Using Cortisol Tests When on HC or Other Adrenal Support

My previous post referred to an excellent website produced by Dr. Henry Lindner:

I would now like to draw your attention to another page from the same website which discusses cortisol insufficiency.

In particular, Dr. Lindner points out how he uses cortisoll saliva tests whilst patients are taking hydrocortisone or adrenal support to assess their cortisol levels. Thyroid patients have long been told that the use of cortisol tests during HC (hydrocortisone) replacement is not viable. Dr. Lindner disagrees with this and uses cortisol saliva tests regularly with his patients. He is just very clever about the way he does it.

Dr. Lindner makes it clear that symptomatic information is highly important in determining if his patients are taking too much or too little hydrocortisone. However, if oral HC is used and is swallowed down quickly with water (to avoid too much saliva contamination) then cortisol saliva tests may be done.

If high cortisol were suspected, the cortisol saliva test samples would be taken just before the next oral dose of HC. These cortisol results should be 'low-normal' or 'low' for that time of day (because the cortisol level would have been much higher in the couple of hours after the previous dose of HC). However, if the saliva cortisol result is higher than 'normal' for that time of day, then the preceding dose of HC could be reduced because it must have been much higher earlier.

If low cortisol were suspected, the saliva test could be taken 1-2 hours after each dose of HC, and if the result from this saliva test was just 'normal' for that time of the day, the HC dose may be too low (since the cortisol level would be much lower at 3 or 4 hrs after the HC dose - when the next HC dose is due).

Dr. Lindner makes it clear that this is a fine tuning process that is unique to each individual in order to eliminate their cortisol-deficiency symptoms.

Having communicated with Dr. Lindner on this topic extensively I know that it is his opinion that symptoms are far more important than lab testing. But this approach may be used to confirm a diagnosis based on the symptoms and signs of the patient in response to treatment.

Multiple serum cortisol tests could also be used.

I suggest that this approach may offer great value to thyroid patients using HC or other adrenal support and I recommend reading Dr. Lindner's website and this page on cortisol insufficiency:

Best wishes,