Cortisol test results and graves disease

[Scole89]

Hi, im new to this site. I recently had a cortisol stim test after my thyroid levels have been yoyoing all over the place between hypo and hyper. My baseline corrisol was 13.8 my 30min was 16.6 and my 60min was 18.8. My endo says this is normal but im unsure if it is because of the little rise in level. Not sure if anyone has experience in this and can reassure me that its an okay test result??

[SlowDragon Administrator]

If going between hypothyroid and hyperthyroid that's more likely early stage Hashimoto's disease

Cortisol results need ranges added if you have them

Have you had thyroid and vitamins tested?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If TPO or TG thyroid antibodies are high this is usually Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease). But these can be raised due to Graves' disease

Early stage Hashimoto's can start with hyperthyroid phases

About 90% of all hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's and Graves. Food intolerances are very common too, especially gluten.

So it's important to get TPO and TG thyroid antibodies tested at least once, plus TSI or TRab antibodies tested if Graves' disease is suspected

Private testing for suspected Graves - TSI or TRab antibodies

medichecks.com/thyroid-func...

Ask endocrinologist for copies of blood test results to see exactly what has been tested and equally important what hasn't been tested yet

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

[Scole89 in reply to SlowDragon]

I’m still waiting on my acth level but the reference range said 6-30 which is crazy and not for the stim test all three draws came back with the same reference range. But the conversion would be my first 8am draw at 380 my second at 30min would be 457 and my 1 hr draw was 518. Not sure if the conversion helps at all.

[SlowDragon Administrator in reply to Scole89]

Results show your cortisol levels can rise as result of stimulating

It doesn't test wether cortisol does so on a regular daily basis

Can you add Thyroid and vitamin blood test results and ranges

[Scole89 in reply to SlowDragon]

I test positive for antibodies all though I’m not sure what level but it the tpo I believe, I had an uptake year which confirmed Graves’ disease a few years back. My tsh right now is .014 but a month ago was 4.5 and two weeks ago .45 so I’m trending downward. My sister month and father are all hypo which I’m sure I will eventually be too, I was just concerned about the low increase in my cortisol. I was under the impression that it should doubt or increase by a certain amount at 30 or 60min??

[SlowDragon Administrator in reply to Scole89]

Getting vitamins tested and optimal can help

Many people find strictly gluten free diet helpful too

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

Ideally ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet




(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)




Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

[MaisieGray]

Normal cortisol values at 60 mins vary lab to lab - they can be somewhere between 18 to 25 mcg/dl, but can be as low as 16 mcg/dl - so your result could be okay but to be sure, you need to know the value used by the lab carrying out your testing.

[Scole89 in reply to MaisieGray]

The cutoff for 60min is 18.8 so I’m good on that my concern is only increasing from 13.8 to 18.8 in that time frame, shouldn’t it have increased more?

[MaisieGray in reply to Scole89]

In Critical Care Medicine 2008, it states for instance "An increase in serum cortisol of less than 9 μg/dL following 250 μg of cosyntropin (synthetic ACTH) is highly suggestive of adrenal insufficiency irrespective of the baseline cortisol level. An increase in serum cortisol of greater than 17 μg/dL suggests adrenal competence."

[Scole89 in reply to MaisieGray]

I read that also and usually the cut off is a value >18-20 at 60 min I’m just worried because I mentioned this to her and she didn’t seem concerned as long as she seen the 18 value she said. But it doesn’t make sense to me, what if I started at 18 and end at 18, wouldn’t that mean I’m making the minimum but if I need to make more I wouldn’t. I work as a welder/mechanic and the thought of needing that extra cortisone in the event of an accident and not having it really scares me.