Cortisol question with severe hypo

[Dee8686]

Hi again, apologies for posting again so soon, trying to understand my own health puzzle !

I posted the other day about TSH of 11 and BELOW range T4 and T3. Have an endo appointment next week to discuss this.

My Genova cortisol test has just come back and I'm surprised because everything looks pretty good. I was expecting flat cortisol judging by my often and current bedridden state!

Secondly, I was expecting low cortisol as when under acute stress, I tremble exessively. I literally FEEL the adrenal dysfunction I have going on. I also feel better after I cry (cortisol release?! ) And in the past for brief periods when put on hydrocortisone.. (brief periods- energy not sustained however..)

My questions are : with such bad hypo readings and symptoms, can it be the case that adrenals aren't an issue? Literally a case of getting meds and vitamins optimal? Would the acute stress and adrenal symptoms be down to thyroid being undermedicated then? Can you really feel this fatigued without adrenals being an issue?! I ache. I feel fluey. I feel groggy. No cellular energy to do anything. Unrefreshing sleep. Painful legs on standing. Inability to handle stress. Palpitations. Hard heartbeat on exertion.

Thank you all. I have been feeling very low and am grateful for this supportive outlet to ask questions and learn.

[humanbean]

Can you post your saliva cortisol results please, either in text or post the results page (making sure to exclude your personal details). It is difficult to know what to say without seeing your results.

[Dee8686 in reply to humanbean]

Here it is humanbean

Adrenal profile

[Hidden in reply to Dee8686]

Your cortisol results looks fine which is good. I haven't heard of anyone getting "trembles" when their cortisol is low, for most of us with adrenal insufficiency we experience feeling nauseous, have a low BP, fuzzy headed & have some abdominal pain. I think most people will feel better once they've had a good cry & will feel better when they are given steroids. As you say, it's more a case of getting your vitamins & thyroid meds at an optimal level. Low B12 & Vit D can really impact your health so get them checked out but your adrenal glands look fine.

[humanbean]

I don't actually know what to say about your first two results (Waking and 30 minutes). I also notice they don't come with a reference range so I can't really say anything about them, sorry. But it does seem that your cortisol really rockets up when you wake up.

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Your results for the other four samples.

Sample 1 5.96 (2.68 - 9.3) --- Approx 50% of the way through the range

Sample 2 2.92 (0.75 - 2.93) --- Approx 100% of the way through the range

Sample 3 3.03 (0.36 - 1.88) --- Approx 176% of the way through the range

Sample 4 0.22 (0 - 0.94) --- Approx 23% of the way through the range

...

Optimal results for cortisol :

• Morning at the top of the range --- 9.3 with the range you've supplied

• Noon approximately 75% of the range --- 2.385 with the range you've supplied

• Evening close to 50% of the range --- 1.12 with the range you've supplied

• Nighttime at the bottom of the range --- 0 with the range you've supplied

Source : rt3-adrenals.org/cortisol_t...

I'll comment on the night time "optimal" later, but will carry on regardless for now.

...

Compare your results to the optimal results.

1) Yours = 5.96 --- Optimal = 9.3 --- You produce 64% of optimal

2) Yours = 2.92 --- Optimal = 2.385 --- You produce 122 % of optimal

3) Yours = 3.03 --- Optimal = 1.12 --- You produce 270% of optimal

4) Yours = 0.22 --- Optimal = 0 --- Percentages of 0 can't be done

Totals --- Yours = 12.13 --- Optimal = 12.805 --- You produce 95% of optimal

...

DHEA - Yours is 17% of the way through the range. This is rather low - although it is quite common on this forum to see people with below range DHEA. Note that DHEA is affected by age and reduces as we get older, but I'm pretty sure that it shouldn't be below range in healthy people at any age. It is also likely that as the adrenal glands begin to suffer from ill health that DHEA output will reduce. I think that low DHEA suggests that your adrenals may be going downhill, but they are still currently hanging on quite well with a total of 95% of optimal.

It used to be possible to buy DHEA as a supplement over the counter in the UK. There are one or two people on the forum who have mentioned getting it prescribed in the UK. People from abroad (or people going abroad for holidays perhaps?) can usually buy DHEA as a supplement. But the UK government, in its wisdom (sarcasm), some years ago declared that DHEA is an anabolic steroid and they banned all anabolic steroids because of abuse from bodybuilders and people doing sports.

Some people in the UK do buy DHEA supplements from abroad (I don't know anything about DHEA, and wouldn't know what to buy or what dose to use), but there is a possibility it could get confiscated by customs. Whether getting it confiscated would get you into trouble in the long term I don't know.

Do a web search for "optimal levels for DHEA" and do some research. I found this link from a website that is often okay. It might be helpful, it might not - you'll have to decide for yourself.

drjockers.com/10-tips-boost...

...

Regarding the night time sample and the associated reference range you've been given...

The range given is "less than or equal to 0.94", suggesting that zero is at the bottom of the range and is an acceptable level. But this is obviously nonsense - I would expect a level of zero from a corpse. It definitely wouldn't be good for a human to have zero cortisol at any time of day or night so the reference range is not useful for that last sample. At least your level isn't over the range for the night time sample because that increases the risk of insomnia.

...

Overall your level of cortisol is very good at 95% of optimal. The problem you have is that your cortisol output is erratic. It should be a smooth (ish) curve as shown by the green section of your graph, starting at the top of the green range and dropping through the range as the day goes on, and ending up at the bottom of the green range at bedtime.

These erratic results suggest that you might be in the early stages of developing adrenal fatigue - and at this point I should mention that doctors don't "believe in" adrenal fatigue, so never mention it to them - it annoys them apparently and makes them think the patient is a hypochondriac.

What doctors do believe in is adrenal insufficiency which is described in this wiki article :

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

Adrenal insufficiency is a completely different kettle of fish to adrenal fatigue. For a start, it involves the complete failure of the adrenal glands, it can be fatal, and it needs permanent medication with prescribed steroids to keep people alive. Since your total cortisol levels are not low please don't take steroids to "fix" your adrenals. Taking steroids when they aren't needed could shut your adrenals down permanently.

Adrenal fatigue is where the adrenal output is within range or over the range, the adrenals do actually work but aren't very well, and the levels of cortisol throughout the day are not where they should be for the time of day. People with adrenal fatigue can recover.

There are some people who have low levels of cortisol but they aren't low enough to count as adrenal insufficiency. They may benefit from steroids at low doses with the expectation of weaning off them eventually. But this situation is not something I'm familiar with.

...

I got that internal trembling problem that you describe when my cortisol was high. The symptoms of low and high cortisol do have quite a lot of overlap and it can be virtually impossible to know whether you have low or high cortisol without testing. When I did my first ever saliva test back in 2013, I was convinced I had low cortisol. I bought an adrenal glandular, did a saliva test and posted it off just before going on holiday for two weeks. As soon as I posted the test I started taking the glandular. The glandular made me sweat at a much greater rate than normal and I was already quite sweaty before I started it, I put on weight, I was in such a bad mood that I was almost homicidal, I was breathless, and I got barely any sleep. It was a holiday from hell. The results were waiting for me when I got home and three out of four of my saliva samples were well over the range, and the only one that wasn't over the range was 90% of the way through the range. By taking the glandular while I was on holiday I was pushing my already high cortisol even higher, so it isn't a surprise it made me feel much, much worse.

...

I wrote a very long post to someone on the subject of things that can help adrenal fatigue. I wouldn't recommend any glandulars in your case, but please read this thread all the way through :

healthunlocked.com/thyroidu...

Adrenal cocktails are mentioned in that thread and are cheap and easy to make - it might be worth trying one of those and seeing how you feel. Try taking them at about the time you took the 7am - 9am sample. If they make you feel worse then obviously stop taking them.

...

With thyroid disease lifestyle has a huge impact on how well we feel. Lots of people don't eat enough because they are terrified of possible weight gain. This will reduce conversion from T4 to T3 and will ultimately increase the chances of people gaining weight.

If you haven't already done so it is worth posting your thyroid results, antibody results and nutrient levels, and asking for feedback. The wrong levels of any of those will have an impact on your cortisol levels.

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Please note that I am NOT a doctor and have no medical training. You follow any of my suggestions at your own risk. Please always do your own research before taking anything new or changing anything or buying anything.

[Dee8686 in reply to humanbean]

Thank you so much for your very detailed and helpful reply humanbean. I have an endo appointment tomorrow now to discuss every thing. My TSH is at 11 and frees under range. (Last post). Thank you so much again.