The Adrenal/Thyroid Connection

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The Adrenal/Thyroid Connection

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(http://www.thyroid-info.com/articles/shamesadrenal.htm)

by Mary Shomon

 

A Look at the Relationship, with Drs. Richard and Karilee Shames, Authors of

Thyroid Power

 

Mary Shomon:

Is there an important adrenal component to thyroid optimization?

 

Drs. Shames:

If you have been prescribed the proper amounts of thyroid hormone -- perhaps

with additional substances to balance your reproductive system -- and all is

working well, you do not need attention to your adrenal glands. If, on the

other hand, you are not doing as well as you'd like, and especially if your

symptoms have been somewhat atypical all along, then other factors need to be

considered. One of the most important additional factors to take into account

is your adrenal hormone level.

 

Mary Shomon:

What do the adrenal glands actually do?

 

Drs. Shames:

Your adrenal glands are two tiny pyramid-shaped pieces of tissue situated

right above each kidney. Their job is to produce and release, when appropriate,

certain regulatory hormones and chemical messengers.

 

Adrenaline is manufactured in the interior of the adrenal gland, in an area

called the adrenal medulla. The adrenal medulla is stimulated directly by

nerves from the sympathetic portion of the autonomic nervous system, which

regulates fight or flight.

 

The human body is organized so as to be able to respond immediately to

threatening situations by generating a tremendous amount of energy in a hurry,

which enables the person to run away quickly, or face the threat and fight it

with a massive influx of chemical support. These chemicals increase blood

pressure, heart rate, and blood flow to muscles, while mobilizing sugar to

burn.

Nerve impulses from the brain cause the release of adrenaline from the adrenal

gland, which helps you react appropriately in immediate short-term stress

situations (the " fight or flight " response).

 

Cortisol, the another chemical from the adrenal gland, is made in the

exterior portion of the gland, called the adrenal cortex. Cortisol, commonly

called

hydrocortisone, is the most abundant -- and one of the most important -- of

many adrenal cortex hormones. Cortisol helps you handle longer-term stress

situations.

 

In addition to helping you handle stress, these two primary adrenal

hormones, adrenaline and cortisol, along with others similarly produced, help

control

body fluid balance, blood pressure, blood sugar, and other central metabolic

functions.

 

Mary Shomon:

How is proper adrenal function related to a thyroid problem?

 

Drs. Shames:

A major connection exists between low thyroid and low adrenal. Low adrenal,

also called adrenal insufficiency, can actually cause someone's thyroid

problem to be much worse than it would be otherwise. Correction of low adrenal

is

similar to correction of low thyroid. You merely take a pill that contains

some of the hormone you are lacking. In the case of low thyroid, you obviously

take thyroid hormone. In the case of low adrenal, you simply take some

adrenal hormone. Chapter 7 in Thyroid Power assures you that doing so, when

appropriate, is not only safe and effective, but it can change your life for the

better.

 

Cortisol is in the category of medicines called steroids, a class of body

substances that derive their name from the fact that they are built upon the

structure of the common cholesterol molecule. Both health practitioners and the

lay public have great concern about the safety of taking oral steroids. We

would like to address this issue directly by making a distinction between

high-dose steroid therapy and low-dose adrenal supplementation.

 

What we are talking about is the use of small amounts of natural adrenal

hormone (hydrocortisone) to bring slightly low adrenal function up to its

proper

normal daily range. This is in stark contrast to the high doses of powerful

synthetic adrenal hormones commonly used to treat severe health problems, or

to assist in building muscles.

 

Mary Shomon:

Why is it important for low thyroid people to know the levels of their

adrenal hormones?

 

Drs. Shames:

Adrenal insufficiency symptoms include: weakness, lack of libido, allergies,

dark circles under the eyes, muscle and joint pain, dizziness, low blood

pressure, low blood sugar, food and salt cravings, poor sleep, dry skin, cystic

breasts, lines of dark pigment in nails, difficulty recuperating from

stresses like colds or jet lag, no stamina for confrontation, tendency to

startle

easily, lowered immune function, anxiety, depression, and premature aging. Some

of these symptoms are similar to those of low thyroid.

 

If low-thyroid people with these symptoms are put on thyroid hormone alone,

they sometimes respond negatively. These people may have coexistent, but

hidden, low adrenal. If they take thyroid hormone by itself, the resultant

increased metabolism may accelerate the low adrenal problem.

 

The addition of thyroid hormone in this situation unmasks the also

disturbing low adrenal situation. The proper approach in this case is to treat

the

patient with thyroid and adrenal support simultaneously.

 

Adrenal insufficiency, especially when unmasked by the addition of thyroid

hormone, is unpleasant and uncomfortable. To compound the problem, the doctor

and patient then may wrongly assume that thyroid replacement has been a

mistake. A tremendous opportunity for better health has now been missed.

 

While uncomfortable, this dilemma can become a diagnostic tool. The doctor

could then gradually add thyroid and adrenal hormone together, with the

patient eventually taking optimal levels of both. This careful attention and

delicate calibration are demanding on the practitioner and patient.

Nevertheless,

we have seen patient after patient dramatically improve with such dedication.

 

Also, interactions between your hormones are sometimes as important as the

direct action of the hormone itself. Some adrenal hormones assist in the

conversion of T-4 to T-3, and perhaps assist in the final effect of T-3 on the

tissues. Some scientists believe that even the entrance of thyroid hormone into

our cells is under the influence of adrenal hormones. Thus, if your adrenal

level is low enough, you might do well to take both adrenal and thyroid

hormone together.

 

Mary Shomon:

I've heard that often the problem is that the adrenals are too high. Is the

real problem one of excess of deficiency?

 

Drs. Shames:

A failing adrenal gland goes through a hyper phase before it becomes totally

exhausted. In the 1950;s, the famous researcher Hans Selye divided the

physiology of fight or flight into three phases. In the first phase,

" adaptation, "

a person intermittently secretes slightly higher levels of the fight or

flight hormones in response to a slightly higher level of stress.

 

The second phase, called " alarm, " begins when the stress is constant enough,

or great enough, to cause sustained excessive levels of certain adrenal

hormones. This can be the very earliest glimmer of what later can become

stress-induced illness.

 

The third phase is called " exhaustion, " wherein the body's ability to cope

with the stress is now depleted. At this point, adrenal hormones plummet, from

excessively high to excessively low. It is this latter phase of adrenal

exhaustion that sometimes accompanies, or is confused with, low thyroid.

 

Where do low thyroid and adrenal stress intersect? If you find yourself in

the alarm phase of adrenal stress (high levels of ACTH and high levels of

cortisol), one result might be altered conversion of T-4 into T-3, or

thyronine.

Thus, your adrenal situation might profoundly affect the availability of

biologically active thyroid hormone.

 

Research shows that even success and positive change can result in the

stress response described above. In other words, even activities that you

perceive

as enjoyable, such as working hard on an exciting project, or striving for

and receiving a promotion, can be perceived by the body as stress. This

positive stress, called " eustress, " can accumulate and affect bodily responses

in

the same way as its negative counterpart, " distress. " In addition, some of the

activities that are encouraged to help relieve this situation might actually

make it worse, as in the following example.

 

Mary Shomon:

How would a low thyroid person determine if he or she were low adrenal?

 

Drs. Shames:

It would be wonderful to have a simple, reliable method of assessing a

person's adrenal function. Many tests are available, but none are widely used.

One

reason for this is that most medical doctors consider that the adrenal

system is always functioning smoothly, except in two very severe and rare

circumstances. One of these is caused by extreme excess adrenal function, and

it is

called Cushing's Syndrome. When there is extreme decreased adrenal function,

this is called Addison's Disease. When it is clear to a physician that you do

not have either Cushing's or Addison's, the topic of adrenal metabolism all

too often is shoved aside.

 

Another reason why doctors may not be sufficiently involved in this topic is

that adrenal tests are even more challenging to interpret than thyroid

tests. The biochemistry is extremely complex, and, until recently, the testing

technology had not been useful except to diagnose Cushing's and Addison's, the

two main types of adrenal function. Now the measurements are more

sophisticated. Current technology can be divided into roughly two camps:

conventional

medical evaluation; and the more recently developed alternative adrenal tests.

 

Mary Shomon:

What exactly are the conventional options?

 

Drs. Shames:

The conventional medical evaluation for adrenal function includes

measurements of ACTH (adrenocorticotropic hormone) from the pituitary, as well

as

cortisol (hydrocortisone) from the adrenal glands themselves. Both of these are

simple blood tests. In addition, doctors will sometimes obtain a 24-hour urine

sample for cortisol and related cortex hormones. This involves having

patients collect urine in the same large container every time they empty their

bladder for an entire 24-hour period. One drawback with this measurement is

that

it is not illustrative of variations within the 24-hour period, because the

whole day's worth of urine is mixed together in one bottle. The level of

adrenal hormone is naturally high in the morning, progressively diminishing

through

the afternoon, reaching its lowest levels in the evening. In the case of the

24-hour urine sample, the doctor can determine if the total amount of

hormone is high or low for the whole day, but will not know at what time of day

major variations occurred.

 

Also, a normal level for 24 hours might mask very high levels at one point

in the day, with very low levels at another part of the day. The total for 24

hours would be normal, but the patient may go through half the day with

excessively high levels, and the other half excessively low. Complicating this

test is the fact that the blood cortisol level is dependent on the protein

molecule that carries it around in the bloodstream. The amount of this molecule

can change for a variety of reasons, which changes the level that is measured.

 

Complicating this test is the fact that the blood cortisol level is

dependent on the protein molecule that carries it around in the bloodstream.

The

amount of this molecule can change for a variety of reasons, which changes the

level that is measured.

 

Liver trouble can lower the amount of this carrier protein, which will alter

your test result. Abnormal estrogen levels will also alter the amount of

this protein. In addition to all this, one's level of activity can change the

result of the test.

 

The person's stress level has a significant impact too. Someone may have

rushed to get to the lab or come from a stressful meeting at work. That would

yield a different level than a patient who was calmly sitting in the waiting

room for half an hour before the test. In addition, the conventional tests have

a normal range that is very wide, so that only the most severe, out-of-range

abnormalities qualify as being diagnostic of abnormal adrenal function

(sound familiar?). For these reasons, many doctors do not order adrenal tests

at

all. If they do, they generally focus not on cortisol, but on evaluating

adrenaline levels. You should tell your doctor that you would like the cortisol

testing, and that you want both a " free " and a " total " cortisol level. The free

fraction is available in more recently-developed tests, and has more

revealing information for thyroid sufferers.

 

Mary Shomon:

Are the new alternative-medicine tests for adrenal function better than

those of standard medicine?

 

Drs. Shames:

It is true that conventional medicine's evaluation of mild adrenal

insufficiency is stymied by the adrenal system's subtleties. What do the

alternative

practitioners have to offer? They have chosen laboratories that try to assess

adrenal function somewhat differently. A number of labs will do urinary

measurements as described above, but instead of using 24-hours' worth of urine,

they use four separate samples collected at 8 A.M., noon, 4 P.M., and midnight.

Testing four different samples taken throughout the day is an attempt to

obtain a more complete adrenal profile than one sample would provide. This

allows a more detailed picture of the patient's daily cyclic adrenal function,

and

better distinguishes between alarm the alarm phase and the exhaustion phase.

 

In addition to increased determinations per day, the new test measures more

than cortisol levels. Also commonly tested is DHEA, a precursor to almost all

the other adrenal hormones. (A precursor is a chemical that is not as far

along on the chemical pathway chain as the final product.) The resulting set of

numbers, which some labs call the Adrenal Stress Index or ASI, can be then be

used to initiate and monitor therapy.

 

Saliva measurement is another type of test not yet considered part of a

conventional adrenal workup. The determination of hormonal levels in saliva is,

however, being researched for its effectiveness in assessing glandular health

and balance. One such saliva test is similar to the urinary ASI above. It

tests four saliva samples, collected at four specific times of day (8 A.M.,

noon, 4 P.M., and midnight). Like the urinary tests just mentioned, more than

cortisol levels are measured. Some saliva labs will check cortisol, DHEA, and

pregnenolone. Pregnenalone, like DHEA, is a chemical precursor to many of the

important adrenal hormones. The saliva measurement is a good choice because of

its ease of collection and affordability, but its degree of reliability

remains to be fully evaluated. Some alternatitve practitioners are claiming

improved success with salivary testing.

 

Mary Shomon:

In the debate about which kind of adrenal testing is best, what do you

recommend?

 

Drs. Shames:

We feel that the alternative testing of urine and saliva, evaluating four

separate samples in a 24-hour period, is the preferred choice. It seems to

reveal more of what is actually occurring when a patient experiences

disturbingly

low points in his or her day, or when proper thyroid treatment does not go

well. However, these alternative tests are unlikely to reveal the true level

of adrenal reserve.

 

Mary Shomon:

How is adrenal reserve measured?

 

Drs. Shames:

The method for measuring adrenal reserve has been largely solved by a

conventional medical test, the ACTH stimulation test. Testing for adrenal

reserve

in this fashion is similar to the definitive thyroid test of TSH reserve (TRH

Test) described in Step 4 in our book, Thyroid Power.

 

 

TO CONTACT THE SHAMES:

 

Richard Shames, M.D. offers consultations by telephone. To schedule an

appointment, please see their website.

 

 

 

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