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Thyroid UK
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Cortisol level at 4pm of 49 (78 - 271)

Hello I already have an underactive thyroid and taking Levo for last 18 maths, recently had cortisol tested and my results are above. I have a LONG list of unpleasant symptoms and my endo now wants to check levels in am. I’m guessing that she is wanting to see if I have problems with Adrenials also. She said 49 is a little on the low side, but from what I have been reading, this is very low even though it is a pm reading. Does anyone else have these levels? If so what action have you taken? Thank you.

15 Replies

I notice you are new to the Forum - so Welcome ! If you have a PM reading then surely you have other readings within the 24 hour Saliva Testing window ....

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Hello Thank you for responding and for the lovely welcome. This was a one off test taken to check for other auto immune conditions particularly Sjogrens on a referral to a rhumy (thankfully ruled out) , now passed back to the endo where I am going to have an am test and yesterday i completed a 12 hr saliva test so no results yet. My Vit D 6 months ago was 60 down from 100 the previous years range (50- 200) and I am now supplementing each day. Folate 16.2 (2.91 - 50) Ferritin 54 (13 - 150) ESR 45 HBA1c 38 (20 - 42) iron 24.7 (6.6 - 26) B12 336.3 (140 - 724) T4 14.7 (12 - 22) TSH 1.75 (0.27 - 4.2) does that help?

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Not heard of the 12 hour Saliva Test before :-)

B12 and Ferritin could be higher. In my reply before I was only referring to more results for the Saliva Test which usually has 4 results :-)


Was this a 24 hour saliva test? Surely not just one PM reading in isolation? Post all your adrenal results, also post your thyroid test results, with reference ranges, and anything else tested, particularly Vit D, B12, folate, Ferritin.

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Do you know if you have Hashimoto's also called autoimmune thyroid disease diagnosed by high thyroid antibodies

B12 looks a bit low, do you have any symptoms of low B12


Low vitamins or high antibodies can upset adrenals

Your Thyroid results suggest you might need a dose increase

FT4 should be near top of range. There's no FT3 result.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at


Professor Toft recent article saying, T3 may be necessary for many


Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism



Hello thank you this is very helpful. Yes it is Hashimoto my antibodies very very high at the time of diagnosis. I am most curious about the cortisol reading of 49 as this sounds very low. I also have Ménière’s disease (auto immune) so now concerned that this could be the start of Addison’s Disease.


Sorry Also I have managed to get the Endo to increase Levo and she has put it in writing that she wants me at the top 3rd of the range, not there yet and expect her to up the level again very soon.

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Are you on strictly gluten free diet?

Hashimoto's often affects the gut and can lead to low stomach acid and then low vitamin levels

Low vitamin levels can affect Thyroid hormone working and upset adrenals.

Low B12 is extremely common, symptoms can occur when results are still within range when hypo

Dizziness and tinnitus are common symptoms of low B12


You might want to test homocysteine levels and/or do active B12 test

Using test of Homocysteine levels to check for low b12


Good explanation on homocysteine


Oral supplements may as good as injections


B12 generally


Poor gut function with Hashimoto's can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's gut and gluten connection is very poorly understood, only coeliac being considered

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP or endo for coeliac blood test first

Also ask endo to test FT3








For full Thyroid evaluation TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Private tests are available


Full B12 testing with homocysteine and MMA testing too available too

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular thyroid choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)


Thank you so much for this amazing advice, so grateful for you taking the time to respond in such detail. Thank you

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How high is high - and which anti-bodies ?

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Hello it was Thyroglobulin Antibody 377,800 (0.00 - 115,000) over three times the reference range.


Usually the TPO anti-bodies are tested and not the Tg. Did you have TPO as well ?


The other one was Thyroid Peroxidase Antibodies 10.16 (0.00 - 34.00) is this TPO?

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Yes.Thyroid Peroxidase (just to explain how the abbreviation came about).

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Thank you

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