Effects of thyroid medication, T4/T3 on exhausted adrenal - resulting in RT3 and Thyroid binding globulin

Low Thyroid Function Due to Adrenal Fatigue

Hypothyroidism can be primary or secondary. Primary hypothyroidism can easily be cured with administration of thyroid replacement therapy. If hypothyroid symptoms such as low body temperature, fatigue, dry skin and weight gain persist despite thyroid replacement therapy regardless of laboratory values, one must look elsewhere for the cause of the low thyroid function.

Secondary hypothyroidism is low thyroid function caused by malfunction of another organ system. One of the most frequently overlooked causes is adrenal fatigue. Adrenal fatigue is perhaps the most common cause of secondary low thyroid function, both clinically and sub-clinically. Low adrenal function often leads to low thyroid function, classically evidenced by high levels of thyroid binding globulin (TBG), low free T4, low free T3, high TSH, slow ankle reflex and low body temperature. Few physicians are trained to detect this connection. Fortunately, secondary hypothyroidism can be reversed when the underlying root problem (such as adrenal fatigue) is resolved.

When the adrenals are exhausted, the ability of the adrenals to handle the stress associated with normal bodily functions and energy requirements is often compromised. To enhance survival, the adrenals force a down-regulation of energy production. In other words, the body is being metabolic down-regulated to slow down in order to conserve energy as the body needs to rest. Lower energy output reduces the workload of the body. In times of stress, this is exactly what the body wants. As the thyroid down-regulates, production of thyroid hormones T4 and T3 is reduced. The down-regulation also leads to an increase in thyroid binding globulin (TBG) level. As a result of increased TBG, more thyroid hormones are bounded on a relative basis and less is released to the body cells where they work. This leads to reduced free T4 and free T3 levels in the blood if measured (while total T3 and T4 levels may be normal). In this well orchestrated systemic down-regulation to enhance survival, the body also shunts some of the available T4 towards the production of the inactive reverse T3 (rT3) which acts as a braking system and opposes the function of T3. This reduction in T3 combined with an increase in rT3 may persist even after the stress has passed and cortisol levels have returned to normal. Furthermore, rT3 itself may also inhibit the conversion of T4 to T3 and may perpetuate the production of the inactive rT3. If the proportion of rT3 dominates, then it will antagonize T3 and possibly leading to a state called rT3 dominance. This results in hypothyroid symptoms despite sufficient circulating levels of T4 and T3. The body therefore has multiple pathways to down-regulate energy production to enhance survival under the direction of the adrenal glands....


34 Replies

  • facebook.com/groups/FTPOUKA...

    I can personally say that FTPO has changed my life.

  • For the facebook refuseniks among us, could you tell us a little about what FTPO is and why it is so wonderful?

  • Apparently it stands for "For Thyroid Patients Only"...

  • It is specifically for thyroid patients and is a selection of groups that cover things like adrenals, gut and gluten issues, sex hormones, thyroid cancer, Without a thyroid, T3 only treatment etc.... and also region specific groups for those outside the USA - like Canada, Australia, Europe.

    They are thyroid groups for thyroid patients run by thyroid patients, and information provided is drawn from patient experience rather than medical text books and assumptions made by those who don't live it day to day.

    The FTPO groups stem from Stop the Thyroid Madness


    Heres a list of the groups if in case it piques your interest.


  • bech,

    This HealthUnlocked Thyroid UK group has a specific guideline which says:

    21. Do not solicit members to other websites or forums for your own purposes either via posts or the messages system.


    Over the past two days you have posted five responses (having never posted anything before) all of which mention a specific Facebook group.

    That is tantamount to a campaign of soliciting to that Facebook group. We are generally very tolerant of mentioning other sites in bona fide posts. Your recent activity goes beyond what is acceptable. This is not requiring you never again to mention Facebook, or even that group, but I hope politely requests you to engage here with the people here and not post in a way that is perceived to be a campaign.

    You failed to explain, at least initially, that you have to both be signed up to Facebook and then signed up to a specific restricted group. Many here feel that the openness here is a positive attribute.

    You stated: They are thyroid groups for thyroid patients run by thyroid patients, and information provided is drawn from patient experience rather than medical text books and assumptions made by those who don't live it day to day.

    Virtually every member here on HU-TUK is a thyroid patient, the information provided is drawn from patient experience and medical text books and research findings and... It certainly has lively discussions and posters are most often more than able to avoid making assumptions of the sort you mention.

  • Thank you bech, unfortunately, This content is currently unavailable, but will try again later.

  • You have to join the group cc120. They're closed group to keep information private. A list of the groups can be found on here: stopthethyroidmadness.com/t...

  • Thank you bech.

  • This is a brilliant article. I am just starting out on the road to recovery having seen Dr P.

    I have been ill for years and years, so I know it will be slow going but already after only 6 weeks I am a little improved. Thank god for drs and articles like this because nobody knew what to do with me apart from more anti depressants and beta blockers. It got to the point where I knew I had to try and help myself even though my brain fog is bad. It feels so good to not be sitting opposite a gp/ consultant feeling hopeless and in a way ignored. I knew that something was wrong with my thyroid but nobody would listen because the basic bloods said it was fine. Well it wasn't fine and when I am better I am going to go to my gps and show them everything I have done to help myself. Sorry rant over.

    Keep strong folks xx

  • Definitely adrenal exhaustion can cause much malaise and knock on effects and should be taken more seriously by health professionals.

  • Ray Peat wrote:

    “Thyroid is needed for the adrenals to function well, and adequate cholesterol, as raw material. It’s popular to talk about ‘weak adrenals,’ but the adrenal cortex regenerates very well. Animal experimenters can make animals that lack the adrenal medulla by scooping out everything inside the adrenal capsule, and the remaining cells quickly regenerate the steroid producing tissues, the cortex. So I think the ‘low adrenal’ people are simply low thyroid, or deficient in cholesterol or nutrients.”

    — Raymond Peat, PhD

  • How about extremely high cortisol for long periods?

  • Ummm... I know I've only just got up and not quite firing on all cylinders yet, but there are one or two things that Don't make sense to me.

    It says "Low adrenal function often leads to low thyroid function, classically evidenced by high levels of thyroid binding globulin (TBG), low free T4, low free T3, high TSH" But I thought that was primary hypo, not secondary. I always thought that secondary hypo was low free T4, low free T3, 'normal' TSH.

    Then it says "To enhance survival, the adrenals force a down-regulation of energy production. In other words, the body is being metabolic down-regulated to slow down in order to conserve energy as the body needs to rest." In which case, why is the pituitary still putting out all that TSH?

    Can anyone explain?

    And, as an aside, I know I'm obsessed with grammar, but I'm not sure he used the word 'bounded' correctly... Which bothers me. lol

  • No, sorry, doesn't make sense.

  • Anyone with any suggestions for greygoose?

  • Greygoose doesn't need any suggestions. She's not an idiot. And that article doesn't make sense in some respects. Nobody so far has been able to explain that, so I take it the article is wrong. In which case people need to know that. Explanations, not wild guesses! lol

  • Hi Greygoose, I think mine was secondary hypo as had all the symptoms of adrenal exhaustion before my TSH started rising. Initially TSH was 4, then after some years of feeling awful, TSH rose to 7.5, T4 staying at around 12 (12-22).

  • OK, but his definition of secondary hypo was : low free T4, low free T3, high TSH. Which for me is primary hypo. High TSH. Your TSH of 4 wasn't that high - still in most ranges - so that could have been secondary. But that's not what he says in the article and that's what I'm questioning.

  • Hi Greygoose, TSH was 4 but then went up to 7.5, then 8.

  • I don't really agree with Dr. Lam.

    Here's the problem with "adrenal fatigue:"

    Your adrenals don't over produce or under produce because they are tired. Infact, how would cushing's syndrome ever exist if it was possible for your adrenal glands to get tired? There are people who have extremely high cortisol levels their whole life, and there glands don't get "tired."

    Also, the adrenal glands take orders from the pituitary which takes orders from the hypothalamus. These are the areas that send commands about how much cortisol to produce by releasing CRH and ACTH respectively.

    Now, there appears to be an underlying cause that prompts chronic high or low or fluctuating cortisol levels. It could be infection, inflammation, or autoimmune. In my case I discovered I'm producing autoimmune antibodies, and my cortisol has been high ever since. The body seems to know there is inflammation occuring and releaing cortisol in response.

  • Hi drob32, I have very high cortisol 956 (171 -536) but no autoimmune antibodies. Has been high due to stress/truama, but does fluctuate. Problem is as adrenal goes up and down, cortisol stays high, and gets pushed up higher when adrenal goes up. So constant state of anxiety and stress.

    Fatigue caused by adrenal disfunction caused by chrionic stress over a long period.

    How to discover if person depressed or adrenal exhausted, ask what they would do if they were feeling better. A depressed person will find this difficult to answer, but an andrenal exhausted person will have a long list.

    'Just as your levels of adrenaline start coming down, so rises the amount of cortisol flowing through your veins. Moreover, cortisol has a much larger momentum than adrenaline, which means that even though it builds up slowly, it also takes a long time to go back to normal. And should you constantly be engaging in activities which require adrenaline, so will your levels of cortisol slowly increase. In a sense, you can think of cortisol as a measure of the weighted average of your recent levels of adrenaline. I have tried to capture this feature in Figure 2.'.....


  • Hi cc120,

    Out of curiosity, which autoimmune tests have you had done? I was negative for ANA, and anti-nuclear DNA. However, when I ran the cyrex assay #5, it picked up on elevated antiphospholipid antibodies. These seem to be genetic in my case and I believe they were increased by surgery I had a year ago. Over the course of the last year I've struggled with high cortisol, and I came to believe there has got to be a cause.

    Unfortunately allot of people with autoimmune conditions are seronegative, meaning they are autoimmune but tests can't detect their antibodies at high enough levels. Generally you would go by symptoms, but since high cortisol can cause hypothyroid symptoms, it makes it difficult to differentiate between diseases.

    High cortisol can cause cellular resistance to cortisol (sort of like insulin resistance) as well as to thyroid hormone, and other hormones like testosterone and estrogen, etc. It feels like your deficient in everything, and hypothyroid even if your blood values are normal, of course complicating everything. It theorectically makes you feel like you're low in cortisol when your high (how crazy is that?).

    In any case I don't want to say Dr. Lam is totally wrong, but there are currently two schools of thought. 1. is that the adrenals get tired and stop producing. 2. That the adrenals take orders from brain structures and only do what they are told (minus something an ACTH producing tumor).

  • Thank you drob32, I've had TPO antiobodies: 16 (0.00 - 34 iu/mL) and Thyroglobulin antibodies: <20 (0.00 - 20 KU/L). My TSH was 7 and above from 2007 to 2013 (then self medicated with NDT) T4 12 for the same period.

  • Have you had an Ana test done? There are a ton of auto antibodies to test for. The cyrex assay #5 does most of them for 80 different autoimmune conditions.

  • Thanks drob32, is this something I could get via my GP?

  • I think he would have to have a cyrex affiliation to do that test. Otherwise you would want to start with an autoimmune pannel that does ANA/anti nuclear DNA/compliment c4.

  • Thank you drob32, so ask the GP and if she doesn't have cyrex affiliation, then how do I start with an autoimmune pannel that does ANA/anti nuclear DNA/compliment c4?

  • Correction, it's compliment c3.

    Here's an example of an autoimmune panel, but keep in mind, sometimes figuring out a health problem is like finding a needle in a haystack.


    By the way, if you live in the US, you can get the test on your own for around 100$ without going through a doctor. That's if you go through privatemdlabs.

  • Thank you for the info drob32, I'm in the UK.

  • I'm not sure about ordering a test without a doctor in the UK. The thing about ordering a test this way, at least in the US, is that it's out of pocket because no doctor ordered it.

    In any case, I would put together a notebook of your history and lab results, and bring it with you to the doctors. This way you can build a case based on your symptoms for why you want to test for certain things. Sometimes you have to lead the doctor.

  • Thank you. Our UK doctor's often resist any leading by intimating that our being prepared with results / symptoms is due to our being hypochondriacs. But certainly, if you don't even try to lead them, you get dismissed out of their offices even quicker.

  • THANKYOU. An explanation I have been looking for !

  • Delighted to have brought it to your attention, in that case Micro : ).

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