Adrenal (Cortisol) and Thyroid issues - Thyroid UK

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Adrenal (Cortisol) and Thyroid issues

As shown from my saliva cortisol test, I have very high cortisol level especially in the morning and depressed DHEA, I read somewhere that high cortisol interferes in the transfer from T4 to T3 so can you advise on this issue? Also high cortisol and low DHEA affects the testosterone level which was low in my case. The question I need to ask is why I might have high cortisol is it because the T4 is not converting to T3 and rather to RT3 which is high in my case? Also, I have low vitamin D, low folate, somehow low B12, I might have low stomach acid and bad absorption of vitamins and minerals . Main Symptoms are low temperature and total hair loss. Does the sympathetic nervous system play a role in all this? I am on T4 medicine for 17 years and doctors refuse to consider changing the medicine?

17 Replies


It will help members to advise if you write a new post including your thyroid, cortisol and DHEA results and ranges. Include your vitamin D, ferritin, B12 and folate results and ranges and members will advise how much you need to supplement.

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Hi Clutter, Please note below my saliva test result as well as my blood test results.

ASI Adrenal Stress Index – Saliva

TAP Cortisol rhythm (Saliva)

06:00 – 08:00 AM 35 Elevated 13-24 nM

11:00 – 01:00 PM 6 Normal 5 – 10 nM

04:00 – 05:00 PM 8 Normal 3 – 8 nM

10:00 – Midnight 3 Normal 1 – 4 nM

Total Cortisol Output 52 22 – 46 Nm

DHEA Dehydroepiandrosterone [DHEA + DHEA – S] (saliva)

Single Collection 2 Depressed Adults (M/F): 3 – 10 ng/ml

ISN Insulin (saliva)

Fasting <3 Borderline Elevated : 3 – 11 uIU/ml

Elevated: >11

Non-fasting <3 Borderline Elevated: 6 – 25 uIU/ml

Elevated: >25 uIU/ml

P17-oh 17-OH Progesterone 50 Normal

Optimal: 22 – 100 pg/ml


Total salivery sIgA 10 Normal

Normal: 10-20 mg/dL

FI4 Gluten (gliadin) Ab, sIgA 8 Negative Borderline: 13-15 U/ml

(saliva) Positive: >15 U/ml

My lab test results on the 5th of April 2017 were as follows:

Glucose 107 mg/dL 70 - 110

Potassium 4.3 mmol/l 3,5 - 5,5

Sodium 144 mmol/l 135 - 153

Iron Serum 105 mg/dl 45 - 175

Ferretin 137 ng/ml 22 - 322

Vitamin B12 585 pg/ml 211 - 911

Folate 4,8 ng/ml 4.0 - 13.2

TIBC 272 mg/dl 250 - 450

Transferrin 227 mg/dl 220 - 400

Cholesterol 166 mg/dl 125 - 200

Triglycerides 50 mg/dl <150

Iron Saturation 38,603% (Normal 20-50%)

TSH 0,50 mlU/ml 0,4 - 4,5

FT3 3,55 pg/ml 1,8 - 4,2

FT4 1,29 ng/dl 0,8 - 1,9

Antibodies TG <15,0 U/ml 0 – 60

Antibodies TPO <28,0 U/ml 0 – 80

Vitamin D 25 hydroxy 21,2 ng/ml insufficient >30

Daily Average Temperatures are the following:

27/3 (36.5)

28/3 (36.2)

29/3 (36.3)

30/3 (36.6)

31/3 (36.5)



TSH is low-normal, FT4 is less than halfway through range but FT3 is in the upper third of range which indicates very good conversion. You appear to be adequately dosed.

Thyroid antibodies are negative for autoimmune thyroid disease (Hashimoto's).

Vitamin D 21.2 is deficient. Optimal is 40-60ng/ml. I would supplement 5,000iu D3 daily for 8 weeks then reduce to 5,000iu alternate days and retest in August. VitD should be taken 4 hours away from Levothyroxine.

B12 is good but Folate 4.8 is low. You could supplement 400mcg folic acid or methylfolate for a few months.

The other results dated 5/4/17 are within range.


Thank you Clutter the problem is that my blood test seems very good but I am afraid I am hypothyroid at the cell level because the FT3 measures all T3 and RT3, and I measured the rT3 and it is high in my body so maybe I have a conversion problem because I have symptoms of Hypothryroid.



It is normal to have rT3. What is your rT3 level and range?


Reverse T3: 23 ng/dl (reference value 10-24)

FT3: 3.7 pg/Ml (reference value 2.8-4.4)

Dividing FT3 : RT3 = .1608 adjusted to 16 to compensate for the different lab values. The value should be over 20 otherwise it reflects too much rT3 in the body?

can this be because of T4 medication only. The question to ponder is why my body is converting inappropriately - to RT3 instead of FT3. The most likely causes usually are low iron and poor adrenal function. It can also be from extreme dieting or other chronic illness. RT3 is our body’s natural mechanism for down-regulating our metabolism in times of illness, famine, or stress. Sometimes it gets stuck in this method of poor conversion. High cortisol affects the conversion, I checked my drinking water which has 0.10 fluoride and changed it. Also, I have mercury amalgam fillings and I am looking maybe that affects my body. I don't know the reason behind poor conversion from T4 to T3 in my body. Any suggestion?



Your rT3 is within range so it is not too high. I don't really understand the FT3:rT3 ratio so I can't help with that.

That is a different FT3 result to the one you posted earlier but it still good although just shy of the upper third of range. I really don't agree that you have poor T4 to T3 conversion.


How much levo are you taking?

It's more likely that you are converting badly because you have high cortisol, rather than the other way round. But, if you post a new question, giving all the levels, people are much more likely to be able to help you. Details are very, very important in things like this. :)


Thank you greygoose for your reply. I am taking 150mg 4 days a week and 137mg three days a week. I will another post with my test results

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hi said- I have sympathetic nerve probs- it doesn't switchoff! and my hair is hardly any left- I have adrenal probs and possibly lyme as I have antibodies,my cortisol I s genearlly low,no energy always cold. gene test shows I do not absorb vit d- that can cause hairloss and don't absorb b12 had to fight for a 3 month b12 inject.


Thank you bluepettals2. do you think they SNP is related to thyroid replacement therapy to problems in Adrenals? and how we can solve this issue in your opinion?


In response to Clutter further up, you wrote this :

I am afraid I am hypothyroid at the cell level because the FT3 measures all T3 and RT3, and I measured the rT3 and it is high in my body so maybe I have a conversion problem because I have symptoms of Hypothryroid.

A FT3 (i.e. Free T3) test does not measure all T3 and Reverse T3 it measures only Free T3. Reverse T3 and Free T3 are different things and the two tests measure exactly what they say they do. And T3 (i.e. Total T3) measures the sum of Free T3 (i.e. T3 which is not bound to transport proteins and is immediately usable by the body) plus bound T3 (which is bound to transport proteins and is not immediately usable to the body).


A Free T3 test measures just Free T3 (usable T3 or active T3)

A Reverse T3 tests measures just Reverse T3 (inactive T3)

T3 (or more accurately - Total T3) measures Free T3 + unusable T3.

Sorry, my brain has turned to mush and I can't remember if Total T3 includes Reverse T3 as well as the other things. Total T3 isn't a useful test anyway.

There are several reasons why you might have Reverse T3 high in range. Your cortisol is higher than optimal, and that will be one reason.

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06:00 – 08:00 AM 35 Elevated 13-24 nM

11:00 – 01:00 PM 6 Normal 5 – 10 nM

04:00 – 05:00 PM 8 Normal 3 – 8 nM

10:00 – Midnight 3 Normal 1 – 4 nM

Total Cortisol Output 52 22 – 46 Nm


From this page :

we get the following suggested optimal levels for cortisol :

• Morning at the top of the range

• Noon approximately 75% of the range

• Evening close to 50% of the range

• Nighttime at the bottom of the range

If we apply those optimal levels to your reference ranges then your ideal results would be (units are all nM) :

Sample 1 : Optimal = 24 ; Yours = 35 -- *Too High*

Sample 2 : Optimal = 8.75 ; Yours = 6 -- *Too low*

Sample 3 : Optimal = 5.5 ; Yours = 8 -- *Too high*

Sample 4 : Optimal = 1 ; Yours = 3 -- *Too high*

Total : Optimal = 39.25 ; Yours = 52

You obviously have plenty of cortisol and you need to persuade your body to produce less. This can be very difficult. You also have low DHEA. I'm afraid I know nothing about DHEA. I've never used it, and in fact it is illegal to buy it in the UK. In some countries it is a supplement that can be bought without prescription. I don't know why DHEA is illegal in the UK. *Sigh*

For more information on interpreting adrenal saliva tests, read this. It is tough going, but it may help :

There are various supplements people can buy that reduce cortisol in some people. Personally, I use Holy Basil (Tulsi) supplements - specifically these ones :

In order to get any benefit from it I have to take more than it says on the bottle (a total of 6 a day rather than 4). I tried reducing my dose fairly recently and it backfired on me so I'm up to 6 a day again.

Other supplements available without prescription are :

Seriphos (original formula only)

Phosphatidyl serine

And read this for more suggestions :



Link 1 above is useful and you should try everything and see what helps and what doesn't - but obviously only try one thing at a time!

Link 2 is fairly standard stuff - you can find links like this one all over the internet from loads of different authors. I find them very, very annoying. It says we have to get lots of sleep. But with high cortisol I would say this was almost impossible. I've had lifelong insomnia. I've thought of getting plenty of sleep lots of times (surprise, surprise). But thinking it doesn't make it possible.

The only thing I can suggest is to try and reduce physical and mental stresses as much as possible. Some of the obvious things :

a) Low minerals and vitamins will stress the body. Supplement to get levels optimal. Unfortunately testing is very expensive, and it isn't always obvious where the optimal levels of nutrients are. If in doubt aim for mid-range, but ask for advice just in case someone knows where optimal should be and it isn't mid-range.

b) Eat a healthy diet. Don't eat loads of sugar. Don't eat a low calorie diet. Look into High Fat, Low Carb eating. The body needs fat - so eat healthy fats, not artificial ones. Don't be scared of fat. I use a simple rule for deciding which fats are healthy - if humans, somewhere in the world, have been eating a particular fat for hundreds of years then it is something humans evolved to eat. We didn't evolve to eat fats and oils developed in laboratories.

c) Look into ways of making the gut as healthy as possible. Don't take things to reduce stomach acid without a very good reason. Indigestion and heartburn are usually caused by low stomach acid, not high stomach acid.

This might be useful for you :

Good luck.

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Thank you Humanbean for your valuable and kind notes. I really appreciate all of your notes and believe they are very helpful. I need to ask you for your opinion about other issue. After deep search about my life conditions, I found out that the water I drink (mineral water) contains 0.10 fluoride (F-) and I think since starting to drink that water I start to feel the symptoms of hypothyroid because the levothyroxine was not properly converting to T3 because of this toxic substance in my daily life. 10 days ago I stopped that water and I start to drink normal water without any minerals. My question is how do you think my body will react and do you think that my high cortisol was related to that my thyroid replacement medicine was not doing its job properly and the cortisol was taking over trying to compensate for this situation, the body reacts by producing high cortisol especially in the morning when I take the medicine every morning, high cortisol leads to depressed DHEA because the body steals more pregnenolone to produce more cortisol leaving the DHEA and all the other hormones directly related to DHEA like Testosterone of course. I think this is the situation. How do you think I can revise this imbalance in my body so all will be working fine. Thank you in advance


According to wikipedia :

In 2015, the U.S. Food and Drug Administration (FDA), based on the recommendation of the U.S. Public Health Service (PHS) for fluoridation of community water systems, recommended that bottled water manufacturers limit fluoride in bottled water to no more than 0.7 milligrams per liter (mg/L)(milligrams per liter, equivalent to parts per million).

Assuming the level of fluoride in your bottled water is 0.1 mg/L or less (you don't give the units of measurement) then it is absolutely fine for you to drink it. Fluoride is a substance that occurs naturally in water in many parts of the world, and as long as the level is low it won't have significant effects on the health. If you are happy drinking your tap water then carry on drinking it, but if you prefer your bottled water then that is fine too.

It is true (I think) that the body compensates for insufficient thyroid hormone levels by producing extra cortisol.

And regarding the concept of "pregnenolone steal" you should find this short video interesting - I just wish the man didn't talk so fast.


TSH 0,50 mlU/ml 0,4 - 4,5

FT3 3,55 pg/ml 1,8 - 4,2 * 73% of the way through the range *

FT4 1,29 ng/dl 0,8 - 1,9 * 45% of the way through the range *

I don't know how much levothyroxine you are taking, I don't think you have mentioned it. Your Free T3 is actually good, and is the thing that usually determines how well hypothyroid people feel. You might feel better with a higher Free T4, and you do have a little bit of room for manoeuvre with your Free T3 level. You could ask for a small increase in your levothyroxine. Another 12.5mcg per day perhaps, but it is usually a good idea to avoid your Free T3 going over the range.

Your cortisol is probably your biggest problem. Cortisol levels affect the thyroid and the thyroid affects cortisol levels. Higher levels of cortisol, for example, may raise your levels of reverse T3. I think you should try to get your cortisol levels closer to optimal if you can. But it isn't easy. High cortisol also suppresses testosterone. You might like to see this post from another forum which lists 22 things that affect the thyroid :

In my previous post I forgot to mention that strenuous exercise raises cortisol and uses up Free T3. Being hypothyroid the best exercise is gentle exercise e.g. walking or swimming, rather than strenuous exercise.


Thank you humanbean for your reply and support. I currently take t4 of 150mg 4 days a week and 137mg 3 days a week. Regarding your notes, I think my blood test seems normal but the blood test does not reflect what is being absorbed by the cells, they don't show how much T3 is being entered into the cells thus why I seem to have some symptoms of hypothyroid like hair loss, low temperature and digesting issues (bloating and feeling uncomfortable with my stomach many times) and why the rt3 elevated in my body. I read in two different locations that fluoride inhibits the conversion from T4 to T3 and that is why I was referring to this. I am trying the tab water and I will tell you the result. I have high cortisol level because the T4 is not working properly, low testosterone, high LH and FSH (of course because of low testosterone which is a result of the low DHEA. low Vitamin D, low to average B12, probably low stomach acid, I still can't connect the dots very well but I will keep trying. The main question remains: is the high cortisol is due to insufficient thyroid hormone levels or the high cortisol is due to other reason which I need to figure out? for me this is the key to sort out the issue.


I have the opposite problem to you I think - I have low cortisol and this is as other medications are suppressing it I think.

I was at a fairly advanced stage of adrenal dysfunction when I saw my doc. She put me on pregnenolone and DHEA. These replenish your bodies' own hormones however once all levels come up, they can suppress cortisol - hence why i reduced my dosage of them.

So my point is - I believe that these hormones will counter-act and suppress high cortisol levels. A good doctor would have the ability to prescribe. However - if you are in the same position as me - a good doctor is VERY hard to find


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