Help with Adrenal results: Can someone please... - Thyroid UK

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Help with Adrenal results

Can someone please help decipher these adrenal and dhea result and help me with the right supplements to take. Thank you in advance.

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These links might help:

1) Scroll down to Results Overview:

web.archive.org/web/2018083...

2) You'll need to scroll down a bit for Interpretation of cortisol and DHEA level results of an adrenal stress profile test:

drmyhill.co.uk/wiki/Common_...

Your waking sample is obviously far too low and samples 2, 3 and 4 do follow the normal curve but are too high. I don't know how you treat mixed results like this.

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Thank you! The links helped. I think I will start with Pregnenolone and slow release melatonin.

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Raise the morning level and the others should fall into place.

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Should I supplement with Pregnenolone?

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I'm afraid I have no experience of pregnenolone. My doctor wanted me to take it, but the pharmacy had no idea what it was, so I didn't bother. I took prescribed HC, but my morning level was a lot lower than yours.

Take vit C, certainly, and make sure you get enough salt - adrenals like salt. How are your B vits? Have you had B12 and folate tested?

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My ferritin is low everything else good. I take a ton of vita c powder in my water. When you say take salt do you mean sea salt?

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I put Himalayan salt on my food. Hope that helps.

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If there's enough of it, yes. :)

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Sea salt or pink Himalayan salt. Definitely not table salt! :)

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I only use the pink Himalayan sea salt.

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Saliva tests are notoriously unreliable. A diagnosis of adrenal insufficiency is made on the basis of a synacthen test first thing in the morning without taking hydrocortisone or other drugs. A blood sample is taken, an injection of ACTH (the hormone produced by the pituitary) given and another blood sample taken half an hour later. The cortisol level result of the former should be in excess of 350 and of the latter 450. If you have adrenal insufficiency, you will not need 'supplements' but the drug hydrocortisone to replace the cortisol your adrenal glands are failing to produce. (PS there is no such medically recognised condition as 'adrenal fatigue'; it is a label invented by people who want to sell you snake oil.)

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This message is intended for dbrowning02.

This is exactly right. You need a synacthen test to determine if you have adrenal issues. If not your adrenals then the problem could be coming from elsewhere.

I had 2 synacthen tests last year as my cortisol was very low. 68(155-607). Also my ACTH was very low 0.5(2-11). I past both synacthen tests. So it wasn’t my adrenals. After a long period of debilitating symptoms I found I was a poor converter of T4 to T3.

I had a gene test DIO2 to check if I had a faulty gene. The test came back positive from one parent. Privately I sourced T3 medication. Within 4 weeks of a huge improvement with taking T3 medication along with T4 medication, not only did my thyroid level out but my cortisol improved significantly also. From 68 to 466. It was and is quite remarkable. Now my thyroid and my cortisol are all where they should be and I feel so so much better. From being housebound to going on 10 mile walks.

T3 medication can help cortisol improvement if you are a poor converter T4 to T3. This maybe something you could look in to.

Sorry I hit the wrong reply option this was intended for the member who wrote the post.

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Thank you so much for your response. I'm not familiar with that test I thought the Adrenal, Cortisol saliva test was the best. A little background, I've been on 120 mg of Natures Throid (sometimes Armour) for over 15 yrs and having problems recently with regulating. I also had this same saliva test in 2017 and I was flat and low from noon on. I'm just trying to figure out what is going on in my body.

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Saliva tests are not normally used in the UK because they are not reliable indicators. Cortisol levels vary naturally in the body in a natural (circadian) rhythm over the 24 hours - lowest at 2am, building up to be ready for waking 6-8am, rising a little further to midday and then falling away into the evening. Maybe you need more effective thyroid medication - you may not have adrenal problems, but only a synacthen test can confirm one way or the other.

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I thought that is why they want the saliva taken 4 times throughout the day and evening. Hard to think that blood taken 1 time would be more accurate but I'll look into it. Thanks!

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The blood is taken twice - once on arrival at the clinic, and once 30 minutes after the ACTH injection. This measures how well your adrenal glands respond to ACTH, the hormone produced by the pituitary which stimulates adrenal glands to produce cortisol - which is the critical piece of information needed to diagnose adrenal insufficiency.

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NASA uses saliva tests for its astronauts, apparently. Do a search for "NASA saliva cortisol" and you'll find quite a lot of links on the subject.

I don't think anyone on this forum uses saliva tests as absolute proof of adrenal insufficiency or Addison's Disease. They may just be indicative of a problem, which can be followed up with a doctor if there appears to be justification for it. Just a few months ago someone had results from a saliva test that indicated very low cortisol levels, and after being encouraged on here she followed up with her doctor who did a blood cortisol test which showed catastrophically low levels so she was referred urgently to an endocrinologist. She was diagnosed with Addison's Disease.

As for adrenal fatigue, I do believe it is "real" even if doctors don't like the name. Just as an example of the kinds of things we come across on here (this forum), taking ferritin as an example, if someone has a ferritin test which gives a result of 20 with a reference range of (13 - 150), this is in range, and a doctor will probably say it is fine and because it is in range it is described as "normal". But many of us on here feel at our best when ferritin is substantially higher - mid-range or a little bit over, for example. The same sorts of comments apply to various other nutrients - in range isn't necessarily optimal for us. And what level is optimal depends on the nutrient being discussed.

The same comments apply to saliva cortisol results. They may well be in range but that doesn't imply the results are optimal for us. This link (see example 1) gives suggested optimal results for saliva cortisol :

rt3-adrenals.org/cortisol_t...

There are various ways in which people can improve their adrenal health without prescriptions for steroids or anything else. B vitamins and vitamin C can help raise levels, the adrenal glands need sufficient salt and potassium for adequate functioning. Some dietary improvement and getting plenty of sleep is a good idea. And for people with high cortisol rather than low cortisol there are herbal preparations available without prescription which can reduce it. Even some kinds of teas from supermarkets can help if you know what you are looking for and what you are trying to achieve.

Note that blood cortisol and saliva cortisol aren't measuring the same thing. In blood, cortisol testing is measuring the total cortisol which is bound to transport proteins and also unbound cortisol. Saliva cortisol measures only unbound cortisol (and so does cortisol in urine, although I've never used the test). Unbound cortisol is immediately available for use by the body, unlike bound cortisol. Saliva cortisol can be measured several times a day (usually four times) and it can highlight problems at different times in the day. High cortisol at bedtime, for example, can give a reason for intractable insomnia.

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Thank you! Why does all this have to be so confusing. Hoping my appointment today with a naturopath will shed some light, will ask him if he knows about the Synacthen test.

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Do you know if you need an increase to your thyroid medication. Have you had your bloods done recently.

Also are your B12, ferritin, folate and vit D levels ok.

As these vitamins help your thyroid which I turn can help your cortisol.

I haven’t done a saliva test.

In the UK they sometimes do a day curve test. This is tested through blood samples throughout the day. This is normally done if you are on steroids to help your adrenals to ensure your dose is correct.

Do you feel different at any point of the day. Sometimes as the cortisol drops at noon you can feel quite weak and tired if it’s dropped too low. Have you noticed any pattern at certain times of the day. When I had very low cortisol, I would start the day sort of ok but by noon I’d be crashing. Then Id stabilise for a while then at 6pm i would feel very weak again and crash more. Weirdly though when it came time to go to bed I’d bounce back again. Only when I started T3 with T4 did the situation improve. It did take a good few weeks and I did experience pain in my back where my adrenals are. I think they were just waking up and having to work. Now no pain and I’ve had 3 monthly tests for cortisol and they’ve all gone into 450+ at 9am (155-607).

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Yes I just recently posted all my results and got some help with them unfortunately my doctor fills I'm over medicated and response on here was under so today I'm seeing a naturopath to see what he says. I was only low on Ferritin everything else looked good. I feel jittery most days, very dry skin, used to be get very tired by mid day but since splitting my dose I no longer get tired. I sleep pretty good as long as I don't wake up. I'm also going through menopause hell but bio identical implant has helped a lot with that. I'm just trying to figure out whats going on thyroid or adrenals. Thanks for your help!

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Being jittery can be a sign of being over medicated. Also dry skin can be under medicated. I think thyroid and adrenals go hand in hand.

I had to split my dose too. And in doing that initially I felt better. I use to take my first dose after midday to make sure I wasn’t upsetting my cortisol. I didn’t have any guidance on this it just felt better for me. Maybe your thyroxine meds and adrenals are out of balance. My ferritin was low last year. And my B12 was very low too. I’m now on life long medication for them. I think I just ran myself down and never knew I was a poor converter until recently. Now all the times over the past years when I had faint feelings and what felt like mad adrenaline rushing seems to makes sense finally that it is T4 to T3 poor conversion, that slowly virtually stopped.

Have you thought about Levothyroxine and T3 medication. I went to see a private Endocrinologist who is supposed to be the best in the UK. He took me off NDT and said it was not physiological. He said long term it would do me damage. I don’t understand the ins and outs of that comment. So I switched to Levothyroxine alone at first. It wasn’t long before I was collapsing again and in a mess. He then prescribed T3 medication as soon as my bloods stated I needed T3. I’ve not looked back since. It’s been remarkable since starting T3.

I’ve already been through the menopause. I didn’t take any HRT. I did try it in the beginning as I was only 43 and preferred to go it alone.

I do hope you manage to get the help you need.

I don’t know if I can help you. What I do know is that T3 fixed my situation with my adrenals and thyroid levels.

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Hello

May I ask if your TSH was high (over 3) when you took it?

🦋

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Yes. It’s was 4.5 (0.35-5.56)

When first diagnosed back in 2008 my TSH 36.9 (0.35-5.56)

My GP wouldn’t test my bloods for my thyroid. I had to go back 5 times as they kept saying I was depressed and needed medication for depression. I said the reason I could be feeling depressed was because you won’t help me and I was feeling terrible.

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The really strange thing is in 2017 my Adrenals were the same in the morning but by noon very low and stayed that way so something has changed. When my blood was checked a few weeks ago my T3 free is 3.4 ( 2.3-4.2 pg/ml) T4 4.9 (5.1-11.9 mcg/dl) my TSH 0.14 (mIU/L) so now 2 doctors want to lower my dose of 120 mg Armour (switching back to nature now) . I've been doing great until 6mos ago and trying to figure out what has gone wrong. So scared about this lower dose of a 1/4 but they feel by my symptoms I'm overmedicated. Oh and he is just giving me a supplement for Adrenals.

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Looking at your T4 and T3 looks like you need an increase especially T4. Not a decrease. When I was on NDT Erfa my T4 was always very low but yours is out of range. Could you take say 25mcg Levothyroxine to boost your T4 then maybe your T3 will rise also if you are converting ok. I can’t see your TSH range to see if that’s over or not. My Endocrinologist was fine with mine being on the brink of being over medicated as long as I felt ok

It’s all a mine field. One wrong move and we are in trouble.

I’ve never had so much trouble with my thyroid medications as I’ve had this past 16 months. I was diagnosed with hypothyroidism in 2008. Although in 2004 my TSH was 4.6(0.35-5.56) and nothing was said back then. Only found this out recently.

Did you do your blood draw last time leaving 24 hrs etc. I’m trying to think why your levels are low but TSH seems to be saying you have more than enough medication at that point.

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My TSH is on low range 0.14 . Unfortunately both doctors say I'm overmedicated and want to lower by 1/4 gr. I'm scared that this is going to make me worse but they want to go off of what I feel (mostly the jitteryness) not off of what the bloodwork says. You are the 2nd person on this forum to say I'm under medicated. Those results were taken 5 1/2 hrs after taking 60 mg of Armour. This result was taken 24hrs after dose were my TSH 0.08 L (low) T4 5.4 ( 5.1-11.9 mcg//dl), T3 free 2.9 (2.3-4.2. Pg/ml). I'm just so confused at this point guess I'm going to try it their way and see how I feel☹.

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Hi dbrowning02. I can't work out exactly when you switched what you're taking. You said, "I've been on 120 mg of Natures Throid (sometimes Armour) for over 15 yrs and having problems recently with regulating." and "I've been doing great until 6mos ago and trying to figure out what has gone wrong." The manufacturers of Nature-Throid shut down production and 'reformulated' and many people experienced problems on the 'new' Nature-throid. It's been discussed here a lot, as well as over at Stop The Thyroid Madness. 6 months ago may not fit with when the new Nature-Throid hit the shelves (many complained about a year ago), but I thought I'd mention it in case it'a a factor that has affected how you feel. For example, do you feel any different when you take Armour?

If you think it might be relevant to how you're feeling, here's one of several threads discussing Nature-throid problems...

healthunlocked.com/thyroidu...

On this thread there's some discussion of specific batch numbers. Also some comments about adrenals.

healthunlocked.com/thyroidu...

Hope you are feeling better soon. :)

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So I had to switch about 3 mos ago to Armour due to the shortage and just today got back on the Natures. I started having problems while taking the Nature and it did not clear up when I started the Armour. I do remember reading about others having problems but didn't relate to what I was going through and if its true that I'm overmedicated (time will tell) then that wouldn't be from what was going on with the Nature brand in my mind.

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That makes sense. You've had some good advice here and I hope it helps. Good comments from Silver Avocado on meditation. It's helped me a lot and whether it addresses any specific health issues, it helps us face our challenges with equanimity. Best wishes. :)

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Thank you so much and best wishes to you.

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Do you know how low your t3 was?

Please may i ask on private message re endo?

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On T4 Levothyroxine only.

My T3 was 3.9 (3.7-6.0)

My T4 was 14.5 (7.86-14.46)

My TSH was 4.39 (0.35-5.56).

So my T4 was at the top of the range and my TSH still calling for more T3. This was when my Private Endocrinologist said I needed T3. I’d been asking my NHS Endocrinologist for nearly a year for a T3 trial. He kept refusing on the grounds of cost. And said I didn’t need T3. How wrong was he. I went from a wheel chair and being housebound for months to walking a 10 mile hike a month after I started T3. I lost my dream job. I was working full time prior to this awful period.

I also did a DIO2 gene test which came back positive I wish I’d done this test much sooner

I will message you privately ref the private Endocrinologist details.

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Thankyou so much

Wow. I'm so so pleased for,you

And I could have written much of your post as numbers very similar except for the gene test as mine was negative yes endo refuses t3 for me even though I'm also abad converter as I was in range albeit at the bottom - was persuaded to go t4 route higher and higher but I felt so ill I couldn't manage even 100 ( then I thought oh it's because of the adrenals so got caught in viscious circle as adrenal P said some people can't tolerate thyroid tablets when adrenals are too low)

So to refresh, what are you taking now ?

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Hi.

I too couldn’t tolerate any more than 75mcg Levothyroxine. Initially when I went to see my GP last March my blood were T4 13.86 (7.86-14.46) and TSH was 5.96 (0.35-5.50). No T3 done back then and never been tested in 11 years. GP put my Levothyroxine dose up to 100mcg. Within 4 weeks on 100 I was really tired and couldn’t function properly. I had a take a couple of days off work now as I was quite bad. I collapsed at home. Taken to hospital. My TSH now 0.02. T4 15 and first ever T3 3.9(3.7-6.0). My Cortisol was 68. (155-607) ACTH was 0.5 (2-11) My heart rate 42. They gave me 100ml hydrocortisone at midnight. Then did a synacthen test for Addison’s at 9am. I passed just. That was a big error. You should not have any hydrocortisone for 48 hrs prior to a synacthen test!! Then the Endocrinologist said I had no Endocrine issue. Then he sent me to a cardio ward where I spent a week. Still feeling awful as nothing has changed with my medication. Then I had 15 months of hell and all sorts of twists and turns. I found this fabulous site with all the fabulous helpful people on it. I then knew I needed T3 and was pointed towards a fantastic Endocrinologist by an very helpful administrator on here.

Finally I got the T3 this April from my private Endocrinologist. Thank the Lord. On taking it, it was like a miracle. I had energy within the hour. From housebound to doing anything and everything I wanted within reason. I’ve not looked back only that I’ve recently had a wobble with the T3. I thought I was under medicated when I fact I was over after I got blood tests. I’m better again now.

I’m on 70mcg Levothyroxine which is liquid. I can draw as much or as little to tailor to my needs. I still have to take it in two lots. 35+35. I’m also on T3 5mcg twice a day.

Since starting T3 my cortisol has returned to normal, last test 466 at 9am and 3 previous tests all in 400’s from being under range.

The T3 fixed my thyroid and Cortisol definitely.

I’ve lost 20 of the 28lbs I put on last year. And hope to lose another 20 as I was too heavy always on T4 alone. My skin is almost perfect. I had dry and spotty skin since starting T4. I was put on erythromycin (antibiotics) for 11 years for my skin. I never needed it. I needed T3. Also I was put on meloxicam for joint pains for 11 years. I didn’t need that either. I needed T3. And I guess the gene test has proven that now.

So I always needed T4 plus T3.

After 15 months battling in a very poor state of health the NHS has agreed I need T3 and finally has prescribed it a month or so ago.

I lost my dream job through the NHS’s incompetence. I was a consultant so self employed. Therefore no financial help from anywhere either. I have savings and supported myself by my savings and still do.

I do hope to return to work.

Sorry it’s a long reply. There are ways to get better. Just keep pushing and insisting with dignity and strength.

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.. Thankyou Thankyou your story is outstanding to bring home the point!!!!but to whome??🙈🤷‍♀️ Poor you but how amazing now

Not heard of liquid t4, Sounds good!

I've probably been deficient all my life in various measures,

Because of feeling so low I've moved into some low bone density so want to get this up if poss, and tempted to try these bio identical hormones as my switch went off the way Carol Vaudaman explains and went into darkness, and these regain bone although find it scary, I gotten phobic along the way and of course, the t4 t3 cortisol side paramount too, 😱 It's like a jigsaw

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I’m sorry but I don’t know anything regarding low bone density. I wouldn’t know where to begin even.

I do hope you’re trial turns out well for you.

There is hope. And there is a way to help you. I guess it’s finding it.

👍

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👍🏼Keep going 😊

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Hi ...sympathise as similar

I've been suggested to have bio identical hormones as Carol vaudaman story as it builds thinning bones , it's all a bit of a minefield to me

I saw dr Peatfield now retired, who diagnosed adrenal insufficiency, using old balancing methods, he recommended Adrenavive 11 and said my thyroid would sort out naturally but didn't appear to after a year

I find this all very scary and just want my life back without overthinking all this, the steroids thin bones so it seems a viscous circle.

I'm hoping bio identical hormones may help all round and you k ow you are protecting bones, but please do you know when you stop your implant if the menopause symptoms such as sweats and flashes then begin again?

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Yes when I go to long until implant my hot flashes return. The implant never helped sugar cravings and the strange thing my sugar cravings have gotten better, my levels are now under 100 and I'm having more low blood sugar bouts so not sure what is going on.

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Well implants just replaces I expect, like gels or tablets, and 'normally' our cycles fluctuate and we go into sugar cravings probably when ostregen is dominant? but I know nothing of levels

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Thankyou again 🙃

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Thank you for your response. I will try and find this test in the USA . I have only been offered the saliva test and thought it was the best.

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Dbrowning02, Peacockgranny is giving you the conventional medical view. Don't be alarmed, this is just a completely different paradigm from the saliva cortisol test. Conventional medicine doesn't acknowledge this test, and doesn't acknowledge the state that is called by many names but most commonly adrenal fatigue. Obviously they have their reasons, and the poster is trotting out a few of them.

As you've made the decision to test and treat adrenal fatigue you can largely ignore that conventional view, just keep a healthy amount of skepticism in mind as you read about adrenal fatigue. I agree with you that the 24hr saliva test is the best one. It is measuring something very different from the blood tests.

Personally there is a lot written about adrenal fatigue that I don't believe or don't think is useful, but that doesn't stop me from taking 24hr saliva tests or from treating my own adrenals.

I had a similar result to yours except the other way round. In that mine was a mixed result. I had very high morning levels, and out of shape middle of the day, and then a too low afternoon and night time level. This means we were both in a fairly bad state. It's quite bad to have lost the normal shape of the graph.

I think Greygoose gives the best advice for action, to work on the morning and the rest will fall into place. I have been a bit passive in what I've don't with mine. I think the thing that had the biggest impact was getting my thyroid hormone dose much better. I also started to meditate every day (slowly building up to that), which is also very good for the adrenals, as we need to keep stress low and also get good quality rest. Lots of us don't rest properly, and then when we are resting are still worrying about other things, keeping the body quite tense, etc.

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Thank you for your response. My doctor wants me to start meditating so I will try. I have not been stressed so not sure why the change but my thyroid is off so maybe that also has a part in it. I asked him about that other test and he said those test are for patients with adrenal disease. He has given me a supplement and lowered my thyroid meds so we shall see.

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You're very welcome :)

For meditating here are a few recommendations:

This book that comes with a CD: goodreads.com/book/show/113... Mindfulness: finding Peace in Frantic World.

This is probably the very best book to get started in meditation. Its structured as an 8-week course but you really only need 3 or 4 weeks to get a good start. The CD is guided meditation that are excellent, and the chapters really explain in detail how to do it, how to deal with a lot of early pitfalls and concerns, how to handle emotions and our flow of thoughts.

If you like phone apps, Headspace is also quite good to start with. There's a ten day trial and it gives things like little animations and icons to encourage you to keep going. I don't think it's worth the monthly fee, but if you need that to keep you on track it might be.

There are loads of health benefits from meditation. The biggest thing I'm aware of is that it helps me a lot with sleep, and currently I'm having some heart problems and its great for that, too. It's also a big help with all the crap we have to put up with being sick :p

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Thank you so much. I'm going to check those out😁

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Hi

I was in high emotion state for many reasons so took 3 hypnotherapies to help me back down again

Accupuncture helps bach flower etc

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Yes, I agree. Its good to try a lot of these relaxing things. I also enjoy aromatherapy. At one point I put some effort into setting my bathroom and living room up like a spa, got one of those relaxing lightshows for the ceiling so it looks like its underwater, set up my smells, played birdsong CDs, then either had my bath or meditated in that. I need to get my light show out and start doing that again now the darker evenings are getting near!

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:) this reminds me thanks 🙏🏻

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....but please how do you get a low morning one then? (mines very high at bedtime over range )

Is it just relaxation and medication to lower it ?

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If you've got a low morning result and a high bedtime result yours is quite similar to dbrowning02's graph, so you can follow the advice given in this thread.

If yours is very different you could start your own new thread to ask for more specific advice.

Unfortunately treating adrenals is a bit less clear cut then thyroid, you will hear a lot of different kinds of advice, and might need to try several different things to improve them.

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Thanks Silver Advocado yes agree

and quite sure if had no stress, never worried, exercised laughed and enjoyed again will recover sufficiently, viscous circle thing, one thing that I've learned about stress.

Good wishes

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Dr Peatfield didn't believe in the term adrenal fatigue, if off balance he says they are insufficient - this does make better description I'd think

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