humanbean

With four out of five below-range results for cortisol, as well as the daily total being under range, I think you need to show your results to your GP.

Hidden is very knowledgeable on adrenal insufficiency.

The problem I have in understanding early morning blood tests for cortisol is that they can miss all the low levels later in the day, and completely miss the problem of adrenal insufficiency.

millefleur40 in reply to humanbean

Trouble is with saliva tests the NHS dont recognise them. The blood or urine collection they use, as you say, is one snapshot, not good enough.

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humanbean in reply to millefleur40

Do you have any fairly recent results and ranges for early morning blood or urine cortisol? It would be worth quoting those, if you have them.

I saw in your previous posts that you have had B12 injections in the past but don't get them any more. So your levels could be low.

We really need to see what your nutrient levels are. Have you got any recent results, either private or NHS, for vitamin B12, folate, ferritin, and vitamin D? If you have please post them.

Better levels of nutrients can improve conversion of T4 to T3.

Many of us need to go 100% gluten-free even if we aren't coeliac, and we start absorbing nutrients from food better, absorb thyroid hormones and supplements better. I was found not to be coeliac after an endoscopy, biopsies, and blood tests, but I got a dramatic improvement in how I felt within the first week of giving up gluten completely.

There was one member on the forum who had very, very low cortisol in a saliva test, but her blood tests showed her cortisol levels were fine. ( McPammy ) With the addition of sufficient T3 to her thyroid hormones her saliva cortisol levels rose to be well within range. I hope I've got that story right!

Saliva tests for cortisol and blood tests for cortisol aren't measuring the same thing.

Saliva cortisol measures cortisol with nothing attached. But when carried through the bloodstream cortisol is attached to a transport protein called Transcortin :

en.wikipedia.org/wiki/Trans...

The body can't make use of cortisol when it is attached to transcortin. It seems to me, just from the cortisol posts I've read on this forum, that some people with poor levels of saliva cortisol might have an issue with separating their cortisol from its transport protein. In McPammy's case she needed T3 to help her body do that separation to give her Free Cortisol for her body to use.

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millefleur40

My b12, iron, folic acid were in range, but I am taking good supplements, as they low end of range (doctors don't seem to take that into account!) FSH etc were abnormal. My symptoms feel very much like burnout, low cortisol from years of ongoing stress. I am concerned about the high DHEA, as it says it could be a tumour on the pituitary gland. I think all this is probably causing me to not absorb my thyroid meds & keep increasing the levo is not helping - (maybe pooling?) T3 is only 10mcg per day. I have tried NDT before, but again if your adrenals, vitamins etc arn't good it doesn't have a good effect.

SlowDragonAdministrator in reply to millefleur40

On levothyroxine plus T3 we always need optimal vitamin levels

Frequently necessary to supplement continuously to maintain optimal vitamin levels

What were most recent vitamin results and ranges

Exactly what vitamin supplements are you currently taking

Are you already on absolutely strictly gluten free diet

Do you always get same brand levothyroxine and same brand T3 at each prescription

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Split T3 into 2 doses day before test and take last 5mcg dose 8-12 hours before test

Please add most recent thyroid results and ranges

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humanbean

My symptoms feel very much like burnout, low cortisol from years of ongoing stress

I don't think this is particularly relevant to you because your results are so much lower than the ones given in this thread and I think your results are quite different (and their DHEA was low not high). But you can read the links and suggestions I gave someone else with lowish cortisol here - read the entire thread :

healthunlocked.com/thyroidu...

I should point out that I've never investigated high DHEA. I think you are probably the first person I've seen ever to mention it.

Hidden

DHEA is produced in the adrenal cortex, I've never heard that a pituitary tumour could be the cause of it being high, unless you have high cortisol as well because a pituitary tumour is producing too much ACTH stimulating the adrenal glands to over produce cortisol, this would then be Cushing's Disease. Usually years of stress may cause high levels of cortisol rather than low cortisol levels. I'm also not sure that a pituitary tumour or high DHEA would cause malabsorption of your thyroid meds as that's a different process, however you do need cortisol to be optimal to balance out the thyroid. Your cortisol levels are low so you do need further investigation. It's very easy to make a judgement on the tests the NHS use without understanding which tests are used for low cortisol & which for high cortisol. The early morning serum cortisol is a good starting test, cortisol should be at it's highest level first thing in the morning, so if your cortisol is low then it can give a good indication that you need further investigation for adrenal insufficiency, if it is normal or elevated then you might need further investigations for high cortisol if you are presenting with other symptoms. With Cushing's cortisol can be normal first thing but then doesn't drop through the day as it should. The 24 hour urine is used for investigating Cushing's but it isn't good for low cortisol as cortisol only overflows in the urine when there is too much.

So if your early morning serum cortisol is low then you need referring to an Endocrinologist who is conversant with pituitary/adrenal issues. They should then do a short synacthen test alongside an ACTH test to see if either you adrenal glands or pituitary gland is involved. Salivary tests are used by some Endo's but are best used when investigating Cushing's rather than adrenal insufficiency. I hope that explains it a bit better for you?

millefleur40 in reply to Hidden

Thank you so much. I am already under an Endo, but its very hard to get even a telephone appointment with him these days. My first saliva test at 08.30am was normal, the one at 09.00am was not, neither were the other three. If you look up what does high DHEA mean it refers to a possible tumour on the pituitary gland.

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