Here's my two cents: - many mainstream doctors miss some cases of hypothyroidism because of doggedly clinging to blood tests and arbitrary "cutoff points" to the ranges - which change periodically! This over-reliance on tests and under-reliance on physical diagnosis, exam and history taking, shortchanges many patients.
- on adrenal fatigue - it's ridiculous how polarized this discussion becomes. Mainstream medicine behaves as if there's an on/off switch to the adrenal gland. Either it's in complete failure and you have Addison's, or you have over-production of cortisol and have Cushing's - and everyone in between is completely fine! This doesn't make any sense, of course, as there must be stages of mild adrenal failure that don't meet the criterion for Addison's, just as there are early stages of mild failure in other endocrine glands that are well-recognized.
So why don't we recognize mild adrenal dysfunction? Three reasons, really: - the lack of good blood tests. Cortisol levels swing up and down all day long, so it's true, a blood test can be pretty inaccurate. Even many cases of true Addison's or Cushing's can be hard to diagnose for this reason. Some alternative practitioners use saliva tests for cortisol, measuring them several times a day. The accuracy and usefulness of this test is debated by many, although it is used as a research tool in some big population studies.
- the lack of clear-cut symptoms. Since many of the symptoms of poor adrenal function are vague and can be caused by other diseases, it can be difficult to accurately diagnose adrenal dysfunction by symptoms. This is true even of Addison's disease - Addison's disease often suffer for years before being accurately diagnosed. A physician who is used to seeing patients with adrenal disorders may become accustomed to recognizing a certain pattern of symptoms, but may not be able to "back up" his diagnosis with an abnormal blood test result.
- fear of hydrocortisone. When hydrocortisone was first synthesized, it was a "wonder drug" that healed arthritis,etc. Then a few years later, terrible side effects developed because of the high doses that were used. That left a legacy of fear that keeps most physicians afraid of using small, physiologic doses of hydrocortisone. The Safe Uses of Cortisol is a book that addresses this controversial issue.
I see a lot of thyroid patients, and it is well-documented in the mainstream medical literature that one of the side-effects of hypothyroidism is poor adrenal function. Usually, this will resolve as the thyroid hormone is replaced, but sometimes you get stuck in a catch-22. The patient needs more thyroid hormone, but can't tolerate the increased metabolism because their adrenal function is poor. (It is well-documented in the literature that if you give thyroid hormone to an untreated Addison's patient you can precipitate a life-threatening Addisonian crisis.) In the situation of milder adrenal dysfunction in a hypothyroid patient, I often see very good results by giving some form of adrenal support. For some this might only mean vitamins that support adrenal function (like vitamin C and pantothenate). Some respond to an over-the-counter adrenal glandular supplement. Some actually need to take small doses of hydrocortisone.
As you can see, though, the dilemma lies in the difficulty of establishing an accurate diagnosis in any but the most severe cases of adrenal dysfunction. Hence the wide swings of opinion between mainstream medicine and alternative practitioners.
