Adrenal Fatigue Sub-clinical Hypothyroid Compounding Docs

Adrenal

The adrenal glands are two triangular shaped glands located above the kidneys. The adrenals secrete hormones that are essential to life such as cortisol, aldosterone, estrogen, and testosterone.

  • Cortisol – Helps regulate metabolism by controlling the body's use of fats, proteins, and carbohydrates; in addition, cortisol suppresses inflammatory reactions in the body and has effects on the immune system.
  • Aldosterone – Mainly controls blood pressure by regulating the levels of sodium and potassium in the body; many blood pressure medications work to regulate this hormone.
  • Sex Hormones – Sex hormones secreted in the adrenals are converted elsewhere in the body to female hormones (estrogens) and male hormones (androgens). Throughout one's life, the ovaries (estrogen) in women and testes (androgens) in men produce the majority of sex hormones. After mid-life, the adrenal glands gradually become the major endogenous source of sex hormones in both men and women.

Intense or prolonged physical or emotional stress commonly associated with modern lifestyles or illness can alter the balance of adrenal hormones and lead to fatigue. Fatigue can also be a symptom of many diseases such as anemia, arthritis, diabetes, heart failure and thyroid dysfunction. When fatigue is chronic and debilitating Chronic Fatigue Syndrome and or Fibromyalgia may be suspected. It is important that patients experiencing long-standing fatigue consult their primary care provider or seek the advice of an endocrinologist. Eating a well-balanced diet including plenty of fruits, vegetables, and lean meats; avoiding junk food; getting enough sleep; and exercising regularly will help reduce fatigue. If you or your healthcare provider suspect Chronic Fatigue Syndrome and or Fibromyalgia, the below features should be present for a proper diagnosis.

Chronic Fatigue Syndrome

  • Primary symptom is fatigue
  • Definite onset of symptoms
  • Fatigue is severe, disabling, and affects physical and mental functioning
  • Symptoms for at least 6 months and present more than 50% of the time
  • Other symptoms must be present, particularly muscle pain, and mood and sleep disturbances
  • Certain patients should be excluded:
    • Those with an established medical condition known to produce chronic fatigue
    • Those with a current diagnosis of schizophrenia, manic-depressive illness, substance abuse, eating disorder, or proven organic brain disease

(adapted from Yancey 2012)

Fibromyalgia

  • Characteristic features
    • Chronic widespread pain for at least 3 months
    • Tender points in 11 of 18 specific anatomic locations
  • Associated features
    • Anxiety Cognitive difficulties
    • Fatigue
    • Headache
    • Burning, tingling, or prickling skin
    • Sleep disturbance

(adapted from Chakrabarty 2007)

Thyroid

Thyroid hormone helps the body convert food into energy and heat, regulates body temperature, and impacts many hormonal systems in the body. Thyroid hormone exists in two major forms: Thyroxine (T4), an inactive form that is produced by the thyroid gland and converted to T3 in other areas of the body, and Triiodothyronine (T3), the active form. The role of thyroid hormone and consideration of its impact on multiple body systems is emerging as a critical component of balanced hormone therapy for men and women.

Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

Identifying patients with clinical and subclinical hypothyroidism requires proper screening. The American Thyroid Association (ATA) recommends routine screening beginning at age 35 and then every 5 years. The American Association of Clinical Endocrinologists (AACE) recommends an aggressive case-finding approach with screening of several high-risk groups, including (Garber 2012, Baskin 2002):

  • Men and women > = 60 years old, as thyroid disease is prevalent in this population and such individuals are often asymptomatic or have minimal or atypical symptoms
  • Adults who are taking medication that may affect thyroid metabolism, including estrogen therapy, which can alter thyroid-binding globulin and thus the amount of thyroid hormone required

The treatment of thyroid dysfunction takes a knowledgeable provider as overall thyroid health requires long-term monitoring with dose adjustments in the thyroid regimen needed during one's lifetime. Specifically, thyroid requirements may change when a patient starts/changes/discontinues use of other medications, experiences changes in their diet, or during major life events. Contributing to proper thyroid balance, is a patient's blood levels of minerals such as Iodine, Selenium, and other important nutrients.

  • Iodine – The body requires iodine in order to make thyroid hormone. Diets both low and high in iodine are associated with hypothyroidism. Supplementing iodine may be an important step in treating a person's hypothyroidism. However, because excessive iodine intake can lead to problems, patients should be closely monitored and iodine levels managed by a trained healthcare provider.
  • Selenium – Second to iodine, selenium is likely the most important mineral needed for thyroid health. Selenium is required for the conversion from T4 to T3 in the body. In the absence of selenium, the activation of thyroid hormone does not occur. Selenium itself also protects the thyroid gland, further highlighting the need for careful monitoring and supplementation as needed.

Compounding Docs Pharmacy has extensive experience compounding and guiding care in patients with adrenal and thyroid dysfunction. We consult closely with you and your prescribing physician to tailor therapy to your individualized needs. Let us know how our professional staff can help you.

References:
Yancey JR, Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician 2012;86:741-6.
Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician 2007;76:247-54.
Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract 2012;18:988-1028
Baskin HJ, Cobin RH, Duick DS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002;8:457-469.
Visser TJ, Peeters RP. Metabolism of Thyroid Hormone. In: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, Koch C, McLachlan R, New M, Rebar R, Singer F, Vinik A, Weickert MO, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.2012 Dec 10.

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