Cortisol saliva results: Hi i'm feeling very... - Thyroid UK

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Cortisol saliva results

Salphy profile image
17 Replies

Hi i'm feeling very confused.

I have hashi's controlled on 100mcg t4 and 5mcg t3.

My last AM bloods showed slightly raised cortisol 616 (113-456) very raised prolactin 1627 (102-496)

But just got these saliva results back and my AM cortisol is normal but then low from noon onwards. DHEA towards top end of range.

Does any of this mean anything to anyone? I presume that this would now rule out cushings and make prolactinoma less likely.

Can low evening cortisol cause fatigue and weight gain too?

Thanks x

17 Replies

The Stop the Thyroid Madness website has a guide on how to interpret various labs; scroll down to the adrenal section:

I consider your morning and noon cortisol levels to be suboptimal. However, at night they should be at the bottom of range so not sure why that is flagged as low...when did you collect the evening sample? That result could be considered lowish.

Are you on DHEA?

What are your symptoms+

Salphy profile image
Salphy in reply to

Thank you!

No I'm not on DHEA but I do have PCOS.

My evening ones were 17:15 then 23:50.

I've just noticed the part where it says suggestive of early phase 1 HPA Axis (adrenal gland) dysfunction.

I've tried to search that but it's all coming up as adrenal fatigue which isn't really recognised in the UK.

Thanks again :)

Salphy profile image
Salphy in reply to

sorry main symptoms are difficulty losing weight, slightly irregular but prolonged (10-14 day), light periods, REALLY painful breasts and pain when going to the toilet 1-2 weeks before period, fatigue particularly in afternoon, stretch marks, acne, dry skin, dry mouth, nostrils and other areas. craving salty food and chocolate.

I know most will overlap with my pcos diagnosis though. Which is why I keep getting fobbed off with the pill. So frustrating. X

humanbean profile image

I'm going to use the standard reference ranges for this analysis - I don't know how the optimal ranges have been developed.

All cortisol results are in nmol/L.

Optimal results for cortisol are :

• Morning at the top of the range

• Noon approximately 75% of the range

• Evening close to 50% of the range

• Nighttime at the bottom of the range

Source : See Example 1 :

Sample 1 : 17 (7 - 30) --- Optimal = 30 --- You produce approx 57% of optimal

Sample 2 : 5.3 (2.1 - 14) --- Optimal = 11.025 --- You produce approx 48% of optimal

Sample 3 : 1.6 (1.5 - 8) --- Optimal = 4.75 --- You produce approx 34% of optimal

Sample 4 : 0.5 (0.33 - 7) --- Optimal = 0.33 --- You produce approx 151% of optimal

Totals : Yours = 24.4 --- Optimal = 46.105 --- You produce approx 53% of optimal

Your total production of cortisol for the day is not good. You are producing roughly half the cortisol you need. The individual samples are all much too low, apart from the last one which is too high and may be leading to insomnia.

Your DHEA is nearly at the top of the range which is surprising, but with your cortisol levels being so low it suggests your DHEA might start to plummet at any time.

I've given lots of links to another member with a pattern of results similar to yours but slightly better. You should read this - I would suggest the things I've said apply to you. And make sure you read McPammy's reply in the thread. She found the treatment she needed to improve her cortisol - it might work for you too, if your Free T3 is low.

Salphy profile image
Salphy in reply to humanbean

Thank you! Will have a read now. My free t3 is actually borderline high now. But my endo is happy with that. I'm just very confused how my AM serum blood cortisol was slightly raised but these showing low. I don't know if it makes a difference that my prolactin was so high too. Endo wasn't concerned and basically blamed my pcos :( x

humanbean profile image
humanbean in reply to Salphy

You might find this post of interest. The person who wrote it had "sort-of-acceptable" cortisol levels from an early morning blood test but her saliva cortisol results were abysmal.

As you can see from my own replies I had no real idea of what was going on, but I did discuss the differences between the blood and saliva tests - they aren't measuring the same thing.

I can only assume that other hormones I know nothing about were causing major problems e.g. the sex hormones.

Salphy profile image
Salphy in reply to humanbean

Thank you! Yes doesn't seem like she found an answer either and her results are worse than mine.

I know my sex hormones are a mess too, I just want to know why :(

They just keep blaming PCOS and trying to put me on the pill. Which is fine if it's definitely due to PCOS I can accept that, but what I don't understand is why they don't try to balance the hormones, only mask and over ride them with the pill.

They were so quick to diagnose too. I had one blood test which LH and FSH ratio was off. Then sent for an ultrasound scan which came with very poorly detailed results "enlarged ovaries, inkeeping with pcos." Offered the pill and sent on my way.

In jan I did a medichecks hormone test. My testosterone was slightly raised 1.76 (0.29-1.67.) So only 0.9 over. Yet my endo was more hung up on that being high and confirming diagnosis of PCOS than the fact my prolactin was 1131 over range and my cortisol was 160 over. Told me cortisol was normal to be over and re: Prolactin I shouldn't go testing for things.

Also had an ultrasound in Jan which showed normal ovaries but thin endometrial lining. My HBA1c is fine but never had tests for insulin resistance or anything else that goes along with PCOS.

Just felt like they were quick to jump to that diagnosis without checking anything else. Then when i checked things myself they didn't want to know and I shouldn't be testing things that don't need testing. Even though they are out of range.

I struggle to accept any over range results as "normal" because then what's the point in having the range? But that may come from the lack of trust I now have since they told me my thyroid was normal too... x

humanbean profile image
humanbean in reply to Salphy

Regarding diet and PCOS, you might like to read some of the links mentioning PCOS on the DietDoctor website :

Some people have dramatically reduced their PCOS symptoms with a ketogenic diet.

There are a few mentions of prolactin on the above site too.

I know when I started eating a diet which had lower carb, more fat, and more protein that I improved some symptoms of mine, although I've never been able to stick to the diet for long enough or persistently enough to lose the weight I want to lose. Losing weight on the diet isn't essential to getting benefits from it.

in reply to humanbean

McPammy´s reply is indeed very interesting, but she seems to have had low cortisol as a result of T3 deficiency and improved when T3 was added to T4.

I have read over and over again that the adrenals must be healed before adding T3, and only then can you safely add T3 (back in). From what I remember, Dr. Durrand-P recommends in his book to treat adrenals first (other health care professionals recommend this approach as well), and STTM recommends going off NDT/T3 until adrenals are healed, and then add it back in. The general idea seems to be that T3 is taxing on the adrenals. Doctors like the Hertoghe doctors in Belgium prescribe HC and T3 at the same time.

So there are two or even three diametrically opposing schools of thought.

I wish McPammy is right (if you can talk about right and wrong in this contect...maybe it´s like NDT/T3/T4, that one approach does not work for all), because it would be wonderful if you could heal adrenal fatigue by adding T3 if a poor converter. I´d hate the idea of having to go off meds or back on levo only to "heal" my adrenals...

humanbean profile image
humanbean in reply to

I'm not suggesting that T3 is a cure-all for all things cortisol-related. I was only pointing out that someone had effected a cure/treatment for their low cortisol with T3 because I think it is helpful for people to know what worked for others.

But as you say, curing the adrenals is supposed to be done before treating people for thyroid disease. The problem with that is that anyone found (by doctors) to have the "wrong" levels of cortisol (without having Cushing's or Addison's) will probably be advised to "eat less and move more". If the patient is not overweight they will probably be told to move more and get more sleep. In other words, the patient will be blamed for their own health problems due to their own (assumed) character flaws, as is the case with so many medical problems these days.

in reply to humanbean

I know, this was not meant as criticism, just as food for thought!

It´s just so confusing because there are so many schools of thought. Not even functional doctors seem to agree among themselves if low adrenal function needs to be treated before adding T3 or the other way around...the fact that adrenal fatigue is not a recognised medical condition does not make things any easier...!

This in turn means that adrenal fatigue is rarely discovered and treated before thyroid hormone is added...which also does not make things easier. Some patient forums such as the STTM (and also functional docs) claim that adrenal fatigue often remains undiagnosed until patients are put on NDT or T3...which is not uncontroversial since mainstream medicine does not even recognise adrenal fatigue...

Others claim that low T3 levels will make it impossible for the body to effectively use cortisol. According to this theory, thyroid levels would need to be optimised before treating adrenal fatigue.

humanbean profile image
humanbean in reply to

the fact that adrenal fatigue is not a recognised medical condition does not make things any easier

I agree. Doctors fixate on the "normal" ranges and think they shouldn't treat anyone whose levels are on or within that range, no matter how low or how high. But they clearly switch their brains off when they look at results and don't really care about how the patient feels.

This is why I will do my own testing if I can afford it, and only see doctors with issues that are clearly visible.

Salphy profile image
Salphy in reply to humanbean

"This is why I will do my own testing if I can afford it, and only see doctors with issues that are clearly visible."

Yes unfortunately i'm of that mindset now too. I may sit on this for now and retest in a few months time, see if there's anything more "visible."

Thank you x

SlowDragon profile image

Hashimoto’s can cause high prolactin

PCos may also be linked

Salphy profile image
Salphy in reply to SlowDragon

Thank you. My antibodies have been in remission for a couple of years now.I converted my prolactin level from mU/L and it came back at 76.46 and 62.13 for each result.

The first article says:

There were 14 patients with hyperprolactinemia in three of which serum PRL was over 60 micrograms/L. PRL producing tumor, severe primary hypothyroidism and liver cirrhosis were detected in these three patients, respectively.

The second pcos one says the lady's levels were 70 and she had a 5-6mm prolactinoma and this should be considered in pcos with persistently elevated prolactin.

So I guess I should keep pushing for further testing...

SlowDragon profile image
SlowDragonAdministrator in reply to Salphy

Even if antibodies drop under range ....we still have hashimoto's

Antibodies are the Hoover's cleaning up after an attack

Salphy profile image
Salphy in reply to SlowDragon

Yes I'll always have it. But thankfully they haven't had any cleaning up to do for a good few years now :) but my thyroid gland is small on US so they may have already cleaned up a lot of it lol

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