Hypothyroid vs. Adrenal Fatigue: Know the Signs and Symptoms

Dr. Shawn Greenan, DACM, CFMP®
Hypothyroid vs. Adrenal Fatigue: Know the Signs and Symptoms

It’s 2021, and most of us are running on stress, caffeine, and minimal sleep. As a result, insomnia, anxiety, fatigue, and poor digestion seem to have become the new normal.

If you’ve seen these symptoms in your clinic and didn’t immediately think of thyroid or adrenal dysfunction, don’t worry! You are not alone. Many practitioners do not specialize in hormones and can easily overlook these common medical red flags. The goal of this article is to help you understand the difference between hypothyroid and adrenal fatigue symptoms so you will feel more empowered to test, treat, or refer out as needed.

Let’s start with the basics so you can get a clear understanding of the overlap in symptoms.

Common Signs and Symptoms of Hypothyroid vs. Adrenal Fatigue

As you can see, the signs and symptoms can be misinterpreted depending on patient’s ability to communicate exactly how they feel. This article will help you better understand what to look for, with a brief breakdown of the hormones and glands involved, and what type of test you could use to assist with narrowing down your diagnosis.

Thyroid Gland

The thyroid is a small, butterfly-shaped gland that drapes across the front of your windpipe. It releases thyroid hormone, which controls the growth and metabolism of essentially every part of your body.


Hypothyroidism is a result of the thyroid gland failing to produce enough hormones. This may be due to several factors, including low iodine levels, autoimmune disease, over-response to hyperthyroidism treatment, medications, pituitary disorder, and sometimes pregnancy. (1)

Common Hypothyroidism Signs and Symptoms

1. Feeling Tired: Thyroid hormone is like a gas pedal for energy and metabolism. Low thyroid hormone levels leave you feeling drained.

2. Weight Gain: Hypothyroidism signals the body to eat more, store calories, and burn fewer calories. This combination leads to weight gain.

3. Feeling Cold: Low thyroid hormone slows down your body’s normal heat production, leaving you cold.

4. Sleep disruption: Thyroid hormones are involved in many bodily processes and can cause fatigue during the day and sleep disturbances at night. Some studies suggest that low thyroid hormone affects deep sleep, which may also contribute to daytime fatigue. (2)

Other signs and symptoms to look out for include hair loss, body aches, irregular menstruation, poor concentration, depression, dry skin, and constipation.

Testing Thyroid Levels

Usually, traditional doctors will only test for TSH, but TSH is only one hormone that makes up the thyroid function.

A routine FM thyroid panel usually consists of TSH, free T3, free T4, and thyroid antibodies to show how well the thyroid hormone is being converted to its active form and how it uses the thyroid hormone at the cellular level to drive metabolism.

Gluten intolerance, food allergies, heavy metals, and deficiencies of; vitamin D, vitamin A, selenium, zinc, and omega-3 fats could also lead to thyroid dysfunction. Testing for these is another option to add on, but we will discuss that in another article. (3)

Adrenal Glands

Your adrenal glands sit on top of your kidneys and produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress, and other essential functions.

Adrenal Fatigue

It’s important to note that Adrenal Fatigue isn’t a recognized medical diagnosis, but it is a popular term in Integrative and Functional Medicine. Some doctors refer to Adrenal Fatigue as “Adrenal Dysfunction”, “Adrenal Exhaustion”, or “HPA Axis Dysfunction.” For now, the diagnosis name isn’t as important as recognizing the symptoms so you can accurately test your patients. Adrenal fatigue is thought to occur when the adrenals have become overtaxed by excess cortisol release and can no longer produce levels of cortisol necessary for optimal body function.

Common Adrenal Fatigue Signs and Symptoms

1. Feeling Wired and Tired: Adrenal Fatigue patients commonly wake up feeling exhausted and depend on caffeine to keep them awake throughout the day. Their energy levels tend to crash in the afternoon, but they often get a “second wind” before bed and find they can’t wind down or sleep soundly, perpetuating the cycle. (4)

2. Weight Gain: Cortisol levels rise during times of stress to assist with fight or flight functions. If you have chronic stress or irregular sleep schedules, your adrenals can take a beating and overproduce cortisol. Over time, high levels of continuous cortisol have been shown to increase belly fat and appetite. (5)

3. Temperature fluctuations: Imbalance adrenal hormones can cause a fluctuation of body temperature during times of stress and relaxation. (6)

4: Sleep disturbances: Cortisol is produced by the adrenals and is a key player in adrenal fatigue. It helps regulate sleep patterns and helps the body cope with everyday stress. Normal cortisol levels rise during the early morning hours and are highest at about 7 a.m. They should drop very low in the evening and during the early phase of sleep. But if you are in a constant state of stress or on a disrupted sleep schedule, your adrenals can produce too much cortisol causing disturbances in sleep patterns.  (7)

Testing Adrenals

Most functional medicine practitioners will measure cortisol levels throughout the day. Saliva and dried urine labs are the most common test, and they allow patients to test from the comfort of their homes. Some practitioners will also test for DHEA, another hormone produced by the adrenals.

Putting It All Together

Ok, if you’ve made it this far, I’m proud of you! You wanted to learn something new, and you stuck with it!  You now have the basic signs and symptom to look for and now it's time to test. Luckily for all of us Rupa Health offers many Thyroid and Adrenal Panels to choose from. The sky really is the limit. But we don’t want to leave you stressed and overwhelmed, so here are some basic guidelines to look for when selecting a test.


Look for a full comprehensive panel on Thyroid Testing that includes TSH, free T3, and free T4 with possible Reverse T3 and thyroid antibodies. If they add in anything else, that’s fantastic too!


Look for a panel that tests cortisol levels throughout the day. Remember, your cortisol levels are supposed to be highest in the a.m. and lower in the evening. Testing over the day will give you a good look at how your patient’s body responds to stress.

Our Top 3 Most Popular Thyroid Test Ordered on Rupa Health

Vibrant America Thyroid Panel

Access Medical Laboratories Thyroid Panel Comprehensive Profile

ZRT Comprehensive Thyroid Profile

Our Top 3 Most Popular Adrenal Tests Ordered on Rupa Health

Dutch CAR

Genova ASP with CAR

ZRT Adrenal Stress Profile

That’s it! Not so scary now, huh? The most important thing to remember is you don’t have to be a specialist in everything. Know the basic signs and symptoms and run some tests. Most lab companies we partner with offer free consults to go over the results with you, and at that point, you have the power to treat with what you know or refer out. You aren’t in this journey alone, and we hope that we can help you become more comfortable running functional medicine labs!  

Have a question about any labs? Feel free to reach out to our AMAZING onboarding managers! They are a wealth of knowledge and always happy to help!

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(1) https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284

(2) https://www.sleepfoundation.org/physical-health/thyroid-issues-and-sleep

(3) https://www.thyroid.org/thyroid-function-tests/

(4) https://pubmed.ncbi.nlm.nih.gov/11070333/

(5) https://pubmed.ncbi.nlm.nih.gov/15211363/

(6) https://health.clevelandclinic.org/what-happens-to-your-body-during-the-fight-or-flight-response/

(7) https://pubmed.ncbi.nlm.nih.gov/25905298/

Dr. Shawn Greenan, DACM, CFMP®
Acupuncture Physician Certified Functional Medicine Practitioner®
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