My 40 year old daughter has Hashimoto's on T4 /T3 combination therapy for 6 years. Optimal levels plus optimal B12, folate, vit d and ferritin.Dutch test has shown very low cortisol levels throughout the day. She says she doesn't have any stress, doesn't drink alcohol or coffee, goes to the gym 2 or 3 times a week, eats a clean diet but cannot lose weight.?
Does anyone have any ideas as to what she can do?
Thank you.
please add her actual results and ranges
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
is this how she does her tests
Does she always get same brand Levo and T3 at each prescription
What vitamin supplements is she taking
Is she on strict gluten and/or dairy free diet
Thanks slow Dragon. I don't have her actual results although I have seen them. She has been on this thyroid journey for so long now that she always tests as recommended, knows her thyroid levels are optimal as are her vitamin levels. The results from the Dutch test have come as a complete surprise so will just have to wait for the Practitioner to come back with the plan but I was hoping someone could start her in the right direction Sue
Sounds like Addison's disease but it would be wise to get the pituitary gland checked and other hormones like ACTH and HGH. If possible I would advise genetic testing for any sign of pituitary hormone related conditions. A Short Synacthen test and maybe a glucagon test might clarify where the problem is i.e. adrenals or something else. Hope that helps.
Thank you. She will try for an appt with her endocrinologist who "looks"after her thyroid - she actually manages this herself with advice from the group. He did not order the Dutch test so it will be interesting to see how far he will take this.
Hello! Would you mind sharing what her endo thinks? I had the same results, the nutrionist who suggested I get it done said she thought I had ‘flatlined’ from cortisol over production, so too much chronic stress made so much cortisol it made my body non receptive to it anymore. I haven’t ever shown my doctor tbh as it was 4 years ago and only just managed to get my GP to give me thyroxine!
Hi! I am so sorry to hear about your daughter’s cortisol issues. They feel terrible. I have the same situation with Hashimoto’s and medications- including self-managing. After the first Covid in 2021 I felt exhausted and decided to take saliva cortisol test - four tests in 24 hours. It was way below lowest reference number. And my thyroid meds didn’t work well for a while. This December was my fifth Covid and I feel the same exhaustion which means cortisol is low again. And any physical activity worsens the situation. My endo wants me to do a 24-hour urine cortisol test. As bad for the weight it sounds, but carbs help body withstand low cortisol. Low-intensity walking that doesn’t affect cortisol. Lots of magnesium. All of this really helps recover with time. But, as other commenters mentioned, ruling out all causes first is important. I hope she feels better!
Cortisol results/DHEA, useful thoughts on action for adrenals?
High cortisol
Low cortisol results 
