The following represents gems in wisdom about adrenal issues and treatment which thyroid patients have learned along the way:


1) It is never wise to guess whether you have low cortisol, even if you “think” you do!

Symptoms of high cortisol can be similar to symptoms of low cortisol. Plus there are different variations of an adrenal problem which require different treatments–see below.

2) Saliva cortisol is the way to find out, NOT blood testing.

Blood testing is measuring the combination of bound and unbound cortisol, so you can look high when you are actually low, cellularly. This has happened to a lot of folks! Saliva will test you at four key times in a 24 hour period, and measures your cellular levels, which is key. Some do six times in a 24 hour period, but four gives good information. Places to order saliva testing are here. They even knew saliva was the way to go in 1983! (Note: saliva testing by Quest simply gives the ranges as “less than” or “more than” a particular number. We have found those useless for interpretation. NONE of the saliva facilities listed in the link above use Quest.)

3) Treatment should be based on saliva testing that is no more than three months old.

We learned the hard way that cortisol levels can change over a few months.

4) Saliva results have nothing to do with falling in the normal range!

They have to do with where they fall in the normal range, as we have learned over and over. See where folks fall when their cortisol levels are ideal here.


***Note that the below is in reference to where saliva results should be (with healthy adrenal function), not just being “anywhere in the so-called normal range”. Learn where healthy adrenal function would put saliva results here

    1. High cortisol: 

      Two or more results together are too high, like morning and noon, or afternoon and bedtime, even though the others are where they should be, or close. This often doesn’t require cortisol supplementation, but can require certain supplements like Holy Basil, zinc, PS etc to help lower the high results while correcting what was causing it. In turn, by lowering high cortisol, the other low cortisol results can come up. Excessive progesterone supplementation has caused high cortisol in some women, but so can other issues like continued hypothyroidism, excess stress, active Lyme disease, etc. High cortisol can block the conversion of T4 to T3, favoring conversion to RT3 and putting you further into a hypothyroid state. See Chapter 6 in the revised STTM book for more info. 

    2. A mix of highs and lows:

      An example is a morning result far over the range, very low noon result, overly high afternoon result. Picture a see-saw. Both high cortisol and low cortisol can cause problems raising NDT, first causing hyper-like symptoms from excess adrenaline, then causing too much RT3.

    3. Low cortisol: 

      One might see this at one time of the day, but it’s more common to see two or more times in a day and especially in the morning. This is a very problematic state to be in and prevents you from getting out of your hypothyroid state. This is where the term “adrenal fatigue” comes into play. This will first result in hyper-like symptoms as you raise NDT, and next in excess RT3 if you are on NDT or T4-only, putting you further into a hypothyroid state.


  1. Cortisol-lowering supplements (for high cortisol as shown with saliva, NOT blood).  Patients use cortisol lowering supplements, which include Holy Basil, Phosphatidylserine (PS), zinc, etc. See pages 106 – 108 in the revised STTM book.
  2. Adaptogens (if you have a see-saw of high, then low, then high, then low, or vice versa, etc). Patients use certain adaptogens which help even out your body’s response to stress, both raising low and lowering high.  Examples include Ashwagandha, Rhodiola, Relora, Eleuthero, Maca, Schisandra, etc. Patients will often combine them, or take alone. Patients also state they usually need more than the recommended dose on a bottle. Janie keeps these on hand to use if she’s going through prolonged stress. Many are described in Chapter 15 of the revised STTM book
  3. Licorice Root (If you have slightly low cortisol at one time).  Licorice root, with its glycyrrhizin content, is used to make slightly low cortisol more useable i.e. it prevents your liver from breaking down cortisol as much. Capsules or tea is used. It can’t be used long term, as it tends to raise blood pressure in some folks.
  4. Adrenal Cortex/ACE  (for minor to moderately low cortisol levels): this can be used for low cortisol, as it’s from the area of the gland that produces cortisol. It can be a guessing game as to how much cortisol is in the tablet, so doing the Daily Average Temps (see below #7) is still necessary, as it stress-dosing. See Chapter 6 in the revised STTM book for details we’ve learned when using a cortisol-containing supplement.
  5. Adrenal glandular products (AVOID).  This is a supplement that is giving you the entire gland. But it has a drawback: it contains adrenaline, which most low cortisol patients already make too much of, and you have to take quite a lot of adrenal glandulars to give you back the cortisol you need…thus more adrenaline. Also, like other adrenal supplements, you can never be sure how much cortisol is in each tablet, so you’ll still need to do Daily Average Temps if you use this.
  6. Hydrocortisone (HC) (for seriously low cortisol): For years, this is the product thyroid patients used to give them back the cortisol they weren’t getting, which in turn allowed them to raise their thyroid meds. It’s for more serious low cortisol as revealed by saliva results, and one has to usually start at 25 mg, do Daily Average (DAT) temps to find the right amount, and remember to stress dose in the face of any stressful event. Since HC “suppresses” the HPA feedback loop, one has to “replace” in the right amount, which doing one’s DATs helps figure out.  Chapter 6 in the revised STTM book has the best information anywhere on what patients have learned in the use of HC. It’s important to watch your sex hormones and calcium levels while on HC, as they can dive.
  7. T3 Circadian Method/T3CM (When only your morning is low): For most patients, the T3CM is their first choice if just their morning is low. iThis is a very safe protocol, and when done correctly, avoids the use of any of the above (though adaptogens can be used with it during the day), and helps bring back better cortisol levels.  Good detailed summary here. It probably isn’t enough is you have more than a low morning cortisol.


  1. Failing to do saliva testing: read all four points under TESTING above. Patients have repeatedly found it unwise to guess, or to even go by older saliva results. Blood cortisol has been a failure since it’s measuring both bound and unbound and implies you are okay or high when you are not. 
  2. Using Isocort (which is now defunct), ACE or glandular when they didn’t need it: common when someone didn’t do saliva testing and is guessing. Or, if saliva does prove low cortisol, it’s too low for any of these to do the job well.
  3. Using Adrenal Glandulars for low cortisol when one already makes too much adrenaline: Unless stated otherwise, glandulars contains adrenaline, and if a patient has found themselves with hyper-like symptoms–higher heartrate, palps, anxiety–glandulars can end up contributing because of their adrenaline content!
  4. Using the T3CM when your levels are seriously low: the CT3M works better for just low morning for most.
  5. Failing to do their Daily Average Temps when using Isocort, ACE or HC: This is a huge mistake. See The Temperature Test on page 82 of revised STTM book.

To read more, go here.