I don't usually post on this forum, but per your request, I've slipped in.
As you know a single cortisol is not sufficient to diagnose an adrenal issue; you would have to have the 24 hr saliva test, though many doctors don't recognize it as a valid test. We've had many members in the thyroid community tested for both adrenal insufficiency and hypothyroidism.
It's said that adrenal issues must be treated prior to treating a thyroid condition, but it must be noted that when the thyroid fails, the adrenals kick in to try to take up the slack, so when thyroid treatment is initiated, it often takes time for everything to return to normal. That's one reason why many people feel worse once they start on thyroid medication. The adrenals don't always need special treatment; it's just that the body has to re-balance itself once thyroid hormones are available. That's one reason why it's best to start out thyroid treatment at very low doses and work up slowly - to let the body balance out slowly.
I too also have this question as I am in a similar situation. My cortisol was barely within range (2.2, 2-18), but I've had sleeping problems and puffy eyes far before my abnormal thyroid results came in and now I'm most def hypo too. Couldn't a ACTH stimulation test be done to get the measure of your adrenal/cortisol?
I think you need more checked and an ultrasound of your adrenals to rule our that your hypothyroidism is primary and not secondary. Adrenal issues can mess with your thyroid too.
Do you have abnormal sodium and potassium readings - or low/high end readings? That is indicative of a low adrenal issue. If normal, it may be normal.
As it is, you need many tests (acth, renin, aldosterone etc) and I would suggest not only the free type but also serum to get a baseline on if you have an adrenal issue. Then a stim test to finalize it.
Thanks for your reply. I am unfamiliar with all of those tests you mention.
How do I get this testing if my GP doesn't believe I have an adrenal issue based on one AM cortisol test 487 reference range 170 – 540 nmol/L. This was the result after a 1/2 hour walk to the lab. He knows I have hypothyroidism, but he seems to have no interest in whether it is primary or secondary.
January 31, 2014
Sodium 141 Reference range 135 – 145 mmol/L
Potassium 4.2 Reference range 3.3 – 5.1 mmol/L
Thanks for your reply. What was the measurement and reference range for your cortisol test result? I highly doubt my GP would order an ultrasound given he seems unconcerned about my adrenals even though they are part of the endocrine system along with my thyroid ... I will have to look up what a ACTH stim test is.
I wonder if it is possible to improve thyroid function if the adrenals are properly supported since both are part of the same system (endocrine).
I wonder if I ought to request to have my potassium and sodium tested again. Right now the lab requisition is for TSH, Free T4, Free T3, ferretin, vitamin B12, and CBC.
Your tests looked normal. If it was adrenal your sodium and potassium would be higher or lower..
OK, thanks. You do know those tests are not recent.
Do you know if magnesium and chloride also important to adrenal function?
You mentioned potassium and sodium. Thanks.
I don't know if those are effected directly by the adrenals.
Chloride no.. That is often low when you are fasting.
Sodium and potassium are regulated by the adrenals.
Thank you for your reply. Please note I don't think I have adrenal insufficiency, but I do believe my adrenals are not functioning optimally. I know for a fact that I do have hypothyroidism. I am still trying to support my system without conventional thyroid medication. I am curious to learn what my thyroid levels are in early July.
Just pondering what other tests might be good to have done.
I saw the nurse practitioner at the doctor's office yesterday. She added the following tests to the lab req for early July: folic acid, calcium, and albumin. It already included TSH, Free T4, Free T3, vitamin B12, and ferretin (iron stores).
I have been having nocturnal calf cramps again recently.
What about magnesium? That can cause cramps too.
I asked for magnesium, potassium, and sodium, but the doctor and nurse practitioner said my results were OK 6 months ago so they will not repeat the tests at this time! Things can change. I did get the NP to add a few though. So when I go in early July these tests will be included calcium, albumin, and folic acid. The nurse practitioner seems to think the nocturnal calf cramps could be related to low iron stores or dehydration. I drink water/tea (mostly herbal) & eat foods full of water (fruits and vegies). I do not drink coffee or alcohol. The NP recommended I do stretches before bed and also consider a warm bath.
Hi Rumpled, My cortisol is very low, but my potassium and sodium numbers are within standard range. They're even within the range that functional medicine practitioners recommend. Interesting...
Do you have a doctor who has experience prescribing dessicated thyroid (Armour)?
Please note this is not an option for me as I am a vegetarian. Thanks.
The only thing my doctor (GP) has experience with is conventional medication (Synthroid). I continue to work to support my system without a drug.
I am going for bloodwork on July 2. I've been using a Canadian product called Strest (adrenal tonic) and prior to that I was drinking an adrenal tea from my naturopathic doctor. I don't feel as cold as I did before so I am hopeful that there is some improvement.
I learned through a previous ND quite some time ago that iodine isn't the answer for me. It made my hypothyroidism worse!
You could use cytomel - which is a synthetic T3 and has no animal product.
I used that and T4 in my case levoxyl to help my thyroid.
Thank you for your note. I need to find out what my TSH, Free T4, and Free T3 levels are. I plan to go to the lab for bloodwork on July 2 (tomorrow).
The doctor's office called July 6 requesting I make an appointment to discuss my lab results re: recent bloodwork.
Good. I hope he has insight. Let us know what he says of you like. Good luck.