Dr Henry Lindner's take on control of thyroid hormone treatment and effects on other hormones

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.

22 Replies

Having just had a cortisol test this week, after blood results showed I was low, how apt that Dr Lindner should comment just a few days later. Serendipitous! He's very kind to call the TSH 'silly', I'm sure I could find a more apt word! Thank you Diogenes, for relating this.

Fantastic info !

Who is this doctor ?

He's an American private physician.

This is his website : hormonerestoration.com/

Such a shame as it seems only real change will come about in the private sector, so more than lily the USA. The NHS is unable to adapt to new info at a good speed. More reasons why the NHS needs to be changed.

On Dr Lindner's home page


is this sentence :

They treat a high TSH with just enough levothyroxine to "normalize" the TSH, a practice that has been repeatedly shown to fail to restore physiological euthyroidism.

They aren't even doing this for people over about 50 - 60 now. They've decided that older people don't need a TSH lower than about 4.


I do think the issue with low cortisol can fairly easily be managed by using T4 and T3 in the middle of the night / early morning (Paul Robinsons CT3M).

So before we rush to get the cortisol hormones we should try this early morning routine.

marsaday But not if you can't convert?

If you use T3 then this is not an issue.

The point is taking thyroid meds at this time in the morning is key to helping the body work properly as it replicates how the body is supposed to work (make thyroid earlier in the night in order to make a similar amount of cortisol).

I convert well and so taking T4 at bedtime for me (and now at 4am) is much better for me because i get a cortisol boost. The small amount of T3 makes everything work even better.

Everyone needs to be looking at the early morning dose routine and looking at smaller doses initially as it can be quite a song effect. so much so that it can push you past feeling good into feeling off.

Fair enough. See what you are saying. But when you are struggling to sleep to start with, could be quite hard for many to deliberately wake at 4am to take tablets. Especially if struggling for a while and everything so out of sync. For those still awake at 4am, ideal! LOL!

It maybe hard at first,but people have to make adjustments themselves and get in control.

Loosing 15 stone is hard for someone who is 30 st, but you have to make a start.

Reading is key.

Here is a tip i have read from Dr Blanchard an american thyroid specialist who has a few books out which are a must read, but sadly he died this year.

He was saying to take T4 at dinner time in the evening as this will promote better sleep. I can't remember why, but he explains it.

I don't have an issue with sleep so i have a regular pattern of lights out around 11am and up at 8am. The pattern is the key, not the actual times.

So if you regularly go to sleep at 3am and wake at noon this is fine also as your hormones are being made in this window. So a middle of the night wake up for you would be 8am.

IF you read Paul book on this method the key to taking the thyroid hormones is 2-4h's before you officially wakeup. This is the window when we make our cortisol. So if we artificially boost our T3 in this time we get a big cortisol boost.

You don't want to boost too much however as high cortisol is as bad as low. This is why you would use a small T3 dose and experiment and build up to see what dose does what.

3mcg is very good for me. I think paul takes 20mcg at 4am.

Experimentation is the only way to get better and keep a log. See what the body reacts positively to and note it down. Eventually you can settle on a good system self developed for your body.

It took me a while to figure out basic T4 at bedtime was much better than in the morning, but once that was learnt it becomes part of my routine and improves health. We do not just regain health and are better forever. Things change and we need to adapt our routines.

It is a balancing act and timing. To be honest when I was at my best I was taking my T3 and fits etc all first thing in the morning and it seemed to be working. Things went a bit haywire following a stress period, and have since been hearing different variations of timing issues. So have been experimenting with timing a bit.

Diogenes, thank you very much for posting and I especially liked the last sentence:-

"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."

When will they ever be open to research findings and patients' please for return to good health.

Dr Peatfield recognised how much of a part the adrenal glands play in hypothyroidism. He treats with adrenal cortex. No one in the UK would listen to him. The GMC treated him so badly. He will one day be vindicated.

I do hope you are right amala57 He sorted me out and is helping my son. That is why we have to get the current treatment protocols changed and prove that he and Dr Skinner and the other 'Quacks' were right all along.

Why do doctors want to put on blinders when it comes to adrenal glands? Many have touted the fact that stress is a killer. Do they not connect the dots? Thank you for finding another hero we can turn to for the real facts regarding stress and hormones.

And yet, I believe that if we're in a car crash, the paramedics will administer 'adrenal boosting' substance. Apologies - brain not working very well today. :-(

That is to counteract shock - adrenaline is useful as a counter-shock injection.

Thank you, Diogenes, for bringing this to our attention. It's fascinating stuff. What a shame that the NHS seems so unintelligent when it comes to taking heed of a different approach which is tried and tested. Big Pharma again....😕

Thank you for your post it was enlightening.


GREAT post once again . I don't think that thyroid and adrenals ever made the connection until very recently . We are finding out more and more how very related the two are . Some patients have a harder time raising their T3 due to the fact that adrenals are fatigued . When thyroid patients are hypo adrenals are called in to pick up the slack and causing adrenal fatigue . It's about time this connection of thyroid and adrenals are connected .

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