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 related to the hypothyroid condition.
Another potential cause of thyroid imbalance is HPA dysfunction, when the endocrine system, consisting of the hypothalamus, pituitary, and adrenal glands, may not function optimally. This can affect the entire hormone signaling system in the body, leading to various symptoms.
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CC: Tinnitus, Weight Gain, Hair Loss, Fatigue, Heavy & Irregular Menstrual Cycles
Lauren was a 30-year-old female who experienced symptoms often associated with hypothyroid conditions, such as weight gain, hair loss, and fatigue, following two years of high stress. She also reported chronic nightly tinnitus, which led to her use of sleep aids. Despite getting 6-7 hours of sleep, she felt exhausted and relied on multiple cups of coffee or espresso before 8 am. She worked as a chiropractor and had recently opened her own practice, which was struggling due to the COVID pandemic, causing significant stress.
Her symptoms began about one year before her first visit. About six months after the symptoms started, she changed her diet to a mostly paleo diet and noticed improvements in bloating and stool consistency. However, her hair loss and fatigue had not improved, and she continued to gain weight despite a diet 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, occurring every 3-5 months with heavy bleeding lasting 18 to 20 days.
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 indicated several factors that may relate to her symptoms. Her thyroid panel suggested a non-autoimmune case of hypothyroid with elevated TSH, low Free T3 and T4, and negative thyroid antibodies, ANA, and inflammatory markers like hsCRP.
There were indications of HPA dysfunction potentially affecting cortisol balance, with low total cortisol and DHEA levels and an elevated reverse T3, which can be produced in response to stress. Her urinary panel also showed low total cortisol and DHEA, and confirmed low estrogen and progesterone levels. This low hormone output may have contributed to her irregular and heavy menstrual cycles, affecting her iron and ferritin levels, which can influence both tinnitus and fatigue.
In addition to low iron, Lauren was low in several nutrients, including vitamin D, zinc, vitamin B12, and folate, which are important for thyroid function. Given her previous diet, her system may have been nutrient deficient for some time. Nutrient deficiencies can impact 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 help with digestion and absorption of her diet.
A quality multivitamin with additional support for energy production, including NAC, ALA, malic acid, NADH, and CoQ10, was suggested to support her energy pathways. The multivitamin dosage was adjusted to help ensure adequate nutrient intake for thyroid and adrenal support. Vitamin D3 plus K2 was suggested at 8,000 IU daily until labs were reassessed ten weeks later.
Adrenal support was provided with a bovine glandular adrenal complex containing herbs like holy basil, rhodiola, and maca, which may help support healthy cortisol levels.
A porcine thyroid glandular supplement was also suggested, containing trace minerals and antioxidant enzyme support for thyroid health.
Therapy was recommended to continue, along with gentle activities like morning walks, bike rides, swimming, yoga, or pilates, ideally in sunlight, while avoiding intense physical activity that could increase cortisol levels.
Additional factors for managing cortisol were discussed: eating three meals a day without snacking, avoiding coffee and caffeine, and minimizing stress.
Lauren was referred to a hematologist to discuss options for addressing her iron and ferritin levels.
Follow-Up 10 Weeks Later
Labs showed some improvement, particularly in nutrient-related categories and thyroid function, with TSH lowering to near normal range, and free T3 and T4 returning to normal. Lauren reported feeling better, with a 20% increase in overall energy. Her anxiety had decreased to a manageable level. However, her tinnitus had only reduced by about 10%, occurring 5 out of 7 nights a week instead of every night. She continued to use sleep aids 3-5 nights a week.
We discussed that adrenal support and restoration could take 6-12 months, depending on her dedication to the treatment and stress management. We agreed to continue the supplementation regimen and follow up with labs in 3 months.
Follow-Up 3.5 Months Later
At the six-month follow-up, Lauren was pleased with her results, with all lab values returning to normal, healthy ranges. She reported feeling great, with no return of tinnitus. Her daily energy had improved significantly, and she was sleeping through the night without sleep aids. She noticed a reduction in hair loss and some new growth.
Around two months into treatment, her menstrual cycle began occurring every two months, then every 32 days, with normal bleeding duration and no significant PMS symptoms. She reintroduced some gluten and dairy into her diet without adverse symptoms.
At this point, we reduced her supplements to three times a week to provide ongoing support, with plans to follow up after 12 months of supplementation before considering reducing or stopping supplements.
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Summary
After a stressful few years, many are experiencing the effects of cortisol/HPA dysfunction. This can impact thyroid health and lead to symptoms like tinnitus, hormone imbalance, sleep disturbances, and more. Assessing the full hypo-pituitary-adrenal axis and associated nutrients can help support overall health and well-being.
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