The Adrenal Gland Connection
You've been diagnosed with hypothyroidism and put on levothyroxine. But for some reason, instead of feeling better, you feel worse. You've developed joint and muscle pain and a string of colds that you can't seem to shake. You are nauseous and have started vomiting. You wonder if something else may be going on.
For some people, treating hypothyroidism may worsen a problem called adrenal insufficiency, in which the adrenal glands are not producing enough of certain adrenal hormones. In fact, untreated hypothyroidism may hide the symptoms of adrenal insufficiency.
The adrenal glands are located right above the kidneys, where they produce several important hormones. The inner medulla of the adrenal glands produces epinephrine and norepinephrine (adrenaline). The outer cortex of the adrenals produces several hormones, including cortisol, aldosterone, testosterone, DHEA, and estrogens.
The adrenal hormones play an important role in handling stress by providing the body with the chemical support it needs when you need to react quickly, what is commonly known as the “fight or flight” response. In times of stress, the hypothalamus releases corticotrophin- releasing hormone (CRH), which stimulates the pituitary to secrete ACTH.
In turn, ACTH triggers the adrenal glands to release cortisol. Cortisol and adrenaline help the body brace itself to fight or flee by temporarily improving strength and agility, bolstering concentration and reaction time, and mobilizing reserves of fat and carbohydrates for immediate energy. In addition, these hormones are involved in several other bodily functions, including weight control, heart function, blood pressure, the balance of fluids, and blood flow to the muscles.
In the mid-nineteenth century, when Dr. Thomas Addison first identified adrenal insufficiency, the primary cause was tuberculosis (TB), a highly contagious bacterial infection of the lungs. Autopsies showed that TB was present in 70 to 90 percent of all cases. These days, TB accounts for roughly 20 percent of all cases of adrenal insufficiency.
In people who have adrenal insufficiency, these hormones are lacking. Some patients may be deficient in several hormones, while others may be deficient in just cortisol or just aldosterone, the hormone that regulates salt. If you also have hypothyroidism, it's been suggested that adrenal insufficiency can make it hard to treat your thyroid disease. More importantly, treating hypothyroidism can exaggerate adrenal insufficiency. The result is a highly uncomfortable constellation of symptoms.