iThei mdcdaelcinfd o c elllllrllll ThofthThsefollowed for more than thirty-five years and never developed full-blown
adrenal insufficiency. The concentration of autoantibodies correlates
strongly with the degree of adrenal dysfunction. Most physicians, how-
ever, don’t typically screen patients with Hashimoto’s for anti-adrenal an-
tibodies. This is very disappointing as a person’s adrenals could be break-
ing down without anyone realizing it.
Addison’s is not usually diagnosed until a significant amount of the
adrenal glands has been destroyed by autoimmune damage, but many
Hashimoto’s patients actually present with adrenal insufficiency symp-
toms, which are often mistaken for symptoms of hypothyroidism.
While conventional medicine does not recognize “adrenal fatigue” as a
diagnosis, I would like to propose that perhaps some individuals with
Hashimoto’s who have symptoms of adrenal fatigue may actually have
subclinical Addison’s, in which the adrenals are in the process of being
destroyed but the hormonal changes are not significant enough to be
detectable on blood tests—or the body may still be compensating.
As TSH is a measure of thyroid activity, so ACTH elevation signals ad-
renal distress. Cortisol is the active hormone of the adrenals, just as free
T3 is of the thyroid. You can have, however, normal TSH and free T3
levels and still experience hypothyroid symptoms. Accordingly, we would
recommend a TPO antibody test. Just the same, it can be helpful to
request a 21-hydroxylase autoantibody test despite normal ACTH and
blood cortisol levels.
It is unclear whether the cause of adrenal insufficiency or subclinical
Addison’s is due to depletion, down-regulation, or autoimmune origin, but
it is evident adrenal and thyroid function have an impact on one another.
Treatment of HPA Dysfunction
Recovery from HPA dysfunction may take three months to two years.
Treatment goals should focus on correcting the deficiencies caused by
excessive cortisol production and removing HPA stressors. The use of
adaptogens and glandular extracts may be helpful. In some cases, hor-
monal or pharmacological treatment may need to be used.
• Correcting deficiencies: cholesterol, cofactors, B vitamins, and salt
• Supplementing hormone production: adaptogens, glandulars,
and hormones
• Removal of stressors: This step is the hardest but the most important.