Salivary Cortisol Results Are In

[futurehope]

8 AM I tested the lowest end of normal

4 PM I tested the highest end of normal

11 M I tested 1/10th higher than the high end of normal.

So maybe my really low end number in the AM shows why it's so difficult to move or feel human in the morning?

I really don't know what to make of any of this? Anyone else have these tests done? What were your results?

[sandymbme]

I had the salivary cortisol about two weeks ago. My results were in normal range for the first three samples, but my last one was below normal. The doctor said that this is indicitive of adrenal fatigue, that I had no reserves and exhausted my supply before the end of the day. Also of concern was the fact that my progesterone and my testosterone were VERY low. My doctor felt that the flourinef that I am on caused my cortisol to report higher than it would have otherwise, and started my on natural progesterone and DHEA. I wish I had more insight to offer regarding your results, but I really don't know a lot about this stuff!

[mcaimless]

If your cortisol levels are low or below range at any time of the diurnal cycle it's indicitive of adrenal fatigue. One very common reason is undetected thyroid disease. When the thyroid isn't producing enough hormones the adrenals will kick in and produce more cortisol to try to keep the metabolism running as it should. Eventually they get fatigued and you will see dips in the levels or even increases as they try to keep up with both metabolic and stress demands.

Most doctors do not effectivly screen for hypothyroidism. TSH is a bad test because not only are the ranges not correct (truly normal TSH should be between .3 and 1.5-- but even this is not truely useful if the patient has hypothyroid symptoms or Hashimoto's disease). TSH is actually a test that measures pituitary function, not thyroid. To really find out if you have hypothyroidism you need to have a Free T4, Free T3 to get the level of your actual circulating (or "free") thyoid hormones. These levels need to near the top of range to be at a therapeutic level. Most people are tested and are in the bottom half of range and proclaimed "normal" by their doctor, when they actually are very hypothyroid and need treatment.

Failure to treat both adrenals and thyroid will have very serious long-term health consequences, including heart disease, depression, dysautonomia, infertility, etc. If you have adrenal fatigue you should treat with hydrocortisone at physiologic dosage to give them a rest and allow them to heal and then start with thyroid treatment. If cortisol is low, thyroid hormones will not be able to transfer from the blood into the cells where they need to be.

If you are taking Florinef it will skew your saliva cortisol test and produce a false high reading. One needs to be off all steroids before taking the test.

There's lots of good info about adrenal fatigue and thyroid at http://stopthethyroidmadness.com

[futurehope]

MCaimless,

You need to understand a few things about me. So, if you have a few minutes....

I don't HAVE a thyroid. It was removed for cancer.

My TSH is about 2.55 right now. My Free T 4 is high normal and my Total T3 is high normal. I do not WANT my TSH any lower. In order to keep my synthroid at this dose, I have spent weeks adjusting to the fact that I am more hyper. My heartrate jumps more readily than when I was at a lower dose. My resting heartrate is rather high. So, I do not WANT more synthroid.

As for my adrenal results above, 2 of the 3 are in the normal range except for the 11 PM one was .1 above the high end.

I HAD taken supplemental hydrocortisone in the past, a very small dose. I noticed weight gain and really no improvement in other functions, so I had the above tests done to see if indeed there is a real deficiency? I doubt it. Personally, they can keep the hydrocortisone pills, and I'll keep my figure, thank you very much.

Now, it is possible that UNDER STRESS, my adrenals are mildly deficient, as shown by my less than optimum results on an insulin tolerance test. It is possible that under stressful condition I may need some hydrocortisone hormone.

But, on a routine basis, I'm suspecting that my numbers above are not indicative of needing a supplement.

I was curious as to other peoples' results if they took this test?

Thanks for the info, but I needed to clarify what my situation is.

P.S. What you are saying about Free T4 and Total T3 are not true for me. For me, the TSH is my favorite test for indicating how much thyroid hormone I should be on. I've kept careful notes of all three thyroid tests for MANY years, and the TSH is the best indicator of thyroid function for me. Contrary to what you said, my Free T4 and Total T3 did not vary much when I was hypo, but the TSH did. So, I suggest for anyone else out there that you keep your own running records, with results and how you feel, to assist the doctor. When I mentioned my "normal" results to the doctor, and I discussed results and charts I have kept for years, he could see I had data to back up what I was saying.

[mcaimless]

I'm sorry, I didn't see on your meds list that you were taking synthroid. I just looked at your dx list and didn't see hypothyroidism.

I'm a little curious why you took the saliva test, are you experiencing symptoms? I understand you have high Free T4 levels but have you tested Free T3? Free T3 measures the free or unbound T3 as opposed to the Total T3 (Total T3 is more an approximation of T3 levels). And have you tested your reverse T3? These can all be pieces of the puzzle that might help if you are experiencing hypo symptoms. I do wholeheartedly agree that symptom relief is the key to determining how much thyroid hormone is the right level and you are smart to keep a log of your labs with your symptoms.

Many people don't do well on synthroid or synthetics over the long term, hence why I recommended Stop the Thyroid Madness. If you have high levels of FT4 it could mean you are having troubles converting and the long term use of T4 can stress adrenals as well.

I have had saliva cortisol tests as well. The first was with Diagnos-tech which turned out to be a bad idea because the results were bizarre, my evening levels were 20x the high range. I read since that they are not recommended for testing due to uneven results. I then restested with a ZRT test and had slightly above range in the AM but middle of range the next three times. This was a relief as I didn't want to have to treat my adrenals as well.

[futurehope]

No, the doctor never mentioned a free t3 test to me.

I had my salivary cortisol tested to check my adrenal functioning. I first got my TSH where it needed to be. I am constantly on the lookout for potential reasons for my symptoms and adrenal function is one area of testing. I am unusually dead in the am. My pulse pressure tends to be narrow. I tire very easily. And I'm basically orthostatically challanged.

[mcaimless]

I would suggest you ask for a Free T3 and a reverse T3 (RT3). If the actual levels of T3 are low (or your RT3 levels are high) you could still not be optimized on your thyroid meds. The symptoms you describe often are a result of this. I have POTs, palps and orthostatic issues as well as mind-numbing fatigue and found after much searching that this was a result of my hypothyroidism. My Free T3 and T4 levels were very low and they should be in the upper third of range.

There are a lot of people who are burning out on T4-only meds like Synthroid. With these meds your body is forced to convert the T4 into the T3 you need for your metabolism, whereas if your thyroid were still there it would be producing both T3 and T4 (as well as other hormones like T1,T2 and Calcitonin). The makers of Synthroid and other synthetics have a lot of influence (and $$$ to influence doctors) and have basically re-written the endocrinology clinical guidelines to exclude the natural thyroid hormones (NTH). But, despite this, there is a large groundswell of people who are getting sicker on synthetics going over to that treatment. NTH contain all the same hormones that our thyroids produce and it just makes sense to me to replace like with like here.

Long term use of synthetics tend to burn out adrenals as well because if you are low in T3 your adrenals put out more cortisol than they normally would to try to keep the metabolism working and they become fatigued as a result. I am willing to hypothesize that many cases of POTs and dysautonomia are due to adrenal fatigue and hypothyroidism. I think it would be great if everyone here would get the correct screening for thyroid and adrenal issues to rule it out effectively. It's absolutely amazing how many people are undiagnosed for this condition, some estimate it's in the millions. I highly recommend the Free T3, Free T4, and the thyroid antibody tests (for those who still have a thyroid) TPO-Ab and TG-Ab. Most of us are screened with the TSH only but this is not a reliable indicator of our Free T levels. I was aways "in range" with my TSH while my Free T's were very low and I had many hypothyroid symptoms that cumulated in dysautonomia, fibromyalgia, joint pains and many other disabling conditions. Now that I'm on therapeutic levels of NTH I'm seeing a lifting of all these things.

Did you get your vitamin D, B12, and ferritin levels checked recently? Often we have problems absorbing these vitamins and minerals from food and sunlight and most of us are deficient. It's really important to keep an eye on this too if you haven't already. B12 should be well up over 550 (closer to 800 is best) and D should be over 50. Ferritin should be in the upper half of range. I live in Arizona and have a tan and was astonished to see I was actually below range in vitamin D.

[futurehope]

Hi,

I'm trying to remember all your questions. Yes, my Vitamin D is fine. My serum ferritin is in the normal range in the 20's or 30's (can't remember) and I was going to discuss this with my sleep doctor as he usually wants the number in the 60's - 70's for treating restless leg syndrome (which I have). I had an appointment to discuss this with him, but after waiting 3 hours in the waiting room and watching everyone get into the doctor before me, the doctor came out and told me I wasn't on HIS schedule .....and this was at Johns Hopkins and I had totally prepared for this visit....I was upset and left and am not sure I'm ever going back.

I forgot what else you asked. Also, I did have an appointment with a second endocrinologist. I was to discuss the issue you brought up, bring all my results and ask for natural hormone (what brand, BTW?) but she had a death in the family and I was never able to see her either.

So, I am a bit better since raising my synthroid, but I still react very poorly to stress of any kind. That's obvious to me. So I suspect that despite all my numbers, my Free T 3 may not be optimal.

But, as you can see, I've had mucho problems getting into to see my practitioners, and I'm going away for the next three weeks, so it is out of the question to see them.

After reading your last post, I feel lucky that I got 27 "good" years in on my synthetic hormone before slowly deteriorating.

C'est la vie!

[mcaimless]

I was to discuss the issue you brought up, bring all my results and ask for natural hormone (what brand, BTW?)

Most are going over to Nature-throid by RLC Labs. Unfortunately Armour has been messed with by its manufacturer, Forest Labs, to the point where its long-time users are going hypo in it. Also Armour is getting very scarce. I strongly suspect Forest is planning to discontinue it in favor of their synthetics. This is a shame as it's the most well-recognized brand of NTH out there and had a huge following. There is also a very good product calle ERFA Thyroid from Canada that can be purchased online. But I can get Nature-throid at my local pharmacy and my insurance covers it. I did have to talk to the pharmacist and tell him I needed a good supply and while it was a little slow coming at first, I'm not having any troubles now.

I wish you luck. I had a lot of problems with stress intolerance too, the slightest thing would set me back tremendously, literally make me feel sick. I think it's because my stress hormones were somewhat high from trying to compensate for my lack of thyroid hormones. I'm finding I'm evening out now and my brainfog is lifting (at last!).

Also, you can scroll down when replying to see the posts before yours if you are trying to remember what someone said. It helps me a lot!

[morgan617]

futurehope,

I had this done with serum and was just about like you, only had ACTH test done. it was totally flat and it should at least double. They did the test 3 times and the third time it was high before the injection and barely hit 7, which is the minimal amount it can raise and be "normal."

In the end after all three were abnormal in some way, I was told I was fine. Nothing has ever been done and that was 2005. That's all I can tell ya sweetie, as long as you are anywhere near normal, it's gonna be normal no matter what. Unless I had very clearly defined addisons or something absolutely requiring cortisone, I wouldn't take it. But that's a moot point for you too, as you have no interest in it either. morgan

[futurehope]

At this point, unless I have a received deficiency, which I do not, I will not take the supplemental hydrocortisone. There are too many potential difficulties that can arise from it. But I always want to know how I can help myself.