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What does the following cortisol level indicate?

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Posted on Tue, 26 May 2015
Question: Hi, I have had hashimotos for 14 or so years. I have always had a borderline high Reverse T3, but it has never caused me issue. I take .100 mcgs Synthroid on Saturday and Sunday and .112mcg Monday through Friday. I have felt great other than been under a tremendous amount of stress the last 2 months as my 3 year old was just diagnosed with inflammatory bowel disease and work has me stressed as well. I went to have my 3 month labs done for my thyroid and my doctor did a cortisol test in addition to the thyroid panel. Here are the results:
TSH 0.251 range 0.45-4.50
T3 115 range 71-180
FT4 1.67 range 0.82-1.77
T4 Direct 1.67 range 0.82-1.77

The FT3, RT3 and Vitamin D will follow in the coming days.

I am very worried about my cortisol level since I really don't know what this means. Is this something that I should be worried about?
doctor
Answered by Dr. Ajish TP (17 minutes later)
Brief Answer:
You can decrease the synthyroid dose

Detailed Answer:
Hi,

Welcome to HCM. Thanks for posting the question.

Your TSH is low and T4 is higher side of normal. You can decrease the dose slightly.100 mcg Monday through Friday and 112 mcg on Saturday, Sunday should be fine. RT3 and T3 are usually not recommended for follow up.

Cortisol is a hormone produced by adrenal gland. This hormone can be decreased in adrenal insufficiency (tiredness, low blood pressure, increased skin pigmentation are common symptoms) or increased in a condition called Cushing's syndrome (weight gain, skin thinning, diabetes and high BP are symptoms). Hypothyroidism is usually associated with low cortisol levels.

There is no need to worry about this before getting the reports. Cortisol levels is just a screening test. If low or high we have to do special tests(stimulation or suppression tests).

Hope I have answered your question. If you have any further concerns I will be happy to help you.

Wishing you good health.

Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajish TP (10 minutes later)
Im sorry. I thought I included the cortisol results. My Cortisol was 23. It was tested at about 10am. I had caffine before the test and did not fast. The reference range for the lab is 2.3-19.4. Is this something that could be caused by my thyroid being slightly hyper? Stress? Should I have this retested at a later date when I am less stressed or is further testing needed now?
doctor
Answered by Dr. Ajish TP (24 minutes later)
Brief Answer:
Better to retest

Detailed Answer:
Hi,

Welcome back.

The cortisol value is on higher side. It could be due to stress. You can repeat it at a later date, preferably fasting, at 8 am.

If your physician feel you are having features of cortisol excess he can do a dexamethasone suppression test- which we usually do to screen cortisol excess. Here you have to take 1 mg of dexamethasone tablet at 11 pm and do a serum cortisol next day morning.

In your case I strongly think the increase in cortisol be due to stress.

Regards
Dr Ajish TP
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajish TP (2 minutes later)
Thank you! That is what I was thinking. I tend to always think the worst case scenario, so of course my brain started wondering about tumors and such, but Im pretty sure that it would be much higher, correct? I feel fine. I have no problem with sleep or fatigue, just a little stress with work and family.
doctor
Answered by Dr. Ajish TP (8 minutes later)
Brief Answer:
Usually high

Detailed Answer:
Hi,

I totally agree with you. These hormone levels are pulsatile and may show abnormal results in random sample.

If your endocrinologist was suspecting tumour ( cortisol excess) he would have directly gone for cortisol suppression tests as we don't do random cortisol to look for cortisol excess.

The tumours usually have much higher values.

So don't worry, if you don't have symptoms you can repeat it at a later date.

Regards
Dr Ajish TP
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ajish TP

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What does the following cortisol level indicate?

Brief Answer: You can decrease the synthyroid dose Detailed Answer: Hi, Welcome to HCM. Thanks for posting the question. Your TSH is low and T4 is higher side of normal. You can decrease the dose slightly.100 mcg Monday through Friday and 112 mcg on Saturday, Sunday should be fine. RT3 and T3 are usually not recommended for follow up. Cortisol is a hormone produced by adrenal gland. This hormone can be decreased in adrenal insufficiency (tiredness, low blood pressure, increased skin pigmentation are common symptoms) or increased in a condition called Cushing's syndrome (weight gain, skin thinning, diabetes and high BP are symptoms). Hypothyroidism is usually associated with low cortisol levels. There is no need to worry about this before getting the reports. Cortisol levels is just a screening test. If low or high we have to do special tests(stimulation or suppression tests). Hope I have answered your question. If you have any further concerns I will be happy to help you. Wishing you good health. Regards Dr Ajish TP Consultant Endocrinologist