lot of emotional stress the last 12 months. I crave sugar and salt. What I am also interested in is that I have suffered from restless legs and I believe this is caused my lack of dopamine and you state that the adrenals produce dopamine. I have leaky gut syndrome and high heavy metal toxicity. Can this all be connected? I am about to go onto the GAPS diet. What do you think?

Reply
    Marc Ryan says

    HI Liz,

    Thanks for sharing your story. Wow, it sounds like you have a lot going on. Yes, this certainly can all be connected. The body is not a machine with isolated parts. Its a collection of living breathing ecosystems that all interact in remarkably complex and sometimes unexpected ways. Adrenal issues impact thyroid issues, thyroid issues impact the brain, the gut affects all of these things and on and on it goes. What ultimately happens is you get these vicious cycles spiraling your health downward.

    That’s why I created my program because it really teaches you all about all these interactions and how they affect one another. If you work on all these areas, not just one, you can turn those vicious cycles on their head and start getting positive results that are magnified as the different systems all improve.

    The GAPS diet can be helpful. I don’t really know enough to be able to say for sure, but generally that’s a good place to start. I don’t know of you are aware of it, but I offer a free 30 minute Hashimoto’s Healing Discovery session. In it you can share where you are and where you want to be, I can make some suggestions that will be helpful right away, and we can discuss how I ma be able to help moving forward.

    If that interests you, you can visit my home page and click the button in the right hand column to schedule a session.

    Best, Marc

    Reply
Joan Kosieniak says

Just talking with you and sending emails and listening to (reading) your advice has helped me so much. Now if only my endocrinologist would listen to me rather than criticize, I might get some healing but he only believes in levothyhroxine which I do believe I should not talent because he has never checked my adrenal glands…I am so frustrated!
Joan kosieniak

Reply
    Marc Ryan says

    Hi Joan,

    Thank you for your kind words! I can be really frustrating. I don’t understand why endocrinologists don’t see the importance of properly assessing the adrenals. It really can be frustrating. You just have to continue to be your own advocate and don’t stop until you get what you need.

    Best, Marc

    Reply
Kimberly says

My endo did the ACTH and mailed me a letter saying my levels are in range. I realized I was one my own. I’ve gotten myself a 24 hour saliva test. It confirmed my cortisol is scary high. I’ve been doing my own research and I’m working on it. It surprises me when people don’t even believe me that Endo’s do nothing for adrenal fatigue, I had to ask her just to test my cortisol she did not offer, I’m so disappointed with the care from my endo. Adrenal fatigue is huge for healing. And it’s to important to ignore, although it’s very complicated and is hard to figure out by myself. So thank you for posting this article. Your awesome…

Reply
    Marc Ryan says

    Hi Kimberly,

    Thank you for your kind words! Healing your adrenals is hugely important in healing the web of problems related to Hashimoto’s. If you need any help in interpreting that ASI I offer a free 30 Hashimoto’s healing Discovery session. IN it you can share where you are and where you want to be, I can make some suggestions and we can discuss how I might be able to help. You ca schedule an appointment by clicking the button in the right column of the home page.

    Best,
    Marc

    Reply
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