9am Cortisol Test

[Sharjhen]

Hi. Wonder if anyone can help me. I recently had a 9am Cortisol test and the results came back at 814 nmol/L. Range is > 450 nmol/L. Does mine look on the high side?

[SlowDragon Administrator]

common for cortisol to rise when hypothyroid

Adrenals try to compensate for low thyroid hormone levels

Cortisol levels should improve/reduce as dose of levothyroxine increases slowly upwards over coming months

You not long started levothyroxine

Come back with new post once you get thyroid results

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

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

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

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

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)

[Sharjhen in reply to SlowDragon]

Thanks for replying.

I ve been on 50mg levothyroxine for 8 weeks now. GP tested tsh only at 4 and 8 weeks. Tsh at 8 weeks was 0.76. ( range 0.2 -4.0). GP would not test t4 or t3.

My folate is below range, been taking 5mg folic acid for the past 4 weeks. I am commencing b12 loading injections on 15th november due to low b12 (in range but low end). Taking otc iron as ferritin is in low end of normal too.

Tpoab's positive at 1196 (<100).

I have already consulted privately as j m not prepared to waste months on taking a medication that doesn't work. However Endo says the Levo needs longer and we need to get my vitamins and minerals up

Would you recommend retesting at 12 weeks? .

[SlowDragon Administrator in reply to Sharjhen]

Have you

Which brand of levothyroxine are you taking

Have you always had same brand

Tsh at 8 weeks was 0.76. ( range 0.2 -4.0). GP would not test t4 or t3.

Was test early morning

Get TSH, Ft4 and Ft3 yourself

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)

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

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

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

thyroiduk.org/testing/priva...

Randox FULL thyroid test including both thyroid antibodies just £29

Test at home or in clinic

randoxhealth.com/en-GB/at-h...

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Test vitamin levels at least annually

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

[humanbean]

My folate is below range, been taking 5mg folic acid for the past 4 weeks. I am commencing b12 loading injections on 15th november due to low b12 (in range but low end).

Taking folic acid, particularly at such high doses, is definitely not recommended. In order for your folic acid to do any good it needs to be converted into the active form called methylfolate, but about 50% of the global population can't do the conversion very well. And many people with thyroid disease are in that 50%.

Please read these links :

drfuhrman.com/blog/16/why-y...

web.archive.org/web/2024022...

chriskresser.com/folate-vs-...

Methylfolate is easily sourced online on sites that sell supplements e.g. Amazon, but there are many others, and shopping around is highly recommended. A dose of 800 - 1000 mcg per day is a reasonable dose for someone who is currently deficient. There are higher doses available but they can cause side effects in some people. When your level has risen to roughly 20 micrograms/L you can continue to take the same methylfolate fewer days a week to maintain that level. You might need to take it 2 - 3 days a week, but the only way to know is to try it and see if the level is right.

Ideally, you should have started taking folate a few days after your first B12 injection.

Do you know the result and reference range of your B12 test?

Is there any evidence that you have Pernicious Anaemia (PA)? Has your doctor considered this and tested you for it? You should discuss this with the people on the Pernicious Anaemia Forum (another community on HealthUnlocked) which you can find here :

healthunlocked.com/pasoc

It is better to have tested for Pernicious Anaemia before having your first B12 injection - the PA forum are the people to ask about this.

...

Taking otc iron as ferritin is in low end of normal too.

OTC iron usually only contains a dose of about 15mg iron per tablet. This won't help many people - it is an extremely low dose.

The most popular supplement for iron on the forum at the moment is by a company called Three Arrows and it causes far fewer side effects than the iron salts that are usually found in OTC iron. It has to be imported from the USA.

healthunlocked.com/thyroidu...

threearrowsnutra.com/en-uk/...

If you want to try iron salts of the type usually prescribed by doctors you can buy them without prescription from pharmacies in the UK. I would NOT recommend ferrous sulfate - it is the least well tolerated of all the prescribed iron supplements.

There are three different iron salts. Info and dosages can be found in these links :

Ferrous Fumarate : bnf.nice.org.uk/drugs/ferro...

Ferrous Sulfate : bnf.nice.org.uk/drugs/ferro...

Ferrous Gluconate : bnf.nice.org.uk/drugs/ferro...

Another possibility is ferrous bisglycinate, otherwise called "Gentle Iron" which is available without prescription and works for some people. You can find Gentle Iron on websites selling supplements.

Ferritin = Iron stores.

It is possible for people to have low ferritin and high serum iron i.e. iron in your blood stream. Having high iron and low ferritin is not hugely common but it can happen. And if it does you could end up with iron being deposited in places in your body where it shouldn't be. The body can't get rid of excess iron and in the worst case scenario excess iron has to be removed with "therapeutic phlebotomy" i.e. getting blood taken to remove the iron.

The way to avoid this is to ask your doctor for an iron panel which will show you if your iron is high and your ferritin is low. Assuming both ferritin and serum iron are low, you can take iron, but it must be tested after 2 - 3 months to see if you are absorbing the iron. Some people absorb iron very, very slowly and are better off trying iron supplements of a different type.

[Personal anecdote : It took me nearly two years to raise my ferritin to mid-range. My serum iron hardly budged during that time.]

Initially your aim should be to get ferritin up to 90 - 110 micrograms/L. If this works then your serum iron should rise too, but ferritin and serum iron probably won't rise at the same rate.

This link is helpful to give you an idea of your goals with respect to iron although it is vague with respect to ferritin :

rt3-adrenals.org/Iron_test_...

For info on optimal ferritin :

Link : thyroidpharmacist.com/artic...

Quote from above link :

Normal ferritin levels for women are between 20 and 200 ng/mL. According to some experts, ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/ml.

Note on the units of measurement...

1 microgram/L is equivalent to 1 nanogram/mL.

.

[Juliet_22 in reply to humanbean]

Gosh, what an amazing and helpful post! Thank you!!

I take the gentle iron form, but my iron is slow to rise.

Also, the only way for me to get to 90 level ferritin was to do an iron IV. I can't get there with supplements.

The lady's TSH looks great. Btw, I had the same high cortisol/morning issue. The only thing that balanced it in the end was moving to a sunny climate.

Try the red light therapy, it's absolutely amazing!

[humanbean]

I recently had a 9am Cortisol test and the results came back at 814 nmol/L.

When the thyroid starts to fail the body does what it can to substitute for the missing thyroid hormones by increasing output of cortisol from the adrenal glands. Cortisol isn't a good substitute for low thyroid hormones but its the best we have.

When the patient with failing thyroid and low thyroid hormones is given Levo or other thyroid hormones in tablet form it can take a while for the cortisol level to fall back to "normal". The longer the cortisol has been high the longer it can take for the body to reduce cortisol when more thyroid hormones are made available.

I have no proof of this (and I'm not a doctor) but I am convinced that it is high cortisol that makes Levo hard to tolerate at the start of treatment for some people. The combination of higher levels of thyroid hormones when treatment starts plus the higher than normal cortisol can cause anxiety, and faster than normal heart rate.

In some people the demand for higher than normal cortisol can't be maintained and cortisol levels eventually drop by themselves even if thyroid hormones are still low. That makes Levo hard to tolerate as well. There is a fairly strong relationship between thyroid hormone levels and cortisol levels.

In the meantime, a good policy is to optimise as many things as you can including nutrients i.e. iron, ferritin, vitamin B12, folate, Vitamin D. Plus thyroid hormone levels (Free T4 and Free T3). And reduce cortisol if you can. (I found this very difficult.) Most of the "reduce cortisol" advice on the web is fairly poor and very repetitive, but if you can optimise as many things as possible your cortisol might reduce by itself. I had to start finding my own solutions because mine didn't drop.

I took Holy Basil for several years to reduce my cortisol, just before bed - it made it easier to sleep. This is the one I took :

dolphinfitness.co.uk/en/swa...

You should always shop around though - the price varies every time I look at it. Thankfully I don't seem to need it any more. I only gave it up recently after about 9 years of taking it. Hopefully your cortisol will lower more quickly than mine did.

[McPammy]

That 9am result of 814 is very high. Have you recently had any illness? Or have you been very stressed? I get my 9am cortisol checked every x3 months without fail by my gp. My results are normally around 300 but can go higher if I’d been unwell near to the test. When I’ve had covid it goes much higher. Cortisol is our natural steroid to help fight infections or goes high when very stressed. So you don’t want it high and leave room for those occasions. If that was my result I’d request a retest just in case it’s a lab error ( they do happen). If it comes back still very high I’d speak to your endocrinologist. My cortisol improved significantly once I added t3 medication to my normal t4 medication. I’m a very poor converter of t4 to t3 and have the DIO2 faulty gene but it’s always in range, which is 155- 650 at my local hospital Chester

[JumpJiving]

 Sharjhen - 814nmol/L is high. Whilst it can be caused by stress and other factors, at that level I would be questioning Cushing's syndrome. I would advise seeing your GP and getting a referral to endocrinology to have it checked, particularly if you have any symptoms of Cushing's. When choosing an endocrinologist, I would start by checking at your nearest pituitary centre of excellence, and asking for recommendations online. The Pituitary Foundation has an excellent helpline.

See pituitary.org.uk/informatio...

[Sharjhen in reply to JumpJiving]

Hi. Thank you for replying. I have been very stressed and experiencing panic attacks could that be the reason why it's so high.

My GP has seen reviewed the blood test and marked it as normal!

Should I go back to the GP and maybe ask to see another GP. The lab has marked the result as normal too.

[JumpJiving in reply to Sharjhen]

What was the reference range on the lab results? I would suggest contacting the Pituitary Foundation helpline for advice. At the very least, I would expect another early morning cortisol test to rule out a transient spike from a panic attack etc. If the level is still raised, it needs investigating IMHO

[Sharjhen in reply to JumpJiving]

The ref range just says >450. There is no high ref range

I will contact them and do some further research tomorrow

[JumpJiving in reply to Sharjhen]

Sharjhen The organisation that I get my cortisol tests done by has an upper bound of the reference range of 537nmol/L (which I have to admit to thinking is a bit low). If you look at the graph of the circadian cycle across the day at cahisus.co.uk/pdf/CIRCADIAN... that shows a morning peak of about 700nmol/L in a healthy individual. I don't think that spiking briefly above that because of stress etc would be a concern, but if your levels are regularly high whether because of chronic stress, HRT, or otherwise, particularly if you have symptoms of Cushing's, I would suggest getting it investigated. Even if not Cushing's now, if your levels are regularly high you will want to address that. For me, I found talking therapy very helpful for stress/anxiety, but your GP should hopefully be able to signpost you to a service that can help with panic attacks etc

[Sharjhen in reply to JumpJiving]

Also I am on hrt patches. does this effect the result?