A few years ago at age 42 I had a sudden onset of rapid hair loss that devastated me. I spent over one year researching the causes of hair loss to save my own hair.
I was going through an extremely stressful time in my life. At that very moment my menstrual cycles dramatically changed and my hypothyroidism symptoms in particular the fatigue intensified. While adjusting my thyroid hormone replacement medication was important, treating my adrenal fatigue and the sudden shift in my sex hormones were key to stopping my thyroid hair loss. My experience showed loud and clear the intricate connection between our thyroid, adrenal glands, and sex hormones. Within a few months of intense stress I was completely unbalanced and it wreaked havoc on my entire body including my hair.
Written by Jessica Drummond, MPT, CCN, CHC, The Integrative Pelvic Health Institute
Your Hypothalamic-Pituitary-Adrenal Axis (HPA-A) is the system that helps you to respond to stress. The hypothalamus is in the brain, and thus, this stress response system begins in your brain. Your hypothalamus is also where the signaling begins to stimulate your thyroid, the Hypothalamic-Pituitary-Thyroid Axis (HPT-A.)
These two systems work in parallel.
Stimulation of the pituitary by the hypothalamus (through separate hormone signals,) will signal the adrenal glands to release the stress-buffering hormone, cortisol, and the thyroid to release T4.
In both apparently healthy populations and in those with recognized hypothyroidism, cortisol and TSH (the hormone that the pituitary releases to stimulate the thyroid) are correlated in a positive way (Walter et al., 2012). Essentially that means that in response to a stressful stimulus both cortisol and thyroid stimulating hormone are released.
A study on patients undergoing surgery found a problem with conversion of T4 to the active form of the thyroid hormone, T3 in the post-surgical period possibly due to the stress of surgery (Arunabh, Sarda, & Karmarkar, 1992). So, it was thought that cortisol hinders the conversion of T4 to T3.
But, in a recent study where both humans and rats participated in a stressful running exercise bout (the humans raced and the rats ran on treadmills), the rats were given a drug to block the cortisol that is normally increased during the stress of exercise (Neto, et al, 2013). The medication blocked the cortisol in the rats only. Yet, in both the humans and the rats, the cortisol increased (1.5-fold in humans and 2-fold in the rats) and the serum T3 decreased (by 13% in the humans and 15% in the rats.) Thus the cortisol may not be actually the cause of the drop in conversion from T4 to T3, these may just be correlated. In fact, the cortisol-lacking rats also had lower levels of T4. Cortisol may actually inhibit the thyroid hormones, but somewhere earlier in the pathway.
What does this mean for you if you’re struggling with low thyroid hormones and high levels of stress-induced cortisol?
The bottom line is that exactly how these two hormones interact to cause your low thyroid symptoms is still unclear. However, they are consistently correlated in the research under stressful conditions from surgery to running races.
Stress impacts both the adrenal hormone pathway and the thyroid hormone pathway. Stress can cause inflammation in the brain/ hypothalamus, stress can raise cortisol levels that may inhibit or alter the metabolic pathway of active thyroid hormone (T3), or some other mechanism may be at play.
How this is happening is unclear, but what is clear is that stress affects the biochemical pathway that ultimately produces healthy levels of T3.
Prolonged exposure to stress will cause the over production of cortisol. Cortisol and DHEA-S compete for the same precursor, pregnenolone (Anderson, 2008). Pregnenolone is preferentially “stolen” from making adequate amounts of DHEA-S. DHEA-S is also a precursor of the sex hormones, estrogen and testosterone.
Ultimately the “pregnenolone steal” in the body’s attempt to make sufficient cortisol to support the high level of chronic stress will deplete the body of adequate sex hormones. Not only will your thyroid function be diminished, and you will experience low libido, vaginal dryness, joint pain and stiffness, inability to build muscle strength, and other consequences of low sex hormones.
The bottom line is that if your stress is out of control, your body will steal valuable resources to make stress hormones (including cortisol) instead of healthy thyroid and sex hormones.
How can you tell if you’re under enough chronic stress to be suffering from problems with your HPA- Axis, sometimes called Adrenal Fatigue?
7 Signs of Adrenal Fatigue
1. You wake up tired in the morning, but get a second wind around 9 or 10pm, making it difficult to fall asleep.
2. You crave sugar.
3. You always have to have a snack on hand because you feel hungry, moody, shaky, or tired between meals.
4. You seem to catch every cold or flu that goes around.
5. You have infertility, painful sex, dry skin, or stiff and painful joints.
6. You have hypothyroid symptoms like hair loss, cold hands and feet, or difficulty losing weight.
7. You struggle with anxiety that comes out of nowhere (it may even wake you up at night!) and you worry about the smallest things.
If you’re experiencing any of these symptoms, there is good news. By improving your nutrition, supplemental support, rest, restorative exercise, and changing your relationship to stress, you can dramatically improve your adrenal resilience. But, be patient, it can take 3-6 months to notice significant improvement and up to 2 years to feel fully resilient if you’re suffering from severe adrenal fatigue.
7 Recommendations for Improving your Adrenal Resilience, and Consequently Improving your Thyroid Function & Sex Hormone Levels
1. Supplement with a high quality source of fish oil (1000mg is a good maintenance dose, but up to 7200mg per day (in men) may be necessary if severe) It’s best to test your omega-6:omega-3 ratio before determining your best dose. Home omega-6:omega-3 tests are available. The higher your ratio of omega-6 to omega-3 fatty acids is, the more fish oil you will require. Be careful of taking too much. Excessive omega-3 fatty acid intake can cause excessive bleeding. Consult with your doctor before using this supplement if you take blood thinners or anticipate surgery.
2. Supplement with Vitamin C. Start with 1000mg per day, and increase up to 3000mg per day. Start slowly to avoid loose stool. Take with lemon water. Vitamin C is required to convert cholesterol into pregnenolone.
3. Supplement with a good quality B-complex. B vitamins are required for making steroid hormones.
4. Maintain your blood sugar by eating protein, fiber, and fat at every meal and snack. Start your day with a high protein breakfast. My favorite blood sugar balancing breakfast includes cooked leafy green vegetables (could be leftover from last night’s dinner), some animal protein like good quality breakfast sausages, roasted sweet potato (or other root vegetable), and a few forkfuls of raw sauerkraut.
5. Give yourself a #laptopcurfew. Turn off all electronics by 8pm, and get to sleep by 10pm.
6. Give yourself a bedtime routine. After you turn off your electronics, take some time to relax, connect with your partner or family, read a relaxing book, take an Epsom salt bath (add lavender essential oil to wake up feeling more rested), or drink a cup of herbal tea.
7. Consider adaptogenic herbs and foods. Ashwagandha and Rhodiola are good for supporting the endocrine system. Work with an herbal or functional medicine practitioner to find the best herb and dose for you. It’s always wise to consult with your physician before using any supplement in particular pregnant or nursing mothers and individuals with a known medical condition.
About Jessica Drummond, MPT, CCN, CHC
Jessica Drummond, MPT, CCN, CHC, the Founder and CEO of The Integrative Pelvic Health Institute, is passionate about caring for and empowering women who struggle with women’s and pelvic health conditions. She is equally passionate about educating and supporting clinicians in confidently and safely using integrative tools to treat chronic pelvic pain, hormonal challenges, and other women’s health issues. Having over a decade of experience as a women’s and pelvic physical therapist plus owning a private women’s health clinical nutrition and coaching practice gives her a unique perspective on the integrative, conservative options for pelvic pain management.
Jessica was educated at the University of Virginia, Emory University, The Institute of Integrative Nutrition, and Duke Integrative Medicine. She is currently a doctoral student in clinical nutrition at Maryland University of Integrative Health.
Anderson, D. C. (2008) Assessment and nutraceutical management of stress-induced adrenal dysfunction. Integrative Medicine, 7(5), 18-25.
Arunabh, Sarda, A. K., & Karmarkar, M. G. (1992). Changes in thyroid hormones in surgical trauma. J Postgrad Med, 38(3), 117-118.
Walter, K. N., Corwin, E. J., Ulbrecht, J., Demers, L. M., Bennett, J. M., Whetzel, C. A., & Klein, L. C. (2012). Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women. Thyroid Res, 5(1), 13. doi: 10.1186/1756-6614-5-13