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5 Ways That Stress Causes Hypothyroid Symptoms


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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

We’ve already talked about how blood sugar imbalances and poor gut health can lead to hypothyroidism and Hashimoto’s. The harmful effects of adrenal stress complete the triad.

The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones – such as cortisol, epinephrine and norepinephrine – that regulate the stress response. But these hormones play other crucial roles, many of which are directly related to thyroid health. In fact, as we’ll see in this article, proper thyroid function depends on healthy adrenal glands.

Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life.

But other factors not commonly considered when people think of “stress” place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones. In this context, stress is broadly defined as anything that disturbs the body’s natural balance (homeostasis).

Adrenal stress is probably the most common problem we encounter in functional medicine, because nearly everyone is dealing with at least one of the factors listed above. Symptoms of adrenal stress are diverse and nonspecific, because the adrenals affect every system in the body.

But some of the more common symptoms are:

  • Fatigue
  • Headaches
  • Decreased immunity
  • Difficulty falling asleep, staying asleep and waking up
  • Mood swings
  • Sugar and caffeine cravings
  • Irritability or lightheadedness between meals
  • Eating to relieve fatigue
  • Dizziness when moving from sitting or lying to standing
  • Gastric ulcers

Weak adrenals can cause hypothyroid symptoms without any problem in the thyroid gland itself. In such cases, treating the thyroid is both unnecessary and ineffective, and addressing the adrenals themselves is the key to improving thyroid function.

The most significant indirect effect the adrenals have on thyroid function is via their influence on blood sugar. High or low cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica, hyperglycemia or both. And as we saw in a previous article, blood sugar imbalances cause hypothyroid symptoms in a variety of ways.

But adrenal stress also has more direct impacts on thyroid function. The following five mechanisms are the most important.

1) Adrenal stress disrupts the HPA axis

By now many people have heard of the hypothalamic-pituitary-adrenal (HPA) axis. It’s a complex network of interactions between the hypothalamus, the pituitary and the adrenal glands that regulates things such as temperature, digestion, immune system, mood, sexuality and energy usage – in addition to controlling the body’s reaction to stress and trauma.

Countless studies show that chronic adrenal stress depresses hypothalamic and pituitary function. And since these two organs direct thyroid hormone production, anything that disrupts the HPA axis will also suppress thyroid function.

Studies have shown that the inflammatory cytokines IL-1 beta, IL-6 and TNF-alpha, which are released during the stress response, down-regulate the HPA axis and reduce levels of thyroid stimulating hormone (TSH). Another study showed that one single injection of tumor necrosis factor alpha (TNF-alpha), an inflammatory peptide, reduced serum TSH, T3, free T4, free T3 and hypothalamic TRH for 5 days. TNF-alpha was also found to decrease the conversion of T4 to T3, reduce thyroid hormone uptake, and decrease the sensitivity of the thyroid to TSH.

2) Adrenal stress reduces conversion of T4 to T3

We discussed under-conversion of T4 to T3 in a prior article. Remember that although 93% of the hormone produced by the thyroid gland is T4, it is inactive in that form and must be converted into T3 before it can be used by the cells. The inflammatory cytokines I listed above not only disrupt the HPA axis, they also interfere with the conversion of T4 to T3.

The enzyme 5′-deiodinase catalyzes the conversion of T4 into T3 in peripheral tissues such as the liver and the gut. Both Th1 and Th2 inflammatory cytokines – IL-6, TNF-alpha, IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3. In patients without thyroid illness, as levels of IL-6 (a marker for inflammation) rise, levels of serum T3 fall. And injections of inflammatory cytokines into healthy human subjects resulted in a rapid reduction of serum T3 and TSH levels, and an increase in the inactive reverse T3 (rT3) form, while T4 and free T4 levels were only minimally changed.

3) Adrenal stress promotes autoimmunity by weakening immune barriers

The GI tract, lungs and the blood-brain barrier are the primary immune barriers in the body. They prevent foreign substances from entering the bloodstream and the brain. Adrenal stress weakens these barriers, weakens the immune system in general, and promotes poor immune system regulation.

As we discussed in my previous article on the gut-thyroid connection, when these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong. If this happens repeatedly, the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s.

4) Adrenal stress causes thyroid hormone resistance

In order for thyroid hormone circulating in blood to have a physiological effect, it must first activate receptors on cells. Inflammatory cytokines have been shown to suppress thyroid receptor site sensitivity.

If you’re familiar with insulin resistance, where the cells gradually lose their sensitivity to insulin, this is a similar pattern. It’s as if the thyroid hormone is knocking on the cell’s door, but the cells don’t answer.

While there’s no practical way to measure receptor site sensitivity in a clinical setting, the research above suggests it is decreased in autoimmune and other inflammatory conditions. A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication. In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.

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5) Adrenal stress causes hormonal imbalances

Cortisol is one of the hormones released by the adrenals during the stress response. Prolonged cortisol elevations, caused by chronic stress, decrease the liver’s ability to clear excess estrogens from the blood. Excess estrogen increases levels of thyroid binding globulin (TBG), the proteins that thyroid hormone is attached to as it’s transported through the body.

When thyroid hormone is bound to TBG, it is inactive. It must be cleaved from TBG to become “free-fraction” before it can activate cellular receptors. (These free-fraction thyroid hormones are represented on lab tests as “free T4 [FT4]” and “free T3 [FT3]”.)

When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low T3 uptake and low free T4/T3.

Aside from adrenal stress, the most common causes of elevated TBG secondary to excess estrogen are birth control pills and estrogen replacement (i.e. Premarin).

Balancing the adrenals

Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else. These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.

When they exist, these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful. With that in mind, here are some general guidelines for adrenal health:

  • Avoid or at least greatly minimize stimulants
  • Stabilize blood sugar (via a moderate or low-carb diet)
  • Practice stress management and relaxation techniques
  • Have fun, laugh and make pleasure a regular part of your life
  • Avoid dietary causes of inflammation (refined flours, high-fructose corn syrup and industrial seed oils in particular)
  • Ensure adequate intake of DHA & EPA

Specific nutrients such as phosphatidyl serine and adaptogenic botanicals like Panax ginseng, Siberian ginseng, Ashwagandha and Holy basil leaf extract are also helpful in modulating the stress response and supporting the adrenals. However, these are potent medicines and should be taken under the supervision of a trained practitioner.

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Join the conversation

    • DIM doesn’t because of the way it’s made but excessive intake of cruciferous vegetables do.

      Having coffee wtih your thyroid medication affects it moreso.

  1. I was taking synthroid for many year… over 10. Over the last year my stress level has dropped (external) and I have been taking adrenal support supplement… many of them have similar combination of ingredients. This year I was noticing what I saw as hypER thyroid symptoms including anxiety and eye bulging. I decided to drop the synthroid for a short time and see if the symptoms decreased of over dosing synthroid.

    I felt almost immediate relief and continued improvement so I stayed off of synthroid and allowed my body to adjust. About 90 days later my thyroid numbers were normal so I have not been put on any (I assumed a lower dose but none was needed.)

    I fully support the link between adrenals and the rest of the body and will continue to supplement adrenals and do whatever I can to lessen taking on the stress of other people’s lives. (My boyfriend of 6 years..off and on because of alcoholism… passed away 10 months ago. Codependency of the relationship and others in my life were draining me. I have a chance of learning from my mistakes in the outer world and focus more attention on the inner world calm and adrenal support.

  2. My husband is going through a terrible thyroid crisis. He has been on NDT for three years and starting 6 months ago he his sleep quality has fallen apart. He has experienced body shakes and anxiety. The doctors though he might have gone hyper and told him to stop all thyroid medication. His situation has gotten much worse and severe depression is not part of the mix. His numbers indicate hypo but his symptoms are hyper. He has had low cortisol numbers in past testing. Does anyone have experience with low cortisol being the culprit. A small amount of thyroid will cause him to shake uncontrollably and he hasn’t been able to sleep more than an hour or two a night. We’re desperate.

    • Have you had an improvement? I have had similar symptoms.
      I had no anxiety before begin diagnosed hypo. I was prescribed 25, then 50, then 75 synthroid. Anxiety started at 25. At 75 I had full blown panic attacks and could not sleep. I am back at 50 and taking every natural anti-anxiety supplement that I can find (Chamomile tea – 4 cups a day seems to help a lot). But has your husband made any progress?

  3. Hi, I’ve had hypothyroidism for 26 years and always required high doses of Synthyroid to stabilize my thyroid lab levels. However I have experienced excessive amounts of continuous stress the past 4 years. I am currently taking 250mcg of Synthyroid my TSH is still above 10.5 it should be less than ? I believe 3.2 for high normal range. I’ve had extreme fatigue (to being dx: chronic fatigue syndrome) I’ve had excessive weight gain and not as a result of snacking or over eating. Is it possible to be having Adrenal issues and over production of cortisol that would cause such excessively high doses of Synthyroid medication? I’m also being treated for depression on a higher dose of medication than normal, the psychiatrist feels my body isn’t metabolizing effectively.

  4. When I was diagnosed with hypothyrodism, I used to have high TSH, and low T3. Now I am on levothyroxine 88mcg and laboratory tests are normal but I still feel lazy and have pain in ankles, morning stiffness and week memory. I also have NAFLD. Could I be suffering from Adrenal fatigue as well?

  5. Hi.im daignosed with hypothyrid . Tsh 20 t3 t4 level in range no semptoms.. im sure that the cause of low thyroid function is over stress level..i started treatment with 75 mg .i will get blood test 30 days later. Im wondering that if i decrease stress level .my thyroid function back to normal range ? Thanks your respond.

  6. I have chronic anemia that is treated with iron infusions. can the infusions which include steroids during the infusion to prevent reaction make hpa axis dysfunction worse?

  7. My total t3 decreased by one third over the course of a year to where it is slightly under normal range, .85. But my free t3 increased over the year by 10%. I do not understand how total t3 could drop so much and have more free t3 in m system. Thoughts?

  8. I just want to say this…. ‘Adrenal Stress End’ by Enzymatic! I do not work for them and I am not affiliated in any way. I have Hashimoto’s Disease. My husband has Adrenal fatigue. We both started taking this. He started feeling great and is losing weight! I am seeing the pain go away in my neck, sleep better and losing weight. I am not going to tell you my entire back story of how I was diagnosed or all of the hell I went through with my health. If you have this disease you’ll know. Between taking Armour Thyroid which is natural and taking the Adrenal Stress end, I am finally starting to feel like the happy and energetic person I once was. my husband felt the Adrenal Stress End kick in literally over night. The first morning after he said his stomach felt so much flatter and he felt so happy at work. Telling you…. this stuff is great!

    • Which company makes the Adrenal Stress End that you take? I have found 3. I’d like to try what you were taking.


    • Danie, I have been on thsi roller coaster as well. I was just wondering how you balance the adrenal support with taking the T3 meds. I currently take T3 three times a day, last dose about 5 hours before bed. I am not sure whether to replace one of those doses with the adrenal support or add it to them. My issues all started when I was on high doses of T3 to combat Rev T3 that was blocking all my receptors. That is when the adrenal fatigue issues started. Thanks for your input. Beth

      • Hi Beth! May I ask if you were trying the Wilson’s temperature protocol with the T3?

    • I have Benin sick with adrenal fatigue for over 30 years. Talk about hell. Omg I have gone from dr to dr and still fell terrible I take armor thyroid holy basil and tons of supplements so you feel that this one supplement does it

  9. All it takes is for you to spend just one hour in direct sunlight every day for you to bring down Cholesterol and Hypothyroidism.Apparently , the cholesterol in the skin is broken down to Vitamin-D3.Hope you see the direction I am pointing. 🙂

  10. I’ve been researching Hashimoto’s because I refuse to take the prescribed medication. I’m treating it herbally and feel that it’s got very little to do with the actual thyroid gland itself! I want to reduce the inflammation and down regulate the autoimmune response. The body produces antithyroidal antibodies which prevent the manufacture of sufficient levels of thyroid hormones. They can also bind to the adrenal glands.. When this happens do the adrenals pump out more cortisol which inhibits TSH production, increases kidney iodine excretion & inhibits 5’deiodinase which converts T4 to T3???

    Well that has very little to do with the thyroid.. It’s the poor thyroid that suffers as a result yes

    Thanks for the thyroxine doc that my body can’t convert into active T3. Treat me like a dummy. I’m educated. Shame


    • You hit the nail on the head Xiao. Acupuncture, Paleo diet, life style changes, herbs and supplements and working with a good practitioner THAT is the answer. You are correct it’s not a thyroid issue is it an auto immune issue caused by inflammation. Most people just want a pill so they don’t have to make changes, that’s the shame of it all.

    • AND his work isn’t very scientifical:

      ‘ Adrenal stress weakens these barriers, ‘

      Click on the link in the text and it’ll bring you to a study that does not even talk about intestinal barriers.
      very disappointing.

  11. Timely article for me. It explains what my labs showed…I gave up coffee in October, at that time my TSH was 5.0. Just tested it a week ago and it’s 1.5. 🙂

  12. I appreciate the great article on adrenal fatigue and its relationship with the reduced thyroid production. I’d like to add one key fact to the discussion of adrenal fatigue: it can be caused by the dysbiosis in the gut lowering body immunity to the extent that a viral infection (such as a flu cold) can become chronic (as in Chronic Fatigue Syndrome, CFS) and in my case, my adrenals became extremely overextended and the cellular output of cortisol and other hormones were so depressed that, after I took massive doses of probiotics and improved my immunit to recover from CFS, I had developed adrenal fatigue that tested via a saliva test very low. Now I’ve been healing my adrenals for several years and, although they’re still not well, I’m slowly improving by avoiding stress and caffeine as well as taking supplements. it’s been a really difficult thing to heal and I’m so grateful for all the information in this article! Thank you, Chris!

    • Hi Kathryn,

      I am a 29 year old female from Belgium and I experience the same symptoms as you. I have severe gut dysbiosis and probably leaky gut. I am very tired all the time, no energy, I cannot work, pms, estrogen dominance, cold hands and feet etc.
      I have a chronic epstein barr virus, lyme and bartonella due to a very weak body immunity.

      Which probiotics did help you? What do you take to strenghten the adrenals?

      Many thanks for your feedback,

      I am desperate…I already saw A LOT of doctors and lost A LOT of money 🙁

      Kind regards,


      • Hey Inge, have they tested your antibodies? I’m going to see De Meirleir in Brussels. Since you live in Belgium maybe you could visit him too. I tried everything too and nothing beats my fatigue and brain fog.


      • I just started (about a month) on Spring Valley Probiotic with Multi-Ezyme Digestive Formula with Active Acidophilus Cultures Dietary Supplement, 3/day & it’s really helped alot!!

      • Have you all been tested for Celiac Disease? I was diagnosed 20 years ago and recently diagnosed with Hashimoto’s Disease. Your symptoms sound very familiar!

    • My husband keeps saying I need to get over it, in reference to adrenal fatigue and low thyroid function. I’ve been healing my adrenal glands for almost 6 years. Although I try to prepare for perceived stressful situations, I am not always successful – let alone the unexpected stress. It’s 3 steps forward and 1 backward. I was under the care of a wonderful doctor, but then we moved to an area that is not as progressive and it took 4 years to find a knowledgeable practitioner. There is no quick fix for the adrenal glands.

      • I’m the same way Maria. My spouse doesn’t believe in any of my health issues ..which I have had for 20 years. Hope you have a support system somewhere:).

    • Hi Kathryn,

      I am a 29 year old female from Belgium and I experience the same symptoms as you. I also have severe gut dysbiosis and probably leaky gut. I am very tired/exhausted most of the time, low energy, pms, estrogen dominance, cold hands and feet etc etc. I can’t go to work. I am also on antidepressants (unfortunately), because I feel so depressed. Whenever I try to stop them, I feel awful and cry all the time, ready to end my life…so I saw no other option then to restart.

      I am desperate because I already saw A LOT of doctors and lost A LOT of money without feeling any better.
      Which probiotics were helpful for you? What kind of supplements do you take to strenghten the adrenals?

      In the article Chris mentions the importance of omega 3. As I suffer from a lot of intolerances as well, mostly histamine intolerance, I was wondering if I could take fish oil?

      Many thanks for a reaction!

      Kind regards

      • I’m from nl and have quite a few of the same symptoms as you do but in a way less degree…are you sure you have no candida or something? A lot of symptoms seem to be similar…anyways I recently found someone’s blog with many very helpful articles related to which you might be able to relate:

        • Thank you for the link to the website!

          I already have been treated for candida with MMS. I took this for 2 weeks, but my symptoms remain. It is due to a chronic epstein barr virus and lyme, bartonella. Plus gut dysbiosis.

          • Hi,
            Best natural remedy I have found is milk kefir. As it is full of good bacteria It is excellent way in balancing out your gut microflora. You can read more benefits about the milk kefir online. I bought grains from amazon.
            Good luck,

    • Kathryn,
      What kinds of supplements are you taking? How do you know the condition of your adrenals?

      I’d appreciate your reply. Thanks in advance.


    • its not your adrenals there probably is still another underlying cause and that is why you havent healed

    • What article are you talking about. I would love to be able to read. I am only getting worse in everything and with this the depression is getting really bad and I’m afraid. I have no one left. No family, no friends and my daughters live elsewhere and I don’t think they realize how much worse everything is getting. I’m looking for an inpatient program because I’m afraid I’m going to give up. If you have any good articles to read or hints that are helping you I would be so grateful. If you know of any good inpatient programs I also would appreciate it. I am so happy to hear that you are finally getting relief. I will pray for you that you go into a full remission. Thank you for the comment. Warmly, Leigh

      • Look into Nutritional Balancing with Dr. Lawrence Wilson. It’s amazing, but it takes a really long time to get out of these kinds of issues. The causes are: nutritional deficiencies, toxicity, chronic infections, autoimmunity, inflammation.

  13. Chris,
    I have been trying to address thyroid hormone resistance. My labs are normal but I am hypothyroid with severe symptoms and myxedema. I am able to tolerate very high doses of T3(315 mcg or more) without hyper symptoms. My symptoms began after a severe emotional trauma. How do I address this?

    • Address the trauma by seeing a traumatologist. Treat the underlying cause and not the symptom. No medication in the world will ever take the trauma away, however processing it, will reset your autonomic nervous system, which will lead to improved thyroid function.

  14. Hi Chris, I’ve had all the symptoms you mention here, and have treated them successfully with supplements. However, my adrenals still take highs and lows because I’ve been discovering about this information little by little, and it takes a long time to recover. Because of this I have been unable to work for about six years. I need a written statement to show to the Navy and SSA to apply for disability. My original issue was an anthrax shot, fatigue, weight loss, adrenal stress, infection, a high amount of antibiotics for it, candida, leaky gut, and all the vast things that come after it. I have a recent Cortisol/DHEA/Siga saliva lab test from Geneva labs corroborating this, plus I have thyroid issues which I think have given me low serotonin and depression, which I cured with 5htp. Do you think I can get your medical diagnostic by providing my medical, supplementation, and lab history to you, so that I can save money, as I live in Mexico because of this and can’t afford to pay much, and also, doctors here cannot understand about it yet. Thank you for your kind advice.

    • Hi All,
      I’ve had low Thyroid function for 20 years – tiredness, weight gain, foggy brain and a myriad of other problems. Recently Menopause and Mega Migraines. I have found a great Doctor who instantly put me on T3 (which no other Doctor I saw wanted to know about) and also put me on Pregnenalone (a natural supplement for hormones) and Folinic Acid tabs for my Seratonin levels and VitD-3 as I had none in my system.
      I now feel fantastic……….no more tiredness, foggy brain, aches & pains, NO MORE MIGRAINES. I was 80/90 % better within 4 Months.
      Thanks for reading

  15. Chris, my TSH level was 4.86 when checked two weeks ago. Eighteen months ago, it was only 2.5. I have been under a fair amount of stress, and tend to turn psychological stress into physical stress. I was also physically rundown before the blood test. Assuming the rise in my TSH level was at least in part caused by physical stress, if I get my stress under control and learn to stay more relaxed, can my TSH level go down, or have I perhaps harmed my thyroid gland irreparably? I’d appreciate your advice.

    • Tom …did u figure this out ..my tsh was about the same..I think I did it with caffeine and heavy gym workouts…re testing in January…?

    • Well, I have been bedridden from exhaustion, fatigue, hot flashes, all the above….I’m 59 and peri-menopausal…..don’t really know what that means. I feel as though there is something more serious going on with me…3 yrs….thryoid tests all read normal. Joke finally went to ER and they did a T3 T4 reading and TSH. My THS was 18.00 ! Been on Armour Thryoid for years 3gr….taking supplements, drinking herbal teas….mostly eating clean….any advice ?

      • What is your ferritin level? If you are iron anemic you cannot convert T4 to T3. TSH is way too high at 18. Make sure doctor checks for ferritin level as many don’t know any better and give only an iron test. If ferritin is low you need iron supplementation. The best form of iron btw is dessicated liver tablets.

        Another possibility is that you aren’t absorbing Armour very well. Armour was recently sold out to a different manufacturer and they have changed several ingredients.