The Adrenal Glands and Hypothyroidism

Adrenal fatigue is a condition not widely recognised by mainstream medicine yet, though I believe it’s only a matter of time until it is. It just makes so much sense.

In Dr Izabella Wentz’s experience, adrenal fatigue is present in 90% of us with autoimmune hypothyroidism.

The adrenal glands, which sit atop the kidneys, are responsible for producing hormones in relation to stress and the one concerned in adrenal fatigue in cortisol. Now, there are two recognised conditions in conventional medicine, in association with extreme dysfunctioning of the adrenal glands: Addison’s, which is a long term condition whereby the adrenal glands do not produce enough cortisol and Cushing’s, which is the opposite – where the adrenals produce often dangerously high levels of the hormone.

Adrenal fatigue is a condition well recognised within functional medicine, whereby the adrenal glands produce too much or too little cortisol, though not to the extent of Cushing’s or Addison’s, but abnormal enough that it causes symptoms and issues all the same. It works on the idea that there is a scale rather than just extremes.

Adrenal fatigue can include elevated, lowered or mixed levels of cortisol, without it being the full blown condition of one of those two. This condition is very real. Thousands of people report symptoms and problems, especially thyroid related, with adrenal fatigue (high, low or mixed cortisol levels).

The below have been symptoms listed on various Adrenal Fatigue websites:

Perhaps when you exercise, you suddenly feel light-headed, a blood sugar drop and faint? Perhaps exercising at all is a real effort and feels more difficult than it ‘should’ be? Then it’s likely you could have adrenal fatigue.

The adrenal glands are part of the endocrine system, just like the thyroid. They handle many hormones that are important for a lot of bodily processes, such as handling stress. This where cortisol is produced.

According to James Wilson’s book Adrenal Fatigue, the adrenals first respond to stress by providing you with extra cortisol, but the body can only keep up with high cortisol for so long. So after this, the cortisol starts to fall, leading to low cortisol. In between this, you could have combined highs and lows. You could have high, low or combined high and low cortisol causing these symptoms. This is called adrenal fatigue.  Cortisol has a variety of important functions, including: the metabolism of carbohydrates, proteins and fats, affecting blood sugar levels in your blood, helping reduce inflammation and helping you deal with stress. The latter is especially huge.

I suffer from adrenal fatigue at the moment, after being left hypothyroid for too long without treatment, and then being held to Levothyroxine when I did get treatment, which wasn’t the right medication for me. I arranged for a saliva test to be done privately (a 24 hour, 4 point saliva test). When I got the results back, they showed that my cortisol was elevated 24 hours a day, indicating adrenal fatigue and a cause for many of my ongoing symptoms; mainly fatigue.

In thyroid patients of all ages, many of them may be labeled with psychiatric issues such as mental health issues, when they are actually due to hormonal insufficiencies such as adrenal fatigue. In one study, it was concluded that by correcting the underlying hormonal imbalance, many patients’ mental health improved, with some patients having a total reversal of psychiatric symptoms.

In terms of exercising, Sara Gottfried explains in her book that a sign of adrenal issues can even include trying to exercise, only to find you crash, feeling light-headed and faint. This is due to cortisol being part of the glucocorticoid family, a substance that raises your glucose level. It’s cortisol’s job, to give you energy. When you have this reaction to exercise, it’s a sign you’ve used up your main energy supply as you’re perhaps low on cortisol and so don’t have enough ready to use.

So, adrenal fatigue could be caused by low, high or combined low and high cortisol. What’s the difference?

High cortisol – Stage One

High cortisol has very similar symptoms to low cortisol, and is usually the first stage of adrenal fatigue. If you can catch it while it’s still at this stage then you may have an easier time addressing and correcting the adrenal fatigue. High bedtime cortisol can cause disruption of your sleep pattern, resulting in problems falling asleep, or staying asleep, so this could be a key sign also.

Combined high and low cortisol – Stage Two

This stage is thought to come between high cortisol and low cortisol, when the adrenals cannot keep up with high cortisol any longer, and so it starts to drop at certain points.

Low cortisol – Stage Three

This is not the same as the disease called Addison’s, low cortisol is actually a long-term situation where, though your adrenals may still work, they are either out-of-sync or inhibited. As explained above, this happens when they first produced elevated cortisol, then combined highs and lows of cortisol, and then low cortisol.

But how do I fix it?

Usually lifestyle and dietary changes also need to be made, in order to recover from adrenal fatigue, but it’s very much individual to each person. Lots of info on this can be found in James Wilson’s great book but I’d also recommend consulting a medical practitioner who does recognise adrenal fatigue, such as functional doctor, naturopath etc.

Issues such as a sex hormone imbalance, leaky gut, high thyroid antibodies, diet and food sensitivities are often the root cause behind adrenal fatigue but you have to figure out what it is for you. All of them were behind mine.

Dysfunctional adrenals can result in high amounts of T3 from your thyroid meds to build in the blood, making your free T3 results look high, but with continuing hypo symptoms, or causing hyper-like symptoms. Fixing your cortisol levels should fix this.


Order or ask for a 24 hour saliva test, testing your cortisol levels at four key points of the day, to find out if you have adrenal fatigue. If your doctor won’t do this, you can very simply order it yourself and complete it at home. A UK test can be found here and a US test here. Most doctors will only test it with a one time urine or blood sample, which is not as accurate. Four samples taken over a 24 hour day show how your rhythm of cortisol production is working. It should be highest in the morning, tailing off throughout the day. Only four saliva samples taken in one day will tell you this accurately.

You can click on the hyperlinks in the above post to learn more and see references to information given, but more reading and references can also be found at:

https://theinvisiblehypothyroidism.com/2016/03/19/book-review-adrenal-fatigue-the-21st-century-stress-syndrome-by-james-l-wilson/ 

https://www.ncbi.nlm.nih.gov/pubmed/16399913

https://www.stopthethyroidmadness.com/adrenal-info/

https://doctordoni.com/2014/12/how-cortisol-affects-your-sleep/


Written by Rachel, The Invisible Hypothyroidism

Rachel is a Thyroid Patient Advocate and Expert with Six WEGO Award Nominations, a highly ranked writer appearing in the Top Hypothyroidism Websites and Top Thyroid Websites 2018. Currently studying to become a Life Coach, she has worked with The National Academy of Hypothyroidism, The BBC, The Mighty, Dr. Hedberg, Thyroid UK and ThyroidChange, to name just a few. She is well recognised as a trusted and useful contributor to the thyroid community and has relevant qualifications and certificates in Diet and Nutrition, Reflexology, Motivational Speaking and Positive Thinking.

8 thoughts on “The Adrenal Glands and Hypothyroidism

  1. Can I take a test for this even if I have no diagnosis of thyroid problems at all? (I,m trying to convince my doctor. I’ve just made a list of 38 of the symptoms you have listed under Hashimoto’s that I have but I don’t think even 38 symptoms will convince him!) I am diagnosed with fibromyalgia. I am funding your sites very useful, thank you.

    1. Yes anyone can get it tested 🙂 it must be done via a 24 hr saliva test though, which most docs won’t do. If you’re lucky they’ll do a one time blood or urine sample which isn’t accurate.

      Oh dear, sorry to hear you have so many!! Have they not even ran a thyroid panel to check?

  2. Hi, the article is interesting I feel I have nearly all the symptoms.
    I have under active thyroid after pregnancy 2 & 1-2 years ago.
    Also fibromyalgia
    I have latest set of blood results I’ve you would like a look?
    In the U.K.
    Any advice would be appreciated
    On a small budget also.
    Thank you.

  3. My thyroid peroxidase antibodies are at 482. The normal range is 0-25. My pcp and endocrinologist state increase of meds i warranted since tsh, t3 and t4 are within normal range but i feel terrible. Considering change to naturethroid to increase my dree t3 and reverse t3 levels. Help.

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