Saliva+Blood Cortisol Results Advice

[hollyblue]

Hi,

After receiving the above results from Regenerus I have had a Medichecks cortisol blood test taken fasting 8:40am and received this result this morning.

227nmol/L (113-456)

I appreciate these results are low but are they low enough that I need to worry about them?

[Hidden]

I think where low enough to worry about might be better assessed by how you feel and what changes you can make to address the issue. I think it would be unwise to ignore and important to think about reducing your stress levels. Taking some vitamin C every day might well help as well as meditation, gentle walks amoung the trees, yoga if you can. I take nutri adrenal extra to support low cortisol symptoms. I am not overly keen on the stuff as it contains steroids but frankly I am unable to function without it.

[Hidden]

They are quite low, a normal result should be double that that at around 450-550 nmol/Ls. What symptoms are you experiencing? If you are struggling with weight loss, feeling dizzy, have nausea & fatigue then you should ask your GP to do an early morning blood cortisol. If this comes back under 400nmol & you have symptoms then he should refer you to an Endo to do further testing, however it's important to go to an Endo who understands pituitary/adrenal issues as not all of them do.

[hollyblue]

Thank you both for the fast responses.

I'm not really having any issues with my weight but do experience issues with fatigue, dizziness when I stand up and feel lightheaded a lot of the time.

So is the 9am Cortisol Blood Test that I had done with Medichecks not the same as what would be carried out by a GP?

[Hidden in reply to hollyblue]

The cortisol test you had done by Medichecks won't be accepted by the GP as they like to do their own tests. Personally I would get a GP check before going down the alternative route. Adrenal insufficiency can be a life threatening if you do have it & steroids are the only treatment for that. Hopefully it won't be that & it could be because you need treatment for your thyroid.

[mischa]

I have just read your previous posts and you are clearly hypo and not on any medication. Being hypo will lower cortisol output because your flagging thyroid is is being propped up by stressed adrenals. You need to be on some form of thyroid hormone. You may well find that once you are on thyroid medication your adrenals will pick up naturally as the stress on them will be relieved.

What you are experiencing is quite common with hypothyroidism and is normally a temporary adjustment. If it persists after you are on thyroid medication, then you could support your adrenals with an adrenal cortex supplement.

Incidentally, my cortisol saliva tests were similar when I was first diagnosed. They change.

[hollyblue]

Thanks. I understand what I need to do now.

Reading around there is conflicting advice as to whether to treat the thyroid or the adrenals first.

I wrongly assumed that my cortisol levels would come back fine and was looking at treating my thyroid with NDT, mostly because there is currently a 4 week wait to see my GP.

Where it's a little more complicated than I first thought and I can't wait another 4 weeks for an appointment and a further 2 weeks to have my blood taken, I'm going to look into seeing a GP privately.

[Nico101 in reply to hollyblue]

i can only go on what all the reference books and the wonderful dr p said: treat the adrenals first for 2 weeks, then introduce thyroid support.

[mischa in reply to Nico101]

Yes that it Dr P's view but there is another view. Adrenals will right themselves once on an optimum level of thyroid hormone.

I have read several posts on here where cortisol was low but rose after on a period of thyroid meds. It all depends on what you prefer. And it is a matter of preference.

[Bramble83]

Undoubtedly you need to get your adrenals checked BEFORE starting thyroid medication.

Your 9am cortisol is too low and commencing thyroid treatment increases the demands on the adrenal glands, using up cortisol more quickly and can precipitate an adrenal crisis in undiagnosed adrenal insufficiency.

medscape.com/answers/122393...

I know this is accurate, as I have Addison’s Disease (adrenal insufficiency) and when I recently started Levothyroxine I became quite unwell for the first time and my endocrinologist has increased my steroids, telling me it’s due to the increased metabolism of cortisol from the thyroid function increasing.

I would go to your GP and ask for another 9am cortisol test.

This leaflet is guidance for GPs in diagnosing adrenal insufficiency and shows what a normal 9am cortisol should be (page 2 under primary care investigations)

gpone.wales.nhs.uk/sitesplu...

If your repeat 9am cortisol comes out below 300, then you need to be referred for a short synacthen test to exclude adrenal insufficiency.

[hollyblue in reply to Bramble83]

Thanks Bramble.

I've got an appointment with a GP for Thursday. I'll take along the results of the tests I've had taken over the past several weeks along with the supporting information.

Where it's a private appointment it'll give me plenty of time to explain everything and I'm hoping I'll actually be listened to this time but we'll see