I was working with a new patient the other day, and she had already been to see a number of other practitioners and specialists. She was taking various medications for various diagnoses, but she was still feeling, as she described it, a little “off”.
I asked her which symptoms were bothering her, and the first thing she mentioned was feeling tired all the time. This is one of the most common symptoms I hear about in my practice, and this patient was a hardworking mom, so I wasn’t surprised!
She had recently started to learn about adrenal fatigue (which was one of the reasons why she came to see me), and when she was talking about how tired she felt, she said that she wasn’t sure whether it was because of the adrenal fatigue she suspected she had, the hypothyroidism she had recently been diagnosed with, or the anxiety disorder she’d had for years.
I come across this kind of situation all the time. Conventional medicine has basically trained us to see all of our health concerns, diagnoses, and parts of the body as separate entities, so when we encounter a symptom, we try to match it up to a clear condition with a label.
My patient’s persistent fatigue was not an isolated symptom of her adrenal dysfunction, hypothyroidism, or anxiety, because all of those things are connected and intertwined.
The adrenal fatigue & thyroid connection is one that people don’t always think of right away, but the relationship between adrenal and thyroid function is very real, and important to understand if you are working on healing from issues in either (or both) areas.
The Adrenal Fatigue & Thyroid Connection
Let’s start with a few basics. The adrenals and the thyroid have in common as a starting point that they are both part of the endocrine (hormonal) system. The adrenal glands sit on top of the kidneys and are best known for their essential role in our stress response system, releasing hormones like cortisol and adrenaline that help us cope with dangers large and small. The hormones they produce also play a role in regulating blood sugar, immune system response, digestion, blood pressure, and more.
The thyroid gland is found in the front of the neck, and is also responsible for producing essential hormones that our bodies need in order to function properly.
Adrenal fatigue or dysfunction occurs when we are chronically stressed. Our stress response starts to struggle, our hormone production is dysregulated (we may produce too much cortisol at the wrong times, we may not be able to make enough, we may also not be producing enough DHEA). We feel exhausted and run down, often struggle with headaches, cravings, insomnia, depression, brain fog, and other issues, and we are likely to lean on stimulants like coffee to get us through the day.
The thyroid and adrenals glands work together, and in combination with other glands, to produce and deploy necessary hormones. When adrenal function is low, thyroid function is likely to suffer too.
Fatigue, brain fog, and mild or moderate depression are common symptoms of both hypothyroidism and adrenal fatigue. For those who are diagnosed with hypothyroidism but do not feel better with treatment, it is likely that there is also some adrenal dysfunction or another underlying imbalance present.
The Effects of Stress on Thyroid Hormone Production
Understanding how stress and adrenal function affect the thyroid is the first step towards solving the problem and achieving balance and optimal health.
Our endocrine (hormonal) system is a team that works together, and when something changes with one component, everything can be affected. When the adrenal glands release cortisol in response to stress, it’s a signal for certain other endocrine functions to take it easy. This includes the production of thyroid hormones.
Stress hormones released by the adrenal glands also affect how much we convert the T4 hormone into free T3, and how much we convert it into reverse T3. The increased presence of stress hormones mean that we produce more reverse T3, which basically puts the brakes on all kinds of important functions and processes within the body.
A dysregulated stress response can also lead to thyroid receptors becoming less sensitive to thyroid hormones, meaning that the thyroid hormones we produce can’t really do what they’re supposed to do, and we may not respond adequately to thyroid medications.
The combination of adrenal dysfunction and decreased thyroid function can disrupt our metabolism in major ways, often leading to issues with blood sugar regulation, insulin resistance (which can lead to type 2 diabetes), and weight gain.
Adrenal Fatigue, the Immune System, and Thyroid Disorders
I recently wrote about the connections between adrenal fatigue and the immune system. Stress and adrenal fatigue suppress immune function (so that the body can focus more energy on coping with the stressor).
Chronic interference with the immune system can lead to all kinds of problems, including a leaky gut and autoimmunity. So, how does this relate to the thyroid?
The most common thyroid disorder in the US by a long shot is Hashimoto’s hypothyroidism, which is an autoimmune condition (meaning that the body is attacking its own healthy cells and tissues; in the case of Hashimoto’s, the thyroid).
When it comes to Hashimoto’s, it’s really not the thyroid gland that’s the issue, it’s the immune system– which is greatly influenced by the adrenal glands, the HPA axis, and our stress response.
Hashimoto’s accounts for about 90% of thyroid issues in the US, and is much more common in women than in men. The trouble is that most doctors focus on treating the low thyroid production (by prescribing thyroid hormones and boosting levels), but this doesn’t address the underlying cause, which is immune system dysfunction– often caused, at least in part, by chronic stress and adrenal fatigue.
I don’t think it’s any surprise, and certainly not a coincidence, that the more stressful our world becomes, the more chronic disease, thyroid dysfunction, hormonal imbalances, and autoimmune conditions we see. These illnesses don’t just come out of nowhere! Chronic diseases of all kinds are influenced by what’s going on inside of us, and stress is a major player.
Stress suppresses many functions and processes (again, in order to focus on dealing with the stressor). In addition to immune system function, this includes less of an emphasis on taking care of the gut lining, a process that requires way more energy than you might think. When the gut lining becomes compromised, foods and other substances can leak into the bloodstream (we call this “leaky gut”, or intestinal permeability). This causes inflammation, and can lead to autoimmunity.
The other problem here is that inflammation and autoimmunity are actually stressors, just like challenging life events are stressors, and just like toxic chemicals are stressors. So when our bodies are in a state of dysregulated inflammation or autoimmunity, the adrenal glands and the rest of our stress response system become even more burned out, and it becomes a vicious cycle.
How to Restore Adrenal and Thyroid Function
Because adrenal dysfunction often underlies thyroid dysfunction, including autoimmune thyroid disorders, a comprehensive treatment plan should involve working to reduce stress and regulate adrenal function. Remember, we may not be able to change the stress but we can learn to deal with the stress differently.
An adrenal fatigue treatment protocol is largely diet and lifestyle based, and can be followed in conjunction with other thyroid treatments as necessary.
Here are some of my top tips for healing from adrenal fatigue and restoring thyroid function:
- Reduce dietary and environmental triggers. Think of everything your body takes in as either helping or hurting your adrenal and thyroid function. Step-by-step, work on going through your fridge, your bathroom cabinet, your house, and your life, and clearing out the things that fall into the category of “hurting”. You can think of dietary and environmental triggers as sort of the low-hanging fruit when it comes to stressors. It can be a long-term process and challenge to decrease perceived stress, heal from trauma, and walk away from toxic relationships and situations– all extremely important, but gradual. You are also likely to find more energy and strength the more you can limit your intake of toxins and inflammatory foods, which will help you to make additional, long term changes for the benefit of your health.
- Follow an anti-inflammatory or autoimmune focused diet. Removing inflammatory foods like sugar, processed foods, gluten, and dairy from the diet is important. You also want to make sure that you are consuming enough of the good things that nourish you and contribute to your healing. Focus on clean sources of protein, lots of vegetables, nuts, seeds, and anti-inflammatory herbs and spices. The Autoimmune Paleo Diet is one option for a general framework to follow.
- Make time for self-care and stress management. I always work with my patients on strategies for enhancing mindfulness, stress management strategies, and making room for “me” time. Some of my patients tell me that they’re just not into meditation, and that’s fine! Mindfulness isn’t always sitting cross-legged and meditating. Sometimes it is, and that’s great, but others, they find more peace by walking in nature, listening to calming, classical music, or taking long hot baths. As long as your strategy isn’t introducing more stress or toxins into your body, there is no right or wrong way to practice self-care and mindfulness! Find what works best for you, and make time for it.
- Balance your blood sugar. When adrenal and thyroid function are suppressed, metabolic functions like blood sugar regulation suffer. Give your system a helping hand by making an effort to keep your blood sugar balanced. Eat regular, nourishing meals including plenty of clean protein and healthy fats, and keep nourishing, high protein snacks around in case of emergencies.
- Try adaptogenic herbs. Adaptogens are a powerful category of herbs that help to regulate the stress response, and I’ve found them to be very helpful for many of my adrenal fatigue and hypothyroid patients. Examples include rhodiola and ginseng.
- Work on sleep habits. The more nights of good, long, refreshing sleep you can get, the better chance you will have of improving your adrenal and thyroid function, and feeling better. I don’t know anybody who gets a perfect, uninterrupted 8 hours of sleep every single night, but we can all take steps to get closer to this goal. A lot of it comes down to setting up the right environment for sleep: a very dark room, lightweight and breathable PJs and bedding, limited caffeine and stimulants in the afternoon, and limited use of screens at night. Herbal teas including chamomile can also help to relax you before sleep.
- Consider supplementation. There are a number of vitamins, minerals, and nutrients that can help to boost adrenal and thyroid function, including B vitamins, vitamin C, magnesium, and omega 3 fatty acids.
Making connections is a crucial part of functional medicine and of my approach to health. I talk about the links between major systems and conditions not to make things more complicated but in order to provide a little bit of clarity. The more we can fit the puzzle pieces together, the more likely we are to truly heal the entire body as a whole.
Reviewed by Dr. Mark Menolascino, MD