Thyroid UK
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Hypothyroid, Low Cortisol & Adrenal Synacthen Stress Test?

Blimey! Went for my follow up after bloods & endo has said she can't even consider treating me with any thyroid meds till she's sorted out my Cortisol issue 144 (171-536 range) & Vitamin D. She said she's far more worried about that than my thyroid results:

TSH 4.17 (0.27 - 4.2)

FT4 17.7 (12 - 22)

FT3 1.5 (1.3 -3.1)

VITD 40 (50-200)

I don't have hashis and my iron & ferritin are great as I've been supplementing for years.

Blimey! What on earth is going on? I have been on a crash course trying to understand the Thyroid & now I need to get to grips with adrenals!! Do we think it's possible that my thyroid issue could resolve itself if the VitD & low cortisol levels are addressed!

Now I really am stressed out😖😥x

16 Replies

Vikki, How much vitD has your endo prescribed and what is she doing about the low cortisol? I don't know much about adrenals but adrenal insufficiency (low cortisol) can make it difficult to tolerate thyroid meds and the manufacturer's patient information leaflet suggests special care if you suffer from any condition which affects your adrenal glands. I believe thyroid function may, but not always, improve when adrenal function is improved.

Optimal vitD is 75-200, and around 100 is good for most people. Good levels of vitD aid T4 to T3 conversion but I don't think they do anything else for thyroid.


Thanks, Clutter. She has put me on 20,000iu of VitD and wants to do a Synacthen test next week. I have also suggested a saliva test as I am sure I don't have addisons!!! The only adrenal symptoms I can relate to are cold & tired. The rest just doesn't fit. Think it might have been a rogue reading! She hadn't discussed any adrenal treatment yet. Just waiting for a date for the syn test. Vikki. X


Vikki, 20,000iu is good and should raise levels in a few months especially if you can get in the sun during the spring and summer.


Hi Vikkiod.

Sad you are ill but good your endo seems to be going to the root of the problem. I haven't done well on Levothyroxine and always suspected my adrenals were shot so at last going to see Dr P on Monday. I wonder what your endo will heal your adrenals with.


Hi Gill, thanks for your reply. Please let me know how you get on with Dr P. His book make so much sense. He will surely help you out. Will have to wait & see what this Synacthen test throws up. Fingers crossed she will do a saliva test. I am seeing her privately so hopefully she will go with it. Good luck today💗


Hello Vikkiod,

Today I visited Dr P. He is really nice, so friendly, extremely informative and as you quoted "made so much sense". He explained how all the hormones synergise and what can happen if the adrenals fail. He measured my blood pressure seated & then standing (mine fell, bad news), shone a torch in my eyes to ascertain pupil reflex (mine was unusually slow) and banged my ankles & elbows with a little hammer (my reflex was virtually none existent). Dr P said he was 100% sure my adrenals were failing and has advised adrenal support. He offered information on Armour but I declined so suggested a little thyroid T3 which will hopefully encourage the T4 Levothyroxine that I'm already taking to absorb and convert. I am to fill out a diary provided by Dr P so that my progress may be recorded and we have agreed to consult by telephone in 6 weeks unless I have problems and will call him before. However, he is so utterly confident that my problem is very straight forward and I should respond easily & well to the suggested treatment. Tomorrow I have to stop taking Levothyroxine for 8 days whilst the adrenal support stabilises all the excess unconverted hormone in my blood, before starting on the T3. This is all going to be a little bit scary but I'm in the very fortunate position of not having to work for a few weeks. We go away on holiday in May and Dr P was very confident that I should have seen massive changes by then. Obviously worn out adrenals can take a long long time to really heal but I feel with time off work and the warm weather approaching, that life is gonna be good again. Deep down inside I already knew my adrenals were failing and it felt good to be listened to and guided down a very sensible and workable path that is going to hopefully lead me to a better place.

In his book Dr P States that he is not a fan of the Synacthen test as it can prove unreliable, preferring the 24 hour urine test when clinical appraisal is not sufficient. I considered his clinical appraisal results to be accurate but just for good measure he has organised the saliva test and also the sex hormone test as I'm menopausal.

I hope this account helps and you get what you're hoping for from your endo. Good luck and perhaps you can keep me informed. I'll certainly let you know how I progress over the next few weeks.

Kind regards, Gill.


Can I ask how the cortisol was tested - was it the synacthen test? Sounds as though your endo is on the ball, unlike mine...


Hi Ann, so far it's just been via a blood test that's given a very low result. She's going to do a Synacthen test next week. I think that's only to rule out Addison's disease. I am pretty sure I haven't got that a stars an immune disease. To be honest don't even feel that I have a big adrenal problem - don't seem to be ticking any iOS those boxes apart from cold extremities & fatigue which are prob just thyroid symptoms. I have suggested that in order to get a better overview of my cortisol production she could do a saliva test. Just waiting for confirmation of that. Do you think you have an adrenal issue? X


The endo thinks I may have adrenal insufficiency so I'm waiting for the synacthen test (I'm told there is a worldwide shortage of the substance they use, though I notice that other people are having the test, so I don't know what's going on).

I have had a number of very stressful periods of life, which is why adrenal problems are a possibiity. I was diagnosed with ME in the late 80s, but that is much better and I can function at around 70 - 80% now. I have low-normal thyroids so, of course, the endo won't do anything as he regards TSH as the, quote, 'gold standard'. We need to see what the synacthen test result is first, but I'm not holding my breath!

I seem to be in a place of limbo. I was heartened to come across the article about low-normal thyroid and the health implications (see next posting) so I'm thinking of sending it to my endo.

Hope you get some light shed on things. x


Oh, Ann! I can sense your frustration & apathy. It's just not fair. You sound like you've been through the mill! It's got to be time to start feeling better!

I haven't had the date of the test confirmed yet either, so the shortage might affect my test too.

I have bought some of the Nutri adrenal stuff recommended by Barry peatfield-Durant in his Thyroid book. I haven't taken any yet as I am letting my endo lead the way at the moment. If we lose momentum, though I will definitely take them before I start any Tyroid treatment. got a feeling from my results that my issue is with T3 so I think I might need to do down the natural route.

I just have a feeling that all of my issues are down to my pesky thyroid that has been under performing for many years!!! We owe it to ourselves and our family to get sorted! Good luck, my luv. X💗


The syncathen test will rule out Addison's but its not a lot of use if you are just low on cortisol.

Have you done the Adrenal Fatigue questionnaire on Dr Wilson's website?

It seems to be fairly reliable, although only the saliva test will confirm. Saliva testing isn't accepted by the NHS, so you would end up having to do it privately.

But the short answer is, if you are significantly fatigued it could just be down to the thyroid, or it could also be the adrenals. The two often go hand in hand, and its certainly a good idea to sort out the adrenals first, or you could end up feeling worse by battering your system with T3 when that isn't the primary problem. Your tests would suggest that you aren't converting T4 to T3 terribly well because your FT4 isn't all that bad, but FT3 is rubbish!

Adrenal fatigue would seem to be, in most cases, a misnomer. Latest research shows that in most cases the adrenals are fine, but the messages don't get through from the brain.


Oh, thanks so much for that, Ruthi. I am going to do that questionnaire right now! I honestly don't think I have many adrenal symptoms from what I've already read. They all seem very 'Thyroidy' to me. But, yes, it seems we need to support those Adrenals first, no matter what. Wouldn't it be lovely if that would just kick start my Thyoid without the need for meds!?

I am private so I do hope that she does the Saliva test. It's def not Addisons but I would like to see how my cortisol is performing over a 24 hour period.

T3 is def rubbish. My intuition has always told me that it is a conversion issue. Let's hope Mrs. Endo can see it too & leads me down the right path without too much of a detour.

Thanks so much for you response. X💗


I think its well worth pursuing AF and nutrition in your position - if you can bear it!! There are stories of folk healing their thyroid with diet and lifestyle, and given that thyroid treatment always seems to end badly in the end (or that is how it feels if you read this board too often!) supporting your thyroid naturally is well worth the effort. Mind you, I think it requires you to be pretty strict on diet!

If the endo won't do the saliva test(not all understand it) then you can get it via TUK.

Have you had a hair mineral test?


Thanks, Ruthi, I think that's what she is going to try and suggest. Support the adrenals, ramp up Vitamin D & then retest bloods. I'm sure she will do a saliva test. My symptoms don't ever feel too bad during the summer as my main complaint is being frozen to the core all the time. It will be interesting to see if my TSH will still be high during the summer? So far I have only ever been driven to have it tested in the dead of Jan/Feb when I feel feel shocking & hypothermic! Its always about 4-4.5 ish and has been for at least 5 years! I have vowed to myself that I will not go through another Winter like this, even if I have to self medicate! Thanks for all the advice. Vikki. X💖


The late great Dr Skinner reckoned we need more thyroid hormone in the winter, to compensate for the extra energy we burn (and the extra carbs we eat needing to be burnt!).

There is a theory about that you shouldn't supplement with Vitamin D alone, IIRC because it upsets copper regulation. But apparently if you get your other minerals up - especially magnesium, then the D will come up of its own accord. By the same token synthetic vitamin C is also a no-no.It would be worth your while joining the Magnesium Advocacy Group, and the Adrenal Recovery Group, both on facebook. I hate the format, but there are some nuggets to be found!


Good idea Ruthi. Have just joined the FB Adrenal Recovery group as just started my journey with Dr P. Thank you.


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