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A little unclear on the physiology of a patient who has low free cortisol and low cortisone. Okay, so low free but on the higher end of metabolized cortisol.

Dr. Amy Nett: That sounds to me like a rapid clearance. That would be an increased clearance. If you have low cortisol and high metabolites, I think that’s what you’re saying. Higher metabolized cortisol. Oh, maybe you’re saying high total, so sluggish, so I think you’re saying sluggish metabolism. Again, go to the things that can slow down sluggish metabolism. One of those is hypothyroidism, and you’re saying she has Hashimoto’s thyroiditis and is overweight. It sounds like—I think that’s what you’re saying, so low free cortisol, low cortisone, higher end of metabolized cortisol, so increased clearance. Sorry—I need the graph. Sorry about this. So, you’re saying high end of metabolized and then low free. Okay, so increased clearance. So with increased clearance, hyperthyroid, insulin, and obesity. Just go back—if I have that wrong, I apologize, but the way it’s written, I’m thinking there is increased clearance, so you think about things that are going to up-regulate clearance. Again, obesity, insulin, and hyperthyroidism. Okay. Hopefully that made sense. Sorry. Sometimes it is easier for me to actually see the graph rather than just walk through those verbally.

 

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