Your HPA Axis, Hashimoto’s, and Hypothyroidism

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Your endocrine system is a complex network of glands and hormones that regulates many bodily functions. Among these, the hypothalamic-pituitary-adrenal (HPA) axis and the thyroid are pivotal in maintaining your metabolic balance and stress responses. When either malfunctions, it can have profound implications for your overall health. This article explores the HPA axis, Hashimoto’s thyroiditis, and hypothyroidism and how these conditions intersect and influence each other.

The hypothalamic-pituitary-adrenal (HPA) axis is a major part of your body’s stress response system. It involves your hypothalamus, pituitary gland, and adrenal glands. Here’s a brief overview of how it works:

• Hypothalamus: When your brain perceives stress, your hypothalamus releases corticotropin-releasing hormone (CRH).
• Pituitary gland: CRH stimulates your pituitary gland to secrete adrenocorticotropic hormone (ACTH).
• Adrenal glands: ACTH travels to your adrenal glands, prompting them to produce cortisol, the primary stress hormone.

The hypothalamus, pituitary gland, and adrenal glands work together to control the production of cortisol, making the HPA axis your central stress response system. The HPA axis regulates various body processes, including mood, immunity, digestion, and energy storage. 

When functioning properly, the HPA axis helps the body respond to stress and maintain homeostasis. However, chronic stress can lead to HPA axis dysfunction, which may have widespread effects on the body, including the thyroid gland.

Maintaining a healthy hypothalamic-pituitary-adrenal (HPA) axis is crucial for several reasons.

Stress response and homeostasis

The HPA axis is a significant component of your body’s stress response system. It helps maintain homeostasis by regulating the release of cortisol, the adrenal hormone that influences your metabolism, immune response, and autonomic nervous system. Proper cortisol regulation is essential, as both excessive and insufficient levels can lead to health issues. 

Developmental and long-term health 

The HPA axis begins developing early in life and is influenced by genetic, environmental, and life stress factors. Abnormal development or dysregulation of the HPA axis can lead to long-term health problems, including neuropsychological and physiological diseases.

Mental health 

Dysregulation of the HPA axis is associated with several mental health disorders, such as depression, anxiety, PTSD, and alcoholism. It is involved in the neurobiology and pathophysiology of these conditions, and managing HPA axis activity can be crucial for treatment and prevention.

Chronic disease and compromised immunity 

Chronic activation of the HPA axis due to prolonged stress can result in adverse health outcomes, including neurodegenerative diseases and compromised immune function. Understanding and managing your HPA axis’s response to stress is important to reduce these risks.

Overall, a healthy HPA axis is vital for managing stress, maintaining physiological balance, and reducing the risk of various stress-related disorders.

Hashimoto’s thyroiditis is an autoimmune disease characterized by the destruction of thyroid tissue by your body’s immune system. This condition is a leading cause of hypothyroidism. 

In Hashimoto’s thyroiditis, the immune system mistakenly targets your thyroid gland, leading to chronic inflammation and damage. Antibodies against thyroid peroxidase (TPO) are typically present and can be detected with thyroid blood tests.

As the thyroid gland becomes damaged, it loses the ability to produce thyroid hormone, eventually resulting in hypothyroidism.

The thyroid hormones – primarily thyroxine (T4) and triiodothyronine (T3) – regulate your metabolism, growth, and energy levels. When levels of T4 and T3 fall, hypothyroidism symptoms such as fatigue, weight gain, depression, hair loss, cold intolerance, and others can develop.

While autoimmune Hashimoto’s is the most common cause of hypothyroidism in the U.S., other causes of hypothyroidism include iodine deficiency, surgical removal of the thyroid gland, radiation therapy to the thyroid, medications, and congenital conditions present at birth. While less common, pituitary disorders that affect thyroid-stimulating hormone (TSH) production can also lead to hypothyroidism.

How the HPA axis and thyroid affect each other

The relationship between the HPA axis and your thyroid is bidirectional, meaning that each system can influence the other.

Impact of HPA axis dysfunction on the thyroid 

• TSH levels: A dysfunctional HPA axis also makes the TSH test unreliable. According to research, “TSH is only a valid measure of thyroid status if the hypothalamic-pituitary axis is intact.”
• Cortisol levels: Chronic stress and the resulting high cortisol levels can impair your thyroid function. Elevated cortisol can inhibit the conversion of T4 to the more active T3 form. This inhibition can lead to or worsen hypothyroidism. High cortisol levels can also affect your pituitary gland’s ability to produce TSH.
• Inflammation: Stress and HPA axis dysfunction can exacerbate inflammation and increase the production of inflammatory cytokines, which can further stimulate the immune system to attack the thyroid gland. This creates a vicious cycle where stress worsens autoimmune activity, leading to more significant thyroid dysfunction.

Impact of thyroid dysfunction on HPA axis function

• Thyroid hormones and stress response: Low thyroid hormone levels can affect your body’s stress response. Hypothyroidism can lead to increased cortisol secretion as the body attempts to compensate for reduced metabolic activity.
• Feedback mechanisms: Thyroid hormones play a role in regulating the HPA axis. Low levels of thyroid hormones can disrupt regular feedback loops, leading to further dysregulation of your HPA axis.

Diagnosing a thyroid condition involves blood tests for thyroid function (TSH, Free T4, Free T3) and autoimmune markers (TPO antibodies). 

Identifying chronic stress and assessing its impact on thyroid function and overall health is critical. One marker for chronic stress – especially in the context of suspected HPA axis dysfunction – is cortisol levels. Tools like 24-hour adrenal saliva cortisol tests or 24-hour urine tests can provide insight into cortisol levels and HPA axis activity.

Let’s take a look at the approaches you can take to support optimal health and balance of your HPA axis. 

Get appropriate medical treatment 

For hypothyroidism, thyroid hormone replacement therapy is the medical treatment. This helps normalize your thyroid hormone levels and alleviate symptoms of low thyroid hormone.

If you have Hashimoto’s thyroiditis, it’s also essential to manage autoimmunity and inflammation. This can involve a prescription medication like low-dose naltrexone (LDN), supplements like selenium, and a focus on an anti-inflammatory diet.

HPA axis dysfunction can sometimes be improved with adaptogenic supplements, DHEA, and other supplements to help support balanced cortisol levels. For significant HPA axis dysfunction, prescription hydrocortisone is sometimes recommended. 

A well-balanced diet is fundamental to supporting HPA axis function. Ensure your meals include fruits, vegetables, and whole grains to provide steady energy and help regulate blood sugar levels. You’ll also want to prioritize lean proteins like fish, poultry, legumes, and plant-based proteins that support hormone production. And don’t forget healthy omega-3 fatty acids from sources like fish, flaxseeds, and walnuts, as they play a central role in HPA axis function.

You’ll also want to ensure you get the key vitamins and minerals essential for optimal HPA axis and thyroid function. They include:

• Vitamin C: Found in citrus fruits, strawberries, and bell peppers, vitamin C helps support adrenal function.
• B vitamins: Whole grains, leafy greens, and lean meats support energy production and stress management.
• Magnesium: Dark chocolate, nuts, and seeds help regulate the stress response.
• Zinc: Oysters, beef, and pumpkin seeds support hormone production.

Supporting gut health is vital for HPA axis function, so be sure to consume fermented foods like yogurt, kefir, pickles, sauerkraut, kimchi, and kombucha daily to promote a healthy gut microbiome. You’ll also want to include prebiotic-rich foods such as garlic, onions, and asparagus to nourish beneficial gut bacteria.

Avoiding dietary triggers that may worsen your autoimmune response is also important. Following an approach like the autoimmune protocol (AIP) diet may be helpful. 

Manage stress 

Implementing effective stress reduction strategies is crucial for maintaining a healthy HPA axis. Techniques such as mindfulness or meditation can help reduce stress, regulate the stress response, and improve DHEA-S levels, a marker of adrenal health and HPA axis function. You may also find deep diaphragmatic breathing exercises helpful to activate your parasympathetic nervous system. Progressive muscle relaxation approaches – including yoga nidra – can help reduce stress-related physical tension.

Get quality sleep

Quality sleep is also essential for HPA axis regulation. Try to maintain a consistent sleep schedule, even on weekends. Create a relaxing bedtime routine to signal your body that it’s time to wind down. Limit exposure to blue light from electronic devices before bed. And practice good sleep hygiene, ensuring your sleeping environment is cool, dark, and quiet.

Stay physically active

Physical activity can help modulate your HPA axis. Some recommendations:

• Engage in moderate-intensity exercise for at least 150 minutes per week.
• Include a mix of cardio and strength training exercises.
• Practice yoga or tai chi for their stress-reducing benefits.

Take supplements 

Adaptogenic herbs can help your body adapt to stress and support HPA axis regulation. These include:

• Ashwagandha: Known for its ability to reduce cortisol levels and promote relaxation.
• Rhodiola: May help improve stress resilience and fight fatigue.
• Holy basil: Supports a healthy stress response and promotes mental clarity.

Nervine herbs support the nervous system and promote calm:

• Lemon balm: Has calming properties and may help reduce anxiety.
• Passionflower: Can promote relaxation and improve sleep quality.
• Chamomile: Known for its soothing effects on the nervous system.

Vitamins and mineral supplements may be beneficial in addition to a healthy diet. These supplements include: 

• Vitamin C: Consider supplementing if dietary intake is insufficient.
• B-complex vitamins: Support energy production and stress management.
• Omega-3 fatty acids: A high-quality fish oil supplement may be beneficial if fish consumption is low.
• Magnesium: Many people are deficient in this important mineral for stress management.

Stay hydrated 

Proper hydration is crucial for HPA axis function. Aim to drink at least eight glasses of water per day. Be sure to include electrolyte-rich foods and drinks like leafy greens, bananas, coconut water, and electrolyte drinks in your diet. You may also want to limit caffeine and alcohol, as they can disrupt hydration and HPA axis function.

Manage blood sugar levels

Stable blood sugar levels are essential for HPA axis health. To support healthy blood sugar balance: 

• Eat regular, balanced meals to avoid blood sugar spikes and crashes.
• Include protein and healthy fats with each meal to promote satiety and stable blood sugar.
• Limit refined sugars and processed foods, which can disrupt your blood sugar balance.

Minimize exposure to environmental stressors 

You’ll want to focus on minimizing your exposure to environmental stressors and toxins. For example: 

• Reduce exposure to environmental toxins by choosing organic, hormone-free foods when possible.
• Use natural cleaning products and personal care items to minimize chemical exposure.
• Create a calm and clutter-free living environment to reduce visual stress.

Get social support and prioritize emotional well-being

Nurturing your relationships and emotional health is crucial for HPA axis function. Make sure that you cultivate strong social connections and spend time with loved ones. Practicing gratitude and positive self-talk to promote emotional resilience is also helpful. Consider working with a therapist or counselor to address any underlying emotional issues.

Monitor your HPA axis 

Regular check-ins with your healthcare provider can help monitor your HPA axis function. Specifically, consider having regular testing to assess your cortisol and DHEA levels and track symptoms such as energy levels, sleep quality, and stress resilience.

The interplay between HPA axis dysfunction, Hashimoto’s thyroiditis, and hypothyroidism underscores the complexity of the endocrine system and its response to stress and autoimmune conditions. A comprehensive understanding of these interactions is essential for effective diagnosis and treatment. By addressing both thyroid function and HPA axis health, you can achieve better outcomes and improved quality of life. 

Paloma Health’s approach to hypothyroidism treatment recognizes the importance of supporting your HPA axis health as part of optimizing your thyroid. Our integrative approach – which incorporates thyroid treatment, nutrition, lifestyle changes, mind-body health, and stress management – helps you holistically manage your thyroid health and improve your well-being and quality of life. Find out more about how to become a Paloma member now.