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Thyroid UK
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where too in london after adrenal stress profile

Hi there

please help. : P

NDT use for 3 months took my TSH reading from around 8 to .002. No hyper symptoms at all and NO ABATEMENT of fatigue, brain fog, zero libido, contstipation etc... took my genova adrenal stress results to GP:

Samp 1, post awakening - 35.28 (significantly elevated)

Samp 2, + 4-5 hrs - 12.81 (high)

Samp 3, + 4-5 hrs - 10.89 (high)

Samp 4, (prior to sleep) - 3.31

DHEA mean 0.60

DHEA Cortisol ratio 0.020

typically, my chronic insomnia is not falling asleep, but waking for good after several hours - a classic of high cortisol/ adrenal fatigue. Doctor dismissed it all out of hand... asked me if my mood was low and started probing about depression. Told him politely that possibly he would be depressed if he couldn't sleep, work, poo or shag.

: P

(This is my second GP. first told me to try exercising more even though I told him i swim every day.)

alreday been on the net for 3hrs but any experience about these readings or suggestions about a doctor in London I could see he won't think I'm depressed or a hyperchondriac?

cheers & thanks


10 Replies


You have raised your NDT dose fast and 4 grains is quite a lot. Having no hyper symptoms may show your body has accepted NDT but with nutrient deficiencies, high cortisol & elevated TPOAb, be mindful that thyroid hormone replacement can take a while to bring full benefits, and for many will only work well with optimal Vit B12, Vit D, folate and ferritin.

Many Hashi sufferers are commonly deficient in these (usually due to gut issues caused by long term low thyroid hormone) and require long term supplementation with nutrients known for easier absorption. If you have gut issues, repost a question for members input.

Ask your GP to test and post results complete with ranges (numbers in brackets) for members to comment. You should get these tests on the National Health although most GP's are completely useless re thyroid physiology & don't recognise adrenal fatigue in any degree except full blown Addisons Disease.

Elevated cortisol is the first stage of struggling adrenals as they support your previously low thyroid hormone levels. They need rest and nurture and a daily swim might stress them further until you feel well. I am a big fan of Vit C to support adrenals and take 3g of mixed ascorbate powder daily but there are also many adaptogens known to lower cortisol. Repost a question for further info from members.

Fatigue, brain fog, libido and constipation should all increase once everything reaches optimal//adequate levels but symptoms can remain for many months even after good biochemistry. I am still seeing health improvements after adding T3 to my T4 over a year ago and thyroid hormone should only be increased slowly.

Medicating too much thyroid hormone replacement can be counter productive and actually stop further meds from working. If this were me, at this stage & with a TSH of .002, I would not start trying to adjust dose in an effort to feel better until all deficiencies are addressed, (unless you feel hyper & then reduce meds).. Many members find eating a gluten free diet helps to lower antibodies.

I hope you have had some pm's regarding a London Doctor but if not you can email louise.warvill@thyroiduk.org.uk for a list of sympathetic endos//doctors that members have had positive experiences with.

Dr P's book is very good and another informed read is "The Root Cause" by Isabella Wentz. I hope you feel better soon.


Thyroid//Gluten Connection



Adrenal & Vit C


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thanks for ttaking the time to reply radd. i will look into those... I think my confusion has added to my impatient, as has the severity of not sleeping long term. have a good weekend.


hi radd

I thought there was no abatement of symptoms until doctor advised me to stop taking NDT a week before more bloods... and my mood/mind fell off a cliff.

Had bloods today - do you think I shoukd build up the NDT more slowly this time? was gonna start back on a dose of 2 grains and build to four over 3 months.

thanks for your time




The usual protocol would be something like start on one grain for 2 weeks, raise by half a grain every two week. Hold at two grains and retest thyroid hormones at six weeks.

Keep raising half a grain every two weeks until many symptoms abate, then drop half a grain and hold. Some symptoms may continue for up to six weeks after good biochemistry so be mindful not to go too high.

If this is too slow for you, you could try raising every 7-10 days but be aware, this gradual introduction is to acclimatise your body to T3.

T3 is the active hormone and being 3-4 times more powerful than T4, can be felt within minutes, peaking within 2-4 hours of taking. Because of this, many members split their dose into two (am & pm.)

Thyroid hormone replacement should always be taken on an empty stomach will a glass of water, 1 hour after foods, 2 hours after supplements and 4 hours after calcium and iron.

Did you get nutrients and iron checked ? I notice deficenicies in these generally seem to make their presence known about five - six weeks into taking NDT.

Good luck.


NDT mistakes



Introducing NDT




I'm in the same boat as you. I've been on ndt for 8 weeks and my hypo symptoms actually disappeared BUT I have chronic and severe insomnia. As I'm waiting for the results of my adrenal stress profile I've been googling a lot about cortisol, DHEA and sleep. It seems that low DHEA is associated with high cortisol and insomnia (high DHEA also causes insomnia!). It may be an avenue worth exploring...

I hope you will get much needed sleep soon. I know exactly how it feels ;(

Take care

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Thanks Kitten1978

it was great to get your message. the GP did nt want to know about high cortisol, so I appreciate the link. My DHEA is toward the low end of the spectrum but within the normal range - but I am hoping we are both on the right track regarding cortisol/adrenals and insomnia.

hope you get some sleep soon too!



Hi Hemmingwayjr,

It's good that your DHEA is still within normal range. From what I've read it's also the DHEA to corisol ratio that is important. You didn't include the DHEA to cortisol reference range but I found this example of Genova report where the normal range for DHEA to cortisol ratio is "2.0 - 6.0" (http://www.nutritionalvalues.co.uk/sampleadrrenalReport.pdf). If this is accurate then your DHEA to cortisol ratio would be way too low.

I understand that DHEA is supposed to balance cortisol. Specifically: it lowers cortisol. If DHEA is too low in in relation to cortisol, then it cannot sufficiently balance it. High cortisol leads to insomnia and insomnia increases cortisol levels - it's a bit of a vicious circle. Cortisol is also an antagonist of melatonin.

DHEA is used to produce testosteron in both men and women. I read a reasearch study where DHEA was given to a bunch of elderly ladies. Among other things it made them quite frisky ;)

Given that you are still able to fall asleep but waking up frequently perhaps adaptogenic herbs may help you e.g. holly basil (tulsi), rhodiola, and ashwagandha. Valerian root is also meant to be helpful but only if used consistently over a long period of time.

Another thing is that your TSH seems very suppressed. Some people need it very suppressed, some even need their Free T3 to be slightly above the range. Others need their levels to be well within their levels to feel o.k. What I'm trying to say is that some people need really high dose of ndt while others need a bit less. At this point in time it's impassible to say which category you belong to. I actually have more energy after I have lowered my ndt dose slightly. Too much ndt isn't necessarily a good thing, although some people need a lot of it. It would be good to get your Free T3 and Free T4 tested, in addition to TSH, next time you have your thyroid bloods taken.

Take care :)


thanks again Kitten.

just double checked my own Genova test results and the cortisol to DHEA is definitely 0.015 - 1.150 and listed in the comments as in the nromal range. maybe this is the over 40s ref range... but tthanks for making me revisit my own results as it def seems low to me now!!


You are welcome. DHEA decreases with age so it's logical that the reference range is a bit different for over 40s. It is low though so it may be worth exploring.

I hope you will get some much needed sleep soon!

Take care ;)


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