24 hour Urine Cortisol Results: Hello I have... - Thyroid UK

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24 hour Urine Cortisol Results

Joliplace profile image
11 Replies

Hello

I have posted before on my daughter but wasn't sure if i had to post there or a new post. Apologies if i have it wrong. You were all helpful last time. Thanks again

After a high cortisol result from Blue Horizon we finally managed to get the doctor to do a 24 Hour urine cortisol test. I have spent a while googling but no wiser. I wondered if anyone here had any input they could give me. She is in range but are these results ok does anyone know? I will attach her previous blood results here too in case they are helpful

Serum cortisol level 230 nmol/L [140.0 - 700.0]

The Doctor generally puts no further action despite knowing that she feels rubbish still. She was diagnosed with unilateral PCOS at Christmas but has normal periods generally. She takes Myo-inositol already. Thinking we need to see someone private as don't seem to be getting anywhere GP wise and was told no referral as results seem ok. She cant sleep well, mood is low, she aches, eats very healthily and exercises four to five times a week but is still gaining weight, on top of other things.

Her HbA1c is 37 mmol/mol [20.0 - 41.0] A few months before this it was 39. GP says no issues, I am worried she is in the top of the range. They did do a fasting bloods this week to see but no results back yet for those. Should we be worried about this level?

Her Serum folate level is now 8.4 ug/L [4.0 - 27.0] after being at 2.2 and then put on prescribed supplementation. This still seems the lower end but maybe takes a while to get back up?

Nhs Results below were the same week (March)as Blue Horizon results attached above and have differences between TSH and B12 levels. Blue horizon ones seem higher on TSH but lower on B12, with ranges around the same.

Serum urea level 6.3 mmol/L [2.5 - 7.8]

Serum sodium level 140 mmol/L [133.0 - 146.0]

Serum potassium level 4.9 mmol/L [3.5 - 5.3]

Serum creatinine level 65 umol/L [45.0 - 84.0]

ACUTE KIDNEY INJURY 0; AKI Stage 0 -report without Alert (6)

ESTIMATED GFR (CKD-EPI) > 90 mL/min/1.73m2;

Bone profile

Serum calcium level 2.44 mmol/L [2.2 - 2.6]

Serum albumin level 41 g/L [35.0 - 50.0]

Serum inorganic phosphate level 1.25 mmol/L [0.8 - 1.5]

Serum alkaline phosphatase level 76 u/L [30.0 - 130.0]

Serum adjusted calcium concentration 2.41 mmol/L [2.2 - 2.6]

Liver function tests

Serum total protein level 73 g/L [60.0 - 80.0]

Serum total bilirubin level 3 umol/L [< 21.0]

Serum alanine aminotransferase level 23 u/L [10.0 - 35.0]

Serum TSH level 1.94 mIU/L [0.27 - 4.2] (1.78mlU/L in november)

Serum C reactive protein level 4 mg/L [< 7.0]

Blood haematinic levels

Serum vitamin B12 level 441 ng/L [130.0 - 800.0]; Samples should not be taken from patients

receiving therapy with high biotin doses

Appreciate this is a lot of info and questions. Just trying to find my way through it all. My head is bursting with all the information i have tried to google.

Many thanks

Karen

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Joliplace
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11 Replies
SlowDragon profile image
SlowDragonAdministrator

Were both tests done early morning

B12 too low

Suggest she start a daily vitamin B complex when folic acid prescription finishes

Vitamin D is insufficient.

Ideally……Needs full iron full iron panel test including ferritin

Thyroid levels are on low side

Adrenals try to compensate, hence high cortisol

PCoS and autoimmune thyroid disease (hashimoto’s ) can be connected

20% of Hashimoto's patients never have raised antibodies 

healthunlocked.com/thyroidu...

 

Paul Robson on atrophied thyroid - especially if no TPO antibodies 

 paulrobinsonthyroid.com/cou...

Gluten intolerance is often a hidden issue too.

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

PCOS can possibly be improved with low sugar diet

SlowDragon profile image
SlowDragonAdministrator

Low vitamin D

GP should prescribe 1600iu everyday for 6 months

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

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...

silverbelle51 profile image
silverbelle51 in reply toSlowDragon

Thank you for such a complete post. Sadly most of us start out not knowing how to protect our thyroid function. Here in the U.S.A. far too many doctors treat as though they know less than what you all do. Again thank you!

SlowDragon profile image
SlowDragonAdministrator

Only add one supplement at a time and wait at least 10-14 days to assess before adding another

Starting with vitamin D

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week 

Then once serum B12 is over 500 (or Active B12 level has reached 70), she may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops 

natureprovides.com/products...

Or

B12 sublingual lozenges 

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when she stops vitamin B complex, might want to consider taking a separate methyl folate supplement and continue separate B12

Come back with new post once got iron/ferritin results

Test early morning and fasting. Don’t eat steak or similar night before test

Medichecks iron panel test 

medichecks.com/products/iro...

Joliplace profile image
Joliplace

Thank you

Yes, both tests were early. GP about 930am and home one for Blue Horizon was 8am. Both she hadn't eaten beforehand

Ferritin i missed off. Sorry. Serum ferritin level 73 ug/L [30.0 - 150.0]

She has finished her 12 weeks of Folate from the GP. Her levels above of 8.4 are after this when we asked to check if levels had increased. They say now sufficient so no more prescribed doses.

They wont comment on Vitamin D levels. Every time she gets a telephone appointment its a different dr and they disagree and say nothing wrong, just lose weight when she has actively been tracking foods and exercising most days.

Many thanks

SlowDragon profile image
SlowDragonAdministrator in reply toJoliplace

NHS only tests for and treats vitamin deficiencies

Your daughter will need to self supplement vitamin D and vitamin B complex to maintain at GOOD levels

Ferritin looks reasonable level

Retest thyroid in another 2-3 months after improving vitamin D, B12 and folate

radd profile image
radd

Joliplace,

I commented on BH results previously regarding your daughters PCOS. This post states a 24 hour urine collection but I cannot see results, only serum cortisol which is a blood test. 

Do you have further results? Urine is usually measured in mcg/24hrs. 

Joliplace profile image
Joliplace in reply toradd

This has confused me too! Which is why i posted again as i couldn't find out why it was like that. I've been back into her GP tests and she had a fasting glucose bloods done last week at the exact time of the printed cortisol result so I am wondering if its got mixed up and maybe the urine hasn't come back yet. It was dropped off last Monday. There is an email address on the results of the person that did the test. I am not sure if we are allowed to email to question this stuff but i may do as its such a hard thing to speak to the GP and then its always a different one each time.

Omze profile image
Omze

Hi ,It appears that she is having a weak thyroid and that being compensated by the high cortisol and hence high weight , most of the iodine in body being shifted to healing of pcos and not thyroid .

Thyroid supplements like iron and may be meds will help but require further testing

Hth

silverbelle51 profile image
silverbelle51

Impressed about how extensive the lab work profile was. Wish I had been give that extensive a profile before I was misdiagnosed and presented a diagnosis that was wholly wrong and was made so very sick!

Joliplace profile image
Joliplace

24 hour urine is back today and copied from results it is

24 hour urine cortisol output 77 nmol/24h [< 118.0];

Still in nmol though, not sure how to convert that. GP says normal. No further action.

Fasting glucose was Plasma glucose level 4.7 mmol/L [4.0 - 6.0]

I guess we need to book a private appointment as the GP says everything has been checked and in ranges so no issues. Are there any other tests that may be worthwhile before we do that?

Many thanks

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