Adrenal insufficiency and Hypothyroidism, interlinked.

Anyone who has seen ballroom dancing would notice how well they are choreographed, one person leading the other into an endless motion of grace. Your body works in this same synchronistic fashion, a dance that leads from step to step. When one step is misplaced the motion that was once graceful and elegant becomes horsey and clumsy into a free fall. Same thing happens to your hormones, a cascade effect from one hormone creates health, but when one is out of step with another it lead to long-term health issues. Issues that you may think are associated with one organ when really it's dependency of function is from all hormones. 

Same goes for the thyroid hormone and adrenal stress or insufficiency. The adrenals are little organs that sit atop your kidneys. They introduce the "fight or flight" or what we experience today, chronic cortisol release, that leads to a host of health related issues: including hypothyroidism, diabetes type II, cancer, heart disease.... the list goes on.

To understand the correlation between the thyroid and adrenals here's a study from 2006 that states that thyroid hormone replacement therapy is unwarranted if adrenal insufficiency is in action. Oddly enough I don't see enough of this correlation in treatment with the patients I see, they are automatically put on a thyroid hormone, based on test thyroid hormone results, without looking at the whole endocrine function and where it misplaced it's step. 
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Reversible subclinical hypothyroidism in the presence of adrenal insufficiency.

Abdullatif HD1, Ashraf AP.

To describe 3 different scenarios of reversible hypothyroidism in young patients with adrenal insufficiency.

We present 3 case reports of patients with adrenal insufficiency--one with delayed puberty, the second with type 1 diabetes and poor weight gain, and the third with hypoglycemia-related seizures and glucocorticoid deficiency--who had biochemical evidence of hypothyroidism.

Our first patient (case 1) initially had a mildly elevated thyrotropin (thyroid-stimulating hormone or TSH) level and a normal free thyroxine (FT4) level that, on follow-up assessment, had progressed to persistent mild elevation of TSH and low FT4 concentration. The other 2 patients (cases 2 and 3) had low FT4 and mildly elevated TSH values at the time of diagnosis of adrenal insufficiency. In all 3 patients, the results of thyroid function tests normalized with use of physiologic doses of adrenal hormone replacement therapy, without thyroid hormone replacement. All 3 patients remained euthyroid after 4, 3, and 1 year of follow-up, respectively.

These observations add insights into the complexities of the thyroadrenal interactions. These examples are important because thyroid hormone replacement in the setting of adrenal insufficiency could be unwarranted.

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When it comes to hormones, it's all about the big picture, this is where modern medicine falls down, hard on a cement floor. They look to solve the issue not deal with the underlying problem, solve the symptoms does not solve the problem it masks it, adding pills can create a host of other issues and side effects that lead to more pills and more side effects. 

For those that are on hormone therapy I would get your panel tested again WITH additional cortisol levels so that you can accurately see where the endocrine cascade has gone awry. 

For those who would like a little more holistic at the dinner table. Here's some good and not so great foods that you can intake to help with your hypothyroidism. I don't agree with adding more dairy but more Vitamin D supplements and foods, would be better option.

9 Foods to Avoid With Hypothyroidism

Foods to Avoid

Hypothyroidism can be a tricky condition to manage, and what you eat can interfere with your treatment. Some nutrients heavily influence the function of the thyroid gland, and certain foods can inhibit your body's ability to absorb the replacement hormones you may take as part of your thyroid treatment. There's no such thing as a "hypothyroidism diet" that will make you well, but eating smart can help you feel better despite the condition. Here are nine foods to limit or avoid as you manage hypothyroidism:

Soy

The hormone estrogen can interfere with your body's ability to use thyroid hormone, says Stephanie Lee, MD, PhD associate chief of endocrinology, nutrition, and diabetes at Boston Medical Center and an associate professor at the Boston University School of Medicine. Soy is loaded with plant-based phytoestrogen, and some researchers believe too much soy may increase a person's risk for hypothyroidism. People with hypothyroidism should moderate their intake of soy. However, because soy hasn't been definitively linked to hypothyroidism, there are no specific dietary guidelines.

Cruciferous Vegetables

Cruciferous vegetables, such as broccoli and cabbage, can interfere with the production of thyroid hormone, particularly people who have an iodine deficiency. Digesting these vegetables can block the thyroid's ability to absorb iodine, which is essential for normal thyroid function. People with hypothyroidism may want to limit their intake of broccoli, Brussels sprouts, cabbage, cauliflower, kale, turnips, and bok choy. Cooking the vegetables can reduce the effect that cruciferous vegetables have on the thyroid gland. Limiting your intake to 5 ounces a day appears to have no adverse effect on thyroid function.

Gluten

People with hypothyroidism may want to consider minimizing their intake of gluten, a protein found in foods processed from wheat, barley, rye, and other grains, says Ruth Frechman, RDN, a dietitian and nutritionist in the Los Angeles area and a spokesperson for the Academy of Nutrition and Dietetics. Gluten can irritate the small intestine and may hamper absorption of thyroid hormone replacement medication.

However, if you do choose to eat gluten, be sure to choose whole-grains varieties of bread, pasta, and rice, which are high in fiber and other nutrients and can help improve bowel irregularity, a common symptom of hypothyroidism. Also be sure to take your hypothyroidism medication several hours before or after eating high-fiber foods to prevent them from interfering with the absorption of your synthetic thyroid hormone.

Fatty Foods

Fats have been found to disrupt the body's ability to absorb thyroid hormone replacement medicines, Dr. Lee says. Fats may also interfere with the thyroid's ability to produce hormone as well. Some health care professionals recommend that you cut out all fried foods and reduce your intake of fats from sources such as butter, mayonnaise, margarine, and fatty cuts of meat.

Sugary Foods

Hypothyroidism can cause the body's metabolism to slow down, Frechman says. That means it's easy to put on pounds if you aren't careful. "You want to avoid the foods with excess amounts of sugar because it's a lot of calories with no nutrients," she says. It's best to reduce the amount of sugar you eat or try to eliminate it completely from your diet.

Processed Foods

"Processed foods tend to have a lot of sodium, and people with hypothyroidism should avoid sodium," Frechman says. Having an underactive thyroid increases a person's risk for high blood pressure, and too much sodium further increases this risk. Read the Nutrition Facts label on the packaging of processed foods to find options lowest in sodium. People with an increased risk for high blood pressure should restrict their sodium intake to 1,500 milligrams a day, according to the U.S. Centers for Disease Control and Prevention.

Excess Fiber

Getting enough fiber is good for you, but too much can complicate your hypothyroidism treatment. Guidelines currently recommend that older adults take in 20 to 35 grams of fiber a day. Amounts of dietary fiber from whole grains, vegetables, fruits, beans, and legumes that go above that level affect your digestive system and can interfere with absorption of thyroid hormone replacement drugs. If you're on a high-fiber diet, ask your doctor if you need a higher dose of thyroid medication. Your maintenance dose may need to be increased if you aren't absorbing enough medication.

Coffee

Caffeine has been found to block absorption of thyroid hormone replacement, Lee says. "People who were taking their thyroid medication with their morning coffee had uncontrollable thyroid levels, and we couldn't figure it out," she says. "I now have to be very careful to tell people, 'Only take your medication with water.'" You should wait at least 30 minutes after taking your medication before having a cup of joe.

Alcohol

Alcohol consumption can wreak havoc on both thyroid hormone levels in the body and the ability of the thyroid to produce hormone. Alcohol appears to have a toxic effect on the thyroid gland and suppresses the ability of the body to use thyroid hormone. Ideally, people with hypothyroidism should cut out alcohol completely or drink in careful moderation.

7 Hypothyroidism-Friendly Foods to Add to Your Diet

Eat Right to Support Thyroid Function

When you have hypothyroidism, or an underactive thyroid, symptoms can include fatigue, depression, constipation, and other more serious health concerns. Fortunately, eating certain foods can help boost the effectiveness of your thyroid — a little butterfly-shaped gland in your neck with a big role in how well your body works.

The thyroid produces hormones that regulate mood, metabolism, energy levels, body temperature, heart rate, and blood pressure. Hypothyroidism occurs when this gland isn't producing enough hormones. Along with taking your thyroid medication, you can bolster thyroid function with a well-balanced diet that includes lots of produce and protein, among other healthy foods, says Gregory B. Dodell, MD, an endocrinologist in New York City. The next time you're at the grocery store, look for these seven nutrient-rich foods.

Fish

The omega-3 fatty acids found in fatty fish such as wild salmon, trout, tuna, or sardines make this food an excellent choice for lunch or dinner, says Virginia Turner, MS, RD, LDN, clinical nutrition manager at The University of Tennessee Medical Center in Knoxville. Unmanaged hypothyroidism can increase the risk for heart disease as a result of higher levels of low-density lipoprotein (LDL), the "bad" cholesterol. "Omega-3s are known to decrease inflammation, help with immunity, and lower the risk for heart disease," she adds. Fish is also a good source of the nutrient selenium, which is most concentrated in the thyroid. Selenium also helps decrease inflammation.

Nuts

Another great source of selenium, nuts make a handy snack that you can take anywhere. They also go well in salads or stir-fries. Brazil nuts, macadamia nuts, and hazelnuts are all particularly high in selenium, which helps the thyroid function properly. With Brazil nuts, you only need to eat one or two; with other nuts, a small handful is enough to get your daily nutrients — and be sure to keep an eye on portion size, as nuts are also very high fat.

Whole Grains

Constipation is a common symptom of hypothyroidism. Whole-grain foods such as cereal, bread, pasta, and rice are high in nutrients in addition to fiber, which can help with bowel regularity. However, fiber can interfere with synthetic thyroid hormones, cautions Turner. Some people with hypothyroidism choose to avoid whole-grains altogether, but if you do choose to eat them, "the recommendation is to take your thyroid medication several hours before or after eating foods rich in dietary fiber," she says.

Fresh Fruits and Vegetables

An early symptom of hypothyroidism is weight gain. Low-calorie, high-density foods such as fresh produce are the cornerstone of every successful weight loss program. Include either fresh fruits or veggies at each meal, if possible. Specific foods such as blueberries, cherries, sweet potatoes, and green peppers are also rich in antioxidants, nutrients that are known to lower risk for heart disease.

However, people with hypothyroidism may want to limit their intake of cruciferous vegetables, such as broccoli and cabbage, to 5 ounces a day, as they can block the thyroid's ability to absorb iodine, which is essential for normal thyroid function.

Seaweed

Seaweed has a high concentration of iodine, an essential nutrient for thyroid function. "Iodine is the precursor for the production of thyroid hormone," Dr. Dodell explains. Seaweed, packaged as nori, wakame, and dulse, can be used in sushi, soups, and salads. Another plus: Seaweed offers nutritional benefits of fiber, calcium, and vitamins A, B, C, E, and K.

It is possible to have too much iodine, which can worsen thyroid disease, Dodell cautions. However, according to the American Thyroid Association the likelihood of this is greater if you're taking supplements that contain iodine. Be sure to talk with your physician before increasing your iodine intake.

Dairy

There is an association between vitamin D deficiency and Hashimoto's disease, the most common cause of hypothyroidism, according to a study in the issue of August 2011 issue of the journal "Thyroid". Fortified milk not only has added vitamin D, but also significant amounts of calcium, protein, and iodine. Because Hashimoto's may also lead to changes that contribute to gut issues like heartburn, foods such as yogurt with good bacteria may help regulate other bacteria, Dodell says.

Beans

An inexpensive and versatile food, beans are a great source for sustained energy, which can be helpful if hypothyroidism leaves you feeling drained. Beans contain protein, antioxidants, complex carbohydrates, and loads of vitamins and minerals. They are also high in fiber, which can be beneficial if you suffer with constipation, a common side effect of hypothyroidism. If you're new to beans, there are many varieties to try, all of which can be used as the base for entrées, as side dishes, and to enhance soups, salads, and stews. Just be sure not to overdo it — guidelines recommend that adults get 20 to 35 grams of fiber each day, but excess fiber can interfere with your hypothyroidism treatment.