Thyroid UK
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I have posted on this forum a few times and I am still learning as I go along. A big thank you to everyone who takes time to answer people's questions. My next one is, there is a lot of mention about adrenal fatigue and problems with adrenals but if you are on levothyroxine for underactive thyroid, what can you do about adrenal glands as I don't think doctors prescribe anything or run a test to check? Is it a case of taking a supplement for adrenal support?

5 Replies

Hello Philly2748,

Adrenals get fatigued when cortisol has to prop up a failing or under medicated thyroid gland. First they become hyperactive, symptoms being a racing heart, gut issues, trouble sleeping, etc and then eventually depleted, symptoms being generally unwell and tired, hypoglycaemic and skaky moments when adrenaline finally takes over.

Doctors do not recognise the importance of good adrenal health and will only blood test which measures both protein bound and free cortisol.

Members have found a saliva stress test by Genova Diagnostics to be reliable in giving a clearer picture of available cortisol and adrenal activity over a 24 hour period.

Results would determine what supplements or adaptogens could be used to encourage better adrenal health.

Test details are on the Thyroid UK website.



Thank you so much for the explanation. I will take a look at the website and the saliva test.


Recommended reading is

Adrenal Fatigue: The 21st Century Stress Syndrome by Dr. James L. Wilson


I've always found rhodiola rosea very useful to support the adrenals - I buy it online direct from Viridian Nutrition.


Hi Philly,

The problem is that there is no medical condition labelled adrenal fatigue. If patients have low cortisol it is due to adrenal insufficiency; when due to failure of the adrenal glands diagnosis is easier. I have pituitary cortisol insufficiency, which means I suffer in exactly the same way as those with adrenal cortisol insufficiency (Addison's disease). However, to get diagnose is extremely difficult and if you refer to adrenal fatigue rather than insufficiency it is like a red rag to a bull.

There was an interesting post here a little while ago This was my response:

Thank you for this interesting article, it is good to be aware of suggestions which can help patients with adrenal fatigue, but the problems diagnosing adrenal insufficiency also needs to be publicised.

I would like to dispute the statement from Ashley Grossman, a professor of endocrinology at the University of Oxford, “Tiredness, low blood pressure, sleepiness, salt cravings and irritability are all non-specific symptoms that a lot of us have a lot of the time. But for every one patient I see with adrenal failure, I see a thousand who are simply feeling a little under the weather.” He explains that an endocrinologist would typically investigate adrenal function using a blood test called the synacthen test, which measures your body’s ability to make cortisol. “Most people who complain of adrenal fatigue can still make cortisol – there’s nothing wrong with them,”

Many people as Professor Grossman's comments suggest, after receiving a “normal” result from the short synacthen test are diagnosed with ME/CFS and left ill without any medical help. Yet the short synacthen test is only accurate detecting low cortisol for patients suffering from failure of the adrenal glands (primary hypoadrenalism). Patients with low cortisol due to failure of the pituitary gland (secondary hypoadrenalism) require further testing.

The Pituitary Foundation has written :

Please note: for patients with symptoms that may suggest cortisol deficiency that a ‘pass’ on a Synacthen Stimulation Test may not always mean that cortisol deficiency is excluded, and that with persisting symptoms referral to an endocrinologist is recommended where testing may be carried out with alternatives such as the glucagon test or Insulin Stress Test. Choosing the correct test and then interpreting it correctly and considering alternatives is why endocrinology cannot be simply ‘a protocol’. No test is perfect and that consideration for further opinion is always an important option.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE admitted in June 2014 that NICE CG53 issued in 2007 was “not fit for purpose” and there was “dangerous neglect” for patients diagnosed with CFS/ME, “it had been assumed there were specialists who knew what to do and there were not”. .

The Parliamentary and Health Service Ombudsman is fully aware of the situation, somebody somewhere must be able to help people get the help they so desperately need.

The thyroxine leaflet has recently been changed, the onus used to be on the patient to identify if they had a condition that affected their adrenal glands, now it states your doctor will be able to advise you if you are not sure.

Trust you will find this info useful Philly, educating yourself is the only way to get help as your GP will know very little about the adrenal glands particularly that the pituitary can cause the problem. Good luck.


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