Good afternoon, I made my first post 3 weeks ago & everyone was incredibly helpful, I've learnt so much, so, thank you 😊 I'm still waiting for some blood results (various antibody tests) MRI clear 🥳 ultrasound confirmed hashimoto's (thyroid much smaller than it should be I was told) before my consultation with my endocrinologist. He did do a cortisol test (requested at 9am but they couldn't fit me in till 11) but I had no idea it was so important to have it at 9am until I joined this site, so used medichecks,
Waking 5.67 < 20.3
12.00 4.17 1.6-5.6
16.00 1.73 < 6.94
Before bed 1.96 <7.56
Can anyone advise me please? I would be grateful 😊
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Elle137
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It is, very low. And that's when it should be highest - nearer the top of the range.
Under 20.3 is the 'range', not the ratio. But not a real range because it hasn't got a bottom number. So, 0 could be said to be within range, but if you had 0 cortisol you'd be a corps! With whom did you do this strange test?
Cortisol is often low with untreated hypo, but this is much too low, and needs further investigation.
Sorry for the delay in my reply, I've checked the email (medichecks did the test) and there is no lower number on the morning test, 4pm & bedtime test, all just show < and a top number? I will email them about this because as you say, 0 could be the bottom number? I'm new to this & still learning so thank you 😊
I’m just learning up on cortisol myself, but chances are your ranges are in the ballpark of the sample report I googled below (and other people here has received similar reports with their results here.)
Another point of reference- for me my 7-9 am blood cortisol test range was 5.3-22.5 mcg/dl.
And my results at 8:30/9 have been about 23-26.
So with the broad reference above, you are indeed on the low side.
What time exactly did you take the saliva sample… what time did you wake up and exactly how many minutes until you started/finished collecting?
Edit:
As your waking one definitely looks way too low, but the others get closer to what might be in the lower end of optimal (all of which may change if you bet totally different ranges from the company that did this test.)
Ps, also units across cortisol tests look confusing but I think it’s easier than it appears ug/ml or ng/ml and mcg/dl are only decimal places apart and I am pretty sure are equal enough to eyeball the ranges for our tests.
Hi, I woke up late that morning at 8.30ish & took the test 10 mins later, roughly? Because I'm "new" to this test I didn't even think about a lower number? Just knew I needed to do another one as the 11am previous test was pretty much irrelevant from what I've been reading? Even though is was expensive & doctor requested 9am, it's a long road! Thanks for replying 🙂
So I’ve had a few blood cortisol tests at 8-9 am tacked onto my regular thyroid panels.
I just did a 6 point saliva cortisol and prob have the results in my inbox at this point so will be jumping into that soon.
But what I’ve learned so far is that particularly with the first 90 minutes of waking - that’s what we measure as the “cortisol awakening response.”
So if you look at the chart in my other reply you can see what is supposed to happen as you wake up… cortisol should jump.
What I don’t know is… what if I wake up at 7 and do 7 am and 7:30 am tests … vs waking up at let’s say 9 am and do a 9 and a 9:30 test. Or what if I wake up at 11 am…
I’m not sure what point of the graph results should follow!
Your awakening result does look low… and even the others are on the lower side.
Hi, those results are in my endocrinologist file which I will check?I'll post tomorrow, really appreciate you responding, none of this is easy! This site is super helpful I'm so pleased I found it 😊
I am waiting for my results from a SIX point test. I woke up and did the sample. 30 min later again. And 30 min after that, again. Then lunchtime, evening, bedtime. I’m very much looking forward to seeing the results.
Also - as with thyroid, reading “in range” results as “normal, nothing to see here” is never helpful for us hypo folks. We learn over time the nuances of what’s optimal for us.
Cortisol is my current learning frontier : ) we’ll see!
Also - how do you feel, are you sluggish in the morning, hard time waking up and getting going? Why did you explore the cortisol test in the first place?
I'm not well most of the time (since last summer ish) but morning's are difficult with inflammation (hands & feet) puffy eyes, joint pain, stiffness etc....I've been "poorly" for ages so it's hard to remember what "normal" felt like as I owned a hotel which I ran by myself so was exhausted back then!! Sold the business to retire & found myself questioning all these "symptoms" as I wasn't working anymore? Major hair loss (traumatic) made me start down this road, cortisol is linked with hypothyroidism so been reading & reading & reading!!
Good morning, hope you're well 😊 an update now I've found the cortisol test my endocrinologist did, it was 274, ratio 73.8-291 so I have no idea why the saliva test was so low?He's calling me tonight & I'm going to ask for armour? I think? What are your thoughts?
For us hypo folks - especially us hashi types! - from a health perspective our underactive thyroid needs treatment.
Personally and many here tackle cortisol once thyroid is being addressed because to be honest low thyroid hormones are truly the root cause of so many things head to toe. Usually we look elsewhere after those last remaining symptoms don’t seem to clear up with some form of thyroid hormone replacement first.
HOWEVER! Knowing that is only half the battle, the other half is navigating the NHS.
And since I’m in the US I will be of no help there : )
You can either start a new post (probably a good idea)… or you could tag (“@“) some people on your first thread but it’s very common that old/long thread ads get buried and lost.
1) Cortisol can be tested in blood, urine and saliva.
a) Blood tests for cortisol are supposed to be done at about 9am. The idea is to catch the maximum point of the patient's circadian rhythm. Doctors usually assume that the maximum cortisol level in blood occurs at about 9am. But this could be way off the mark if the patient suffers from long-term insomnia or works night shifts. Blood testing doesn't tell you anything about what your circadian rhythm for cortisol is telling you. For example your blood test result may be perfectly good at 9am, but then go very high or low throughout the rest of the day and evening. People with chronic insomnia often have very high cortisol at bedtime, for example, but 9am blood testing won't tell you that.
b) Urine testing for cortisol is usually done by peeing in a bucket every time the patient needs to pee over 24 hours. Then the pee is mixed up, the total amount of urine produced during the 24 hours is noted then a sample is put into a small container and frozen, then the sample is sent through the post to the lab. So the lab receives a small sample of frozen pee, tests the levels of cortisol in that sample, and they can work out how much cortisol is produced in 24 hours. Very few people do urine testing for cortisol. I haven't seen it mentioned much on this forum, but I believe that some doctors do it.
c) Saliva testing for cortisol is the most popular method used by patients on this forum who are "doing it for themselves". Usually the patient produces four samples spread throughout the day and evening. Do a search for "circadian rhythm of cortisol" to see the type of result a healthy person might get.
Example 1 on this link gives you the optimal results for saliva cortisol throughout the day and evening :
There are several problems with saliva testing that can occur depending on the testing company used.
One problem is that cortisol is produced in tiny, tiny amounts later in the day, and some testing machines can't actually measure the amounts accurately. So the customer gets results that are absurd e.g. (made up numbers)
Sample 3 : Result < 0.8 ; Range < 0.5
OR
Result < 0.5 ; Range < 0.8
How can anyone interpret either of those results?
Another problem is that some reference ranges will allow for a result of zero which is nonsense. If anyone ever had zero cortisol they would probably be dead or very unwell.
...
The two recommended cortisol tests suggested on this forum, which avoid the above issues, are from Regenerus Labs and Genova Diagnostics UK.
Sadly, the price for the Regenerus test has gone up by about 50% in recent months.
For info on Genova Diagnostics UK and how to order (it isn't like other companies - it refuses to deal directly with patients so read this link carefully if you decide to use them):
That is really helpful thank you, it looked like my cortisol was up near the higher end on my blood test but much lower on the saliva tests?? I wanted to know as I'm considering trying NDT as a "starting medication" I am at present unmedicated but having a telephone consultation tonight with my endocrinologist?
Blood, urine and saliva cortisol aren't all testing the same thing. So, for example, results from blood testing will use different units of measurement and different reference ranges compared to saliva testing.
Hormones of various kinds, including cortisol and thyroid hormones, are carried through the blood stream attached to various transport proteins.
When attached to transport proteins cortisol is referred to as either Total Cortisol or Bound Cortisol.
When unattached to transport proteins cortisol is referred to as either Free Cortisol or Unbound Cortisol.
Similar terminology is used for thyroid hormones.
Cortisol and thyroid hormones (and probably some others) do not become active (and hence able to enter cells) until they are separated from their transport proteins.
This is why patients need test results of their Free T4 and Free T3 rather than Total T4 and Total T3, because the Totals can be misleading.
Blood cortisol testing measures Total/Bound levels of cortisol but won't give you any hints about your circadian rhythm.
Saliva cortisol testing measures Free/Unbound levels of cortisol and will give you info on your circadian rhythm.
Urine cortisol testing measures Total/Bound levels of cortisol but won't give you any hints about your circadian rhythm.
...
A problem that has affected one member of the forum ( McPammy )is that she got her blood cortisol measured and it showed a very good, "normal" result.
Then she did a saliva cortisol test and her results were dreadful - her cortisol was way below the range.
At the time there was nobody on the forum who knew what caused cortisol to be separated from its transport proteins to make cortisol active. But McPammy got prescribed some T3 and suddenly her saliva cortisol levels became "normal".
I'm not suggesting that T3 is the only factor required in separating cortisol from its transport proteins but it is an essential one.
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