Give me your throughts about Adrenal Fatigue
February 28, 2021 2:45 AM   Subscribe

I have Hashimoto's since about 10 years. During the last three years the hormone replacement therapy seems to not work any more: despite ever increasing dosage and taking the meds faithfully, the symptoms persist. Searching various Hashimoto's fora a large number of people describe similar problems and often claim that treating "Adrenal Fatigue" is the answer.

Do you or someone you know have any experience with adrenal fatigue? Is adrenal fatigue even a thing? I have a hard time finding any medical doctors here in Vienna, Austria who believe this is a genuine condition, it seems that most people offering diagnosis and treatment are not medical doctors but practioners of complementary medical treatments. The only two medical doctors in my city that I found online who advertise that they diagnose and treat adrenal fatigue, both have rather peculiar statements on their websites re covid 19... so don't seem very trustworthy to me at all.
However, I am also very desperate. I had a nervous breakdown in fall 2017, and another one on fall 2019 and have been on sick leave now since April 2020, with a diagnosis of first PTSD, then burnout and dysthymia by a psychiatrist, she prescribed meds whcih help with the mood but not with the extreme fatigue. The doses are very small and also I had the complete fatigue long before I started the Lexapro so I dont think it is that.

In January I switched to another thyroid specialist for the Hashimoto, as the previous one kept insisting I was not taking meds. The new one believes me and upped the dosis yet again. She said I would notice a marked improvement by mid February. But I don't, not even a slight trend. I have another appointment with her in 4 weeks, and also with the psychiatrist. I also have diabetes II, but this is well under control and I don't think it is the cause, neither does my GP.

In the meantime I am getting desparate. The tiredness and brainfog and sleepiness are crippeling. I spend most of my time sleeping and when awake I am basically a zombie.

So adrenal fatigue sounds tempting, but I am not interested in alternative medicine, nutrional supplements and other not mainstream stuff.
So, my question is should I pursue this as a potential explanation for failure of the thyroid hormone substitute or is it a waste of time and money?
posted by 15L06 to Health & Fitness (11 answers total) 11 users marked this as a favorite
Best answer: I am not your doctor, nor am I am an endocrinologist, but I have yet to meet a trustworthy doctor who thinks "adrenal fatigue" is anything more than repackaged neurasthenia.

There is something called Addison's disease, or adrenal insuffiency, which is an autoimmune (or sometimes post-infectious) condition that often keeps company with other autoimmune disorders like Hashimoto's thyroiditis. But that has pretty clear clinical and lab criteria.
posted by basalganglia at 4:02 AM on February 28, 2021 [11 favorites]

Best answer: I had a lot of the symptoms of adrenal fatigue about 3 years after I had my second child - 4 after my first child died. I don’t know that I think it’s a thing exactly nor do I think there are supplement/treatment based cures that are proven.

However. I was managing that and a very high pitched media career and I certainly was having bad symptoms — falling asleep driving, bad thinking, anxiety, unable to climb stairs due to periods of overwhelming fatigue, lack of coordination, and bad mental space...fog but just bad judgment too.

What I did do out of that was helpful was I stopped treating my symptoms as personal failings and started taking my health seriously. The first thing I did was prioritize sleep in two ways...sleep hygiene and also I starting insisting that my spouse get up with our son one day a week so I could sleep in and wake up naturally. I had developed a bad caffeine habit so I decreased that. I started exercising more, which had fallen off due to work/child, and by more I mean one yoga class a week to start which was all I could do due to the fatigue and the first few weeks I mostly laid there in child pose.

I forced myself to go outside for a 20 minute walk each day (in nature which near my work at that time meant a cemetery.) And although my at-home diet was solidly while food based at that time due to child, I was eating junk at work, so I worked on that. And I started taking just regular amounts of B12.

I also stopped trying to be a perfect mum and initiated a few low key traditions like “Fridays we eat outdoors or in front of a video (up until then we had not had much screen time)” and let some chores go.

I couldn’t entirely limit my screen time because being up to date on things was part of my job but I did initiate Sunday afternoons “out of range” and turn my phone off.

I do think my alert system was out of whack, whether it’s a thing or not. Some of my response to Covid has felt similar.

Over time it really did shift. I think my advice would be if there’s something where you’re not paying someone or spending more than regular pharmacy prices on well established supplements like vit d, b complex, magnesium, fish oils (we just ate more fish) then it’s worth trying. Sleeping in that one day was the magic for me I took months but it’s the one habit that if I stop now I notice in a few weeks. The exercise/outdoors as well.

Good luck, hope there’s something in this wall of text.
posted by warriorqueen at 6:07 AM on February 28, 2021 [5 favorites]

Best answer: I have Hashimoto’s as well and really only feel functional when my TSH is actually around 1. Once I get to ~2.5 I start getting severe hypothyroid symptoms. Last time I was at 4 I was non-functioning and suicidal. Those values are all within the “normal” range for TSH. I know this because my primary providers would always insist I was fine based on that range and not on my symptoms. I finally got an endocrinologist and there wasn’t even a second conversation needed, she was totally on board. She also switched me to brand-name Levoxyl instead of generic levothyroxine or Synthroid. It’s possible some of that tweaking you can do with direct thyroid management will help you too.

Adrenal fatigue is pretty exclusive to woo-practitioners and charlatans in my experience.
posted by shesdeadimalive at 6:17 AM on February 28, 2021 [4 favorites]

Best answer: In addition to the advice above, have you had a general blood workup, and had them check your Vitamin B12 level? I am on thyroid medication, but I also have pernicious anemia, which is a B12 deficiency. Tiredness and brain fog are some of the symptoms.
posted by gudrun at 8:12 AM on February 28, 2021 [2 favorites]

Best answer: Anecdatum: my friend has Hashimoto’s and did a (many-week, many-times-day) course of supplements for adrenal fatigue, and she didn’t feel like it made a difference. She needed rest and lower stress - she got out of a job that was causing an RSI and was also emotionally distressing and that did help.
posted by momus_window at 11:02 AM on February 28, 2021

Best answer: Your old doctor believed that you were not taking the meds? That's a big red flag that maybe your meds are not being absorbed properly.

Do you always take your thyroid meds an hour before eating anything or drinking coffee in the morning, and four or more hours after eating anything? (Some doctors say that waiting half an hour to eat after you take your meds is sufficient.) Do you take calcium or iron supplements within four hours of taking your meds? (You shouldn't.) Do you eat iron-fortified breakfast cereal or calcium-fortified orange juice for breakfast? (Same problem as with supplement pills.) These are the most common problems with absorbing thyroid medication.

Other things that cause the same problem are certain medications, such as bile-acid-binding resins (for treatment of high cholesterol levels), any antacid medication such as Tums or Gaviscon, the osteoporosis drugs raloxifen, and proton-pump inhibitors such as Prevacid.

Gastrointestinal problems can also lead to poor absorption of thyroxine.
posted by chromium at 12:12 PM on February 28, 2021

Best answer:
Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease
was found in a recent study in 5% of a sample of 159 patients with autoimmune thyroiditis (another name for Hashimoto’s):

When patients with ATD are troubled by recurrent stress-associated gastrointestinal or constitutional symptoms or nonrheumatic musculoskeletal symptoms which have remained unrelieved by adjustment of thyroid medication, these symptoms may be a manifestation of comorbid latent PAI. It is worth investigating such patients for latent PAI.
So you’re definitely not barking up the wrong tree.
posted by jamjam at 12:21 PM on February 28, 2021 [1 favorite]

Best answer: Another problem with Hashimoto's is that there are two main forms of thyroid hormone: the less-active but longer-acting T4, which is levothyroxine, which is what's in Synthroid and is the usual treatment for hypothyroidism, and the more-active but shorter-acting T3, which is liothyronine, which is what's in Cytomel.

The human thyroid makes both T4 and T3. It makes ten times as much T4 as it does T3, but T3 is four times more active. The majority of people who need thyroid treatment can turn enough T4 into T3 that they can get by on supplementing only T4. A significant minority of people who need thyroid treatment are not as good at converting T4 to T3 in their tissues; these people never feel right when taking only T4, and need to take some T3, as well.

One way to do this is to be prescribed by levothyroxine and liothyronine; another is to instead take natural desiccated thyroid, a prescription medication that is very carefully standardized so that it is just as reliable as the synthetic form, though some doctors don't realize this; the major brand name for this in the US is Armour Thyroid. A problem with desiccated thyroid is that it contains twice as much T3, relative to T4, as most people need, so some people take half their thyroid supplementation as levothyoxine and half as Armour Thyroid.

All this is very much by prescription only, and requires regular blood tests. Some doctors are willing to try prescribing Cytomel or desiccated thyroid, while others are not, though clearly it should be a matter solely of what works best for a particular patient.
posted by chromium at 12:28 PM on February 28, 2021 [5 favorites]

Response by poster: Basalganglia thank your providing me with a much needed laugh! I had to look up neurasthenia and found this lovely gem there Barbara Ehrenreich, restating James's view, considers that neurasthenia was caused by the Calvinist gloom,[18] and it was helped by the New Thought, through replacing the "puritanical 'demand for perpetual effort and self-examination to the point of self-loathing'"[18] with a more hopeful faith.[18][19]
I spent about 12 years in fundamentalist christian sect with rather puritanical, pietist and calvinist ethos. Yeah, so maybe this is the key (just joking).
But thanks!
posted by 15L06 at 12:39 PM on February 28, 2021

Best answer: Hashimoto's can be co-morbid with other autoimmune disorders, FWIW. To build off chromium's answer about T4-only thyroid medication:

In two-thirds of women with persistent symptoms of hypothyroidism despite appropriate levothyroxine therapy, restoration of serum ferritin above 100 µg/l ameliorated symptoms. [...] Clinicians should be aware that even if a hypothyroid patient is being treated with L-T4, a number of studies have found that giving selenium as well as L-T4 resulted in a greater reduction in TPO-antibodies, inflammatory cytokines and C-reactive protein. [Rayman, M. (2019). Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society, 78(1), 34-44. doi:10.1017/S0029665118001192] &

One should always consider iron deficiency (without anemia) as the cause of persisting, unexplained unspecific, often severe, symptoms, regardless of the primary underlying disease. [Soppi E. T. (2018). Iron deficiency without anemia - a clinical challenge. Clinical case reports, 6(6), 1082–1086.] Fatigue & brain fog like yours can be symptoms of iron deficiency without anemia.

TL;DR: ask for iron tests incl. the ferritin test
posted by Iris Gambol at 5:13 PM on February 28, 2021 [3 favorites]

Best answer: I have had Hashimoto's for the past 25 years, and struggled terribly with extreme fatigue, brainfog and other symptoms while on a T4 regimen only. Chromium has very clearly laid out what worked for me, a T4/T3 regimen, as I was not converting T4 to T3.

I have been taking a low dose of levothyroxine/T4 plus a fairly high dose of Cytomel/T3 for 20+ years successfully. YMMV.
posted by alwayson_slightlyoff at 12:48 PM on March 1, 2021 [1 favorite]

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