Chronic Fatigue and the Proper Testing of Thyroid and Cortisol Function

Here's a summary of Dr. Nemechek's message regarding thyroid and cortisol testing in the context of chronic fatigue:

Thyroid Function Testing:
- Simplicity in Testing: Thyroid function can be effectively managed by monitoring TSH levels, except in rare cases involving pituitary disorders.
- Misinterpretation of Tests: Other thyroid function tests (like T3, T3 uptake, free T4) are often unnecessary. A normal TSH level typically indicates no need for thyroid hormone supplementation.
Treatment Missteps:
- Inappropriate Supplementation: Prescribing thyroid hormones based on non-TSH test results can lead to overtreatment, potentially causing hyperthyroidism and other health issues.
- Neglecting the Real Issue: Over-focusing on thyroid hormone levels can result in the true cause of fatigue being overlooked, particularly if TSH is within the normal range.
Cortisol Levels and "Adrenal Fatigue":
- Myth of Adrenal Fatigue: Dr. Nemechek refutes the notion of "adrenal fatigue" as inaccurate, stating that adrenal glands either suffice or fail entirely, leading to an adrenal crisis.
- Testing for Adrenal Function: The proper test for adrenal insufficiency is the ACTH stimulation test, which has become less accessible due to cost increases.
Investigating Other Causes:
- Beyond the Thyroid and Adrenal Glands: When thyroid and adrenal tests are normal, yet symptoms persist, the investigation should turn to the autonomic nervous system as a significant potential cause of chronic fatigue.
Seeking Further Medical Advice:
- Consultation Recommendation: If a patient’s TSH levels are normal but there’s still a push for thyroid hormone treatment, seeking a second opinion from an endocrinologist is advised to ensure proper diagnosis and treatment.

By summarizing Dr. Nemechek's protocol as such, the guidelines become more accessible and can serve as a clearer guide for those dealing with chronic fatigue and concerns about thyroid and cortisol functions.