adrenal insufficiency and thyroids

One in twenty of those with thyroid probs have adrenal insufficiency, according to a japanese study published in the Eur. Thy. J. Sept. 15.

The symptoms of those found to have AI included recurrent non specific gut problems or stress related fatigue, as well as non rheumatic musculo-skeletal problems.

All were diagnosed and treated for their thyroid probs. Dr Yamamoto tested for low morning cortisol, and further investigated those with under 303n/mol.

Then he gave provocation tests, and those who showed AI were treated with hydrocortisol.

I thought this was really interesting - the chances of being tested by a gp for this can't be high, yet one in 20 seems a large number of women suffering while "in range" with their thyroid results.

I also see an Icelandic study finding that hypothyroidism is the disease most closely associated with Addisons. Be lovely if they did similar research in GB.

26 Replies

  • Great post, aspmama. I thought it was due to an iodine problem for a while and it still could contribute but the past few years have me feeling that the adrenals being the first line of defense for stress makes a lot more sense. The adrenals have to balance many other hormones as well as glucose and when the adrenals begin to fail, so does the thyroid.

    STTM: And there is a remarkably large percentage of hypothyroid patients, as well as those who feel they have no thyroid problem, who report finding themselves up with poor levels of cortisol as revealed by both symptoms and saliva testing. This is not the same as the disease called Addison’s in most. Instead, it’s simply a long term situation where though your adrenals may still work, they are either out-of-sync or inhibited, it appears. And dysfunctional adrenal output equates first to combined highs and lows of cortisol that are not normal, then to low cortisol, patients have noticed. Aldosterone can fall in some, too, patients have reported.

    Cortisol, a corticosteroid hormone, has a variety of important functions, from the metabolism of carbohydrates, proteins, and fats, to affecting the blood sugar levels in your blood, to helping reduce inflammation, to helping you deal with stress. The latter is especially huge.

  • Aspmama,

    It depends what the term “adrenal insufficiency” is referring to.

    Convention medicine uses it to define Addisons Disease but in functional medicine it is used as a reference to adrenals that are deficient in hormone on any level. In this case I would consider it refers to practically every case of (medicated) hypothyroidism given that the thyroid and adrenal glands are so intricately connected.

    Hypothyroidism is rarely diagnosed until the body has deteriorated to such a depth that shows marked symptoms causing the adrenals constant stress.

    There is some thought that sub-clinical hypothyroidism develops into full blown hypothyroidism through the immune responses caused by excess cortisol as the adrenal-hypothalamus-pituitary feedback loop regulates the secretion. When the cortisol is depleted thyroid problems become even worse because adrenal hormones assist in the conversion of T4 -T3 and the hypothalamus-pituitary-thyroid axis becomes compromised . I am now reading how adrenal hormones influence the cells ability to uptake thyroid hormone.

    With so many negative changes in the body being caused by adrenal insufficiency as indirect consequences, it is often unrecognised and misunderstand.

    General medicine is completely ignorant of these facts, hence why there are so many struggling people who blame the meds. Obviously not every med suits every person but no thyroid meds will work properly without a good supply of adrenal hormone.

    I bet if the UK adjusted the Addisons Disease range just slightly there would be a flood of hypothyroid patients newly diagnosed.

    I believe the thyroid and adrenals should always be treated together as an accelerated metabolism may be too much for struggling adrenals to cope with, stressing them further.

    Luckily we have our lovely forum to help us learn and discover how to self manage our conditions.


  • Since this is published in a top rank conventional peer reviewed journal I am sure he is referring to AI as early stage Addisons, not "adrenal fatigue". That's why it's so interesting, if conventional medicine replicates this finding then doctors will become more open to testing ... and treating.

    I have no doubt that you are right that thyroid and adrenal function are so tightly linked that there is some adrenal involvement in every case.

  • Aspmama,

    I agree in this instance AI is referring to early stages of Addisons.

    There always seem to be lots of studies conducted by people with Japanese names. All us Hashi sufferers have Mr Hakaru Hashimoto to thank for the name of our diagnosis. (Even though I believe the paper was published in Germany.)

    Maybe they have a more vested interest due to the amount of seaweed they eat.! ! Although I have read that the Japanese people are better genetically dispositioned to cope with excess iodine there are still subsets who develop goitres, etc.

    And then there's the increase in thyroid cancer since the Fukushima disaster. Poor people.

    I can't envisage these findings changing the UK doctors way of thinking in the near future though as it would use up too many resources but we can live in hope.

    Thank you for posting


  • aspama- I agree with every thing you have said there.

  • Very interesting Aspmama - thank you!

  • My hypothyroidism was underlined by first exhausted chronically fatigued Adrenals... as mentioned before, this does not mean I had Addisons Disease and the bad thing about poeple who are hypoadrenal and hypthyroid is that the Synacthen test will put your body under immediate stress and could cause a serious reaction.... = total exhaustion. The stress test will put already compromised T4 into RT4 leaving little for T3 conversion... as well as a high output of cortisol leaving already high adrenals little scope for recovery.... the result is really awful. Anyone with hypothyroid symptoms and signs should get cortisol tested at least 3 times over 3 months in the morning (7-9am) for an overall measurement. If under range or low, should go about repairing adrenals AND gut repair. Low cortisol increases inflammation and immune imbalance can also increase oestrogen dominance which again will affect thyroid function.... by inhibiting T3. Its a finely balanced eco system which relies on ALL parts working well to acheive optimal health. Often low cortisol and leaky gut are the cornerstones of thyroid repair.... once the absorbtion is corrected, the low vit D, B12 and so forth corrected..... the gut repaired, selennium and magnesium and zinc taken along with pro biotics, L glutamine and other necessary vitamins (A, E and D useful) AND krill or balanced Omegas.... ALONG with removal of inflammatory foods and gluten (grains, processed, sugars, soy, dairy and reduce coffee to occasional organic dry roasted cup as a treat, reduce caffene and alcohol to occasional treats and choose type of alcohol carefully - non inflammatory, non yeast/gluten) carry this protocol on for at least 6- 18 months and you will feel much better, a new person....!!! It is a multi system failure. Adding T4 will help with surface issues but ALL these need to be addressed systematically. AI and thyroid and adrenals is a real tightrope - and if building up an exhausted depleted body needs careful handling every day, week in week out, month in and month out to start to move the needle back again. Even after a few months one cannot get complacent... it is a slow path to recovery and requires a total overhaul of self educated on foods, nutrients, vitamins, minerals..... and understanding your AI spectrum and all organs involved...... One day it will be such common knowledge that it will be preventable. People with RH- blood, and a family history of AI will know how to manage their diets as a preventable measure.... until then we blindly stumble forward being passed round the Drs, their lack of in depth knowledge and a big pharma hungry for our weakness for profit..... imo! Good luck everyone out there, knowledge is power.... do the research... or just ask people who have managed their symptoms naturally and you'll be doing yourself a favour.

  • Thank you for that, Sara. I agree that gut problems seem almost omnipresent in hypoT, and they may even be causal ... or high in the causation cascade... though worsened in a nasty loop when hypo takes off. Were you treated with cortisone at any point? And did you have all the symptoms mentioned?

    I haven't mastered putting links in on the ipad yet, but the research mentions two different provocation tests.

    Reducing coffee and the evening glass of wine is very difficult because for so many years I got through life depending on coffee to stimulate the system so I could work. I am sure this is very, very common amongst hypoTs. You must have had to work really hard to change so many things, I salute you.

  • Copy & paste Aspmama.

    Tap finger on web site address. Tap again to "copy".

  • I see on the website of the Pituitary Network Assoc that Addisons is supposed to be very rare, 1 in 100,000, no doubt this is why drs rarely suspect it. But if five per cent of hypoTs have it, then surely it is much more common. Not that maths is my strongpoint, but thyroid disorders are common.

    Celiac disease was also thought rare till Dr Alessio Fasano found it was actually common if you looked for it. Now we know it is 1 in 100 at least.

    If Addisons disease is usually diagnosed via Addisonian crisis, when people often die, and 90 per cent of the adrenal cortex has been destroyed, then they need to start looking harder.

  • Thanks Aspmama, that's really interesting. Do you have a link to these studies please?

  • This is really interesting as i have low morning cortisol(only just low in range but it has been a lot lower prompting an acth test) but the ACTH test was negative for addisons (no surprises there then), hashis (currently take 200mcg levo and am struggling) and estrogen dominance for which i was taking Northesterone but have been taken off it by the DR as it is not the right solution. Unfortunately having put on so much weight now i also have auxiliairy breast tissue as result of the excess estrogen. I am really fed up to say the least. I am trying to increase the nutrients but when i go to the doctors i am afraid the only thing that gets addressed is the thyroid as this is something they can help with (apart from prescribing T3!) i mention low morning cortisol and its ignored as is the low progesterone (im over 40 so they probably think too old for having babies!) So...what should i be doing in terms of treating which symptom first?

  • There is a good summary of A I published as a seminar online by the Lancet in 2014. It points out that "mild secondary adrenal insufficiency can be missed" by the tests, and says drs should use their clinical judgement when symptoms are present. It also says the saliva tests can be useful. This is very much a conventional medicine paper though. If you google adrenal insufficiency Evangelia Charmandari it will come up. Greek authors. Maybe we should all move there.

  • Yup, if one in twenty hypoTs have Addisons, I wonder if there are more of us who are merely on their way to Addisons?

    It's an odd thought that Jane Austen might have been on this forum if it had existed in the early nineteenth century.

  • This seems to apply to all those with autoimmune thyroid diseases, not just hypothyroids.

  • OK, and now I am madly adding to my own post, but there is a recent Polish study of Autoimmune Addisons, which I am sure is the variant we are likely to have if we have it at all. They looked at 85 people with this condition, and 46 !! also had lymphocytic thyroditis (the majority hypoT, but 19 had Graves). The second biggest co-existing condition was atrophic gastritis, (29.4 per cent, massive overlap) which we know has in itself a huge overlap with thyroiditis some studies have suggested around 35 per cent overlap. Addisons was also closely linked with Pernicious Anaemia, the end result of atrophic or autoimmune gastritis, (11.8 per cent). Just 3.5 per cent of them also had celiac disease.

    The population of Poland would be genetically pretty close to the indigenous population of Britain,

    more so than the Japanese, obviously. So here we have further evidence of very close links between Addisons and lymphocytic thyroiditis.

    Am I right to deduce that the fact that there is a stronger link between Addisons and thyroiditis than between thyroiditis and Addisons may suggest that something in the Addisons causes the thyroiditis in its sufferers?

    Or is that just my poor thyroiditis-affected brain failing to work properly? Maybe someone who is optimally medicated has a view.

    Anyway, it looks like evidence is building. Yay!

  • Hi thanks for providing the link . Apologies for being 2 months behind with this post.I have read your post with great interest.I have had addisons disease for 14 years and now also hypothyroidism. Ive been on 50mg of levo for 6 months and i feel exhausted and doctor says my thyroid levels are fine so i questioned him about my cortisol levels since starting the levo.He said levo should not affect my cortisol levels.He is now sending me for a day curve analysis where my bloods are taken every hour to check cortisol levels.Thank you once again. some great information on this site.

  • Have you posted your thyroid test levels cragwards? 50 is a low dose.

  • Sorry iam actually on 25mcg for the last 6 months.I dont no what my levels are.I just took the doctors word.I am due to see endo in 2 weeks so i can find out then.

  • I had recently had my second insulin tolerance test which resulted in me having to take steroids when I get slightly unwell, last Sunday evening after having a slight cough I did wake up shocking at 1.30am with stomach pains and ran to the toilet, I then had profusely sweating and though I was going to pass out, I quickly then took my hydrocortisone pills, scared me so much 😔

  • So the second test resulted in a diagnosis of adrenal insufficiency, ie addisons? And your reaction to a mild viral infection was to begin to go into an Addisonian crisis...? It demonstrates how important diagnosis is. The finding above may be afreak result, but if it is replicated then all of us should be tested for Addisons on diagnosis, and monitored for developing Addisons, because it is life threatening.

  • I have reached that stage of research where I have become obsessive, please everyone forgive me. Obviously it is linked to my own case; others might be aware, though, that there is a piece of research that found mothers of autistic children had exceptionally low cortisol. Cause? Consequence? No one yet knows. My guess is more probably linked to cause.

    Here is an excerpt from medscape: Addisonian Crisis Precipitated by Thyroxine Therapy. It clearly explains why if you are hypoA levo would make things worse.

    "The great danger of APST is treatment of a presenting hypothyroid state without recognition of cocomitant hypoadrenalism. This may precipitate Addisonian crisis through two mechanisms.

    1. HypoT reduces cortisol clearance. (I think it is saying that cortisol lingers longer in the body in hypoT.. much in the way that ssri drugs keep serotonin longer in the brain]

    The addition of thyroid hormone replacement INCREASES cortisol clearance, thus decreasing cortisol availability. (so you will feel even more tired and unable to cope with stress after a while on levo if you have low cortisol).

    2. Hypothyroidism reduces the metabolic rate (ie, it slows us all right down. We all feel that. This would make sense if in those with low cortisol, hypothyroidism is the body!s reaction to it, slowing everything down to help us.) The increased metabolic rate accompanying thyroxine replacement increases the cortisol requirements that cannot be provided by failing adrenals. (the body is like an engine that suddenly begins to accelerate under the fuel rich thyroxine, but the engine can't cope with the sudden high revs and may slow down or even explode.) Patients may die from ensuing Addisonian crisis.

    The brackets above are mine. But this is really important, if this Japanese study is correct, if it can be replicated elsewhere, then it explains much of what is being reported on this forum, and it is crucially important.

    Of course the Japanese study may be a chance result. Meanwhile, we patients need tombe very alert to the possibility that it is right.

  • very family is affected buy addison al my sibling apart from 1 an myself are carryer or affected what buzz me out it i got over active thyroid grave an they are so closely related..

  • Just to add in a link:

    looked at cortisol rates and hypothyroidism, interestingly it found heightened cortisol associated with higher TSH even where the TSH wasn't high enough to get a diagnosis of hypothyroidism from most doctors.

    This was a study of "healthy young people" (obviously they weren't really healthy). My question is, if at first cortisol goes up along with the TSH, does a point come where the cortisol level drops? And at what point?

  • And here's an extract from that summary: "Linear regression modeling revealed that TSH levels in the 0.5-10 uIU/L were significantly and positively correlated with cortisol levels. This positive TSH-cortisol relationship was maintained below the accepted 4.5 uIU/L subclinical hypothyroid cutoff. (HAH!) The TSH-cortisol relationship was maintained for TSH levels (uIU/L) ≤4.0, ≤3.5, ≤3.0, and ≤2.5 but not ≤2.0. Linear regression modeling did not reveal a relationship between free T3 or free T4 levels and cortisol levels.


    Results suggest a positive relationship between TSH and cortisol in apparently healthy young individuals. In as much as this relationship may herald a pathologic disorder, these preliminary results suggest that TSH levels > 2.0 uIU/L may be abnormal."

    Yes, you read that correctly .. TSH over two may be abnormal. Well, who could have predicted that???!!

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