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Is It Your Thyroid or Your Adrenals?

Learn how to determine which is the culprit and what the best next steps are to achieving a diagnosis.

People are more medically savvy and health literate than ever before thanks to popular shows like The Dr. Oz Show, The Doctors, and Grey’s Anatomy. So when savvy consumers need medical help, it is generally for two reasons: they want treatment for a problem they are already aware of (chronic conditions) or they have symptoms they cannot explain (fatigue, depression, poor digestion, anxiety, thinning hair, etc.). Many of these symptoms can be attributed to chronic hormone imbalances like thyroid disease or adrenal stress. But how do you know which is the culprit and what the best next steps are to achieving a diagnosis? Here’s how.

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Thyroid Disease vs. Adrenal Stress:
General Considerations

Thyroid Symptoms: The symptoms of thyroid disease can be severe, but they are usually fewer in number. People with thyroid disease commonly have two to four specific symptoms. These tend not to come and go, and they typically worsen in a steady fashion. Thyroid symptoms also tend to have a specific time of onset. A classic statement would be, “I never really had a weight problem until two years ago.” Thyroid symptoms tend not to fluctuate or change based on time of day, amount of rest, or how recent the last meal was.

Adrenal Symptoms: Adrenal stress can cause a seemingly endless number of symptoms. These symptoms can come and go and change over time from one to another, and key variables often make them better or worse. Think about the last time you were on vacation for several days. Did your symptoms get better? If so, your adrenals are the more likely culprit. Do some of your symptoms ever get better after a meal, or get worse if you miss a meal? Your adrenals also control your blood sugar. Adrenal symptoms get worse if your blood sugar is unstable.


Your Symptoms Checklist: What They Might Mean

The list of possible symptoms that can be caused by thyroid or adrenal stress is nearly limitless. The following table lists top specific symptoms and their most likely culprit. Check the box to the left of any symptom you have and see the correlating culprit on the right.


Specific Symptom Checklist

  Symptom  Culprit
Dizziness when standing suddenly Adrenal
Salt cravings Adrenal
Insomnia Adrenal
Weight-loss resistance Adrenal
Poor exercise recovery Adrenal
Hair loss Thyroid
Difficulty swallowing Thyroid
Cold intolerance Thyroid
Muscle pain Thyroid
Weight gain Thyroid



What to Test For

Best Thyroid Tests: These tests are optimally done in the morning between 7 and 9 a.m., after fasting from midnight on the night before and consuming no liquids besides water. For those who are already taking thyroid medicine, it is best to do the blood test before taking that day’s thyroid pill or any other medication.


Comprehensive blood tests for thyroid function should include:

  • TSH
  • Free T3
  • Free T4
  • Anti-thyroglobulin (TG) antibodies
  • Anti-thyroperoxidase (TPO) antibodies
  • Thyroglobulin
  • Reverse T3
  • Thyrotropin receptor antibodies
  • Thyroid stimulating immunoglobulin (TSI)


Thyroid Ultrasound: Thyroid disease can affect how the thyroid works, the structure of the thyroid, or both. For this reason and because thyroid cancer is the fastest growing type of cancer among women, I recommend thyroid ultrasounds as well as blood tests for those with suspicious symptoms.

Best Adrenal Tests: Adrenal problems can be caused by adrenal stress, or more rarely, by adrenal disease. It is good to check for both. Blood tests are most reliable for detecting adrenal disease. Salivary tests detect adrenal stress best. Adrenal blood tests should be performed in the morning between 7 and 9 a.m., again in a fasting state (no food after midnight the night before) with no beverages except water.

Comprehensive blood tests for adrenal function should include:

  • Serum cortisol
  • Serum DHEA-S
  • ACTH
  • Adrenal antibody panel
  • Serum pregnenolone

Adrenal Salivary Tests: The best tests measure salivary cortisol in four separate samples at different collection times: 8 to 9 a.m., 11 a.m. to noon, 4 to 5 p.m., and 11 p.m. to midnight.


Other Considerations

Thyroid disease and adrenal stress are not mutually exclusive. In fact, they often overlap. Between the two, adrenal stress is by far the most common and many can have it without thyroid involvement. But of those who do have thyroid disease, a large number also have adrenal stress. Of course the adrenals and thyroid are not the cause of all human maladies. Whenever something is not right, it is important to discuss it with your doctor so you can understand all possible culprits and how you might proceed. Make sure you’re working with a health professional you trust and who listens to you.


About the Author

Alan Christianson, NMD, specializes in natural endocrinology with a focus on thyroid disorders. He coauthored The Complete Idiot’s Guide to Thyroid Disease and authored Healing Hashimoto’s. In between these works, he contributed chapters to the Textbook of Natural Medicine, 9th Edition. In 1997, he founded Integrative Health, a physician group dedicated to helping people with thyroid disease and weight-loss resistance regain their health. He was named a 2011 Top Doctor in Phoenix magazine and has appeared on national TV shows, including The Doctors, Today, and The Insider, as well as in countless leading magazines.




Illustration: Marie Guillard

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One response to “Is It Your Thyroid or Your Adrenals?”

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