Adrenal and Thyroid Testing
Please click on the test links given below to see more detail, collection instructions, sample reports etc...
For Adrenals, most people want to see what their cortisol and DHEA are up to during the day. The most popular test is the standard Adrenal Test, which measures 4 salivary cortisols and 2 DHEA samples throughout the day. This gives you the info you need to see what's most likely going on, where issues in the day might be and when to take boosters or calmers etc. The Adrenal Plan is based around this test and shows you what to do with your results, the protocols to use etc. In over a decade of use in-clinic, I have found this a very useful test and the plan sorts most people out. Note that the Adrenal Test kit includes two extra vials now. You only need to do those if you are doing CAR and SIgA (see below); otherwise, please ignore them.
There is also now a newer kid on the block in Adrenal testing called the DUTCH test. This stands for Dried Urine Test for Complete Hormones. The difference here is that they measure using dried urine samples and include several metabolites which can give you more information, for example, on more hidden adrenal issues. I think the extra info you can get with it is quite useful, especially if you've done the standard testing and treatment and need to go a bit deeper. There isn't as much research to back it up obviously as it is pretty new and it costs more, of course. If you're unsure, do a standard adrenal test and follow the Adrenal Plan as that will sort the vast majority of cases out; then you can go more complex later only if you need to.
My general advice is turning out to be do a Standard Adrenal Test which is fine for most people. If your results don't seem to fit how you feel (ie. you feel fatigued yet your cortisol looks high rather than low), follow up with a metabolite check using the Dutch Advanced Adrenal. You can read a blog post I wrote about the DUTCH tests here too.
DUTCH also do several hormone tests that include this adrenal test and I have listed those in the Hormone Tests section. Note that if you mess up your samples, a new test kit costs a further amount - about £12 currently) so just be aware of that.
Cortisol Awakening Response
In some cases, you can see an adrenal problem developing before it shows in the normal 4 saliva sample scores by measuring the CAR, cortisol awakening response, so it can be worth including that. The CAR essentially is the spike we experience on waking and within the first 30 minutes. If your CAR is below 50%, it shows you are not able to mount a wakening response and there is an adrenal issue, even if it isn't showing on the main test parameters. You can see a sample report for the CAR here.
Secretory IgA (SIgA)
It can be useful to add SIgA (secretory IgA) especially if you think you might have poor immunity, allergies or high inflammation. SIgA is a marker that shows where mucosal or gut immune activity might be going on - ie. fighting something like candida or having a food sensitivity or inflammation going on chronically. The Comprehensive Adrenal includes SIgA or you can do SIgA only later if need be, or if wanting simply to check progress on that later without doing the whole cortisol/DHEA test.
Similarly, you can do a simple DHEA only too if you need that.
People who think something might be going on at night eg. chronic insomnia, can do a single night-time cortisol test if necessary.
Over the years I have found the Thyroid Plus gives the most effective, useable information. I like it because it looks for the usual TSH, free T4, free T3 etc, but also gives an idea of how much inactive reverse T3 you are making, shows up conversion problems that might be related to selenium or iodine deficiency (surprisingly common this latter one, see it in Nutrient Tests) and measures the two main peroxidase and thyroglobulin autoimmune antibodies. With all that info, you can make a start on seeing what is going wrong, what further investigations might be useful and how to treat effectively.
If you suspect hyperthyroid rather than hypothyroid, the Thyroid Advanced Test, is very similar to the Thyroid Plus but also includes the most common hyperthyroid (Graves) autoimmune antibody TRAb.
It measures: TSH, Free T3, Free T4, Total T4, Thyroid Peroxidase antibody (TPO Ab), Thyroglobulin Antibody, Reverse T3 and T3 Uptake, plus the advanced TSH Receptor TRAb - TSI (thyroid stimulating hormone receptor antibody) for hyperthyroid. You can read much more about the different thyroid antibodies here if you need that and see a sample report here. Centrifugation of this sample is not required but it must be sent the same day as the draw on Monday to Thursday only back to the UK lab.
There is also a new blood spot and dried urine thyroid test from ZRT which might make life easier for those of you who don't want to do a full blood test. The ZRT Comprehensive Thyroid Panel has most of the usual markers I look for - although only one of the autoimmune antibodies and no Reverse T3 - but it does include thyroid elements like iodine, selenium, arsenic and bromine. It's a new methodology - which always makes me slightly nervous! - but it should certainly give you enough info on thyroid problems and I rather liked the report they give too. You can read all about it here and see a sample report here. I've added a Reverse T3 on for you so you can include this if doing the ZRT if you wish.
Thyroid Gene Testing
There are many genetic variants that can affect how thyroid hormones are metabolised and used in the body. Sometimes, if you can't seem to get your thyroid to sort itself out with usual measures, it can pay to look for genetic clues. The simplest and best known is the DI02 Deiodinase 2 Thyroid Gene Test. Some people have a fault on the gene that controls T3 delivery to the brain and these are often people who don't do well on normal thyroxine treatment and who do much better in combination with T3. You can read much more about it here: DI02 Deiodinase 2 Gene Test.
However, it can be a lot deeper than that and I now have a VX Thyroid Gen panel which covers the main genes involved. Click on the link to see a full sample report and what each gene refers to. You can do the gene panel on its own as the Thyroid Gen test, which is a simple cheek swab. Or, you can also add the thyroid blood markers as the Thyroid Pro. I like this as it includes all the usual thyroid markers including the autoimmune antibodies as well as Reverse T3, serum and red cell folate, serum and active B12, plus ferritin, Vitamin D and an inflammation CRP check. Even better, you can also add an adrenal test to this as the Thyroid Elite. That includes six salivary cortisol measurements rather than the usual four, plus DHEA-s, testosterone and oestrogen. Both the Thyroid Pro and Elite tests are blood tests and include phlebotomy in the price (at designated clinics/hospitals).
Simply put: if you suspect underactive thyroid, do Thyroid Plus (which I prefer) or the ZRT. If you suspect overactive thyroid, do Advanced Thyroid. From that, we can then assess whether you need further eg. iodine or halides testing to confirm hidden issues, which you can see below. If you want a deeper look and to include genetics, do either the Thyroid Gen or Thyroid Pro. If you want to add adrenals to a genetic test, do the Thyroid Elite.
Iodine Loading is very useful, especially to help find reasons for thyroid hormone conversion problems. You can do standard iodine too, of course, but I am listing loading as I find it more clinically useful. You can also add bromine and flourine to the iodine as the Halides Loading test if you need that - I get asked a lot so I have listed it for you as an option. See the Nutrient Tests section for these, where I have put a load of tips, Q&A for you on this test too towards the bottom of the page.
Testing Hints & Tips:
Steroids like the pill, inhalers, creams etc and any adrenal/thyroid boosting supplements might affect results. The lab advises to stop them 48 hours before taking the test unless monitoring yourself on them. Please be advised by your health professional before stopping anything.
Note that long term steroids may affect cortisol levels and they can show artificially high. If you are on long term steroids, you may not get reliable results. If stopping a steroid medication (via your doctor), you are advised to wait 2 months before adrenal testing to allow them to come out of your system.
Always follow what the lab notes in your test kit tell you to do re avoidance of stuff before testing. There is a useful run-down of adrenal-affecting meds and foods etc here on STTM which might be useful too.
Freezing time. Genova says: Frozen saliva samples are stable at room temperature for 3 days and frozen for 1 month. In other words, you can freeze your samples for a good few days if you have to hang on a bit before sending.
CAR: With CAR we want to get the measurement from when you naturally wake, so if you wake up at 4am, for example, take the samples then and 30 minutes later. The best is to wake naturally at your normal time, not measure an 'odd' day where you wake early or something.
Most people will test whilst they are on long-term thyroid meds eg. thyroxine to see how they are on it/is it enough etc? If you are on something like Armour, again you can test on it - just take your usual dose after the blood draw - or, if you are stopping either (with health professional's assent, of course), then the lab advises you would need to wait 90-100 days for it to come out of your system and get a clear result.
Reverse T3 doesn't need freezing like some other labs request. Genova explain: "We run most of the thyroid analytes here in the UK, therefore we have in our kit insert that if the client is unable to send it immediately place in a refrigerator to retain sample stability. We run our components here in the UK and then freeze the remainder for the RT3 to be sent to the US at receipt. We do this to avoid repeated freeze thaw processes that can affect sample stability."