10 Ways Thyroid Patients Can Beat Adrenal Fatigue

by Mary Shomon Patient Advocate

Like many people who are hypothyroid or hyperthyroid, you may be sick and tired of feeling tired. Even after treatment, fatigue is one of the most common complaints of people living with a thyroid condition. Assuming that you are already being treated for a thyroid condition, the underlying cause for your fatigue may be a condition known as adrenal fatigue. Let’s look at 10 ways to tackle exhaustion that results from thyroid-related adrenal issues.

The adrenal glands highlighted in torso.

What is adrenal fatigue?

Your adrenal glands are located on top of your kidneys and, along with your thyroid gland, are part of your endocrine system. Adrenal glands secrete key hormones including cortisol, which helps your body maintain glucose levels needed for energy. Another key hormone is epinephrine, also known as adrenaline, the “fight or flight” hormone. The body releases epinephrine — which raises your heart rate and sends blood to your muscles and brain — when you are in acute stress or danger.

Doctor holding stethoscope in hand, conducting of exam of adrenal gland model.

What goes wrong with the adrenal glands?

When you have chronically high levels of cortisol, you can have an autoimmune disease called Cushing's syndrome. Chronically low levels of cortisol are associated with autoimmune Addison's disease. Integrative physicians have identified another condition associated with insufficient — but not chronically low — levels of cortisol, known as adrenal fatigue, or adrenal insufficiency. The existence of adrenal fatigue is still considered controversial in some endocrinology circles.


What causes adrenal fatigue?

Integrative physicians theorize that when you have a preexisting endocrine dysfunction like hypothyroidism and are also exposed to chronic physical and/or emotional stress, your adrenal glands can become less able to produce enough cortisol, resulting in a chronic state of adrenal fatigue. Some doctors refer to this situation as non-Addison's hypoadrenia, subclinical hypoadrenia, hypoadrenalism, or neurasthenia.

Tired but wired woman in bed with computer.

What are the symptoms of adrenal fatigue?

In addition to fatigue and exhaustion, some symptoms of adrenal fatigue include:

  • Feeling “tired but wired”
  • Morning fatigue, feeling tired after sufficient sleep
  • Feeling unable to cope with stress
  • Cravings for sweet and salty foods
  • Difficulty sleeping
  • Being most energetic at night, waking in the middle of the night
  • Low tolerance for and recovery from exercise
  • Brain fog, difficulty concentrating
Lab. tech preparing saliva samples for testing.

How is adrenal fatigue diagnosed?

Typically, in addition to a clinical exam and history of your symptoms, integrative or complementary practitioners run a 24-hour saliva cortisol/DHEA test. This test gets one DHEA(dehydroepiandrosterone) measurement, along with up to six cortisol levels — usually in the morning, midday, afternoon, dinnertime, bedtime, and middle of the night — to map your cortisol curve and identify any imbalances in your cortisol levels.

Doctor and patient discussing treatment options.

How is adrenal fatigue treated?

If you are diagnosed with adrenal fatigue, a first step is to make sure you have optimized your thyroid treatment. If that does not resolve fatigue, there are other lifestyle, nutrition, and treatment approaches that can help get your adrenal function back into balance and improve your energy.

Young couple enjoying good morning in bed with eyes closed.

1. Get enough sleep

If you feel tired, raise your hand. (If you get at least seven or more hours of sleep per night, put your hand down.) To those of you whose hands are still raised: Don’t blame your thyroid or adrenals if you are not getting the seven to nine hours of sleep that experts — including the National Sleep Foundation — say most adults need to function well. Your first step to combat adrenal fatigue, then, is to gradually increase your nightly sleep time, until you close that deficit.

Woman smoking a cigarette and drinking coffee.

2. Avoid stimulants

Stimulants such as caffeine, nicotine, and simple sugar — as well as prescription stimulants such as amphetamines — may provide a short-term boost of energy, but in the longer term, they may further exhaust the adrenals, and make it harder for them to recover full function. Experts recommend that you limit or avoid any stimulant substances.

Stressed out with too many tasks.

3. Learn to manage stress

It’s important to learn to manage your stress levels. While some stress is unavoidable, you can make lifestyle changes, such as:

  • Avoiding stressful news and media
  • Limiting exposure to high-stress, toxic people
  • Changing a high-stress job, or getting off a night-shift job
  • Avoiding multitasking

A therapist or life coach may be able to help you craft an effective approach to managing stress, including an active stress reduction practice.

Meditating business woman on desk.

4. Practice active stress reduction

Most physicians who acknowledge and treat adrenal fatigue recommend that you manage your stress using an active stress-reduction practice that generates the relaxation response, as defined by Herbert Benson, M.D. These practices, which lower heart rate, blood pressure, and respiration rate, and help balance stress hormones, include:

  • Breathwork — When you breathe deeply and properly, you increase the oxygen level in your blood, which can improve energy. Consider pranayama yoga breathing or Transformational Breath
  • Meditation/guided meditation
  • Gentle movements, such as yoga, qi gong, or tai chi
  • Crafts and handiwork, such as needlework, gardening, or coloring, or breadmaking
Healthy food clean eating selection

5. Support your adrenals with good nutrition

Processed and sugary foods, foods filled with pesticides and hormones, and foods contaminated with heavy metals are all dietary stressors. Experts recommend that for adrenal health, you should limit or remove these dietary stressors as much as possible and emphasize organic, hormone-free, pesticide-free meat, poultry, seafood, and produce, ideally as whole and not processed foods.

Hands pouring mix of vitamins and nutritional, dietary supplement pills from a bottle, close-up.

6. Support your adrenals with supplements

Under the direction of a knowledgeable practitioner, supplements may help to balance your cortisol levels to relieve adrenal fatigue. These include:

• Adaptogenic supplements such as the Ayurvedic remedy ashwagandha • Vitamin C • Pregnenolone, a precursor for DHEA • DHEA • B vitamins, including B-12 and B-1/thiamine • IronD-ribose • Licorice

woman working out.

7. Get moving

When you’re exhausted, exercising doesn’t come to mind as a solution. Research shows that regular, low-intensity exercise oxygenates your blood, improves heart and lung function, and can decrease your fatigue by 65 percent, and increase your energy by 20 percent. Until your adrenals are back in balance, limit adrenally-exhausting, high-intensity and endurance exercise, which can further strain your adrenal glands.

Man drinking water from water bottle.

8. Stay hydrated

Even mild dehydration is associated with an increase in fatigue. Getting enough water — known as rehydration — can reverse these effects and help improve your energy level. The old "eight glasses of water a day" is a good place to start. Some experts suggest as much as 1 ounce of water per pound of body weight. At minimum, drink enough so your urine is pale yellow or colorless.

Man reading supplement label.

9. Try adrenal glandular supplements

For more significant adrenal fatigue that doesn’t respond to supplements and lifestyle changes, some patients appear to benefit from adrenal glandular supplements. These supplements, which can help support low cortisol levels, include actual glandular material from animals. Note: Most healthcare providers do not recommend taking glandulars unless directed by a professional.

Doctor about to write prescription.

10. Take prescription hydrocortisone

If your adrenal fatigue is debilitating and cortisol levels significantly low, some physicians recommend a short course of prescription hydrocortisone, along with a program of lifestyle and nutrition changes and supplementation. The theory is that this gives your adrenal glands a short-term break, allowing them time to heal and return to full function.

Mary Shomon
Meet Our Writer
Mary Shomon

Mary Shomon is a patient advocate and New York Times bestselling author who empowers readers with information on thyroid and autoimmune disease, diabetes, weight loss and hormonal health from an integrative perspective. Mary has been a leading force advocating for more effective, patient-centered hormonal healthcare. Mary also co-stars in PBS’ Healthy Hormones TV series. Mary also serves on HealthCentral’s Health Advocates Advisory Board.