The Shames Ladder for Successful Thyroid/Adrenal Care

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Very few conditions are as frustrating as a combined thyroid/adrenal challenge. Frequently, the adrenal insufficiency is undiagnosed. If you have been fortunate enough to be diagnosed and treated for thyroid problems, but this treatment hasn't been fully successful, there may be additional information you need in order to feel well.

The thyroid/adrenal issue was given one chapter in our previous book THYROID POWER.

Based on responses of patients and readers, our book Feeling Fat, Fuzzy or Frazzled gives equal weight to thyroid, adrenal, and sex hormone interrelations. We have found that this new approach has tremendous benefited people who had otherwise been struggling for years, despite regular thyroid care -- sometimes even very good thyroid care by top practitioners.

Whether thyroid treatment -- be it alternative, over-the-counter, or by prescription -- works properly is entirely dependent on your adrenal function. Many people with low thyroid -- standard hypothyroidism -- have the same immune difficulty with their adrenal gland as they do with the thyroid, an adrenal fatigue situation.

Most all low thyroid is due to Hashimoto's autoimmune thyroiditis. A frequent co-existent condition with thyroiditis is adrenalitis. It is generally mild enough to go undetected, yet serious enough to interfere with thyroid hormone's function in your tissues.

You might be dealing with a combined thyroid/adrenal problem if you are a thyroid sufferer and:

  • you have particularly low stamina for stress
  • you have excess mood responses after eating carbs (hypoglycemia)
  • you have particularly low blood pressure (momentary lightheadedness upon standing up)
  • you have chronic allergies
  • you are feeling "tired but wired"
  • you have your best energy when others are getting ready for bed
  • you have poor resistance to respiratory infections
  • you have cystic breasts
  • you have difficulty recuperating from extra exertion or jet lag

In fact, in our book we refer to this as the "emotional (adrenal-driven) endo-type", a low adrenal situation compounded by low thyroid.

The main way you can help your practitioner succeed with combined therapy of any sort is to realize that you need to alternate interventions (much like climbing a ladder, left foot, right foot alternating). This means starting with a very small amount of adrenal support first (natural, OTC, or prescription in very minute dosage). After that initial support for a week, there is frequently needed a slight boost in thyroid support for another week. Then, a small addition to the adrenal support for the next week; after that, a further small increase in thyroid support.

This dual upward titration approach (what our colleagues have called "The Shames Ladder") is often successful when other types of intervention have failed.

This is because a mixed thyroiditis/adrenalitis is a very sensitive situation. Each gland needs the other for support. You can't simply boost one without also boosting the other, and can't do it well by giving big doses of either at any one time. The glands need to gradually adapt to the new environment of expanded function.

Details of exactly how this dual therapy approach would best be accomplished are available in our books, websites, and through individual coaching sessions. The point we want to make here is that if you have been struggling to reach more optimal thyroid balance, this process has been amazingly gratifying to us and our patients. 

Richard Shames MD
Karilee Shames PhD, RN

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