Morning cortisol confusion: Am due to have a... - Thyroid UK

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Morning cortisol confusion

Portia1974
Portia1974

Am due to have a morning cortisol test tomorrow.

Question 1: Does caffeine affect it? Can I have a coffee beforehand basically?

Going through my notes I had a cortisol test in Sept 16. The result was 233 (range 140-690 nmol/L

). I remember at the time saying to my GP, if this is the time of day my cortisol is meant to be at its highest, then shouldn't it be higher than that? He replied emphatically that it was in range so it was absolutely fine. So....

Question 2: is the range above the range for 9am cortisol only...or for 24hrs? Is 233 low, normal or optimal for 9am?

Thanks in advance!

31 Replies
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It should be for 9 am only.

Doctors are taught in med school that anything in-range is fine. And they're not very good at thinking out of the box. Yes, your cortisol is rather low for that time of day, but your doctor will never acknowledge it. If it were out of range, he'd probably test for Addison's. Yours is a little low, and possibly there's a certain degree of adrenal fatigue. But, doctors don't believe adrenal fatigue exists, so you wouldn't get a diagnosis of that.

I don't know about the coffee before the test, but it's probably not a good idea. I always do all my test as fasting tests, just in case. :)

Yes I broached the subject of Adrenal Fatigue with him at the time in 2016 which was why he agreed to the test. He was a very shruggy "sometimes there are no answers" GP. (Nice enough, but did very little to help me). Who despite my saying "I can't accept there isn't an answer until we've asked all the questions" somehow managed to convince me to attend a CBT clinic to help me manage my fatigue and then slapped a diagnosis of CFS on my file , (without asking any of those questions) and washed his hands of me. I basically gave up and accepted my fate for two years until I got hold of my medical notes earlier this year and then got "the rage" after reading what was in them. The rage is the best thing that could've happened I think. It's woken me up to my life and health wasting away while shruggy "nice enough" GPs (and asshole ones) twiddle their thumbs.

Thanks for your input. Kinda confirmed my thoughts. How would low cortisol fit in with a picture of Central Hypothyroidism do you think?

Well, if you have hypothyroidism of any kind, for long enough, the adrenals have to take up the slack. And, even though it's said that 'adrenals don't fatigue', it gets to the point where they can't cope, anymore.

So do you think that results suggests my adrenals were struggling back then and the hypothyroidism has been ongoing for some time?

I don't have enough information to answer that question. But, it's quite possible that you've been hypo for some time. The symptoms don't appear over-night. The body adjusts to lower and lower hormone levels, the adrenals start taking up the slack, but symptoms can appear before abnormalities start showing up in blood work. I doubt anyone can tell you how long you've been hypo.

Oh I appreciate that. No way of knowing for sure. When I look back at results /entries in my medical record, in the context of what I know now, the clues are there.

Mamapea1
Mamapea1
in reply to Portia1974

Ahh yes! Nothing like reading the medical notes for a reality check!😕. Amazes me how they can leave patients so obviously ill and not bother to even TRY to make further investigations! A broken system. Fortunately this forum has very knowledgeable members who will help you find the answers. Good luck 🍀 x

Portia1974
Portia1974
in reply to Mamapea1

It is. Totally broken. Thank GOD for this forum and others like it!

Thought you may be interested....NEW GP who I saw this morning after my cortisol test agreed....233 is low for 9am! She said that's why the wrote "9am" in huge letters on the blood form so they send back the right range. So she was already there. Way ahead of me!

Well, that's comforting. So, what is she going to do about it?

That was the old test from 2016 we were discussing. New bloods taken this morning. Results back Friday. She's retesting everything including all antibodies for PA, Coeliac and Hashis. 9am cortisol, prolactin, CBC, ferritin etc.

OK, well, be interesting to see the new results. :)

Hi greygoose ! Just posted a new post with results. Interested in your feedback if you get a chance. (Apologies in advance. It's longish!)

Hidden
Hidden

I absolutely agree with GreyGoose. And she mentioned she does something that I always do. That is have all lab work if possible done NPO (nothing by mouth). I fast at least from midnight'often from 8PM the evening before. Not all tests require this and doctors will often say fasting is not necessary. But, in my opinion, since doctors can sometimes be cavalier about the way they interpret results and we don't always know 100% what might affect a test we need all the help we can get. If test results look too good/normal/fine/in range (take your choice) we risk not getting the effective care we need. Fast and be covered. Take care. irina

Portia1974
Portia1974
in reply to Hidden

Gah! No coffee for me in the morning then! Cavalier is a perfect word for it! Thanks Irina!

Hidden
Hidden
in reply to Portia1974

You're welcome.😁

The result was 233 (range 140-690 nmol/L)

This is too low for 9am. It looks like a range for a random cortisol which is taken at any time of day. At 9am it should be at the top or very near the top of the range.

And anyone who has a cortisol low in the given range at 9am is in trouble!

Well that's what I thought! It's too broad to be just a 9am range surely. Yep, I'm pretty much in trouble every morning, lol!

I just found this post that I remembered reading a few days ago :

healthunlocked.com/thyroidu...

The last post in the thread by PaulineS is very relevant to you. Pauline knows a lot about adrenal insufficiency/Addison's Disease as she is a sufferer herself.

Thank you! Off to read!

Thought you may be interested....NEW GP who I saw this morning after my cortisol test agreed....233 is low for 9am! She said that's why the wrote "9am" in huge letters on the blood form so they send back the right range. So she was already there. Way ahead of me!

So, is the doctor going to do anything helpful about your result?

That was the old result from 2016. Had another done this morning along with loads more. Results should be back Friday morning. So we'll see. She's also writing to the haematologist ahead if my appointment nxt month to reinforce the need for an iron transfusion and testing for MMA, Homocysteine, and serum gastrin and pepsinogen to check for achlorhydria/hypochlorhydria. Essentially I wrote down what I wanted and why I wanted it in a letter for the haematologist. I expressed concern that he wouldn't even read it and asked if she would consider doing it instead; so she said "give me a copy so I know what you want and I'll write to him for you"!

Good luck. :)

Thanks!

Hi @humanbean! Just posted a new post with results. Interested in your feedback if you get a chance. (Apologies in advance. It's longish!)

HiddenThis reply has been deleted
greygoose
greygoose
in reply to Hidden

I very much doubt you have to stop caffeine for a few days. That's over-kill. Just leaving it off in the morning before the test would do.

Portia1974
Portia1974
in reply to Hidden

I think you're right!

I’ve just got my results back which I fasted for and didn’t take my thyroid meds for either that morning as I read food / coffee and T3 can spike cortisol.

I was told by my GP that the range was 149-500 from 8am to 2pm. Hope that helps

Portia1974
Portia1974
in reply to MissFG

Thank you MissFG!

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