I pointed out that anyone with thyroid deficiency over a period of time, especially if it is more than mild, is likely to have their deficiency accompanied by the Low Adrenal Reserve Syndrome. If this is not dealt with before providing supplementation, response may be disappointing, and there is a risk of a thyroid crisis. This occurs when the system becomes overwhelmed with thyroid replacement from the medication, which it is unable to deal with, and the patient may have violent palpitations, headaches or collapse. The obvious difficulty lies in knowing whether adrenal support is required. Well, the difficulty is more imaginary than real. Firstly, the history of the symptoms, the postural hypotension, the fainting attacks, the digestive upsets and other problems I mentioned in the last chapter, along with possible pointers from a blood test, are likely to make low adrenal reserve a strong possibility. Secondly, if there is any doubt, initial support must be given since there are real problems if it is needed and not given. Thirdly, prescribed in the way I am going to discuss in a few moments, there is no risk, since the amount of adrenal support is physiological (explained below). This means even if it isn't necessary, no damage is done, no risks are taken, and it can be withdrawn whenever tough appropriate.