Low thyroid and adrenal output are very common in M.E.
Testing for thyroid problems
Even if thyroid problems are not detected on the first test, M.E. undermines the thyroid gland and so thyroid problems can develop later and so it's a good idea to test thyroid function repeatedly (Free T4, T3 and TSH), at least at yearly intervals. Reverse T3 testing may also be useful.
The author of the book The Brainpower Plan (along with many other experts) explains that standard tests for thyroid function are up to 30% inaccurate and that a more accurate way to check thyroid status is the Barnes method. This is a self administered thyroid temperature test.
Upon waking, before getting out of bed, place a thermometer under your armpit and take your temperature. The result is your AM basal temperature. Normal is between 97.8 and 98.2 Fahrenheit (36.5 and 36.7 Celsius). If your temperature is below 97.8 F (or 36.5 C) for 4 days, then this indicates that your thyroid output is low. Note that women should not do this test during their period as this can alter the results.
The book Prescription for Nutritional Healing recommends that a morning temperature of 96 F (35.5 C) means a starting dose of 3-4 grains of armour thyroid, and 97 F (36 C) means 1-2 grains.
The temperature test is said by some to be very accurate, but it should be noted that temperature can also be affected by low adrenal output and also several other factors. Suspect low adrenal output if your temperature is erratic from one day to the next, at the same time of day. Also note that low adrenal output and low thyroid output are linked, and low function in one may be compensated for by the other..
The thyroid peroxidase antibody test (TPO) and an antithyroid antibody test (ATA) may also be useful. See the articles Thyroid Scale Matrix, Low Metabolic Energy Therapies and Thyroid Scale Overview by Bruce Rind MD for more information on thyroid testing.
Testing for adrenal problems
Adrenal function can be tested via blood tests measuring cortisol levels (usually once or twice daily) and via a 24-hour urine collection test. These tests must be ordered by a doctor.
For patients that prefer private testing VRP offers several simple saliva tests measuring cortisol levels as well as the levels of various other hormones, if desired. The basic cortisol kit measures am/noon/evening/pm cortisol. 24 hour saliva tests give you far better information than the one time blood test that doctors will tend to recommend and also gives you far more specific information than the 24 hour urine test.
Dr Wilson’s book on interpreting hair mineral analysis testing also explains how to use this simple test to assess thyroid and adrenal function. Low blood pressure can also be an indicator of low cortisol levels. As the Westen A. Price Foundation explains,
The regulation of blood pressure is a mysterious process which involves at least three mechanisms working in complex relation to each other. Receptors—called baroreceptors—which reside in various organs and detect changes in arterial pressure. These receptors adjust the pressure by altering the force and speed of the heart’s contractions, as well as the resistance in the arteries. The renin-angiotensin system (RAS), involves hormones secreted by the kidneys. When blood pressure drops, the kidneys compensate by activating a vasoconstrictor called angiotensin II. When the kidneys do not produce enough of this hormone, blood pressure will also be low. Aldosterone is a steroid hormone produced by the adrenal cortex, which stimulates sodium retention and potassium excretion by the kidneys. When aldosterone is increased, the body retains fluid retention and blood pressure is raised. Alternately, low aldosterone production will result in low blood pressure.
Causes of thyroid problems
Dr Sherry Rogers explains that there are environmental, nutritional and metabolic causes of thyroid problems.
Environmental: Food allergies, chemical and mould toxicities, goitrogens from soy and other foods, and high levels of fluoride (especially in drugs such as Prozac), heavy metal and chemical contamination from things such as cadmium, mercury, PCBs, dioxins and phthalates (plasticisers). Cadmium can lower T3 but not raise TSH. It can lower thyroid function in a way that leaves the TSH test completely normal.
Nutritional: Low levels of the nutrients needed to make thyroid hormone such as selenium, zinc and iodine. Poor cell membrane function can cause thyroid problems as can high levels of trans fats.
Metabolic: Candida overgrowth and the use of NSAIDs (Celebrex and ibuprofen), can lead to a ‘leaky gut.’ This in turn triggers the body to make antibodies that attack and destroy its own thyroid gland. This can be tested for using a thyroid antibodies test.
Other causes include virally caused damage to mitochondria, pituitary gland problems and chronic infections.
Causes of adrenal problems
There are also environmental, nutritional and metabolic causes of adrenal problems. Adrenal burnout tends to occur in M.E. over time very often, particularly where the patient is regularly ‘running on adrenaline’ and overexerting. For more information on this topic please see: Assisting the M.E. patient in managing relapses and adrenaline surges
When the adrenal glands are too weak to handle the stress of the body’s normal metabolic energy they may force a down-regulation of energy production. Hashimoto’s Thyroiditis and Grave’s Disease can also cause adrenal stress and low adrenal output. Severe caloric restriction can be another cause of adrenal and thyroid problems.
Treating thyroid problems
The question of whether or not low thyroid output in M.E. should be boosted with medications such as armour thyroid or treated indirectly via a more general deep healing program is a difficult one. It is possible that giving the thyroid gland the nutrients it needs will be enough, but this may depend on how long the thyroid has been dysfunctional and how severe the problem is, and what the actual cause of the problem was to begin with. Longer term and more severe cases will likely require more support than milder and newer cases. It is also important to keep in mind that low adrenal and thyroid output may well be a protective mechanism, protecting our bodies from further harm and that supplementing thyroid hormone may send a signal to the body to slow down thyroid hormone production even further. These are issues that should be discussed with your holistic medical expert.
Thyroid problems in children can cause problems with brain development and lowered intelligence.
Basic thyroid support includes B complex vitamins with an emphasis on vitamin B1, selenium, zinc, vitamin D and C, magnesium, manganese, iodine, DHA and EPA and adequate dietary protein. All of these are essential. Also important are strict toxin avoidance and a detoxification regime, avoiding goitrogenic foods and trans fats in foods and treating a ‘leaky gut.’ High-dose vitamin C can help protect against damage caused to the thyroid gland by heavy metal exposure.
Dr Rogers explains that for some patients raising zinc, iodine and selenium levels and starting a detoxification and toxin avoidance regime will be enough to treat thyroid problems and there will be no need for products such as armour thyroid. She also recommends that patients eat a diet high in brassica vegetables and take an Indolplex supplement twice daily to help prevent thyroid cancer, as well as breast and prostate cancer.
A more intensive program will also include thyroid glandular substance (for up to 6 months) in milder cases and daily armour thyroid tablets for more severe cases.
Vitamin D, iodine and the thyroid gland
The article, Vitamin D – the Re-discovered Key to Illness Prevention, by Tony Pearce RN explains that vitamin D, Oestradiol (E2) and thyroid hormone belong to a class of steroid hormones termed ‘C-ERB’ and as such they are structurally similar, closely related and posses the capacity to influence the other’s expression. This article explains that one recent study (Lee, 2007) found that ‘sufficient’ Vitamin D (more than 40 ng/ml) is required for optimal triiodothyronine (active thyroid hormone – T3) ‘receptor expression.’ Vitamin D is also thyroid and cortisol hormone ‘sparing’ when optimum 25(OH)D levels are maintained (60 - 80 ng/ml). Vitamin D testing is an essential part of any thyroid treatment program.
Iodine is an essential element. Although its main function is in the production of thyroid hormones by the thyroid gland, other organs in the body have a need for iodine in order to function normally. When thyroid levels have been shown to be low, this may be an indication that an iodine loading test may be necessary. This test (available from companies such as VRP, though requiring a doctor’s consent) indicates whether or not additional iodine supplementation may be beneficial. Note however that some experts explain that taking extra iodine may be contraindicated if you have thyroid antibodies and an autoimmune thyroid disorder.
Armour thyroid vs Thyroxine
Note that ‘Armour thyroid’ is far more beneficial and better tolerated than Thyroxine, Synthroid, Levoxyl, levothyroxine, Eltroxin, Oroxine and Levothyroid etc. This product should always be the first choice over T4-only medications. Thyroxine etc. may place stress on the adrenals, and also does not properly treat low thyroid output as it contains only T4 and not also T3. The body also uses up precious enzymes trying to convert T4 to T3.
As the ‘Stop the thyroid madness’ website and book explains,
The theory was that T4 would convert to the T3 needed for the body. But in nearly ALL patients on T4 meds, the T4 does NOT convert into an adequate amount of T3, leaving you with symptoms that neither you OR your uninformed doctor realize are related to inadequate treatment. In other words, healthy thyroids are NOT meant to rely solely on T4-to-T3 conversion!
But there’s even more to the problem: it’s called the TSH lab. Around 1973, the TSH lab test was developed. Based on a sampling of several volunteers, a so-called “normal” range was established—.5 to 5.0 (recently lowered to 3.0). But volunteers with a history of family hypothyroid were NOT excluded, leaving us with a range that leans towards being hypothyroid! In fact, the TSH RARELY corresponds to how a patient feels. There is a large majority of patients who have a “normal” TSH, even in the “one” area of the range, and have a myriad of hypothyroid symptoms.
So what’s the solution? Patients and their wise doctors are returning to a medication that was successfully used from the late 1800’s onward: natural desiccated thyroid hormones, more commonly known as Naturethroid, Erfa’s Canadian “thyroid”, Armour, etc. They are made from pig glands, meet the stringent guidelines of the US Pharmacopoeia, and gives patients EXACTLY what their own thyroids give them—T4, T3, T2, T1 and calcitonin.
Additionally, patients who are working with certain wise doctors are not dosing by the TSH. Instead, they raise their desiccated thyroid according to three criteria (and not in any particular order): 1) the elimination of symptoms 2) getting a mid-afternoon temp of 98.6 using a mercury thermometer, while maintaining a normal, healthy heart rate, and 3) getting their free T3 towards the top of the range (in the presence of healthy adrenal function).
On a T4-only medication, we have noted that the majority of patients have a less-than-optimal free T3, a mid-afternoon temp lower than 98.6, and/or the continuation of some hypothyroid symptoms for the rest of your life, no matter how high your doctor raises it.
Some groups warn that you need to chew up either Armour or Naturethroid to release the desiccated thyroid from the cellulose filler. Make sure to take armour thyroid as far away from calcium supplements as possible, as calcium can reduce how well this medication is absorbed. At the very least take them 2 hours apart, or 4 hours apart if you can. (The same is true for supplements containing iron, or estrogen and supplements or foods containing soy.) Armour thyroid should be taken in at least 2 or 3 daily doses. Some patients, especially those with adrenal issues, dose 4 to 5 times daily.
If upon starting desiccated thyroid you experience new-onset symptoms such as anxiety, insomnia and shakiness, this may be a sign that you may need adrenal support. As the ‘Stop the thyroid madness’ website and book explains,
Cortisol is needed to distribute thyroid hormones to your cells, and if you are not making enough cortisol from sluggish adrenals, your blood will be high in thyroid hormones, producing the above symptoms. Adrenal support is used to give back to your body what your adrenals are not, which in turn allows the thyroid hormones to get to your cells.
Feeling ‘hyper’ after beginning to take Armour thyroid can also be an indicator that you need to take only T3 containing medication, or that you have simply raised the dose too quickly, as the Natural Thyroid 101 article explains. A starting dose is usually 1 grain (less for those with severe adrenal issues) and this is raised by half a grain every few weeks until the optimum dose is reached.
Treating adrenal problems
Generally it is recommended that adrenal issues be treated BEFORE thyroid issues, as treating thyroid issues first places more stress on the adrenals.
As with low thyroid output, the question of whether or not low adrenal output in M.E. should be boosted with cortisone tablets or treated more gently and indirectly via a more general deep healing program is a difficult one. It is possible that giving the adrenal gland the nutrients it needs will be enough, but this may depend on how long the adrenals have been dysfunctional and how severe the problem is. Longer term and more severe cases will likely require more support than milder and newer cases. It is also important to keep in mind that low adrenal and thyroid output may well be a protective mechanism, protecting our bodies from further harm and that supplementing adrenal hormone may send a signal to the body to slow down adrenalhormone production even further. These are issues that should be discussed with your holistic medical expert.
When cortisol levels are tested to be extremely low, doctors may feel the need to immediately prescribe daily cortisone tablets. Dosage is usually under 20 mg daily. Hydrocortisone and Isocort are usually recommended. Hydrocortisone gives you simply cortisol whereas Isocort etc. gives you the entire adrenal cortex, but many patients seem to prefer HC and find it to work better than Isocort. Minimum dosing is 3-4 times daily. Generally this type of adrenal support is designed to be short term, lasting a few years just to give the adrenals a rest so that they can heal and begin working normally again without assistance.
Basic adrenal support includes vitamin C, B complex vitamins with an emphasis on vitamin B5 (1- 2 grams is recommended daily by Dr Wilson) and B6, unrefined sea salt, vitamins A and E, iodine and manganese. Eating a diet containing adequate fat and protein and that is lower in sugar and carbohydrates is also important. Daily carbohydrate intake may be best reduced to a maximum of 75 – 100 grams. Some of the additional fat taken in should be as cod liver oil to supply vitamin A. The adrenal cortex cannot make adrenal hormones out of cholesterol without vitamin A. Stimulants should be strictly avoided. Also important are strict toxin avoidance and a detoxification regime.
Avoiding overexertion and getting adequate rest is absolutely essential in rebuilding adrenal function.
A more intensive program will also include adrenal glandular substance (for a limited time period), and then, finally, daily prescription cortisone tablets.
Low adrenal output is linked to low stomach acid, so this finding may be an indication that Betaine HCl or apple cider vinegar may be helpful.
Ashwagandha is an inexpensive adaptogenic herb that can be useful short-term in treating the symptoms of adrenal exhaustion to some extent. Ashwagandha works by delaying release of cortisol by the adrenals. (This helps to prevent the adrenals from becoming exhausted and aids in the repair of the gland once it is already exhausted.) Ashwagandha also supports thyroid function. It also has a sedative effect and can greatly improve sleep, improve your ability to handle emotional stress, and it can also calm the central nervous system. Ashwagandha can also have positive effects on the immune system (by increasing the number of T and B cells), be neuroprotective, be an antioxidant and an antidepressant and may possibly also be anti-cancer. (It may also be useful for degenerative neurological diseases such as Parkinson’s and Alzheimer’s.) It is usually well-tolerated. Note that you may need to take LESS thyroid meds when taking Ashwagandha so make sure you reassess your thyroid mediation level after taking this supplement. Significant effects are often seen after just 3 weeks though it may take 3-4 months for the full benefit to become evident. Make sure you buy ashwagandha that is standardized to contain a minimum of 8% withanolide glycosides, a minimum of 32% oligosachharides.
Detoxify or Die by Dr Sherry Rogers. Dr Rogers recommends taking 25 mg of DHEA twice daily (for a limited time) to see if the adrenals are weak, and comments that taking cortisone and thyroid medications is problematic as it sets up feedback inhibition and tells the body not to produce these hormones.
T4-Only Meds Do Not Work, Take your Temp!, Natural Thyroid 101 and Armour vs. Other Brands (this article contains an excellent overview of different natural and synthetic thyroid products) from the Stop the Thyroid Madness website.
Dr David Brownstein’s book IODINE: Why you need it Why you can't live without it and Iodine – An Important Mineral Today by Lawrence Wilson MD, plus the HFME paper on iodine.
Low Blood Pressure from the Western A. Price Foundation.
The article Those durn adrenals: How they can wreck havoc in many thyroid patients gives some very useful information on adrenal testing (including a temperature test) and cortisone supplementation.
Dr Wilson’s book on interpreting hair mineral analysis testing explains how to use this simple test to assess thyroid and adrenal function. See Nutritional Balancing and Hair Mineral Analysis by Dr. Lawrence D. Wilson. The book is a very interesting read. Some of this information is also available on his website
Clinical value of 24-hour urine hormone evaluations Townsend Letter for Doctors and Patients, Jan, 2004 by Alan Broughton
Vitamin D – the Re-discovered Key to Illness Prevention by Tony Pearce RN
Information on the role of each vitamin in supporting adrenal and thyroid function is available in many of the books on vitamins and nutrients listed in the books sections of HHH.
Note that the aim of this site is to provide a starting point for health and healing research for ill people; especially very overwhelmed and disabled ill people. This site provides recommendations, summaries and reviews of books but is not meant to be a replacement for actually reading some of these wonderful health books if the reader is at all well enough to do so. (Plus getting individualised advice from a doctor that is also an orthomolecular medicine expert if possible). There is no substitute for reading as many of these books as you can. The HHH site can only really hint at their full brilliance. The amount of insight, scientific references, logic, intelligence, compassion and experience in the recommended books will most likely amaze you. HHH aims to encourage people to do their own reading and learning, and to always make up their own minds. All content copyright Jodi Bassett 2006 - 2014.