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Cortisol — often called the “stress hormone” — is released by your adrenal glands and plays an important role in your body’s response to stress. In small, short bursts, it can help you stay sharp and energized. But when cortisol levels remain high for too long, it can wreak havoc on your health. That’s where cortisol blockers come in. These medications are designed to lower cortisol and are essential for treating conditions like Cushing’s syndrome. But what about using them for other reasons, like boosting muscle gains or shedding extra weight? And more importantly, are they safe if you’re living with a thyroid condition such as hypothyroidism or autoimmune Hashimoto’s disease? Let’s look at the risks and realities of using cortisol blockers outside of traditional treatment.

Cortisol is a steroid hormone produced and released by the adrenal glands, which sit on top of your kidneys. Cortisol has many vital functions in the body. 

Managing the stress response

Cortisol is often called the “stress hormone” because it plays a crucial role in your body’s response to stress. 

When you experience physical or emotional stress, cortisol is released as part of the “fight-or-flight” response. Going back to our primitive ancestors, cortisol has had a protective function. When we sensed a threat, like a predator, the hypothalamus in the brain signaled the adrenal glands to release cortisol, so blood and energy could shift to the organs necessary for saving our lives—primarily the heart, lungs, and muscles. Another hormone released in this process is adrenaline, which helps direct blood flow away from “non-critical” tissues like the gut, sending it instead to the heart.

This “fight or flight” system is still present in our modern human bodies and appears during various high-stress physical or emotional situations. When activated, it: 

• Increases glucose for energy
• Enhances brain function
• Suppresses non-essential functions (like digestion and reproduction)

Regulates metabolism

Cortisol helps control how your body uses fats, proteins, and carbohydrates. It increases blood sugar levels by promoting gluconeogenesis (the production of glucose from non-carbohydrate sources), providing quick energy in times of need.

Reduces inflammation

Cortisol has anti-inflammatory properties and helps regulate immune system responses. This is why synthetic steroid drugs – including prednisone, a synthetic form of cortisol – are used to treat inflammatory conditions.

Controls blood pressure

Cortisol helps maintain blood pressure by regulating the balance of salt and water and influencing how your blood vessels constrict.

Supports the sleep-wake cycle

Cortisol follows a daily rhythm, and it’s typically highest in the morning, to help you wake up,  and lowest at night, to allow rest, contributing to your circadian rhythm.

Many physical and other factors can affect your cortisol levels. 

Temperature: Extreme cold or heat can raise cortisol levels, as the body interprets temperature stress as a threat to homeostasis. Cortisol helps mobilize energy and regulate body temperature in response to environmental stress.

Shift work: Irregular work hours, especially night shifts, disrupt your body’s circadian rhythm, which regulates cortisol production. Normally, cortisol peaks in the early morning and declines at night. Shift work can invert or flatten this rhythm, leading to hormonal imbalances and fatigue.

Poor sleep or sleep deprivation:  Cortisol follows a daily rhythm linked to the sleep-wake cycle. Lack of quality sleep, especially REM and deep sleep, can lead to elevated nighttime cortisol levels, increased inflammation, and impaired glucose metabolism.

Exercise: Physical activity temporarily increases cortisol levels to mobilize energy and reduce inflammation. While moderate exercise can help regulate cortisol over time, excessive or intense training without adequate rest can lead to chronically elevated cortisol.

Diseases, infections, and trauma: Any physiological stressor—including injuries, infections, surgeries, autoimmune diseases, or chronic illness—triggers the release of cortisol as part of the body’s inflammatory and immune response.

Obesity: Increased fat, especially visceral (belly) fat, is associated with higher baseline cortisol levels. Adipose tissue also influences cortisol metabolism and sensitivity, contributing to a feedback loop of hormonal imbalance.

Certain medications: Steroids like prednisone mimic cortisol and suppress natural production via negative feedback. Birth control pills and hormonal contraceptives may also affect cortisol-binding globulin levels, increasing total cortisol in the bloodstream, though free (active) cortisol may remain unchanged.

Pregnancy: Cortisol levels naturally increase during pregnancy, especially in the third trimester, to support fetal development and prepare the mother’s body for labor. The placenta produces corticotropin-releasing hormone (CRH), which boosts cortisol production.

Alcohol, caffeine, and nicotine: Caffeine acutely raises cortisol, especially when consumed in large amounts or under stress. Nicotine can cause a spike in cortisol levels after exposure. Alcohol can also elevate cortisol temporarily, particularly with chronic use, contributing to sleep disturbances, mood issues, and blood sugar dysregulation.

Nutrient deficiencies: Deficiencies in magnesium, vitamin C, B vitamins, and omega-3 fatty acids can impair the body’s ability to regulate cortisol and recover from stress. These nutrients support adrenal health and modulate the hypothalamic-pituitary-adrenal (HPA) axis.

Chronic pain: Persistent pain signals activate the stress response, keeping cortisol levels elevated over time, which may further exacerbate pain sensitivity and inflammation.

Inflammation: Low-grade, chronic inflammation can stimulate the HPA axis, leading to persistent cortisol elevation. This is common in metabolic syndrome, autoimmune conditions, and aging.

Circadian rhythm disruptions:  Beyond shift work, disruptions caused by jet lag, blue light exposure at night, or inconsistent sleep patterns can all blunt or shift the natural cortisol curve.

Menstrual cycle and menopause: Fluctuations in estrogen and progesterone influence cortisol sensitivity and metabolism. Perimenopause and menopause can cause exaggerated cortisol responses to stress due to declining hormone levels.

Dehydration: Lack of adequate hydration is a physical stressor, increasing cortisol to help conserve water and maintain blood pressure.

Hypoglycemia (low blood sugar): When blood sugar drops, cortisol stimulates gluconeogenesis (sugar production in the liver). Frequent hypoglycemia can lead to elevated cortisol and strain the adrenal glands. 

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Hypercortisolism refers to a state of excess cortisol in the body, regardless of the underlying cause. It is essentially the clinical condition resulting from chronically elevated cortisol levels. 

Hypercortisolism, often associated with conditions like Cushing’s syndrome, can present with a wide range of physical and metabolic symptoms. One of the most common signs is weight gain, particularly in the abdominal area (central obesity). Patients may also develop a characteristic “moon face” and a “buffalo hump,” which refers to fat accumulation at the back of the neck and upper back.

Muscle weakness is another frequent complaint, along with thin, fragile skin that bruises easily. The presence of purple striae, or stretch marks—especially on the abdomen, thighs, and breasts—is another telltale sign. Hypercortisolism can also lead to elevated blood pressure and increased blood sugar levels, sometimes progressing to diabetes.

Bone health can be compromised, with osteoporosis being a common complication. Mood changes such as depression and irritability are also reported. In women, hormonal imbalances may cause irregular menstrual cycles or even amenorrhea (absence of menstruation), and both men and women may experience a reduced libido.

Diagnosing hypercortisolism typically involves a series of tests to confirm elevated cortisol levels and determine the underlying cause. Common diagnostic tests include a 24-hour urinary free cortisol measurement, which evaluates the amount of cortisol excreted during a day. The low-dose dexamethasone suppression test helps assess whether cortisol levels can be properly regulated by feedback mechanisms. Another useful tool is the late-night salivary cortisol test, which measures cortisol levels when they should normally be at their lowest. 

There are several conditions most associated with excess cortisol levels. 

Cushing’s syndrome

Cushing’s syndrome is the most well-known condition associated with hypercortisolism. It is a clinical disorder caused by prolonged exposure to elevated cortisol levels. The syndrome can be classified into two main categories: endogenous and exogenous Cushing’s syndrome.

Endogenous Cushing’s syndrome results from the body’s overproduction of cortisol, often due to an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma—a condition known as Cushing’s disease. Less frequently, it can be due to adrenal adenomas or carcinomas, which directly secrete cortisol, or ectopic ACTH production, typically from small cell lung carcinoma or other neuroendocrine tumors.

Exogenous Cushing’s syndrome, on the other hand, occurs due to prolonged or excessive use of glucocorticoid medications, such as prednisone or dexamethasone, prescribed to treat inflammatory or autoimmune conditions. These medications mimic the effects of cortisol and can suppress the hypothalamic-pituitary-adrenal (HPA) axis.

Adrenal tumors and hyperplasia

Adrenal adenomas and adrenal carcinomas can independently secrete cortisol, leading to ACTH-independent Cushing’s syndrome. In such cases, the feedback mechanism that regulates cortisol production becomes impaired, causing unregulated hormone release. Bilateral adrenal hyperplasia, a condition involving the overgrowth of adrenal tissue, can also result in cortisol excess, sometimes due to mutations in genes regulating hormone synthesis.

Ectopic ACTH syndrome

Ectopic ACTH syndrome involves non-pituitary tumors that secrete ACTH autonomously, stimulating the adrenal glands to produce cortisol. Commonly associated with small cell lung carcinoma, carcinoid tumors, and medullary thyroid carcinoma, this condition can present rapidly and with severe symptoms of cortisol excess. The severity and abrupt onset often distinguish it from pituitary-driven Cushing’s disease.

Iatrogenic (medication-induced) hypercortisolism

Long-term use of corticosteroids is one of the most common causes of hypercortisolism, particularly in patients with autoimmune diseases, asthma, or post-transplant immunosuppression. Though medically necessary in many cases, these drugs can cause the same systemic effects as endogenous cortisol excess. The risk increases with dose and duration of therapy. Tapering corticosteroids gradually is essential to prevent adrenal insufficiency and minimize complications from HPA axis suppression.

Elevated cortisol levels that aren’t due to a specific disease like Cushing’s syndrome are often called non-pathological hypercortisolism. This functional imbalance is typically the result of chronic stress or disruption in the body’s natural stress-response system, rather than a tumor or genetic disorder.

There are many common triggers for this cortisol imbalance. Chronic emotional stress from work pressures, relationship challenges, or trauma is a major contributor. Disrupted sleep patterns or irregular circadian rhythms can also interfere with normal cortisol regulation. Physical factors like overtraining or chronic inflammation, along with lifestyle habits such as excessive caffeine intake or nutrient deficiencies (particularly of B vitamins, vitamin C, and magnesium), can further exacerbate cortisol dysregulation. Additionally, blood sugar imbalances can create a cycle that keeps cortisol elevated.

People experiencing a cortisol imbalance may notice symptoms such as difficulty falling asleep or waking frequently during the night, feeling tired yet restless or “wired,” increased anxiety or irritability, and cravings for sugary or salty foods. Other common signs include weight gain around the abdomen, brain fog, reduced libido, weakened immune function, and, in women, irregular menstrual cycles. These symptoms reflect the wide-ranging impact of cortisol on different body systems.

Testing for cortisol imbalance often involves measuring cortisol levels at multiple points throughout the day to assess diurnal patterns rather than looking for extreme elevations. This is usually evaluated using saliva cortisol testing several times during the day. 

Note: It’s important to distinguish this type of cortisol imbalance from Cushing’s syndrome, where elevated cortisol is due to tumors or steroid use. In contrast, cortisol elevation from chronic stress is typically more moderate and reflects the body’s adaptive response, which becomes maladaptive when prolonged. When the body perceives constant psychological, physical, inflammatory, or metabolic stress, it can lead to sustained, elevated cortisol levels. This is not considered a disease in itself, but it can disrupt many body systems over time.

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If left unaddressed, chronic elevation of cortisol can lead to more serious health consequences over time. 

Metabolic effects are some of the most common signs of elevated cortisol. One of the most visible is weight gain, particularly around the abdomen, face (creating a characteristic “moon face”), and upper back (often called a “buffalo hump”). This is frequently accompanied by muscle wasting and weakness, especially in the limbs, due to protein breakdown. The condition also contributes to insulin resistance, which may progress to type 2 diabetes, and often causes elevated cholesterol and triglyceride levels. 

Skin and hair are also affected. People with hypercortisolism tend to have thin, fragile skin that bruises easily and may develop purple stretch marks (striae), acne, and excess facial or body hair (hirsutism), particularly in women. Wound healing is typically delayed.

The immune system is affected by cortisol, with increased susceptibility to bacterial, viral, and fungal infections. Cardiovascular complications are also common, including high blood pressure and a heightened risk of atherosclerosis and heart disease. Mental health is significantly impacted, with many individuals experiencing depression, anxiety, irritability, cognitive issues, and sleep disturbances such as insomnia.

In terms of reproductive health, women may experience irregular or absent menstrual cycles, while men may develop erectile dysfunction and decreased libido. Fertility can be impaired in both sexes. 

High cortisol can also lead to osteoporosis, making bones more fragile and prone to fractures, along with back pain or rib fractures, and muscle weakness that may make everyday tasks like climbing stairs difficult.

Some individuals may also experience eye problems such as increased intraocular pressure or glaucoma, and potentially cataracts. Appearance changes, such as a red, puffy face and central obesity, are common and often distressing to patients.

‍Hypercortisolism has a profound and often detrimental effect on thyroid function. Chronic elevation of cortisol, whatever the cause, can impair multiple aspects of thyroid hormone production, conversion, and signaling. This dysregulation has significant implications for people with hypothyroidism and autoimmune thyroid conditions like Hashimoto’s thyroiditis.

Hypercortisolism and the hypothalamic-pituitary-thyroid (HPT) axis

Cortisol negatively affects the HPT axis, which is responsible for regulating thyroid hormone production:

• Inhibition of TRH and TSH: Elevated cortisol levels suppress the release of thyrotropin-releasing hormone (TRH) from the hypothalamus and thyroid-stimulating hormone (TSH) from the pituitary gland. This leads to reduced stimulation of the thyroid gland, decreasing production of thyroid hormones thyroxine (T4) and triiodothyronine (T3).
• Blunted TSH response: In chronic stress or hypercortisolism, TSH levels may be inappropriately normal or low despite hypothyroid symptoms, potentially leading to underdiagnosis or delayed diagnosis of thyroid dysfunction.

Impaired conversion of T4 to T3

Cortisol interferes with the conversion of T4 (the inactive thyroid hormone) to T3 (the active thyroid hormone) in peripheral tissues:

• Increased reverse T3 (rT3): High cortisol promotes the conversion of T4 into reverse T3, an inactive metabolite that competes with T3 for receptor binding, effectively contributing to “functional hypothyroidism.”
• Reduced tissue availability of active thyroid hormone: This alteration in peripheral metabolism diminishes the availability of active T3 at the cellular level, leading to hypothyroid symptoms despite normal blood levels of T4 or TSH.

Impact on thyroid hormone receptors and cellular sensitivity

Cortisol also affects the body’s ability to use thyroid hormones:

• Thyroid hormone resistance: Chronic cortisol elevation may reduce the sensitivity or expression of thyroid hormone receptors, decreasing cellular responsiveness to T3.
• Downregulation of gene expression: Cortisol may inhibit the transcription of genes stimulated by thyroid hormone, further blunting thyroid hormone action at the cellular level.

Hypercortisolism and Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is an autoimmune disease characterized by chronic lymphocytic infiltration of the thyroid and the production of antithyroid antibodies, including thyroid peroxidase (TPO) antibodies. Cortisol has complex effects on the immune system: 

• Short-term immunosuppression: Acutely elevated cortisol can suppress immune activity and might temporarily dampen autoimmune responses. This is why corticosteroids are sometimes used to manage thyroiditis flares or associated pain.
• Long-term immune dysregulation: Chronic stress and elevated cortisol can dysregulate the immune system, potentially contributing to the development or exacerbation of autoimmune diseases like Hashimoto’s. Cortisol-induced changes in cytokine profiles (e.g., increased IL-6, TNF-alpha) and disruption of regulatory T-cell function may promote a shift toward autoimmunity.
• Th1/Th2 balance: Hypercortisolism often shifts immune balance toward a Th2-dominant response. While Hashimoto’s is traditionally Th1-dominant, chronic stress and cortisol dysregulation may create a more unstable immune environment, perpetuating or worsening autoimmune thyroid damage.

Hypercortisolism and primary hypothyroidism

For people with primary hypothyroidism (i.e., underactive thyroid due to intrinsic thyroid dysfunction), hypercortisolism worsens the condition through multiple pathways:

• Delayed diagnosis or mismanagement: Because cortisol suppresses TSH, patients may have “normal” TSH values despite having symptoms of hypothyroidism. This can delay appropriate treatment or result in undertreatment.
• Reduced effectiveness of thyroid hormone therapy: Elevated cortisol can interfere with both thyroid hormone conversion and receptor sensitivity, making standard doses of levothyroxine or combination therapy (T4/T3) less effective.
• Contribution to symptoms: Cortisol dysregulation may mimic or worsen symptoms of hypothyroidism, including fatigue, brain fog, weight gain, depression, and low libido, complicating the clinical picture.

Cortisol-blocking medications, also known as glucocorticoid receptor antagonists or cortisol synthesis inhibitors, are drugs designed to reduce the effects of excess cortisol in the body. 

Prescription medications

There are two main types of cortisol-blocking medications.

Cortisol synthesis inhibitors prevent the adrenal glands from producing cortisol. Cortisol synthesis inhibitor drugs include: 

• Ketoconazole: Originally an antifungal, ketoconazole can block cortisol production at high doses. It’s often used off-label for Cushing’s syndrome.
• Metyrapone (Metopirone): Directly inhibits cortisol synthesis. Often used in diagnostic testing but also therapeutically in Cushing’s disease.
• Osilodrostat (Isturisa): A newer drug approved for Cushing’s disease that blocks 11β-hydroxylase, an enzyme essential for cortisol production.
• Etomidate: Used in emergency settings to rapidly reduce cortisol levels (often in intensive care), but not practical for long-term treatment.

Glucocorticoid receptor antagonists block cortisol’s action at its receptor rather than reducing its production.

• Mifepristone (Korlym): Known for its use in terminating early pregnancy at different doses, but also approved to treat Cushing’s syndrome in people with type 2 diabetes or glucose intolerance by blocking cortisol from binding to its receptor.

Cortisol-blockers are typically prescribed in patients who have Cushing’s syndrome, and rarely, in some instances of adrenal cancer. They are sometimes prescribed off-label for patients with psychiatric conditions like depression. 

Prescription cortisol blockers are sometimes used off-label—that is, for purposes not officially approved by regulatory agencies like the FDA. People also experiment with them for other reasons. Here are common off-label uses:

Weight loss and belly fat reduction: High cortisol is linked to abdominal fat accumulation and metabolic disruption. That’s why some people take cortisol-blockers to flatten belly fat or overcome “stress weight.”  However, according to Katherine Zeratsky, R.D., L.D., with the Mayo Clinic, there is no concrete evidence that cortisol blockers help with weight loss or are helpful in strength training. The FDA and Federal Trade Commission have even fined some dietary supplement companies that make cortisol blockers because they falsely claimed to provide rapid and permanent weight loss. 

Anxiety and stress relief: Because cortisol plays a significant role in the body’s stress response, some people believe that blocking it might reduce symptoms of anxiety or emotional overreactivity. 

Insomnia: Elevated nighttime cortisol can interfere with melatonin and disrupt sleep cycles. People sometimes use cortisol-lowering agents at night to help sleep onset and improve sleep quality.

Bodybuilding and athletic recovery: Cortisol breaks down muscle tissue and inhibits recovery. Some bodybuilders and athletes use it to prevent muscle breakdown and maximize growth hormone action.

Adrenal fatigue or HPA axis dysfunction: While controversial, some integrative/functional medicine practitioners treat “adrenal fatigue” with cortisol-lowering therapies when they suspect cortisol is chronically elevated.

Over-the-counter (OTC) medications and supplements to block cortisol

In the U.S., there are no OTC medications that block cortisol in the same way that prescription drugs can. However, supplements marketed as “cortisol blockers” or “adaptogens” may help modulate or reduce cortisol levels indirectly through stress response regulation. They don’t block cortisol outright, but may help reduce excess cortisol output due to chronic stress. They include: 

Vitamin C:  Research indicates that vitamin C (ascorbic acid) supplementation can lower cortisol levels, particularly in situations of chronic or acute stress. Both human and animal studies support this effect, though the strength of the evidence and the magnitude of the impact can vary depending on the context and dosage.

Phosphatidylserine: May reduce cortisol levels in response to acute stress. Some studies show it can blunt cortisol after intense exercise or psychological stress.

Ashwagandha: An adaptogen that may lower perceived stress and reduce cortisol levels. Clinical trials show cortisol drops of ~20–30% with use.

Rhodiola rosea: An adaptogen that may help normalize cortisol and improve energy/resilience. Some trials show reduced stress and fatigue, though cortisol data are mixed.

Magnolia bark: Thought to reduce anxiety and modulate cortisol via the GABA pathway. Some human studies show reductions in cortisol and stress-related eating.

Holy basil (Tulsi): An adaptogenic herb that may help lower cortisol and support mood. Limited human data, but traditional use and some small trials support the effects.

L-Theanine: An amino acid from green tea that promotes relaxation without sedation. There’s some evidence that it may reduce stress-induced cortisol spikes.

The off-label use of prescription cortisol-blocking medications, such as mifepristone, ketoconazole, and etomidate, carries significant risks and must be approached with extreme caution. These drugs were developed for specific medical conditions, and using them outside of those intended contexts, especially without close medical supervision, can lead to serious health consequences.

Mifepristone, for example, is FDA-approved and works by blocking cortisol receptors rather than reducing cortisol levels themselves. However, if not carefully dosed, it can lead to adrenal insufficiency—a dangerous condition in which the body can’t produce enough cortisol in response to stress. Symptoms may include extreme fatigue, low blood pressure, and even life-threatening adrenal crisis.

Ketoconazole, primarily an antifungal medication, also inhibits cortisol synthesis. While effective in lowering cortisol, it is associated with potentially severe liver toxicity. Routine liver function tests are required when using this medication, and in some cases, liver damage may be irreversible. Similarly, other cortisol blockers like etomidate and metyrapone come with their own risks, such as electrolyte imbalances and sedation, and must be used in a tightly controlled setting.

Side effects of these medications often include fatigue, nausea, dizziness, and symptoms associated with cortisol suppression. When these drugs are overused or not properly titrated, they can cause adrenal insufficiency—a state of chronically low cortisol that may require emergency treatment. Because of the complexity and potential dangers, anyone using cortisol blockers must be under the care of a qualified healthcare provider, with frequent monitoring of adrenal function and hormone levels to avoid complications.

Overall, while cortisol-blocking medications can play a role in managing conditions of cortisol excess, their off-label use presents significant health risks. Misuse or overuse can lead to serious side effects, organ damage, or life-threatening hormonal imbalances. Careful oversight and medical expertise are essential to ensure safety and effectiveness.

Cortisol blockers have complex and sometimes unintended effects in people with hypothyroidism and/or Hashimoto’s thyroiditis, because of the close interplay between the hypothalamic-pituitary-adrenal (HPA) axis and the thyroid axis.

Potential benefits 

In someone who is in a diagnosed state of hypercortisolism, there are some potential benefits of blocking cortisol. 

Lowering excess cortisol may improve thyroid function: Chronically high cortisol suppresses TSH and deactivates T3. Reducing elevated cortisol might improve thyroid hormone levels and relieve symptoms like fatigue, weight gain, and brain fog.

Lowering excess cortisol may help modulate the immune system: Elevated cortisol can suppress or dysregulate immune function. Balancing cortisol may help modulate autoimmune activity in Hashimoto’s, though the evidence here is preliminary.

Potential risks and cautions

Adrenal insufficiency risk: Blocking cortisol in someone whose adrenal function is already impaired or borderline (common in chronic illness or Hashimoto’s) may worsen fatigue, hypotension, or dizziness. Some people with Hashimoto’s may already be in a “low cortisol” state due to HPA axis dysfunction. Blocking cortisol further can be harmful.

Impaired stress response: Normal cortisol levels are essential for managing inflammation and stress. Over-suppressing cortisol might increase inflammatory markers or autoimmune flares in some instances.

Thyroid medication interactions: Some cortisol blockers (especially pharmaceuticals) can interfere with liver enzymes and potentially change the metabolism of thyroid hormone replacement medications.

Managing cortisol levels is an important but complex aspect of treating hypothyroidism and Hashimoto’s thyroiditis. Cortisol, the body’s primary stress hormone, is key in energy regulation, immune function, and inflammation. However, its relationship with thyroid health is nuanced, and using cortisol-lowering supplements or medications without a clear strategy can do more harm than good.

It’s important to take a thoughtful, individualized approach to cortisol management, especially when considering using prescription or supplement blockers. Here are some key recommendations:

Testing comes first

Before initiating any therapy to reduce cortisol, it’s essential to test your cortisol levels. This can be done using comprehensive salivary or urinary cortisol panels, which measure fluctuations throughout the day.

Why is this important? Because not everyone with hypothyroidism or Hashimoto’s has high cortisol. Depending on the stage and chronicity of the condition, cortisol levels may vary significantly:

• Early Hashimoto’s: Cortisol levels may be elevated as the body attempts to manage inflammation and autoimmunity.
• Chronic or late-stage hypothyroidism: Cortisol production may decline or become dysregulated due to long-term stress on the adrenal system.

Using cortisol blockers without confirming elevated levels may suppress an already inadequate stress response, leading to increased fatigue, worsened thyroid function, and other adverse outcomes.

There’s no “one-size-fits-all” solution

Cortisol management must be personalized. The same intervention that helps one patient might harm another. Particularly in autoimmune conditions like Hashimoto’s, the stage of the disease, symptom profile, and adrenal function all influence the best therapeutic approach.

For instance, someone newly diagnosed with Hashimoto’s and high cortisol may benefit from stress reduction techniques and targeted adaptogens. On the other hand, someone with longstanding hypothyroidism and low cortisol may require adrenal support rather than suppression.

Use adaptogens with caution

Adaptogens such as ashwagandha, rhodiola, and holy basil are available over the counter and can be used to modulate the body’s stress response and support balanced cortisol levels. However, not all adaptogens are appropriate for every patient.

Ashwagandha, for example, has been shown to support thyroid function and reduce stress, but it may also stimulate the immune system. In some people with Hashimoto’s, this could worsen autoimmune symptoms or increase antibody production.

It’s recommended that you use adaptogens only under the guidance of a knowledgeable functional or integrative provider, who can monitor their effects and adjust protocols as needed.

Avoid the blanket use of cortisol blockers

You should avoid unsupervised use of cortisol blockers, especially when:

• Cortisol levels haven’t been tested
• Symptoms of adrenal fatigue or low cortisol (e.g., low blood pressure, dizziness, burnout) are present
• The patient has advanced hypothyroidism or a complex autoimmune profile

In such cases, suppressing cortisol can backfire, worsening fatigue, mood issues, or even thyroid function.

Work with a functional or integrative provider

If you’re a thyroid patient, cortisol management should be overseen by a qualified provider who understands the intricate interplay between adrenal and thyroid health. Functional and integrative practitioners are often well-versed in the use of cortisol-modulating therapies and can guide patients through:

• Proper testing (including interpretation of diurnal cortisol patterns)
• Safe use of adaptogens
• Lifestyle changes that support adrenal balance
• Avoidance of inappropriate cortisol suppression

Your next steps? 

If you have hypothyroidism or Hashimoto’s and are considering cortisol blockers or cortisol-lowering supplements, here are your recommended next steps: 

• Test your cortisol levels first (ideally using salivary or urine testing)
• Consult with a functional or integrative provider who can individualize your treatment
• Be cautious with over-the-counter cortisol blockers or medications that claim to reduce stress hormones
• Consider gentler adaptogenic herbs like rhodiola or holy basil, but only under supervision
• Tailor your plan to the stage and severity of your thyroid condition

By taking a personalized, test-driven approach, you can support both your adrenal and thyroid health in a way that promotes energy, immune balance, and long-term well-being.

At Paloma Health, we believe that personalized care is essential when it comes to diagnosing and managing hypothyroidism and Hashimoto’s. No two individuals experience these conditions in the same way, which is why we take a careful, customized approach to your diagnosis and treatment. From comprehensive blood testing that you can conveniently do at home, to integrative care that blends conventional medicine with lifestyle and nutrition support, we’re here to help you feel your best, every step of the way. Our mission is to empower you with the tools, insights, and expert guidance you need to take control of your thyroid health.

• Cortisol is essential for managing stress and metabolic functions, but chronic elevation can harm health.
• Persistently high cortisol levels may lead to weight gain, muscle wasting, high blood pressure, and mood disturbances.
• Hypercortisolism disrupts thyroid hormone production, conversion, and cellular action, worsening hypothyroid conditions.
• Chronic stress-induced cortisol imbalance can mimic or aggravate thyroid dysfunction symptoms like fatigue and brain fog.
• Prescription cortisol blockers are used for conditions like Cushing’s syndrome but carry risks and are not safe for casual use.
• Individuals with thyroid disorders should be cautious with cortisol-lowering medications due to their potential to impair thyroid function further.