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 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.
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).
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.
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
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!)
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 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.”
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…..
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 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).
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.
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.
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!
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