The hormones cortisol, estrogen, and testosterone are secreted by the adrenal glands, which reside on top of the kidneys. These hormones affect the body in a myriad of ways, including in regard to weight distribution, allergic reactions, and sexual traits. Intense or long periods of emotional and/or physical stress along with various illnesses can cause Adrenal Fatigue. When this happens, it severely inhibits the body’s ability to reduce allergic and harmful reactions, like cancer and autoimmune disorders. Cortisol and similar hormones directly affect the use of carbohydrates, fats, cardiovascular function, gastrointestinal function, and the translation of fats and proteins into energy. Appropriate adrenal support is fundamental to facilitate the proper hormonal structure for optimal wellness and requires correct nutrition, adequate sleep, habitual exercise, stress management, and supplementation of any deficient adrenal hormones.
What is Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome (CFS, Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) refers to severe, continued tiredness that is not relieved by rest and is not the direct result other medical conditions. It often presents as a hypothalamic, pituitary, and/or immune dysfunction.
How is CFS treated?
In most CFS patients, the pituitary dysfunction, thyroid resistance, and high reverse T3 produce hypothyroidism. When this occurs, supplementation with T4 alone is often unable to produce a favorable outcome. T3 or a combination of T3 and T4 are a preferred alternative. Unfortunately, the retail medication Cytomel, a short acting T3, and is very difficult to use, due to its tendency to spike blood levels and cause undesired adverse reactions, such as arrhythmias, MI, angina, hyper or hypo tension, and even heart failure. At AgeVital, we can compound sustained-release T3 that your practitioner can use to avoid spiking blood levels and help you to reach your goals for effective CFS or FM therapy.
While hypothyroidism is often manifested in CFS, it is not the only condition. Other treatments aside from thyroid hormone supplementation can be beneficial. Various nutritional supplements, proteins, amino acids, and hormones can complement and strengthen the immune system. Since the immune system is often degraded by free radical damage, antioxidants, such as ascorbic acid, may also prove advantageous. Low thyroid or adrenals gland can also inhibit the absorption of vitamin B-12. Since low B-12 has been associated with fatigue and depression, supplementation could be beneficial. Also, D-ribose supplementation has been known to reduce symptoms, with improvements in energy and well-being of over 30% on a visual analogue scale. Supplementation with NADH for one month has resulted in significant improvements in CFS, and magnesium has also produced some measurable improvements. Since most CFS patients tend to respond poorly to placebo treatments, favorable, measurable results in regard to supplementation is often interpreted as confirmation of successful treatment.
Adrenal Dysfunction and Chronic Stress
Stress can be caused by environmental, physical, psychological or nutritional factors. One of the body’s initial responses to fear or stress is the release of hormones such as epinephrine (adrenaline) and cortisol that initially help us to react or adapt to a stressful situation. Cortisol raises blood sugar and blood pressure, increases the breakdown of protein, interferes with thyroid hormone action and stimulates visceral fat deposition, which can lead to metabolic syndrome. But, chronic stress is maladaptive and ultimately disrupts the body’s signaling system (the Hypothalamic-Pituitary-Adrenal Axis = “HPA Axis”) and the adrenal gland’s normal pattern of cortisol release. This can lead to problems such as:
- Insulin resistance/diabetes
- Cardiovascular problems including arrhythmias, CHF, MI, atherosclerosis and hypertension
- Dementia/memory loss
- Immune suppression
- Impaired thyroid function
- Decreased kidney function
- Exacerbation of skin conditions (acne, psoriasis, eczema)
- Gastrointestinal problems (GERD, Irritable Bowel Syndrome)
- Mood disorders and depression
- Increased risk of neurodegenerative diseases
- Sleep disorders
- Reproductive disorders
- Premature aging
Over time, the body may no longer be able to produce the needed amounts of cortisol and patients can ultimately end up with low cortisol levels (hypocortisolism). Fatigue, pain and stress associated with HYPOcortisolism may result in Chronic Fatigue Immuno-Deficiency Syndrome (CFS), Fibromyalgia and Post Traumatic Stress Disorder (PTSD), asthma, chronic pain syndromes, and autoimmune diseases.
Treatment of Adrenal Dysfunction
- Stress reduction techniques –Gentle exercise, Tai Chi, yoga, Pilates, meditation
- Sleep hygiene - Regular sleep-wake cycle, avoid third shift work. The following supplements may be helpful: 5-HTP, Melatonin, Phosphatidylserine, L-Theanine, Calming herbs (Valerian root, Chamomile, Hops, Passion flower)
- Lifestyle modification - Delegating responsibilities to eliminate stressors, regular meals, avoid caffeine and alcohol
- Vitamins and minerals - Magnesium Glycinate or Magnesium Citrate, B Vitamins, selenium, zinc, calcium, manganese, Vitamin E with mixed tocopherols, Vitamin C (Ascorbate)
- Adaptogens – Ashwaganda, Rhodiola, Holy Basil
Recommended Reading: “Adrenalogic – Outsmarting Stress” by Lena Edwards, MD, FAARM
Thyroid Hormone helps the body convert food into energy and heat, regulates body temperature, and impacts many hormonal systems in the body. Thyroid hormone exists in two major forms: Thyroxine (T4), an inactive form that is produced by the thyroid gland and converted to T3 in other areas of the body, and Triiodothyronine (T3), the active form. The role of thyroid hormone and consideration of its impact on multiple body systems is emerging as a critical component of balanced hormone replacement for men and women.
Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.
Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). For example, T4 preparations are often ineffective for patients with Chronic Fatigue and Immuno-Deficiency Syndrome (CFIDS) and Fibromyalgia(FM). The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all CFIDS/FM patients.
A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable to T4 alone. However, the only commercially available form of T3 is synthetic liothyronine sodium (Cytomel®) in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body causing serious side effects. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects. Ultimately, it is the expertise of the prescriber, use and interpretation of appropriate tests, dosing of the T3 or T4/T3 combinations, and the formulation of the medications that determines the success of treatment.
N Engl J Med 1999 Feb 11;340(6):424-9
Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.
A randomized, double-blind, crossover study found inclusion of T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. Patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete.
J Endocrinol Invest 2002 Feb;25(2):106-9
Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations.
John M. Lee, M.D., an Australian physician, points out that any thyroid function problem should be examined in the larger context of adrenal fatigue, hormone imbalances such as estrogen dominance, nutritional deficiencies, liver dysfunction, and digestion and absorption problems. Many vitamins, minerals and amino acids are needed to convert T4 to T3, and to get T3 into the cells. Dr. Lee believes that conservatively, 40% of women in the U.S. have measurably low thyroid and as a result are suffering from fatigue, depression, cold hands and feet, dry skin and hair and many other symptoms associated with hypothyroidism (low thyroid). Dr. Lee has a unique approach to treating patients with low thyroid function and advocates using only T3 for thyroid hormone replacement, and because the use of commercially-available T3 (liothyronine) is associated with serious problems such as rapid heart rate, Dr. Lee uses a slow-release T3 and reports the therapy is successful.
While hypothyroidism is a condition, Hashimoto’s is a disease. Hypothyroidism is commonly caused by Hashimoto’s disease, but not always. Sometimes known as Hashimoto’s thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis, Hashimoto’s is an autoimmune disease where antibodies interact with proteins in the thyroid gland, causing a gradual degradation of the gland, and decreasing the gland’s production of thyroid hormones. Possible symptoms include those common in hypothyroidism and is usually diagnosed with a clinical examination demonstrating one or more of the following:
- A goiter (enlargement of the thyroid)
- A radioactive uptake scan showing diffuse
- uptake in an enlarged thyroid
- An ultrasound revealing an enlarged thyroid
- Fine needle aspiration (biopsy) of the thyroid showing lymphocytes and macrophages
- High antibody levels against thyroid peroxidase (TPO) and thyroglobulin (TG) detected with a blood test
Periods of anxiety, diarrhea, insomnia, and/or weight loss may come and go or be followed by periods of constipation, depression, fatigue, and/or weight gain as Hashimoto’s causes fluctuations in thyroid performance. Such cycling can be typical with Hashimoto’s but is not always evident
Often Hashimoto’s is caused by environmental triggers such as iodine, infection, pregnancy, or cytokine therapy, resulting in the generation of large numbers of T helper cells, cytotoxic lymphocytes, and autoantibody-producing B cells. Immune cells accumulate in the thyroid and lead to a prevalence of T helper mediated autoimmune responses and cytotoxic effects of T lymphocytes. All of this results in apoptosis (destruction) of thyrocytes, which is the ultimate cause of Hashimoto’s thyroiditis.
How is Hypothyroidism treated?
Most often, hypothyroid patients are treated with levothyroxine (synthetic T4). However, some patients remain symptomatic, and T3 is sometimes required for optimal therapy. Both T3 and T4 are secreted by a healthy thyroid gland. Unfortunately, the only commercially available T3 is a synthetic liothyronine sodium in an immediate release form which is absorbed rapidly and can lead to high systemic T3 concentrations in the body, resulting in undesirable side effects, such as heart palpitations. AgeVital can compound sustained-release T3 which could be an alternative when the administration of T4 alone has not proven sufficient to produce the desired results. Some studies have shown that the inclusion of T3 in thyroid hormone replacement therapy has improved cognitive performance, neuropsychological function, overall physical status, and has reduced depression when compared to therapy with T4 alone.
Contact us if you have any additional questions about thyroid disorders or treatments. We are more than willing to assist you in your quest for information, and would welcome the opportunity to become part of your health team.
Thyroid Hormone Therapy
The treatment of thyroid conditions is complex and can vary drastically from one patient to another. The medications are precisely adjusted and may not be substituted haphazardly. One could argue that dosing for thyroid is as much an art as it is a science, and it is for such reasons that we often speak of the “practice” of medicine.
Low levels of thyroid hormone (hypothyroidism) can lead to aching muscles, aching joints, anxiety, cold and heat intolerance, constipation, decreased heart rate, deep voice, depression, dry hair, dry skin, enlarged tongue, fatigue, fluid retention, headaches, high cholesterol, high triglycerides, hypoglycemia, hypotension, infertility, irregular menstruation, low sex drive, memory impairment, slowed metabolism, swollen neck, and weight gain.