Low cortisol levels can be very bad news for any thyroid patient hoping for an immediate recovery from hypothyroidism. There are some clues when hypocortisolism (low cortisol or low cortisol-effect) is present:

  • Low blood sugar, which may cause dizziness, feeling unwell or more frequent hunger.
  • Severe fatigue/tiredness.
  • Dizziness on standing up.
  • Fainting or passing out, particularly after standing up.
  • Poor response to thyroid hormone replacement therapy.
  • Anxiety.
  • Irritability.
  • Feeling cold/low body temperature.
  • Fluctuating body temperature during the day.
  • Heat intolerance or sweating.
  • Possibly having dark rings under the eyes.
  • Pale and 'washed out' skin colour.
  • Slight darkening of the skin.
  • Hair loss on body, legs.
  • Skin appears thinner.
  • Digestive upsets.
  • Nausea (especially when stressed).
  • Salt craving.
  • Trembling or shakiness.
  • Rapid heartbeat or pounding.
  • Difficulty sleeping.
  • Low blood pressure, which is even lower if the blood pressure is taken immediately after the patient stands up (postural hypotension).
  • Worsening symptoms in the presence of stress of any kind, including minor infections or colds.

Low levels of thyroid hormone can also cause several of the above symptoms. If someone has been hypothyroid for a considerable time before diagnosis and treatment, then it is possible that there will be low cortisol present.

Hypocortisiolism may be exposed during thyroid hormone treatment. Quite often the result of prolonged hypothyroidism is to not immediately have obvious low cortisol levels, because the general slow down of the metabolism may also have slowed down the rate at which cortisol is used up and cleared by the body. In this case, it is more likely that any hypocortisolism will be exposed, once thyroid hormone replacement commences.

For a patient with extremely low cortisol levels, when thyroid hormone is given and gradually increased a variety of reactions can occur - many of them not good!

However, it is important to note that in many cases when the right form of thyroid treatment is provided and it is managed carefully, then cortisol levels improve.

The adrenal glands produce more cortisol, DHEA, androstenedione and to a lesser extent aldosterone, through the stimulation of ACTH by the pituitary. It is reduced ACTH that is most frequently linked to hypocortisolism. It is hypothalamic-pituitary dysfunction that is often at the root of low cortisol issues. I discuss this at length in my books: 'The Thyroid Patient's Manual', 'The CT3M Handbook' and 'Recovering with T3

As soon as hypocortisolism is suspected the patient should seek the advice of a medical practitioner who has experience of dealing with thyroid hormone replacement in the presence of low cortisol.

However, some people with hypocortisolism may recover quite swiftly once the correct level of appropriate thyroid hormone replacement is in place.

Severe low cortisol may well need some form of intervention with medication. Note: for somone with suspected Addison's disease, no thyroid treatment should be commenced until an endocrinologist diagnoses and treats it.

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