Dr Henry Lindner has been discussing the complicated relation between thyroid hormones, cortisol and others and the difficulty in getting them all in balance.
Hypothyroidism and all its effects are reversible with time--but it can take many months, even years. However, there is another, equally important endocrine deficiency that exists in many persons who develop hypothyroidism--and that is hypocortisolism. It is undiagnosed--almost universally. The medical profession can only diagnose nearly complete adrenocortical failure due to obvious disease/damage of the adrenal glands or HP system. As with hypothyroidism, they are missing 90% of the insufficiency that exists and is causing symptoms, degrading people's quality of life.
Prolonged hypothyroidism actually causes hypocortisolism--as the HP-adrenal system also underfunctions in hypothyroidism--every tissue does. A pre-existing hypocortisolism is also very common in persons with autoimmune diseases--as sufficient cortisol constrains the immune system and so helps prevent autoimmunity and allergy. So hypocortisolism is often a contributing factor to Hashimoto's and Graves' diseases--and this is a large percentage of persons who are given thyroid replacement therapy and who are included in the T4/T3 studies. I certainly see hypocortisolism of various degrees in many such patients. Sometimes I can alter the T4/T3 therapy to get around the relative cortisol deficiency. Other times I just have to give them a trial of hydrocortisone replacement to see if it will restore their health and vitality. If it works, I adjust the dose and add DHEA which is absolutely necessary for long-term health when taking HC or any artificial steroid. Endocrinologists are not trained to optimize one of these major hormones, let alone both in the same person. Thyroid and cortisol counteract each other strongly, making it a real challenge to restore and balance them.
Hypocortisolism is the major reason, in my experience, that many persons are not restored to health and vitality by thyroid replacement alone. Hypocortisolism causes muscle stiffness and achiness among many, many other problems. Like hypothyroidism, hypocortisolism causes dysfunction of just about every tissue and system in the body. Like hypothyroidism, most of the hypocortisolism in the population is not being diagnosed because it is not due to obvious disease/damage to the primary gland or HP system. Indeed, every time I try to help a person with T4/T3 I hope that they only have hypothyroidism, but I anticipate that they may have an underlying hypocortisolism that will complicate my efforts to help them. It was only by giving suffering people powerful T4/T3 therapy increased according to symptoms, in violation of the TSH-T4 paradigm, that I discovered just how common hypocortisolism is, especially in women (probably a 10:1 female/male ratio). I knew something else must be wrong with their endocrine system when T4/T3 caused their fatigue, achiness, depression and brain fog get worse instead of better. Conventional endos are taught that thyroid replacement can worsen adrenal insufficiency--they just have no idea that they only see the tip of the iceberg.
So reform in endocrinology has much, much farther to go than simply abandoning the silly TSH-T4 reference range paradigm. That is just the necessary first step. Once they do that, and when they actually try to help suffering people with effective T4/T3 therapy, then they will start, for the first time in many decades, to actually learn more about the endocrine system's role in human health and vitality, and in particular about hypocortisolism. But those are just the two most powerful hormones. If one restores them to optimal/youthful levels/effects, one creates problems (e.g., bone loss) unless one also restores the major anabolic hormones--DHEA, estradiol, progesterone and testosterone. It truly is a symphony in which all hormones just be in a youthful/optimal balance. The current failure of the endocrine profession to treat ovarian failure in women, to replace hormones lost to the complete failure of the gonads, is but another sign that it is a completely dysfunctional specialty. It needs a new paradigm.