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The Adrenal-Thyroid Connection
A Look at the Relationship, with Drs. Richard and Karilee
Shames
An interview by Mary Shomon as
it appears on her website Thyroid-Info.
http://www.thyroid-info.com/articles/shamesadrenal.htm
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 to pay much 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, he art 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 st art le 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 counterp
art , "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 p art 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 p art 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.
An interview by Mary
Shomon as it appears on her website Thyroid-Info.
http://www.thyroid-info.com/articles/shamesadrenal.htm
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