26 year old Male here - no history of any illness and no medication taken whatsoever
Just asking for a little advice on my cortisol test results which I’ve posted above.
Firstly - For the past 10 - 11 months I’ve been having horrible fatigue between 12 - 6pm (it varies but roughly between those hours)
Symptoms - spacey, foggy, out of body, slight confusion, mild weakness some days, subtle off balance feeling, can’t be bothered to talk, need to lie down, people talk to me but I can’t register what their saying and sometimes get my words muddled up (yup brain foggy).
I did have a bad bout of stress over a year ago which lasted a week - severe restlessness, nervousness, dehydration (blood test results at the time confirmed dehydration), insomnia, eye floaters etc
Since then I’ve eaten exceptionally well, exercised, sleep is great, mood is better most days, I take the right amount of good quality supplements a day (Vit d, magnesium oil, occasionally zinc picolinate, Vit C and probiotic)
My hormones are good, apart from prolactin which four times in a row now has come up elevated at 863mIU/l - (range 86 - 324) I’ve had an MRI which was clear, no head injury, no medication - so lingering stress effect? GP’s don’t seem bothered, got an Endo appt in jan.
Opticians - good
ENT - good
Coelic - Clear
Thyroid - TSH, T4, T3 and antibodies all came back normal
Bloods all seem good and in range - apart from the Prolcatin of course.
Ive posted my adrenal tests
Can anyone shine a light on this? Maybe that describes my symptoms and maybe it’s the reason why my prolactin is high?
Any help or insight would be appreciated, thanks
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Gman12
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Hi, I'm sorry you are having issues. Have you put on weight as well, especially around your tummy area but your are & legs are still thinner? Your cortisol is slightly on the high side which could point towards Cushing's & the fact that your prolactin is elevated could point towards a pituitary issue. When you had the MRI did they give you contrast to show things up better. With your prolactin really high& elevated cortisol you may have the start of a benign pituitary tumour. Your GP should be able to run an early morning blood cortisol test to see if that come back high. Are you being treated for the high prolactin? You should be especially as a man you won't be wanting to have female hormones going through your body! You probably should see an Endocrinologist to follow up with these tests, certainly the symptoms you describe are quite typical of a hormone issue. The Endocrinologist should be one conversant in pituitary/adrenal issues as not all of them are. Have a look on the Pituitary foundation's website for more information on high prolactin & high cortisol, let me know if I can help anymore.
Thanks for reply, find this all very interesting (if not a bit unnerving!)
The medichecks dr stated that ‘Cushings and Addison’s don’t appear to be the issue, and have some tips to reduce stress. Thing is - I do all those things and I’m not stressed anyway! I was a year ago, not now.
No other doctor seemed overly fussed about it as they said it would have to be off the scale in the 1000s to suggest a tumour. I’m not sure if the MRI had the contrast done, I just had the phone call to say it was clear. I’ve never been offered medication for rescuing the Prolactin as there is no proof of it being a tumour. I’ve heard B6 and Vit E are good for lowering it a bit but that still doesn’t get to the bottom of it.
I weight 12 st, quite Broad, muscle tone, my legs have always been thinner than my top half and my chest is not gyno but has always been a bit flabbier and I’ve been self conscious of it since school days.
I’ll certainly check out that website, thanks again!
Sadly any Endocrinologists are conversant in Adrenal/pituitary issues so don't understand the issues. You need to find one that does but ask your GP to do a morning blood cortisol to see what that is, it's not always important to have DHEA tested when looking at Cushing's or adrenal insufficiency. If you do decide to have further testing done then don't take any supplements until you know what is going on. I'm not sure that they can say a tumour has to show prolactin in the 100o's or even 100's!!! Yours is certainly outside of the normal range for a man. The Pituitary Foundation will help you to find an Endo who is knowledgeable in pituitary/adrenal issues. The fact that your prolactin is high points to a pituitary issue rather than just adrenals.
‘Us doctors don’t start getting excited about Prolactin levels until their in the 1000s - if all tests and everytime else is fine, you just have erm, high Prolactin’ and shrugged.
I’ve started taking a b complex so I’ll stop that along with the others. All I know is, since that stressful event a year ago I haven’t felt the same. Maybe it triggered this and put my body out a whack?
Or these symptoms were laying in wait and triggered the stress in the first place? Who knows. I always remember feeling mildly tired but then who doesn’t?
They also think in black and white. So if your blood results are right at the top or right at the bottom of the normal range, as mine were, it is "normal, no action" in spite of symptoms. But if the result was one point higher or lower it would be Cushings or Addisons.
Unfortunately, many members do this test with Medichecks (and Blue Horizon) but it doesn't include DHEA along with the cortisol, both are needed as it can affect how the result is treated (if necessary) and they don't give a proper result for the bedtime level. It could be at the bottom of the range (where it should be) or it could be as much as 70%, there's no way of knowing.
These are optimal results for cortisol:
• Morning at the top of the range - yours is 132%
• Noon approximately 75% of the range - yours is 64%
• Evening close to 50% of the range - yours is 131%
• Nighttime at the bottom of the range - your result is useless because there isn't a number
So you can see Samples 1 and 3 are far too high, Sample 2 isn't too bad. Maybe you can identify the reasons for Samples 1 and 3 being high?
The best tests are done by Regenerus and Genova Diagnostics, who both include cortisol plus DHEA.
I had my DHEA Sulphate taken the same time as my prolactin actually,
My DHEA Sulphate a month ago was
8.620 umol/l - (Range - 4.34 - 12.20)
My TSH - 17th Nov - 2.76 mIU/l - (0.27 - 4.20)
TSH again 28th Nov - 2.08 mIU/l
T4 - 14.200 - (12 - 22pmol/l)
FT3 -5.36 - (3.10 - 6.80pmol/l)
And all thyroid antibodies were << so clear
I have no idea why the cortisol raises at those times.
I made sure to test on my day off as well - I was doing nothing, relaxing! But the same symptoms kicked in early afternoon as described above, very odd. It’s 16:50 and I’ve got a dull headache right now along with groggines/foggy head/tiredness.
The 17th November TSH is slightly higher than one would expect for a normal healthy person, although the 28th November one is just about at the limit, 2 or below is where one would expect it to be for someone without a thyroid problem.
When looking for a diagnosis TSH needs to be as high as possible, and this is as early as possible in the morning for blood draw as TSH is highest at midnight then lowers throughout the day and is lowest early afternoon. Eating can also lower TSH and coffee can affect it as well, so delaying breakfast and water only until after the blood draw all helps with TSH.
Do you have any previous thyroid results? Have you ever had FT4 right at the bottom of the range? Low FT4 with a normal, low or slightly elevated TSH can indicate central hypothyroidism which is where the problem lies with the pituitary or the hypothalamus, this is where the signal to the thyroid to make thyroid hormone doesn't get through well enough and the FT4 stays low.
Adrenal tests should be done on a "normal" day to reflect your normal levels.
I did my 2 recent TSH Tests first thing in the morning (around 7am) and fasted. So hopefully their more accurate.
My T4 on a previous test was 17 I think so it’s still within normal range. The lowest my TSH has been was a year ago at 1.99 - and that was taken around 9am after breakfast so not so accurate.
I think I’m getting somewhere since. investigating hormone issues. Put it this way - every test for every single thing I’ve ever had done has come back fine APART from Prolactin and cortisol tests. So that’s where I’m headed I think.
What the route cause was, I’ll never know but I’m guessing it has to be the stressful episode.
I’ll look to re do the adrenals maybe after Christmas
I’ve been advised from other members to let you know about my vitamin test results (posted down the thread) as well as my supplement regime. Thanks for you help, it’s very much appreciated!
I would echo SeasideSusie's advice, and if you can tell us whether or not you ate, or drank anything but water before your TSH blood draw, that would really enable us to make further suggestions.
Without that info, it's a bit chancy to draw conclusions, but it does seem as though your thyroid may be starting to struggle. My other reason for saying that is your high prolactin, which doesn't always indicate a primary pituitary problem, but instead can be one (temporary) consequence of weak thyroid function. When my own thyroid function really began to wind down my prolactin output shot up into the stratosphere. An MRI with contrast did not reveal a pituitary tumour though.
This is extremely interesting, thank you! I honestly think my TSH tests were done early (7am) I think one was done after a banana and a drink of water though - so I’ll have to re do again at some point!
It’s got to be literally and mean LITERALLY impossible to get a GP to even believe that my thyroid is struggling surely? My mums hypo and her TSH was 17 but before then they wouldn’t care unless it was 10 or above! The dr would laugh me out the room.
Just out of interest, any idea what caused your issues and what were your symptoms?
My reply to you last night should have appeared directly under yours and not down below...
I take it you're in the UK? The medical profession in this country is an outlier in terms of setting the upper limit for TSH at 10 before starting treatment for hypothyroidism. I can't remember off-hand which country has proposed an upper limit of 2.5, but you get the picture. Many people on this forum find that once they are symptomatic their TSH needs to kept at 1 or below. Bear in mind also that the TSH lab reference ranges are derived, at least nominally, from healthy people.
You mention your mother has hypothyroidism. The condition often runs in families. She must have felt very unwell with her TSH at 17! Is she being prescribed levothyroxine?
You could get your own private tests of thyroid function through Blue Horizon or Medichecks. If you do, make sure you choose one of the more comprehensive thyroid panels for your first one, testing TPO and TG antibodies, FT4, FT3 (most important), TSH, vitamins B12, folate and D, ferritin, and CRP. Come back to the forum with the results, but start a new post, and we'll do our best to help.
We still need to think about your raised cortisol, but from what you've told us so far, it may just reflect the fact you are under physiological stress from elsewhere in the body. Cushing's should be ruled out though, as it carries an increased risk of cardiovascular disease, among other problems.
If you haven't already done so, have a read of the Thyroid UK website, and come back to the forum if you need additional references for your research. You'll see a symptoms list on the website - I think I must have had every one of them in the days when my health was being mis-managed by the NHS.
Yeah my mum struggled, she has been on Levo for years now and seems back to normal. Hypo and hyper runs in both sides of the family - all women though.
I’ve beat you to it - I’ve had those tests done aswell haha they are...
Both antibody tests are < 10 - (0.0 - 115 & 0.0 - 34)
T4 - 14.2 pmol/l - (12 - 22)
FT3 - 5.36 pmol/l - (3.10 - 6.80)
TSH - 2.08 mIU/l - (0.27 - 4.20)
Active B12 - 93.8 pmol/l - (37.50 - 188)
Serum folate - 4.71 - (3.89 - 26.80)
Vit D - 86 nmol/l - (50 - 150)
CRP - 0.27 mg/l - (0.0 - 5)
Ferritin - 131 ug/l - (30 - 400)
Iron - 25.3 umol/l - (5.80- 34.50)
T.I.BC - (59.43 umol/l - (42 - 72)
TS - 42.62 % - (20 - 50)
The saliva tests do kind of measure how I feel, my cortisol is above the high range first thing in the morning -might explain why i feel quite energetic and ready to go first thing in the morning.
Mid afternoon I start going downhill especially after I’ve eaten (healthy clean meal with water). My cortisol is also too high at 4pm - so why don’t I feel energetic then? I’m spaced out and Brian fogged out my mind at that point.
It seems that at bedtime also my cortisol crashes significantly <1.5 - Range 0.0 - 2.0 which would explain why at 10 - 11pm lm like a sedated zombie.
We do need cortisol in the morning to get us up and about (I make very little of it) but thereafter it declines gradually through the day. If you feel like crud again in the afternoon when your cortisol is higher than it should be, then your adrenals are trying to compensate for a deficit elsewhere. It indicates stress, whether physiological or mental. But if you have Cushing's, then you have a primary adrenal problem, and that needs specialist attention.
Are those thyroid function test results from the blood draw you had after eating? If so, it's important to repeat them.
Your folate and vit D could stand improvement, and also your B12, which some people have to keep high in range to feel well.
I should add that your FT4 is near the bottom of the reference range, though your FT3 looks ok at the moment. That pattern is something we often see here in people who are not feeling unwell or are unusually fatigued. It's another indicator that the thyroid is beginning to struggle. Read posts and comments by Diogenes on the forum. He is Dr John Midgley, an active researcher into hypothyroidism.
I'm glad you've added these vitamins. It was the question I had in mind all the way through the thread. You mentioned you supplement, but you really need to see the tests to target supplements you need.
B12, Folate, Ferritin and Vit D are said to be the 4 to look at first. You've got all of those and they all look a bit low. The rule of thumb is you usually want them at least halfway up the range, but for Vit D and B12 the ranges are set low, so it's better to be near the top.
You've had SeasideSusie comment in your thread, she's the most knowledgeable about vitamins. If I were you I'd cut and paste this vitamin information as a reply to her and ask for advice to supplement these.
This isn't bad. Below 70 is where it warrants investigation into B12 deficiency, so yours is OK. I don't know the optimal level for Active B12, just with serum B12.
Serum folate - 4.71 - (3.89 - 26.80)
This is very low, it should be at least half way through it's range, so 15.5+ with that range.
Vit D - 86 nmol/l - (50 - 150)
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L. To bring your level up to the recommended level the Vit D Council suggests supplementing with 2,500iu D3 daily. However, they also suggest supplementing with 5,000iu on the days we don't sunbathe, so as it's winter and we can't make Vit D naturally from the sun, you could take anything between those two doses but retest in 3 months time. Once you've reached the recommended level then you'll need a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/
There are important cofactors needed when taking D3 as recommended by the Vit D Council -
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
Check out the other cofactors too (some of which can be obtained from food).
If you have Hashi's then for best absorption use an oral spray or sublingual drops.
If you don't have Hashi's then a good quality softgel with minimal ingredients is a cheaper option, look at Doctor's Best (only 2 ingredients - D3 and extra virgin olive oil).
CRP - 0.27 mg/l - (0.0 - 5)
Great result.
Ferritin - 131 ug/l - (30 - 400)
Ferritin is recommended to be half way through range. Your level isn't dire by any means but if you want to increase it then you can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...
Thanks again, I’ll re post this up here so you get it. It’s strange as my folate a year ago was 8.00 with a diet that wasn’t so great? And now a year later it’s 4.71 after eating extremely healthy.
My only guesses is that either stress or has triggered an absorption problem. Or, I’ve had an absorption issue all along and just never knew?
My diet a year ago included a lot of whole grains - bread/pasta/cereals - these are usually fortified with folic acid and not much green veg at all. I’ve cut all those carbs/starchy/grainy foods out mainly and decided to try and get my folate from Greens - and hey ho, my folate level has dropped. Does that mean I can only absorb synthetic folic acid as opposed to natural folate I wonder? Maybe that explains the drop in levels?
I’ll start experimenting with both supplements and see what benefits me most. As far as I know, my experience with methyl supps aren’t great - I felt wired and anxious on methyl b12 for example.
I agree with what's been said elsewhere about the shape of your graph, the higher afternoon value will be because your body is struggling at that time.
Cortisol is kind of the everyday version of what we think of as adrenalin and fight and flight, it covers for the ups and downs we have every day, including getting us out of bed.
I spent some time this year looking into my own adrenal issues, and I partly concluded that the adrenal saliva test is more like a marker of how unwell we are generally, rather than necessarily the cause of it.
I agree that your thyroid is looking a little underperforming, and the family history is quite important. These things very much run in families.
I'm afraid I don't know anything about the prolactin
How much rest are you able to take, that's another thing to look into with helping the adrenals and fatigue type symptoms? You don't mention if you're in paid work or otherwise racing around in those 6 hours. Have you tried taking a nap at 12-ish, and /or really taking it easy during that afternoon period? Is it possible to reduce your activity during those hours, or even in your week in general? Cut down on exercise, travel, work, sit down more, lie down more, during your day?
With most illness the advice is to try and keep active, but with the adrenals and to a lesser extent thyroid issues its important not to do too much. My own experience has been that the more I rest, the greater quality the rest of my time is, and its almost like I'm doing more. Having a high cortisol result means your body is in overdrive and not coping during those times, so the more you can reduce what's being asked of it the more energy you'll free up for healing and running the essential systems of the body (brain included).
It might be that if you can't get to the bottom of any physical diagnosis, you can change your lifestyle and build it around nurturing the illness instead. Unfortunately with thyroid and related issues we sometimes don't get entirely better, and have to accept being at eg 80% of where we were. And this means changing our expectations and activity levels to still live a comfortable life.
I have in fact got a cupboard full of good quality supplements. Starting from the top, my Vit D in Dec last year was 53nmol/l. I purchased some Vit D oil gel capsules at 2500iu and managed to get my Vit D up to 93nmol/l by April. Of course we had a good summer and I had a holiday in Spain so I cut out the D supplement and tried to get it naturally. Now start of this winter it’s dropped slightly (86nmol/l) so now I’m back on them. I tried supplementing Vit d with Vit K2 (mk4 and mk7) - I can’t tolerate it, I get reaaaaly fatigued and almost drugged. Read up a few times that k2 isn’t ‘all that’ either and I’ve cut it out.
I use mag oil every day about 400mg worth of sprays , Vit C with bioflavonoids, a probiotic I’m the morning and evening, and I’ll cycle 25mg of zinc picolinate at dinner 2 weeks on, 2 weeks off. This is all included alongside a healthy diet.
I’ve actually recently purchased a b complex - a natural one that doesn’t have rediculois RDA %’s. And a separate methlyfolate at 400mcg - I heard it’s better than folic acid. I used to supplement a b12 as methylcobalamin at 500mcg - 1000mcg but after 4 days it made me wired and nervous so I stopped it.
I eat a TON of folate containing foods - organic as well! I couldn’t believe it when my folate was down the low end.
I’m a self employed hairdresser so I stand up 8-9 hours a day, 5 days a week but I love it and it doesn’t really cause any stress - in fact it’s the weird symptoms that get in the way sometimes.
I exercise 3-4 times a week but that’s only in the past 3 months - I had these symptoms before hand! I workout 30 - 40minute weights first thing in the morning - please note my waking cortisol Test was done on my day off with no exercise. I love the gym. I don’t over exert myself stupidly really, it makes me feel good and gives some direction and a bit of a hobby you could say.
From what I’ve been told, stress can impact Prolactin so it’s all part of the same package it seems one thing effecting another. The cause, I’m really not sure
I can't fault your vitamin regime, but I'm not at all an expert, SeasideSusie would be best to spot if there are any obvious gaps. Not being able to tolerate B12 sounds like it could be a clue. B12 deficiency and anaemia is a whole other rabbit hole to look into that might be useful. Some people end up injecting instead of the sublingual tablets. I'm not sure if you need to look into the ferritin, but Susie could advise.
I'd say there's definitely a lot you could try with reducing your activity and see if resting improves your symptoms. 'Stress' just means asking more of your body than it's able to give, so these can be very enjoyable but still be hurting you. Something to give a lot of thought to, because its always a painful process for everyone to give things up. There's a huge stigma about resting in our society, but it really is true that it's the best medicine. My advice would be to really give a hard look at that big list of activities you gave, and think about what you can cut out or convert to something lower energy, for example ditch the weight lifting and do gentle walking or yoga instead, or even better go home for a nap, or take on a few hours of work at a desk each week, or cut down the hours you work altogether.
Its worth redoing the test on a day that you're doing your normal amount of activity. Its always said to do it on a stressful day, not a day when you're resting. Unfortunately there isn't enough traffic about this to know if it makes much difference But it may be that what you're looking at is quite misleading. Looking back I noticed that you're doing some of the most intense exercise in the morning, and I think that's a bad idea because the test shows that your body is already quite stressed just from getting you out of bed.
Another little thing with adrenals is that they act to do the work of keeping you going when you haven't eaten recently. So definitely make sure you're eating as soon as possible when you wake up, and don't be doing things like exercising without food beforehand. When my adrenals were bad I would also eat if I woke up in the night, and one of the first early symptoms I had would be to wake up ravenous in the middle of the night after I'd been lifting weights. My personal experience has been that weightlifting is one of the most challenging exercises to stress the adrenals and slightly downgraded thyroid function. Now I've been a lot more ill I can look back and see I was having symptoms around weightlifting years before I noticed them anywhere else. At the time I just thought I needed to increase my cardiovascular fitness to handle it.
Oops, I also wanted to mention that having low vitamin levels isn't a comment on the quality of your diet. Its more to do with the digestive system not being on top form, so the nutrients you're eating are not ending up absorbed into your body and being used.
Poor quality stomach acid is just one example that goes hand in hand with thyroid problems.
Thanks again! I’ll aim to get the cortisol re tested after Christmas in the new year. At least I’ve got an insight which gets me on the right track.
It’s strange as my folate a year ago was 8.00 with a diet that wasn’t so great? And now a year later it’s 4.71 after eating extremely healthy.
My only guesses is that either stress or has triggered an absorption problem. Or, I’ve had an absorption issue all along and just never knew?
My diet a year ago included a lot of whole grains - bread/pasta/cereals - these are usually fortified with folic acid and not much green veg at all. I’ve cut all those carbs/starchy/grainy foods out mainly and decided to try and get my folate from Greens - and hey ho, my folate level has dropped. Does that mean I can only absorb synthetic folic acid as opposed to natural folate I wonder? Maybe that explains the drop in levels?
I’ll start experimenting with both supplements and see what benefits me most. As far as I know, my experience with methyl supps aren’t great - I felt wired and anxious on methyl b12 for example.
I used to kill myself in the gym around 8 - 9 years ago now I’m very sensible with it. Maybe I’ll try switching the times I workout and see if they improves. It’s just that training ag 7:30am is more beneficial before work and also I feel stronger.
I don't know enough about vitamins to comment on the folate. For all I know it could fluctuate quite a bit in general, although I've just looked up my own results and mine stays quite stable over time.
It's possible that grains did suit you better, a strange thing with thyroid problems is that some people do very well on a low carb diet, and other do very badly.
I was thinking about your thyroid panel results, and how you have a pretty low freeT4, but a good freeT3 ( with these it matters a lot where you are in the range. These are a normal distribution, so the average healthy person would have a readin right in the middle of the range, the lower it is the more likely it is the thyroid is playing up), and I remembered something. The thyroid makes a lot more T4 than T3. T4 is the storage form, and the body has to turn it into T3 to use it.
A thyroid researcher that uses the forum is researching how the body will work hard to keep the T3 level good, even when the thyroid starts to fail by increasing the effectiveness of the conversion throughout the body. This explains a pattern like yours, the freeT4 is low because the thyroid is struggling to make enough hormone, but the rest of the body is increasing conversion to T3, so the freeT3 remains good.
Although I've just noticed youve only typed 'T4', so maybe this isn't a freeT4 test, and I may be completely wrong.
But if I'm right it's a bad position to be in, because as you commented above, a doctor won't diagnose you until your numbers get much much worse
Yeah it’s free t4 so your right. My free t4 has been ‘17’ A couple of months ago which is bang in the middle so it can do it. I suppose it’s normal for thyroid hormones to fluctuate daily and mine only do slightly. But yes, I have heard to best for TSH to be 1 - 1.5 (basically under 2.5 ideally). In fact if I lived in certain other countries I’d be regarded as ‘boarderline hypo’ as their cut off is 2.5 I believe. I think Germany is one of the countries that has a 2.5 cut off in fact.
Ah it’s all very complicated and every slight change makes a difference. As it stands my aim is to,
Raise my folate
raise my Vit D
raise my ferritin - ( even though my iron levels are quite towards the high end so I Don’t understand while Ferritin is low?)
Raise my b12
Rest and concentrate on repairing my adrenals better - this I have been doing for the past 10 months or so, maybe it’s just going to take longer to repair/re start them.
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