The Link Between Adrenals and Autoimmune Thyroid Disease

A Peak Into the "Adrenal Fatigue" Controversy

Shot of a tired young woman sitting on the floor leaning against her bed

Research suggests a potential link between autoimmune thyroid disease, like Hashimoto's thyroiditis and Graves's disease, and a condition that involves your adrenal glands called primary adrenal insufficiency (Addison's disease).

Although primary adrenal insufficiency is considered a rare disease, understanding the connection it has with autoimmune thyroid disease is worthwhile, especially for a select (but small) group of people. In fact, one study suggests that primary adrenal insufficiency may be the culprit behind some people's persistent symptoms, despite treatment of their thyroid disease. 

Anatomy of the Adrenal Gland

Your adrenals are two small glands, one located on top of each of your kidneys.

Each adrenal gland is divided into an outer cortex and an inner medulla. The cortex and medulla of your adrenal glands produce different hormones. 

Adrenal Cortex

Your adrenal cortex consists of three different regions, with each region producing a different group or type of hormones. Chemically, all the hormones produced by your cortex are considered steroids.

  • Mineralocorticoids are secreted by the outermost region of the adrenal cortex. The principal mineralocorticoid is aldosterone, which acts to regulate sodium and potassium levels in your body, as well as your blood pressure.
  • Glucocorticoids are secreted by the middle region of the adrenal cortex. The principal glucocorticoid is cortisol, which increases blood glucose levels and helps a person's body respond to stress.
  • The third group of steroids secreted by the innermost region of the adrenal cortex is the androgen hormones (for example, testosterone and dehydroepiandrosterone, or DHEA). Of note, in addition to the adrenal glands, the testes and ovaries produce androgens in men and women, respectively.

Adrenal Medulla

Your adrenal medulla produces two hormones: epinephrine, and norepinephrine. These two "fight-or-flight" hormones are released in response to stressful physical and emotional situations, like sleep deprivation, financial worries, work pressures, family challenges, arguments, traffic, illness, surgery, and poor nutrition.

Symptoms of Primary Adrenal Insufficiency

Primary adrenal insufficiency occurs when the adrenal glands cannot produce an adequate amount of hormones, despite a normal or increased corticotropin (ACTH) level. ACTH is a hormone produced by your pituitary gland (located in your brain) that stimulates the adrenal glands to release their hormones.

Some symptoms of primary adrenal insufficiency include:

  • Fatigue
  • Muscle aches
  • Weakness
  • Loss of appetite with weight loss
  • Gastrointestinal symptoms like nausea, vomiting, and abdominal discomfort
  • Craving salty foods
  • Feeling lightheaded when standing up 

Primary Adrenal Insufficiency and Autoimmune Thyroid Connection

According to a study in European Thyroid Journal, about 5 percent of people with autoimmune thyroid disease have primary adrenal insufficiency—a small percentage, but high considering how rare primary adrenal insufficiency is considered to be. 

With this finding, the authors of the study suggest that people who continue to experience certain symptoms, like fatigue, muscle aches, and gastrointestinal problems like nausea (despite being treated for their autoimmune thyroid disease) should be tested for primary adrenal insufficiency.

A Note on Adrenal Fatigue

It's important to not confuse primary adrenal insufficiency with the term, "adrenal fatigue" which is used to describe a situation in which laboratory data (like blood cortisol and ACTH levels) do not support a diagnosis of adrenal insufficiency, but a person still reports adrenal-related symptoms like:

  • Excessive fatigue and exhaustion
  • Non-refreshing sleep (you get enough hours of sleep, but wake feeling fatigued)
  • Feeling overwhelmed by or unable to cope with stress
  • Craving salty foods
  • Difficulty concentrating, brain fog
  • Poor digestion

The concept of adrenal fatigue is very controversial and is not currently recognized by any Endocrine society, meaning it's not acknowledged as an actual medical condition.

In fact, according to a large review study in BMC Endocrine Disorders, investigators report after a thorough analysis that there is simply no scientific proof that adrenal fatigue exists. 

Even so, one main society that still believes adrenal fatigue is a real and under-diagnosed medical problem is the American Academy of Anti-Aging Medicine. This society is not recognized by the American Board of Medical Specialties or the Association of American Medical Colleges. 

A Word From Verywell

There are two take-home messages:

  • Consider being tested for primary adrenal insufficiency if you have persistent symptoms like fatigue, muscle pains, and/or digestive issues (after treating your thyroid disease). 
  • Until the adrenal fatigue controversy is teased out, focus on engaging in healthy habits like seeing your doctor for regular checkups, getting enough sleep, avoiding or moderating caffeine intake, and eating a nutritious diet. Some people opt for a low-glycemic diet (for its anti-inflammatory effect), but talk with your doctor first before embarking on this.
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Article Sources
  • Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16(1):48. 
  • Edwards, MD Lena, et. al. "Beyond Adrenal Fatigue: From Anecdotal to Evidence-Based Medicine." The American Academy of Anti-Aging Medicine. 2015. 
  • Melmed S, et. al. "Williams Textbook of Endocrinology. 12th ed." Philadelphia, PA: Elsevier Saunders; 2011
  • Yamamoto T. Comorbid latent adrenal insufficiency with autoimmune thyroid disease. Eur Thyroid J. 2015 Sep;4(3):201-06.