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I’m somewhat confused about testing the HPA axis in terms of thyroid health and how this could confuse things. On page 14 of Datis Kharrazian’s thyroid book, he says, ‘In people with hypothyroidism, urinary excretion of several arena hormones decreases. So someone could appear to have an advanced case of adrenal fatigue when, in fact, they’re simply doing a poor job of clearing the hormones through the kidneys. He’s basically explaining that he prefers salivary testing. You briefly mentioned this in last week’s material how urinary cortisol metabolite measurement might become a means of diagnosing subclinical thyroid dysfunction in both hyperthyroid and hypothyroid. Do you agree with Datis that this is a problem with urine testing, and if so, are there ways around this or extra tests on top of the DUTCH Complete so the thyroid malfunction doesn’t get confused with HPA-D?

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Thyroid Disorders
I’m somewhat confused about testing the HPA axis in terms of thyroid health and how this could confuse things. On page 14 of Datis Kharrazian’s thyroid book, he says, ‘In people with hypothyroidism, urinary excretion of several arena hormones decreases. So someone could appear to have an advanced case of adrenal fatigue when, in fact, they’re simply doing a poor job of clearing the hormones through the kidneys. He’s basically explaining that he prefers salivary testing. You briefly mentioned this in last week’s material how urinary cortisol metabolite measurement might become a means of diagnosing subclinical thyroid dysfunction in both hyperthyroid and hypothyroid. Do you agree with Datis that this is a problem with urine testing, and if so, are there ways around this or extra tests on top of the DUTCH Complete so the thyroid malfunction doesn’t get confused with HPA-D?

I’m somewhat confused about testing the HPA axis in terms of thyroid health and how this could confuse things. On page 14 of Datis Kharrazian’s thyroid book, he says, ‘In people with hypothyroidism, urinary excretion of several arena hormones decreases. So someone could appear to have an advanced case of adrenal fatigue when, in fact, they’re simply doing a poor job of clearing the hormones through the kidneys. He’s basically explaining that he prefers salivary testing. You briefly mentioned this in last week’s material how urinary cortisol metabolite measurement might become a means of diagnosing subclinical thyroid dysfunction in both hyperthyroid and hypothyroid. Do you agree with Datis that this is a problem with urine testing, and if so, are there ways around this or extra tests on top of the DUTCH Complete so the thyroid malfunction doesn’t get confused with HPA-D?

Chris Kresser: No, I don’t think it’s a problem because you’re testing free cortisol and metabolized cortisol in the urine, and you’re doing it in a diurnal fashion. I think that is a lot different than the 24-hour cortisol, metabolized cortisol testing that he was probably referring to when he wrote that book. You can always combine the DUTCH test with the cortisol awakening hack that I mentioned if you want to get even more data, but I think DUTCH testing is very accurate for cortisol testing, at least according to our experience and the clinical data that we’ve seen so far.

Yes. Brant wrote in, “When he wrote the book, DUTCH wasn’t available yet. It was years before DUTCH was available.” So there was only just the 24-hour metabolite testing available at that time.

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