Written by Valerie Taylor, thyroid and adrenal patient
The adrenal glands are two small glands that sit on top of the kidneys. They produce some of the most important hormones for the proper functioning of your body. Without them you cannot live without replacing the hormones they produce.
When our bodies are hypothyroid for long periods of time, the adrenal glands can become fatigued from trying to produce enough cortisol to compensate. Hypothyroid lifestyles often put MORE strain on the adrenals as we try to cope with our lives with less than optimal energy. Dealing with the stress of a job, and just trying to keep a house clean can sometimes be the straw that breaks the adrenals.
There seems to be quite a bit of controversy over how MUCH cortisol the body needs to function. My theory on this is that it is as individual as we are, with some needing 20-30MG a day and others may need up to 40MG a day (according to Dr. Peatfield) and that is on a normal, unstressful healthy day. When we are under stress, or ill, these needs may become doubled or even tripled in a matter of minutes. Weak adreanals simply can’t produce enough to do this.
Most every thyroid prescribing information I have read states that adrenal function should be tested before prescribing. Why is it then that MOST doctors never check this? Many do not believe that adrenal fatigue is possible. The tests they do, when they bother at all, are inadequate as they only show Cushings (extremely too much Cortisol) or Addison’s ( NO cortisol) diseases. The only tests that seem to be fairly accurate are saliva tests for 24 hour cortisol as these show the different levels that should be present for a normal circadian rythym. These show 4 different times in the day when, for example, first thing in the morning we should have our highest levels of cortisdol, and at midnight, when they should be lowest. A total cortisol is inaccurate as you could be high at night, inapropriately, which causes wakefulness in the middle of the night, and low in the morning when it should be high to provide the energy needed for your day. Cortisol is necessary for thyroid to get into your cells to work.
There are at-home tests you can do for adrenal fatigue but they are fallible. A negative from this testing does not mean you definitely do not have adrenal fatigue, but a positive certainly points to it. One of the most accurate tests for adrenal fatigue you can do at home is a temperature test. Follow the instructions and use the charts from www.drrind.com and the fluctuations in your temp will tell you when you need to raise or lower your adrenal support meds. I firmly believe that ALL testing should be used as a guideline only. As adrenal fatigue and weakness are NEW concepts in medicine, they are not an exact science. The very way that the adrenals function when working properly makes their functioning difficult to assess and monitor.
In stages of adrenal fatigue, the first stage, cortisol may be high at inappropriate times. Doing a 24 hour cortisol saliva test you may see the late afternoon and midnight levels higher than the morning and noon levels. This happens when your adrenals are almost depleted and they are stimulated all day but just can’t produce enough cortisol for your needs, but they dump out excess at night as they are still in a state of stimulation due to low daytime levels. This is followed by total adrenal fatigue where the levels are too low all the time, or maybe just the midnight level is too high.
When interpreting a 24 hour saliva cortisol test, I look for top-of-the-range levels for the first two tests; the third test in the afternoon I feel should be middle-of-the-range and the midnight one mid-to-low range. These are the levels I shoot for when people ask what information to give to their doctors. I have seen many results for this test and when people are on medication for it, they can even be over range on the first two and feel well. This is my own personal interpretation from looking at many of these and comparing it to when the symptoms of adrenal fatigue go away.
What medications are used to treat adrenal dysfunction? The ones I most commonly see GOOD results from are Hydrocortisone (Cortef) or Isocort. Isocort is an OTC medicine that probably contains less than the 2.5MG of Cortisol per pellet, and can be found from many sources by doing a Google search. Most the herbal remedies I would not recommend simply as they are not regulated and we have no way of knowing how much cortisol is in each tablet or capsule. Licorice has been recommended, but again it works in such a way as to prevent the body losing cortisol normally, not in any way replacing what is needed WHEN it is needed.
Most people with weak adrenals will need to learn to adjust their medication by how they feel. My personal experience was to start at 5 MG first thing in the morning, then four hours later (cortisol only stays in your system 4 hours) another 5 MG. I did this for a week then added a third 5MG four hours after the last one. Another week I added 5MG to my first dose to bring me to 20MG a day. This must be held for a while to determine the body’s response to it. Often this is a great maintenance dosage for most people. The experts in this field seem to agree that it can take from 2 months to 2 years for adrenals to heal. I also feel the thyroid levels MUST be optimal for this healing to happen.
(NOTE: since Valerie wrote the above paragraph, patients have discovered the need to “start on” 20-30 mg, rather than ramp up to. See the How to Treat page, or for more detail, Chapter 6 in the revised STTM book.)