There are multiple proposed mechanisms linking the higher occurrence of tinnitus to hypothyroidism however no definitive cause has been found. Hormone disruption leading to blood pressure and electrolyte transportation issues have been proposed, along with overall vitamin and mineral deficiencies, all of which could be directly related to the hypothyroid itself.

Another direct cause of thyroid imbalance is HPA dysfunction, when the endocrine system, consisting of the hypothalamus, pituitary, and adrenal glands, loses its proper rhythmic chemical signaling. This affects the entire hormone signaling system in the body leading to many symptomatic provoking consequences.

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CC: Tinnitus, Weight Gain, Hair Loss, Fatigue, Heavy & Irregular Menstrual Cycles  

Lauren was a 30-year-old female who presented with classical hypothyroid symptoms of weight gain, hair loss, and fatigue following 2 years of extremely high stress in her life. On presentation, additional symptoms were discovered, like her chronic nightly tinnitus that resulted in her habitual use of Ambien so she could sleep through the noise. She was getting 6-7 hours of sleep but waking exhausted, relying on 3-4 cups of coffee or espresso before 8 am. She worked as a chiropractor and had recently opened up her own practice, which was struggling due to the COVID pandemic. This resulted in stress to the point that she sought out therapy as she was beginning to experience dissociative states due to her high anxiety level.

Her symptoms started about one year before her first visit. About six months after the symptoms began, she changed her diet pretty radically to almost an entirely paleo diet and noticed that her persistent bloating and loose stools cleared up within a month. Her hair loss and fatigue had not improved, and she was continuing to gain weight despite her diet consisting of fruits, vegetables, lean meats, some fermented dairy, and nuts and seeds. Her menstrual cycle had been irregular since stopping birth control five years prior. Within the last two years, her cycle was only occurring every 3-5 months and she was experiencing very heavy menstrual bleeding anywhere from 18 to 20 days at a time.

Initial Lab Work

Dried Urinary Hormones Panel Results

Estradiol and Progesterone as well as their metabolites: low/below optimal range

Testosterone: within normal limits

Total DHEA production, 24hr Free Cortisol and Metabolized Cortisol: low

Lab Analysis

Lauren's labs indicate many factors related to her symptoms. Her thyroid panel indicated a non-autoimmune case of hypothyroid seen with her elevated TSH, low Free T3 and T4, and negative thyroid antibodies, ANA, and inflammatory markers like hsCRP.

We see a few factors relating to HPA dysfunction driving cortisol imbalance with her low total cortisol and DHEA levels and an elevated reverse T3, an unusable form of thyroid hormone that can be produced in response to persistently elevated cortisol. Her urinary panel also aligned with her blood results of low total cortisol and DHEA, and it confirmed the suspected low estrogen and progesterone. This low hormone output resulted in her irregular and heavy menstrual cycles, contributing to her overall low iron and ferritin levels, which can further exacerbate both tinnitus and fatigue.  

In addition to her low iron, Lauren was low in almost all the nutrients evaluated, including vitamin D, zinc, vitamin B12, and folate. Many of these are essential to thyroid function. Knowing Lauren was eating a standard processed American diet six months ago, her system was likely nutrient deficient for a long time. Nutrient deficiencies drive hypothyroidism due to the many vitamins and minerals needed for proper thyroid, adrenal, and HPA communication.

Interventions

Lauren was encouraged to continue with her paleo diet, and appropriate portions of macronutrients per her body weight were reviewed. Mindful eating was also discussed to ensure she was digesting and absorbing the highly fibrous diet she had adopted in the last six months.

A quality multivitamin with additional mitochondria support in the form of NAC, ALA, malic acid, NADH, and CoQ10, was recommended to support her main energy production pathway. The multivitamin dosage was doubled to ensure optimal nutrient intake for the thyroid and adrenal glands. Vitamin D3 plus K2 was recommended at 8,000 IU daily until labs were redrawn ten weeks later.

Adrenal glands were supported with a bovine glandular adrenal complex that contained additional herbs to help support healthy cortisol output, like holy basil, rhodiola, and maca, which also has additional direct estrogen and progesterone stimulating effects.

A porcine thyroid glandular supplement was also recommended that additionally contained trace minerals and antioxidant enzyme support necessary for optimal thyroid function.

Therapy was recommended to be continued, as were gentle morning walks, bike rides, swimming, yoga, or pilates, ideally in the sunlight, while avoiding intense physical activity that would spike cortisol levels.

Additional factors for spiking cortisol were discussed: eating three meals a day with no snacking between, avoiding coffee and caffeine, and keeping stressful friends/family/situations out of her life while she's healing.

Lauren was referred to a hematologist with the recommendation of a blood transfusion to elevate her total iron and ferritin level quickly.

Follow-Up 10 Weeks Later

Labs showed some improvement, most notably of nutrient-related categories and thyroid function with TSH lowering to almost a normal lab value range, and free T3 and T4 back into a normal range. Lauren was feeling better, with a 20% increase in her overall energy. Her anxiety had calmed down to a manageable level. But, her tinnitus had only reduced by about 10%, although it was only occurring 5/7 nights a week rather than every night. She was still taking Ambien 3-5 nights a week.

We discussed how adrenal support and restoration work could take anywhere from 6-12 months, depending on how dedicated she was to the treatment and removing the sources of stress from her life. So, we agreed to stick with the supplementation regimen and have a follow-up for labs in 3 months.

Follow-Up 3.5 Months Later

At the six-month follow up, Lauren was very pleased with her results and to see all her lab values return to normal, healthy ranges. She said around seven weeks after starting the supplements, she woke up one day feeling great, and her tinnitus has not returned since. Her daily energy had remarkably improved, and she was sleeping through the night without any sleep aid medications. She had noticed a reduction in hair loss and was starting to see some new growth around the crown of her head.

Around two months into treatment, her menstrual cycle began shortening to every two months. Then around four months, it shortened further to occur every 32 days, and she was having a normal bleeding duration of 5 days with no significant PMS symptoms. She had brought some occasional gluten and dairy back into her diet with no adverse gastrointestinal symptoms.

At this point, we reduced all her supplements to 3 times a week to provide ongoing support with the hopes of following up after 12 full months of supplementation before retesting and hopefully removing all supplemental support.

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Summary

After a very stressful few pandemic years for the world, we are now seeing the long-term effects of cortisol/HPA dysfunction resulting from long-term adrenal/cortisol overdrive daily in our patients. From direct thyroid disease and its life-altering symptoms like tinnitus to hormone imbalance, sleep disturbances, autoimmune disease, gastrointestinal dysfunction, and cancer, assessing the full hypo-pituitary-adrenal axis and its associated nutrient factors are needed to help support our patients and prevent irreversible damage.