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‘Adrenal fatigue‘ or ‘adrenal dysfunction’ (though it is more accurately referred to as ‘hypothalamic-pituitary axis dysfunction’) is a condition not widely recognised by mainstream medicine yet, though it makes a lot of sense to many thyroid patients and is recognised in functional medicine and by functional practitioners.
In fact, in Thyroid Pharmacist Izabella Wentz’s experience, adrenal dysfunction is present in 90% of us with autoimmune hypothyroidism. 
I was among that 90% and this article will discuss what I did about it.
What is ‘Adrenal Fatigue’?
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. There are two well-recognised adrenal conditions in mainstream 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.
However, ‘adrenal fatigue’ recognises that when 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, then this can also be a problem and cause issues.
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. Thousands of people report symptoms and problems, especially thyroid related, with ‘adrenal fatigue’ (high, low or mixed cortisol levels) which resolve once cortisol levels are returned to normal.
See also: The Adrenal Glands and Hypothyroidism
The below have been symptoms listed for this condition:
- Struggling to fall sleep at night, or waking up a few hours after you do
- Feeling more tired in the morning
- Experiencing a mid-afternoon ‘slump’
- Often feeling over-emotional
- On-going fatigue that affects your day to day life
- Often wanting to be alone
- Unable to tolerate stress
- Hot flushes/sweats
- Jumping or feeling irritable at loud noises
- Feeling extra sensitive and taking things to heart more so than you used to
- Being on thyroid medication for a while and still not feeling better
- Being hypothyroid for several years before being diagnosed
- Having gone through chronic emotional, mental or biological stress
- Craving for salty foods
- A weakened immune system
- Dark circles under the eyes
- Mental fog
- Changes in bowel movements
- Sudden sensitivities to certain foods, like gluten or dairy
- Dizziness, imbalance, collapsing and blacking out
- Dry mouth
- Joint pain
- Weight gain particularly around the middle
- Low libido
- Coldness in hands/feet
- Cravings for sugar/ salt
- Leaky gut, acid reflux, GERD, GORD etc.
- Dry skin
- Extreme tiredness after exercise
- Loss of muscle tone
- Lower back pain
- Numbness in your fingers / Poor circulation
- Inability to fall asleep despite being tired
- Heart palpitations
- Low thyroid function
- Feelings of hypoglycaemia (low blood sugar) though test results are normal
- Hair falling off out
- Muscle pain of unknown reason
- Inability to concentrate or focus
- Short of breath even though breathing is fine
- Legs that feel heavy at times
- Chronic Fatigue Syndrome unimproved with medicine
- Fibromyalgia unresolved after conventional help
- Irregular Menstrual Cycles
Perhaps exercising at all is a real effort and feels more difficult than it ‘should’ be?
If so, it’s possible you could have adrenal issues.
The Adrenal and Thyroid Dance
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.
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. Therefore, cortisol levels can begin to decrease, leading to low cortisol. In between this, you could have combined highs and lows. This is what is referred to as ‘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.
My Experience With Adrenal Dysfunction
When I suspected cortisol issues back in 2016, 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.
I experienced heart palpitations, hot flushes, anxiety and sleep complaints. I also really struggled to tolerate much exercise at all.
Addressing this by getting my cortisol levels back in to their normal places was crucial and formed a really big piece of my thyroid jigsaw puzzle.
How Did I Fix My ‘Adrenal Fatigue’?
Many aspects were looked at by myself and my functional medicine practitioner. I’ve listed them below to try and make it as clear as possible. At lot of these also cross over with what I have listed in my Thyroid Jigsaw Puzzle article. Please keep in mind that some of these may apply to you, but not all. And you may also have other things that need addressing to resolve your adrenal dysfunction. What drives it for each of us can really differ.
Click on the below to discover what I did to address each of these.
- Getting My Thyroid Levels Optimal (helped greatly by changing from Levothyroxine to Armour Thyroid)
- Getting My Hashimoto’s in to Remission
- Considering Herbal and Vitamin Supplements (note: I tried holy basil and ashwagandha but they didn’t do anything for me)
- Dietary Changes – less sugar, removing gluten, caffeine and alcohol
- Balancing My Blood Sugar
- Addressing My Eating Disorder – no more dieting which was increasing my cortisol levels
- Addressing Oestrogen Dominance
- Choosing Wiser Exercise
- Improving My Gut Health
- Implementing ‘The Spoon Theory’
- Improving My Sleep
- I kept in mind that I am a HSP (highly sensitive person) and learned to take care of this part of myself
- Managing Stress (explained below)
Learning how to manage my stress levels better was imperative if I was to get my adrenal health under control. I could never really get in to meditation, but I did begin to set firmer boundaries on my time. Learning to say ‘No’ sometimes and better prioritise my time and needs felt good.
No more overworking and more time off social media. Less time doing tasks that other people should have been doing themselves and more time reading books, doing yoga and walking in nature. I also tried CBT and saw a Step 4 Therapist on the NHS to help me learn techniques for managing anxiety and stress more effectively.
How To Check for Adrenal Issues
Order or ask for a 24-hour 4-point saliva test (which tests your levels at four key times of day), to find out if you have cortisol issues. If your doctor won’t do this, you can simply order it yourself and complete it at home, just as I did. You can find testing options here and 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.
Lots of info on this can be found in Dr. Wilson’s book but I’d also recommend consulting a medical practitioner who recognises adrenal fatigue, such as functional doctor, functional medicine practitioner, naturopath etc.
Have you explored ‘adrenal fatigue’?
You can click on the hyperlinks in the above post to learn more and see references to information given.
The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which builds on this article in detail. Reclaim your thyroid healthy life.
Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial contributor to the thyroid community and has a large social media presence. Her books include “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”.