4 x Salivary cortisol is a better measure of adrenal cortical function than serum cortisol, however I would ask for a more complete stress profile which would include 2 averaged DHEA-S.
See online Adrenal Stress Profile – BH #201 from BioHealthLabs for details.
I would also recommend you look into the "GI Pathogen Screen", especially now that your cortisol levels came back somewhat low.
Cortisol regulates the immune cells in our gut so when cortisol is depleted those cells become dysregulated, making us more susceptible to pathogens like bacteria, yeast, and parasites.
From looking at your results, your AM Cortisol should be much higher as you mentioned, which is substantially lower than your what your serum cortisol tests indicated for many years.
That leads to the theory that your high cortisol could not be sustained indefinitely and has come to the point where your adrenals cannot produce high amounts of cortisol.
It is possible that you have developed adrenal fatigue and should this be the case, treating hypothyroidism becomes a challenge and it should take a secondary position to treating the adrenal fatigue.
The adrenals hold a higher rank than the thyroid (for survival purposes), therefore, in such cases the adrenals force the thyroid to function at a lower level ( secondary hypothyroidism) for adrenal recovery, which takes place by means of T4 converting to Reverse T3( instead of T3).
So let's say your are on Synthroid or Levothyroixine which are synthetic forms of thyroixine (T4), you might be unknowingly supplying more Reverse
T3, lowering your T3 levels even further.
A starting dose of Cytomel (T3 only) instead could be considered as atrial along with the AF treatment.
You would need a reputable and knowledgeable ND or Functional Medicine
Doctor to help you with this.
It is unfortunately not within the scope of practice for most conventional doctors to diagnose and treat adrenal fatigue, unless it becomes life threatening, which is stage 4-adrenal insufficiency/failure.
A little too late, to my opinion, as it is irreversible once it reaches this stage.
You have time to get it evaluated and treated- based on your symptoms you posted. The sooner,the better.
You may consider doing a screening questionnaire/assessment first.
If you want the one I have been using, I'll be glad to send it to you and feel free to complete it and return it to me for my opinion on a PM.
Also:
Grains/carbs/gluten intolerance
Look into Gliadin test (urine), by Cyrex labs. They test 12 forms-not just the alpha ordered by most doctors- of gliadins regarding gluten intolerance (not necessarily digestive).
Now they can also test which part of the body is affected.
Most hypothyroid/hashimoto's sufferers have gluten intolerance and don't even know it!
The gluten molecules-mainly from gmo grains- resemble the TPO(Thyroid Peroxidase - an enzyme necessary for the signalling Thyroid hormone production) molecules and thus the immune system in its response against gluten, attacks the TPO in the Thyroid also!
Best wishes,
Niko