Cortisol/DHEA results

[Justine_Case]

Hi I recently had a Regenerus test, due to my frequent adrenaline surges, and just feeling generally awful.

To be honest, I thought the results were going to say my cortisol was high, but I think the results suggest the opposite?

Could anyone take a look and let me know?

Cortisol AM30 24 nmol/L 14.0 – 25.0 7.0 – 30.0

Cortisol Noon 1.6 nmol/L 5.0 – 10.0 2.1 – 14.0

Cortisol Evening 1.9 nmol/L 2.0 – 5.0 1.5 – 8.0

Cortisol Night 0.61 nmol/L 1.0 – 4.0 0.33 – 7.0

DHEA* 75 pg/mL 106 – 300

Then -

AM cortisol level appears adequate, although the suboptimal diurnal cortisol pattern

is suggestive of early (Phase 1) HPA axis (adrenal gland) dysfunction.

DHEA levels typically decline with age and the level measured here is below the

reference range. Note: Supplementation with DHEA may increase testosterone

and/or estradiol levels

I wasn't sure what HPA axis dysfunction meant (Googled but none the wiser)

Should I speak to my GP regarding this, or take supplements/medication?

Advice much appreciated

[SlowDragon Administrator]

Suggest you take these and most recent thyroid results to thyroid specialist

Thyroid results from 3 months ago

healthunlocked.com/thyroidu...

perhaps retest thyroid before booking consultation

List of thyroid specialists and endocrinologists

healthunlocked.com/thyroidu...

[Justine_Case in reply to SlowDragon]

Thank you - I will I just downloaded the specialist list. It seems this is the only way to go.

So is HPA axis dysfunction the same as Adrenal Fatigue, or something different?

Also will starting Levothyroxine help with this, or is it unrelated?

My FT4 and FT3 levels were really low on my last private test - 7% and 24.3% respectively.

GP uninterested when informed, and only wants to speak about my high cholesterol (appt 6th Sept).

[SlowDragon Administrator in reply to Justine_Case]

Getting started on levothyroxine and improving Ft4 and Ft3 will slowly improve cortisol

High cholesterol is strongly linked to being hypothyroid

Refuse statins

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually 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...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Justine_Case in reply to SlowDragon]

Thank you I will read your links