Could someone please help me to interpret my cortisol saliva test results and what I should do next to resolve any issues? Any advice on lowering cortisol levels? I had a total thyroidectomy in late 2017 (Graves disease). Was on 100mg levothyroxine, could not tolerate as heart problems started due to it. Since late 2018 I am on NDT. Thank you for any help!
Cortisol Results:
7:35am-10.04 nmol/L (range 2.68-9.30)
12:04pm-6.59 (range 0.75-2.93)
4:05pm-2.70 (range 0.36-1.88)
11:40pm-0.72 (<=0.94)
DHEA-0.66 (range 0.25-2.22)
DHEA:Cortisol Ratio-0.07 (range 0.05-0.32)
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Despite my high cortisol I don't experience stress. I am taking b complex vitamins, vitamin d3 (3000 IU), vitamin k2, vitamin c from acerola extract, glucosamine and chondroitin complex for knee pain, ferrous fumarate 324 (150mg elemental iron as I take 1 and 1/2 tablets). I never tried gluten free diet before.
My iron study blood test from 21 January shows:
Serum iron 3.2 (11-36 is normal).
Serum TIBC 82.8 (53-85 normal).
Serum ferritin 7 (14-148 normal).
transferritin saturation index 3.9% (20-40% normal)
Mean corpusculur haemoglobin 23.2 (27-33 normal)
Red blood cell distribution width 16.3% (11-16 normal)
When I was on levothyroxine 100mg my tsh and FT4 were always at the top range, sometimes my Ft4 was over the top range. I never felt well on levothyroxine but in October 2018 I felt very bad with high blood pressure, pulse, palpitations, I couldn't walk for a long time, I felt terrible. At that time my TSH was 3.44 (0.3-4.20 normal) and Ft4 was 22.9 (12-22 normal). My gp sent me for ECG which came abnormal, although 1 year ago before my thyroidectomy my ECG was completely normal. My GP decided to reduce levothyroxine from 100 to 75mg. After that my TSH rose to 12(0.3-4.20 normal) and Ft4 was 18.4 (12-22 normal). Despite this I did not feel better. I asked my GP for t3 trial but she said she can't give it to me and only levothyroxine is available in UK. So I had no choice but to order Thyrogold from USA as I could not find a doctor in London to prescribe NDT for me.
So from 12 December 2018 I started Thyrogold whith small dose and increased little by little every 2 weeks. Immediately I felt my symptoms disappearing. I was feeling better and better. I think I miscalculated the dose or I received a weak batch as I thought my dose of thyrogold will be half of 300mg capsule. In January my results came TSH 26.6 (0.3-4.2 normal) and FT4 8.7 (12-22 normal), FT3 2.9 (normal 3.5-7.8). The dose I took was not enough. So I increased my thyrogold to 1 capsule 300mg and later to 1 1/3 capsule.
In March TSH 3.21 (0.3-4.2 normal) and FT4 14.7 (12-22 normal), but I was still feeling a little dizzy probably because of low iron.
I decided to try another NDT, THIROYD. Now I am taking 2 tablets of thiroyd. I think I feel better on it than thyrogold. I am planning to do my next blood test after a few weeks with vitamin and mineral panel. I am concerned about very high cortisol in afternoon.
transferritin saturation index 3.9% (20-40% normal)
Mean corpusculur haemoglobin 23.2 (27-33 normal)
Has your doctor seen these iron-related results? I'm surprised you can walk. You are very iron deficient and also anaemic. You would be better off being given an iron infusion. Trying to raise such low levels of iron with tablets could take you a couple of years, whereas with an iron infusion you would improve your levels within hours.
I do know that some people have paid to have an iron infusion privately, but I have no idea how much it cost them.
I haven't heard of ferrous fumarate 324mg, but I've heard of ferrous fumarate 322mg. The therapeutic dose is one tablet twice a day, so taking 1 and a half is lower than necessary.
Take each iron tablet with high dose (1000mg) vitamin C. If you get constipated take more vitamin C. If you get diarrhoea take less vitamin C. If you can't tolerate the iron tablets on an empty stomach then try taking them with food. Take the iron tablets 4 hours away from thyroid meds.
If you eat meat you could eat liver or black pudding or liver pate to improve your iron intake.
I used to eat gluten and didn't absorb iron well. Going gluten free helped quite a lot in improving my iron absorption, and I've never regretted it.
My GP ordered this iron panel for me together with a full blood count test. When I asked her for the results she did not even mention the low iron levels! I asked for print results of the test and then I found out that I am low in iron. I think everybody should ask for print results of their tests as some doctors will ignore the results. I run on a regular basis.
I think you should show the results to a doctor at your surgery, and ask for an iron infusion. I doubt the doctor will agree, but if you don't ask you won't get.
I did both saliva and blood cortisol tests recently and also had raised levels (more so than yours). The advice I was given was to reduce stress levels, by getting regular and reasonable length sleep, exercising, socialising and do hobbies (all of which I do already).
For me, the first thing I am doing is to reduce my caffeine intake dramatically, much of which was required to wake me up again after taking amitriptyline for migraines as that knocks me out. To allow me to reduce the caffeine, I am also weaning myself off the amitriptyline.
Do you have high stress levels, or do you get through lots of caffeine?
In terms of stress, I would also advise taking up mindfulness, resting more overall, but also learning how to take quality rest. Exercising should be gentle, too, more vigorous exercise wants to be reduced, and eating healthy without things like long breaks that require extra work from adrenals.
There are also adaptogenic herbs, and the option to supplement with adrenal extracts.
It's quite a complex area looking into herbs. I had high cortisol at one point, and was thinking of taking Rhodiola, but there are several other options.
Getting vitamins and thyroid replacement optimal also helps. For me in the end improving my thyroid hormone, along with mindfulness and general rest, improved my cortisol so much I ended up not taking the adaptogen.
I agree with all that’s been said but the most important thing is how do you feel?
The first result should be 100 of range and it’s just over.
The second and third should be 75% and 50% of range. So they are too high. Some people cannot tell whilst other can feel extremely strung out.
My own were v high and initially I never noticed. When they increased slightly I definitely did and all my vitamins were optimal.
If you feel anxious ( on top of the great advice) The adaptagen to lower cortisol is ashwaganda.
Tulsi tea ( pukka) helps too. I found decent doses of vit c in my herbal tea helps. I take ascorbic acid. It also keeps any bugs away.
Whilst your dhea is in range it’s not overly high. The cortisol/ dhea ratio is v low.
High cortisol and low dhea is the most common category of adrenal issues.
Slowdragon as always is right you need to ensure you’ve good foundations to get everything tip top.
Diet
Vitamins
Absorbtion
Then adrenals and thyroid meds.
If your dhea drops further and everything else is optimal you may have to consider pregnenelone. Obviously ensuring everything else is good is a priority. ( low dhe does make you v tired)
A good read is
Www. Drmyhill.co.uk and on the home page in the top right hand corner type in orchestra.
It’s a fab article on achieving good health. She’s a top endo and general specialist.
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