Guest Author - Jim Lowrance

For many thyroid patients on hormone replacement treatment for their hypothyroidism, the results can be less than satisfactory and for others, down right disappointing however, for a percentage of treated patients, results can be very successful.

What in the world are some of the factors involved in treatment for hypothyroid patients, that can cause such a wide range of results? There actually are many factors that can hinder the effectiveness of thyroid hormone replacement treatment but in this article we will look at one of the more common problems that is experienced by patients, the one called “Adrenal Fatigue".

It is always my determination, when addressing such a subject, to avoid any negative references to medical professionals, out of concern that such discussion will appear to be directed at all who are in these areas of the medical field, so let me say emphatically, that this absolutely is not the case! There are many excellent medical professionals out there but having said this, I must add that there are also those who for some reason, are not as well-informed as others or are not updated on advancements in treatments as well as others are.

One common problem that hypothyroid patients experience, is co-existing “adrenal fatigue” (sub-clinical adrenal insufficiency), which can actually result in a negative affect for a period of time, from the introduction of thyroid hormone replacement medication, into their systems. The main hormone adrenal fatigue patients are low on, is “cortisol”, the stress hormone that helps the body to cope with stressors both physical and mental. Cortisol is also essential in its role in giving our bodies the ability to metabolize thyroid hormone and in dealing with the added stress to the body from increased levels of thyroid hormone, that are introduced into it, via hormone medication.

The manufacturers of thyroid medications themselves acknowledge in their “contraindications” that patients with “untreated adrenal cortical insufficiency”, can experience a worsening of their low-adrenal state (see their websites), if they implement thyroid hormone replacement medication, without correcting the adrenal insufficiency. This in my opinion is the very reason many thyroid patients experience a worsening of symptoms, for a period of time, when they begin thyroid hormone medication treatment. They may also at times experience a resurge of their symptoms, if the adrenal fatigue has a tendency to return from time to time. These patients have a sub-clinical form of adrenal insufficiency, due to slow developing hypothyroidism or long-standing hypothyroidism and the introduction of thyroid hormone, into their systems, causes an immediate worsening of the adrenal fatigue. Certain symptoms will worsen, just as stated by the Pharmaceutical companies who make the thyroid medications and they further state that if the adrenal insufficiency is full-blown (much more rare), the patient can actually experience an “adrenal crises“, which is a medical emergency that can result in coma or death. This more severe response does not happen to patients who have the more common adrenal fatigue and not full-blown adrenal insufficiency but their symptoms can still be concerning and frustrating.

The problem with this scenario, is that many Doctors do not recognize sub-clinical forms of adrenal insufficiency (adrenal fatigue) and therefore, a patient who experiences a worsening of symptoms when starting thyroid medication, are either told it is in their head (imagined) or not thyroid related but of another cause. The increase in joint pain, they may be told, is co-existing arthritis. The increase in fatigue and emotional symptoms, they may be told is an emotional issue, needing an antidepressant. While such possibilities could very well happen, the fact that these symptoms increase after starting thyroid medication, in my opinion merits further investigation by the patient’s Doctor, not to exclude tests to see if their adrenal hormones might be the culprit.

It is my understanding that physician references, used by Doctors, actually recommend testing patients for possible low-adrenal function, before starting them on thyroid hormone medication however, this is seldom done. My belief is that this is due to the fact that true, full-blown adrenal insufficiency is quit rare. The problem is however, that those who have a sub-clinical form that still causes a negative reaction from implementing thyroid medication, are left to suffer, until their own adrenals slowly recover on their own, or until they add some adrenal support to their regimen, to help them recover.
My questions to anyone in the medical field who actually believe adrenal fatigue is not a real condition would be these; 1. If hypothyroidism causes a slowing down of all bodily functions and organs, how could it not be possible that the adrenals would also be greatly affected in some patients? 2. Why, if sub-clinical hypothyroidism is recognized and pre-diabetes (insulin resistance) and other sub-clinical organ dysfunctions are recognized, that this is not also the case with adrenal function?

By simply getting adrenal hormone levels tested, adrenal fatigue can be seen plainly, in black and white on lab results. The problem is, these patients with low adrenal hormone levels, such as cortical, will usually pass a test that is recognized by many Doctors, as the only true test of adrenal function, called the “ACTH Stimulation Test”. If a patient has a negative (good) result from this test, which certainly is diagnostic of full-blown adrenal dysfunction, many Doctors will look no further. This leaves the patient with sub-clinical adrenal hypo-function, with no further options for resolving their problem.

It is my opinion that even when a patient passes an ACTH Stimulation test but their actual adrenal hormones are still revealed as low on lab results, how could it possibly be harmful, to treat this condition with some of the non-steroidal treatments that are available? The only treatment for true, full-blown adrenal insufficiency, is lifelong corticosteroid steroids (ie; Prednisone and Cortef) and there are actually some Doctors who will use these steroids to treat severe adrenal fatigue, under strict control and for short term, until the patient’s adrenal function is restored to normal. There are however, non-steroid treatments that are safer and have proven to be very effective in helping restore adrenal function, in patients with adrenal fatigue. Once this is accomplished, these patients have much better improvement from their thyroid hormone replacement treatment!

If the thyroid hormone medication manufacturers recognize this problem as being a real possibility, it should always be a consideration, when a thyroid patient has a negative reaction to thyroid hormone replacement therapy.

See my articles in "Related Conditions" about treatments for adrenal fatigue.