Low cortisol

[Lollipop93]

Hello I wondered if anyone could help, I was referred to an endo for my thyroid as my TSH was 0.1 and ts3 was 6.4 (range 4-6) so they thought I could gave hyperthyroidism especially with my symptoms of fatigue, abdominal pain, weakness and graves in my family, etc however I did the tests and my TSH have now come back in range (unmedicated ) but she said my cortisol should have been really 300+ but it’s come back at 230 so she’s referred me for an ACTH blood test to rule out Addisons etc. I’m naturally a bit worried and just wondered if 230 seems of concern or if this is just below average? She said I will have the blood test within the next 2 weeks, i wonder what peoples experience of this is? Thanks

[SlowDragon Administrator]

What time was test done

Cortisol is highest early morning

Just testing TSH and Ft4 is inadequate

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see for autoimmune HYPOthyroid disease also called Hashimoto’s

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Graves disease

thyroiduk.org/hyperthyroid-...

Graves Disease antibodies test

medichecks.com/products/tsh...

[Lollipop93 in reply to SlowDragon]

thank you for the reply I appreciate it, my TSH, TS3, TS4 and antibodies were tested and all fine and mid range, she thinks I had thyroiditis with my previous results and now these coming back fine, everything else you mentioned has been tested and came back fine apart from being vitamin d deficient which I’m taking supplements for thanks to advise on here. My test was taken at 10:30

[humanbean]

The time of day the blood was taken for the cortisol test is very important to the interpretation of the results.

Cortisol output has a circadian rhythm. In the case of most people who work "normal" hours, don't work shifts, and don't have severe or long term insomnia, cortisol will be at its highest at approximately 9am.

Doctors really ought to test cortisol in blood when it is at its highest. However some doctors arrange blood tests for cortisol without paying attention to the time and they do what's called a "random cortisol" test.

If your blood was taken at 9am or very near to that, then that's fine. But random cortisol tests are a complete waste of time - although I don't know how many doctors would agree to that.

Another comment is that cortisol testing in blood is not as informative as a cortisol saliva test which usually requires 4 samples of saliva to be tested at certain times a day. But doctors only "believe in" blood cortisol testing and don't use saliva testing. [NASA uses saliva testing for their astronauts in space, by the way, so it isn't quackery. ]

Some people buy saliva cortisol testing kits privately and they are very useful but they are quite expensive. Ask about this if you are interested - not all companies that sell saliva cortisol testing kits are worth doing, so ask for advice before spending a single penny.

...

If you are going to have a Short Synacthen test done in a hospital you should read pages 68 - 70 in this document, so you know what to expect :

imperialendo.co.uk/Bible202...

If you do have this test, try to make sure that the test for ACTH is included. A lot of doctors don't bother with it to save money, and if this happens they can only diagnose primary hypocortisolism (if the patient has it), they can't diagnose secondary or tertiary hypocortisolism even if the patient has one of them.

For info on the different types of hypocortisolism see this link :

en.wikipedia.org/wiki/Adren...

Note - Hypocortisolism is another name for adrenal insufficiency.

...

She said I will have the blood test within the next 2 weeks

I don't believe it will take two weeks. I think it will be more likely to be closer to 3 - 6 months. Hospitals are really strapped for cash and staff and everything takes for ever these days. But you might be okay, I am only guessing.

...

Good luck.

[Lollipop93 in reply to humanbean]

Thank you for this that’s really helpful, my test was at 10:30 I’ve read that if it’s not at 9 then it pretty much invalidates the results? Well here’s hoping it’s in a few weeks!

[humanbean in reply to Lollipop93]

This is what a standard cortisol output graph would look like (it's a bit cartoonish, but it gives you an idea) :

lchf-rd.com/wp-content/uplo...

Since your test was done at 10.30 I would expect your result to have dropped from its peak, assuming that your maximum is at about 9am.

For a rough idea of what optimal levels are for saliva cortisol, see example 1 on this link :

rt3-adrenals.org/cortisol_t...