Recognizing Weak Adrenal vs. Weak Thyroid Patterns

Recognizing Weak Adrenal vs. Weak Thyroid Patterns

Both low adrenal function and low thyroid function can reduce the metabolic energy available to the body, creating the symptom of fatigue. In this way, the two are often confused.

The adrenals help us manage stress and maintain homeostasis, while the thyroid establishes the basic energy setpoint. Compounding the confusion is that the two conditions tend to coexist in many chronically ill patients.

Determination of which gland is more in need of support is through laboratory testing for thyroid and adrenal hormone levels.

Sign or Symptom

Hypothyroid Tendency

Hypoadrenal Tendency

Body temperature Low and consistent Low and fluctuates
Energy pattern Generally sluggish “Wired and Tired”
Body type Difficulty losing fat Difficulty gaining muscle
Blood pressure Normal to high Low to normal
Total cholesterol High Low
Facial color Reddish Pale
Sweating Scanty or none Profuse
Bowels Irritable or hyperfunctioning Sluggish/Constipated


General Signs and Symptoms of Adrenal Dysfunction and Prevalence

As Hans Selye observed, “the physician, in dealing with GAS, may be faced with a patient with no clear-cut diagnostic patterns, but just vague feelings of ill health.”

Fortunately, there are now more tools available to help with assessment of adrenal dysfunction, an important first step in choosing from treatment options.

Patient history, physical signs and symptoms can be the most useful methods of diagnosis.

The following is a list of the common signs and symptoms of adrenal exhaustion and the percentage of patients who experience them.


  • Excessive fatigue 94%
  • Nervousness/Irritability 86%
  • PMS 85%
  • Salt craving 84%
  • Depression 79%
  • Sweet craving 75%
  • Allergies 73%
  • Headache 68%
  • Headache 68%
  • Alcohol intolerance 66%
  • Weakness 65%
  • Neck/Shoulder pain 65%
  • Confusion 61%
  • Poor memory 59%
  • Palpitations 57%
  • Poor digestion 51%
  • Backache 48%
  • Lightheadedness 47%
  • Constipation or diarrhea 45%
  • Fainting 42%
  • Insomnia 40%
  • Dermatitis 39%



  • Postural hypotension 93%
  • Dry skin 91%
  • Scanty perspiration 91%
  • Low basal body temp 85%
  • Sparse body hair 83%

Additional Symptoms

  • Problems waking in the morning
  • Afternoon low energy and/or evening “second wind”
  • Increased irritability/decreased tolerance toward others
  • Symptoms that are worse if meals are skipped and better after eating
  • Increased susceptibility to
  • Decreased libido
  • Increased susceptibility to illness and increased time to recover
  • Intolerance to cold

Laboratory Tests

Lab testing may be helpful to help assess the level of adrenal fatigue , to differentiate the “resistance” from the “exhaustion” phase of adrenal dysfunction, and to monitor recovery.

Saliva Cortisol

  • Likely the best single test, as saliva hormones indicate the amount of hormone inside cells and the testing is simple, noninvasive, and easy to do.
  • Measure cortisol levels at least four times per day (waking, noon, afternoon, evening), which increases the chances of detecting a failure of adrenal reserve.
  • Testing at various times in the day can also be correlated with perceived energy levels throughout the circadian rhythm cycle.
  • DHEA-S and testosterone levels can also be measured with saliva testing, and, if low, are also considered to be indicators of adrenal exhaustion, whereas high levels may indicate adrenal resistance phase.

Urinary Cortisol

  • A 24-hour urinary cortisol test can be used to monitor the output and metabolism of the corticosteroids, aldosterone, and the sex hormones.
  • Because the urine is collected in one container, this test gives a 24-hour average, and therefore the highs and low may cancel each other out in many patients.
  • However, if metabolites of these hormones are included, ratios of these hormones to their metabolites can give a fairly accurate picture of an individual’s adrenal hormone metabolism (useful for diagnosing syndromes, such as Apparent Mineralocorticoid Excess [AME]).
  • This test can also be useful when performing an ACTH challenge test. In the challenge test, adrenal reserve can be functionally measured by comparing 24-hour urinary cortisol before and after stimulation of the adrenal cortex with ACTH.

Blood Tests

Blood tests can also be used to measure circulating hormone levels related to adrenal function. However, because of a wide variation in what is considered to be “normal” levels, many symptomatic patients may not show irregularities, since in most cases o adrenal fatigue the cause is a functional lack of adrenal reserve as opposed to outright Addison’s disease.

Nevertheless, on routine blood screening we may see the following in adrenal fatigue:

  • Serum Sodium low normal
  • Serum Potassium high normal
  • Blood urea nitrogen normal or elevated
  • Eosinophils high


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