Hi, can someone please help me understand my results? I did a zrt saliva hormone panel and a cortisol blood. My am blood cortisol is 3.6 UG/DL.
My saliva estradiol is 0.6, progesterone 90, ratio: Pg/E2 15, Testosterone <5, DHEAS 1.6, cortisol 0.4
My Dr thinks I might have Addison’s disease, but I’ve read that Addison’s is very rare.
Thank you so much for help 
Do you have any ranges for those results? You should always put ranges with blood test results because they vary from lab to lab.
I'm not sure Addison's is that rare. But, doctors are prone to thinking things are rare because they never test for them - if you don't test for it, you're not going to find it, are you! But, you're not going to find out if you have Addison's from just one cortisol blood test. That won't give you enough data to know.
Thank you, I will see if I can add the ranges in.
My Am blood cortisol is 3.6 UG range is 4.3-22.4Saliva cortisol is 0.4 range is 3.7-9.5mg/ml
Saliva DHEAS 1.6 range 2-23 ng/ml
Saliva Estradiol 0.6 range 1.3-3.3pg/ml
Saliva Testosterone <5 range 16-55pg/ml
Shouldn't there be four results for the salvia cortisol? Wasn't it a 24 hour test?
No the saliva was just a single am test. The blood was collected a few weeks after the saliva also a single am test.
I might need to repeat the ZRT with more extensive cortisol panel. I was trying to avoid the extra cost and did not expect I needed the full cortisol panel. However, it looks like I do need a better look.
Well, yes, you do. Because cortisol levels change throughout the day. It's highest in the morning, around the time you get up, to get you started on your day. And, then it slowly drops throughout the day until it's at its lowest at bedtime, so that you can sleep. You need to see what it's doing at stratigic points throughout the day.
Sorry to hijack but reading this got me wound up again lol. I recently had a cortisol test and my morning results were so low they weren’t even within the reference ranges! I saw a famous professor and he said the test isn’t well respected and as the syncathen test he did on me came it at over 600 he wasn’t worried. Well I’m still worried but that was the end of that conversation. Drives me crackers!!
Ps how you doing grey? Long time 😀❤️
They know even less about cortisol than they do about thyroid!
Thanks for asking, but not doing too well, at the moment. Can't get over the the bout of flu I had. And yourself?
Sorry to hear that buddy! Really knocks you for six the flu doesn’t it. I hope you have someone that can give you a hand and help to look after you.
I’ve not had the lurg for a while so it’s only a matter of time and they’re dropping life flies at work so I’m probably next lol
Oh, that is very interesting. Is the test in question the blood or saliva? I think my Dr prefers saliva, but do to my low saliva she ordered a blood cortisol test as well.
I did a saliva test. Four samples over a day 😀 think I once had a blood cortisol done which came back ok to they then decided I had CFS. I’m still not convinced lol
Did they do an ACTH blood test when they did the SST? It needs to go to the lab straight away or put on ice? The ACTH shows if the problem is coming from the pituitary rather than the adrenal glands. The artificial ACTH obviously got your adrenalglands secreting cortisol but you could have secondary adrenal insufficiency where the issue is with the pituitary gland.
Hi Pauline. Not sure if they did this! This was a top notch guy so would have expected him to do what was necessary but perhaps not. I will ask.
Thanks for messaging me. I doubt it was tested if I’m honest.
Can I ask who you saw? You'd probably better do it by private message though!
I think he didn’t suspect adrenal issues because I hadn’t lost weight ..
Not everyone does.
This is good to know, I don’t think my Dr tested for this either.Thank you so much
Your cortisol might be low if under medicated thyroid wise
Looking at previous posts you are on levothyroxine plus T3
How much levothyroxine and how much T3
Do you have recent test results
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Hi,I did also have thyroid blood taken at 7:30am before my thyroid dose.
My TSH is 4.09 range 0.40-5.0 Ulu/ml
My T3 is 3.2 Pg range 2.0-4.4 Pg/ml
My T4 is 1.0 ng range 0.8-1.6 Ng/DL
I take a compound Similar to synthroid (50 mcg) and not T3 due to fast heart rate on synthetic and allergy to porcine in the bioidentical version.
Thank you so much for your help
Well,you are EXTREMELY under medicated, so hardly surprising cortisol is affected
On any replacement thyroid hormones TSH should ALWAYS be under 2. Majority of patients when adequately treated will have TSH well under one.
But it becomes chicken and egg....low cortisol means it’s difficult to take higher dose
Just 50mcg levothyroxine is only a starter dose
What vitamin supplements are you currently taking
When were vitamin D, folate, ferritin and B12 last tested
Oh, that is good to know. I did not realize my TSH is too high. That might be a good start. I wish I could tolerate T3 because it gave me energy but I felt like my heart was going to burst because it would beat so fast.I take 5,000 ui D daily
100mcg K
Zinc 15mg
And I just started a stress B from Thorne.
My D was checked in June it is 65ng/ml range is 30-149ng/ml
Ferritin is 114 range 6-250ng/ml
B12 is 570 range 247-911 pg/ml
Well before considering adding T3 you need to get levothyroxine dose increased slowly upwards in 25mcg steps until on or near full replacement dose
Bloods should be retested 6-8 weeks after EACH Dose increase
Essential to test vitamin D, folate, ferritin and B12 levels
No good just taking supplements without testing at least annually, preferably 2 or 3 times a year
Please add latest vitamin D, folate, ferritin and B12 results
Remember to stop taking any supplements that contain biotin (eg vitamin B complex) a week before ALL BLOOD TESTS
Were you taking biotin supplements when did cortisol test?
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
gp-update.co.uk/Latest-Upda...
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Before considering adding T3 we need levothyroxine dose as high as necessary, all four vitamins optimal and , if cause of your hypothyroidism is autoimmune thyroid disease, likely to need to be absolutely strictly gluten free. ....or at least have tried it. Sometimes dairy free too
Wow, this is great information, thank you so much. I do have autoimmune diseases and have been gluten and dairy free for about 6 years.
I think I had been taking biotin for about a week prior to my blood. Also I use a inhaled steroid 1x a day. My dr doesn’t think the inhaled version steroid would effect things, but I’m wondering if it is a possibility.
I doubt that using an inhaler once a day will affect your cortisol levels.
That is a relief, I have good benefit from using it. I was hoping it wasn’t the cause.
So vitamin levels look good
Vitamin D, you could reduce dose a little. Don’t want level too high
Ok, should I maybe drop down to 3,000 ui? What is the best blood level for D?In the beginning I was so low at 27, that I took 10,000ui daily for a year to get to 65. I am now down to 5,000ui.
Try 3000iu
May need less in summer
Thank you
Is my goal to be around 60? I used to take 2,000 ui but my blood was so low at 27. I’m afraid to get that low again because I felt very sick.
Hidden is very knowledgeable about cortisol
She may pop along
Thank you
Have you had TPO and TG thyroid antibodies tested to see if cause of your hypothyroidism is autoimmune thyroid disease also called Hashimoto’s
About 90% of primary hypothyroidism is autoimmune thyroid disease
Have you had thyroid ultrasound scan
Assuming this is autoimmune thyroid disease, have you had coeliac blood test done
Assuming that was negative doesn’t rule out gluten intolerance
It’s ALWAYS worth trying strictly gluten free diet
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...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
ncbi.nlm.nih.gov/pubmed/296...
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
ncbi.nlm.nih.gov/pubmed/300...
The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease
nuclmed.gr/wp/wp-content/up...
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
restartmed.com/hashimotos-g...
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Why gluten intolerance can upset cortisol levels
kalishinstitute.com/blog/gl...
Very interesting. I suspect I might have celiac disease because I get very sick with gluten and dairy. So sick that I can not go back on those foods in order to test. I don’t think I have ever been tested for TPO or TG. I will ask my dr if I can have that tested.Thank you again, you are always so helpful.
Very grateful
On gluten free diet you may see TPO antibodies are low
No point trying to test for coeliac. You know you can’t tolerate gluten.
Some people find they can start to tolerate dairy 2-3 years after going strictly gluten free
On gluten free diet magnesium is often low
Any magnesium supplements must be at least four hours away from levothyroxine
theceliacmd.com/magnesium-d...
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
2 good videos on magnesium
healthunlocked.com/thyroidu...
This is great to know. I have been suffering from muscle cramps in my feet and legs every night. I bet I am deficient in magnesium.Thank you so much
I'm not sure if you are in the UK or another country? In the UK you would need to ask your GP to do an early morning blood cortisol to see what the level is. if it is low then you need referral to an Endocrinologist, preferably one w ho is conversant with pituitary adrenal issues. Addison's is fairly rare, it's also known as primary adrenal insufficiency & can be an autoimmune condition, this means that the adrenal glands don't secret cortisol. You can also have secondary where the issues is caused by the pituitary gland, the fact that your other hormones are low, this would be more likely. You would need to have a short synacthen test done to see how your adrenal glands react to the artificial ACTH. It is important that they also do an ACTH blood test at the start as this shows if the issue is coming from the pituitary gland. The blood needs to go to the lab straight away or put on ice. Hope that helps you a bit?
Hi Pauline. I live in the US. I was born in Europe, but my parents moved here when I was a baby.My Dr had me go in very early for blood cortisol after my am saliva cortisol was so low. She also is thinking to send me to endo, but I have not been referred yet.
This is great information to know, I will ask about this specific test.
Thank you so much for your help
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