aldosterone and cortisol results: Hi I have... - Thyroid UK

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aldosterone and cortisol results

Triciatextiles
Triciatextiles
25 Replies

Hi

I have received my results from medichecks for the 24 hour urine test for aldosterone. I have very high blood pressure which I believe could be the cause of some of my other medical problems.

Results: 1.1ug <28

I don’t understand the results, i have asked medichecks and because it is within range it is classed as normal. But surely this is a low result or am I misunderstanding this test?

My Gp has tested my morning cortisol and the results are:

286 (150- 620)

My latest thyroid results from my gp are

TSH: 1.02 (0.27-4.2)

T4:16.4 (12-22)

I would welcome any advice or comments

Thanks

Tricia

25 Replies
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suztango

Your 9am morning cortisol is low. This should have showed up to the doctor as ‘borderline low’ and told you. Did they tell you this? It needs further investigation. People here recommend a 24 hr cortisol saliva test that also includes DHEA for the full picture.

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Triciatextiles

Thanks for your advice. I thought it was low but my GP said its normal as its within the range. I have been considering some more private testing.

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PaulineS

The trouble is that GP's don't realise that the range covers the whole day & cortisol fluctuates throughout the day . It should be at it's highest point first thing in the morning & go down through the day.

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McPammy

I would say that your 9am cortisol isn’t low. I’ve had several 9am cortisol results the past year. Often mine were lower than 150. My sister was 100. We both past synacthen tests. So not Addison’s.

What I needed was T3 medication. Once on T3 my cortisol bounced back along with my thyroid levels.

Have you had your T3 checked as you may be a poor converter.

In saying that your TSH looks good so I wouldn’t think your T3 would be low.

Have you checked ferritin, folate, Vit D and B12 bloods?

1 like
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endomad
endomad
in reply to McPammy

I dont think your cortisol is low. My last 9am cortisol 95 ( 150-550) and is considered low but not addisons. After sst it went up to 650. I did 24 hour saliva test and my cortisol was low on all 4 points.

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Triciatextiles

Thanks for your info. I am going to raise my t4 and see if this helps

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PaulineS
PaulineS
in reply to endomad

Your cortisol is low & should be an automatic diagnosis requiring steroids, however as you responded to the SST it shows that the adrenal glands are working. Did they do an ACTH blood test at the same time of the SST? It needs to go on ice straightaway. The ACTH test shows if the issue is with the pituitary gland, unfortunately many Endo departments don't do this test so leave you in a vulnerable position. You need to ask to be referred to a centre of excellence where the Endo's DO have an understanding on adrenal/pituitary issues.

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McPammy
McPammy
in reply to PaulineS

Do you think 286 is low?? I wouldn’t have thought so from what myself and sister has been through the past year or more. Mine got as low as 68 and my sister at 100. Both well below the 155 lowest part of the range. We both past the synacthen tests. So no Addison’s. Since starting T3 my thyroid levels and cortisol have both bounced back remarkably. My latest cortisol was 466. And around 350 prior. My prof of Endocrine said I had no adrenal issues at all. I think it was my really low T3 level that was causing all sorts of issues.

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suztango
suztango
in reply to McPammy

Mine cortisol was deemed borderline low by my GP at 302 at 9am in the morning. She had to raise it at the next appt. That, and my hypothyroidism, meant that she then referred me to an NHS endocrinologist. That appointment was months away so I went private. The first thing the endo did was a short Synacthen test. That came back fine, do my adrenals are fine. BUT, my cortisol levels are too low in the morning. There is something else going on.

Your cortisol levels are lower than mine. I think the best thing to do is do a saliva test. Not Medichecks as it doesn't include DHEA. One like regenerus.

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PaulineS
PaulineS
in reply to suztango

But did they test your ACTH? this shows if it is the pituitary gland that is causing the issues.

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PaulineS
PaulineS
in reply to McPammy

But did they test your ACTH wile doing the SST? This shows if it is a pituitary issues.

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McPammy
McPammy
in reply to PaulineS

Yes. My ACTH was 0.5 (range 2-11). This was after I’d collapsed and was taken to hospital where I stayed for a week. The Endo said I had no Endocrine issues!! At the same time my cortisol was 68 ( 155-607). This was at 10am. My T3 was 3.9(3.7-6.0). My T4 was 14.4(7.86-14.46). And my TSH was 0.22(0.35-5.56). I had too much T4 and hardly any T3. Even when my Levothyroxine was increased T3 was no higher than 3.9.

After starting T3 a year later and after being so very ill my cortisol bounced back. And so did I. It’s been a nightmare.

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endomad
endomad
in reply to PaulineS

And there lies the problem I have been unable to find an endo or anyone who understands the adrenal stuff. My endo gave me 10mg hydrocortisone tablets for emergencies but said if I take them regularly my adrenals will give up working. So he won't refill the prescription, he is good at thyroid and prescribes my T3 so I don't want to move endo.

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Triciatextiles

Hi

That’s interesting. I do think my thyroid levels are low as in the past i have felt well when my Tsh is nearly suppressed so for me its high at the moment. I have had a t3 test in the past and it was about halfway through the range so low. I have tried adding t3 in a very small dose but i can’t tolerate it very well (my husband takes t3 and it gave him his life back after being very ill). I have just raised my t4 to 100mg per day from 100/75 every other day.

I have checked all vits and my gp has been good and she has given me a whole raft of blood tests all came back normal.

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McPammy

When you say you’ve added a small amount of T3 and you can’t tolerate it. Have you also slightly reduced your T4 at the same time. Your adrenals need to catch up with thyroid medication driving your adrenals. So if you take too much thyroid medication your cortisol could suffer in trying to produce enough. You have to take it low and slow at first. 5mcg twice a day and reduce your T4 by say 25mcg. What is your T4 level looking like. If it’s at the ceiling you can certainly reduce slightly. If 5mcg is too much try 2.5mcg to start. It’ll take 5-7 days to feel the true effect I’d say. I got pains in my back for about 4 weeks. I was concerned and called my private Endocrinologist about the pain in my adrenals. He said it’ll settle down. It did. And I’m now ok. And cortisol gone up from 68 to 466!!

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Triciatextiles

Thanks for the advice- I tried taking a very low amount of T3 - 2.5mg but this made me shaky and i got terrible pain in my legs and arms along with other symptoms. My t4 is i think is low at 16.4 (12-22) so I thought i would try to increase this to see if this helps

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Jnetti

Missed this reply, see my comment below. Many people who take T3 have suppressed (extremely low) TSH. Which makes most doctor's panic because they have been told that this is dangerous.

My T3 has been fairly consistent recently, at around 18 or so, but T3, when measured which isn't often, has tended to decrease. I still seem to be undermedicated and am battling to convince the doctor to grant another increase (I'm on T4 only).

Hope this will help. From what I've read on here, most of us hypos seem to need TSH well below 1

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McPammy

Have you or are you on any steroids. This could effect your cortisol results.

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Triciatextiles

No not on and never taken steroids

1 like
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McPammy

Good they are not good for adrenals/ cortisol

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humanbean

You might find this document of interest - it was written by the Imperial College Healthcare NHS Trust, and they do keep it up to date :

imperialendo.co.uk/Bible201...

See pages 68 - 70 for a discussion of how the Short Synacthen Test should be carried out and how results should be interpreted.

You can also search the document for references to Aldosterone and how it should be tested. There are other ways to test it besides urine.

...

I'm shocked but not surprised at what I've read in this thread. The lack of knowledge of what can go wrong with the HPA (hypothalamic-pituitary-adrenal) axis appears to be endemic in the medical profession, even amongst endocrinologists.

The number of people in this thread ( Triciatextiles , McPammy , endomad ) mentioning results that are too low (or dangerously low in some cases) for good health and who have all been declared normal is absolutely scandalous.

The problem in the case of the SST test, I think, is that hospitals won't test for ACTH, presumably to save money, despite there being several ways in which hypoadrenalism can occur - see "Types" on this link :

en.wikipedia.org/wiki/Adren...

Doctors usually only test the adrenal glands themselves (for their ability to produce cortisol) for primary adrenal insufficiency and never the relevant output of the pituitary and/or hypothalamus (for secondary and tertiary adrenal insufficiency).

I'm afraid I don't know anything about aldosterone at all, it isn't mentioned very often on the forum and I've never researched it. The only thing I can tell is that, like cortisol, its production relies on having adequately functioning hypothalamus, pituitary, and adrenal glands.

4 likes
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Triciatextiles

Thanks for the information i will work my way through this. Its interesting what you say about the HPA axis . I think this is part of my problem, as my health crashed last November (see previous post)and i have been trying to recover this since then. I have seen private ent, nhs ent, cardiologist, now a neurologist after Mri showed possible intracranial hypertension (awaiting lumbar punch) and empty sella. ( possibly affecting my pituitary although the GP has given me some tests which came back within the range). I don’t believe my thyroid medication is optimised as many years ago i had heart palpitations and chest pain emergency admission to A&E but they couldn't find anything wrong. I increased my T4 from 50mg to 75 and hey presto the pain and palpitations went!

Thank goodness for this forum as i cant depend upon the NHS to get me well although my new GP has tried and is sympathetic and has arranged for a whole range of blood tests all came back within the range.

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PaulineS
PaulineS
in reply to humanbean

So many Endo units fail to do the ACTH test at the start of the SST, it amazes me that some don't do it. I was at my hospital's Endo unit last week & asked the Endo nurse if they did the ACTH test when doing a SST, she confirmed that they did, but then they are a centre of excellence for pituitary/adrenal issues. It's so important to go to a unit that understands pituitary/adrenal issues.

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Jnetti

"TSH: 1.02 (0.27-4.2)

T4:16.4 (12-22)"

Without a T3 measurement at the same time it is difficult to interpret. Also I know nothing about cortisol or adrenal levels, except that the adrenals try to compensate for low thyroid levels and also suffer from lack of thyroid hormone. Like someone with a bad leg trying to carry someone with only one or no legs.

I am on Levo only, and if my TSH was that high and T4 that low I would not feel at all well! Some of us need T4 and T3 higher than others, even if it means under range TSH. So you could well be undermedicated. I think someone suggested increasing thyroxine slightly, as you couldn't cope with an increase in T3 .

I read somewhere on here that if your adrenal function is low or not optimal the adrenals can't manage much thyroid hormone increase at a time. As T3 is the active hormone and much stronger than T4 that may be the reason for it making you worse.

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Triciatextiles

Thanks for your comments. I think you could be right about the T3. My body seems to react to any drug at the standard starting level and i have to build up very slowly. Its interesting because my husband stopped taking levo one day and took 60mg of T3 the next day, within 24 hours he was well after being quite ill for a long time, for him it was the miracle drug. Sadly his GP stopped prescribing it after his endo left the hospital and his local pct took it off the prescribed drug list. I now buy it privately from Germany.

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