can someone help with interpretation of cortisol results. My doctor says I have low cortisol but it appears normal to me.
Quest 4 point cortisol results
5:30 am .45
11:30 am .19
4:00 pm .06
630 pm <.03
Ranges
8-10 AM:
0.04-0.56 mcg/dL
noon-2 PM: < OR = 0.21 mcg/dL
4-6 PM:
< OR = 0.15 mcg/dL
10 PM-1 AM: < OR = 0.09 mcg/dL
MarteeAnn The general trend of your levels of starting high and dropping off as the day goes on are what would be expected. Numbers are within the ranges given. So, at first sight looks ok. However, we don't know why you took the test (do you have symptoms suggesting a cortisol problem), we don't know what you were doing during the day (exercise can affect levels) or whether you are taking anything that might affect levels (HRT (particularly oral form, although anecdotally transdermal affects some people's levels too), steroids (inhalers, nasal sprays, tablets, creams etc), ashwagandha, liquorice, grapefruit etc). If your doctor thinks the levels are low, I would ask why, and if persuaded I would ask for an early morning (8-9am) cortisol blood test. The only exception would be if you are being seen by endocrinology in Sheffield, as they are leading the way on saliva-based testing in the UK.
MarteeAnn Are you still taking Estratest Generic? If so, you would need to stop that for 6 weeks before doing the early morning (8-9am) cortisol blood test.
You mentioned not being on any supplements other than a probiotic after antibiotic treatments. How is your diet? Avoiding ultra-processed foods and having a varied diet can help with recovering after antibiotic treatments. In the UK, the previous 5-a-day (fruit and veg) recommendation is slowly being replaced by 30-plants-per-week, hence a number of cook books suddenly appearing with titles like that (the one by Hugh Fearnley-Whittingstall is actually pretty good IMHO). Also, one supplement that you might want to investigate if struggling with menopause symptoms is an isoflavone called genistein. There is an unusual hybrid organisation in the UK called Zoe, that is part commercial and part research. They use data from their customer base for multiple research studies, having larger data sets than most researchers can dream of. Zoe's scientists normally dismiss supplements, but even they keep talking about genistein positively.
Looking at previous post you are only on 50mcg Levo and 5mcg T3
looking at previous post from year ago you look like you need dose increase in Levo
Many people on Levo plus T3 find they need BOTH Ft4 and Ft3 at least 60% through range
Typically when on JUST Levo guidelines on dose is 1.6mcg per kilo per day
So unless very petite, levothyroxine likely to be at least 100mcg per day
ESSENTIAL to test vitamin D, folate, ferritin and B12 too
What vitamin supplements are you taking
Now only on Levo 50 . The cytomel was stopped again due to side effects . Which is why the cortisol test was done to look for cortisol problems. I don’t take any supplements other than a probiotic due to past antibiotic treatments .
How much do you weigh
50mcg Levo is only standard STARTER dose
You need to get FULL thyroid and vitamin testing
TSH, Ft4 and Ft3 plus vitamin D, folate, ferritin and B12
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)
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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
cks.nice.org.uk/topics/hypo...
bnf.nice.org.uk/drugs/levot...
nhs.uk/medicines/levothyrox...
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
sciencedirect.com/science/a...
The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.
Now only on Levo 50 . The cytomel was stopped again due to side effects .
That may have been the outcome your doctor wanted.
By reducing your Levothyroxine to 50mcg per day your dose has been reduced below what a normal person needs. This would make people feel terrible. And doctors almost always blame T3 for any symptoms the patient gets because they are a) scared of it, and b) they are told to stop prescribing it if at all possible in many cases because it is (or used to be) quite expensive.
An average healthy person has a thyroid that produces roughly 100mcg thyroxine per day. T3 production from the thyroid or elsewhere is roughly 10mcg or 20 mcg per day - sorry, I can't remember more precisely than that.
When people are prescribed Levothyroxine doctors assume that it tops up a failing thyroid. But in many cases it appears to replace rather than top up what the thyroid produces. And so whatever level of thyroxine your thyroid was producing before treatment will now have mostly stopped and the 50mcg is all you have - and it isn't enough. So those symptoms you got are from too low a level of thyroxine, they aren't from the T3.
When people have too low a level of thyroid hormones the body tries to substitute with cortisol. Some people can boost their cortisol well and some can't. Cortisol is not a good substitute for thyroid hormones and people can end up depressed, anxious, and with panic attacks, whether levels are high or low. When their low thyroid hormone levels are discovered and are treated it can take quite a long time for the body to readjust cortisol levels and so feeling unwell once thyroid hormones are started is very common.
Add to that that having thyroid disease can also upset the digestive processes and stomach acid production and people can end up with low nutrient levels - both minerals and vitamins.
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