I wondered if you can offer some help please? I have been on NDT for a year and all going well but recently I have been feeling dizzy and spaced out so don't know if I am hyper or needing even more NDT I am on 3 grains of Westhroid. My recent blood tests are
TSH 0.02 raTSH 0.02 range (0.2-4.5)
T4 11.2 (9.0-24.0)
T3 4.0 (2.5-5.7)
I have taken my pulse and it is 66 so fine, no shaking just spaced out, wonder if you could offer any help?
Hello bear10,
Sorry to hear that you are feeling unwell after a good period.
Your T4 level looks a bit low but I don't take NDT so really can't comment but will say that all glands work in synergy.
Often thyroid and adrenal problems go together as a long term undiagnosed or poorly medicated thyroid issue can put too much stress on the body.
If your adrenals are producing too much or too little cortisol, that could cause physical, emotional and psychological changes.
I would recommend a saliva stress test in order to ascertain adrenal health before altering thyroid meds/doses which having clearly been working so well for a year.
flower007
Dr. Lam has expertise in adrenal issues. This may be your problem.
Weak adrenals and thyroid, when present concurrently and not attended to properly, start an adverse reinforcing vicious downward spiral of adrenal dysfunction. Those requiring an ever increasing dose of thyroid medication to keep fatigue away may end up becoming dependent not only on the heavy dose of strong thyroid medication, but have to suffer the side-effect symptoms of toxic thyroid (such as heart palpitation) as medication dosage is being increased. They feel "wired and tired" as mentioned earlier, with constant fatigue, unable to fall asleep and feeling anxious throughout the day. Internally, their adrenals continue to weaken as the stimulatory properties of thyroid medication are negated by the continued overwhelming rejection of the adrenal glands, resulting in a body that continues to be down-regulated to conserve energy. This is the worse of both worlds and it happens too frequently and often goes unnoticed. Clinicians and patients alike are baffled by what appears to be clinical contradictions - improving laboratory TSH levels (as a result of increased medications) or high TSH levels that refuse to come down, rising need of thyroid medication to maintain energy and worsening symptoms of adrenal fatigue with continued low basal body temperature, metabolic imbalances, weight gain and increased sluggishness.
For detailed discussion, read article called "Ovarian Adrenal Thyroid Axis Imbalance" at DrLam.com
thank you to both of you really appreciate your replies. I am supplementing with 3,000 mg of vitamin c, 200mg of selenium, Gluthianone and magnesium to support my Adrenals so can't understand it?
Often, cortisol is what is needed to rest the adrenals. Other supplements can stimulate but that is not what is needed for tired adrenals. I think you may need a prescription to receive hydrocortisone. I've read it doesn't take long to save adrenal function but some people are on it for months. I'm not to sure in this area.
Dizziness can be a symptom of low iron, do you know your serum ferritin level?
No I don't know that I will see if I can get that checked. I do also have mild Gilbert Syndrome which means the liver doesn't detox as well, so wondered if it could be that? It is so tricky having to be your own doctor as GP wont help as I am on NDT so you feel unable to talk to them about as they will just say come off NDT.
I don't think you are over medicated. Your FT4 is likely to be lower because you are taking T3 as I understand it and your FT3 reading is slightly under halfway up the scale. So I think the dizzyness could well be low iron or ever low blood pressure.
Have you had your B12 tested? Low B12 can cause terrible dizzyness but it's something doctors never, ever think about!
I agree your FT3 is too low for someone on NDT which means that you are still hypo, which in itself can cause dizzyness. And it can also cause low stomach acid, which will mean low vit B12.
I would suggest an increase in dose and a B12 blood test. 
As others have suggested I think you should get your ferritin and B12 tested as low levels of, especially, B12 can cause neurological problems, ie dizziness and a feeling of being spaced out, which often gets worse when under stress. Doctors aren't generally aware that ferritin needs to be around 70-90 and B12 at the top of the range or even higher. If your levels of these are good then you should get a saliva test for cortisol, DHEA etc.
At this stage I wouldn't increase your dose of NDT because if your adrenals need support adding NDT will put them under more pressure.
My experience is that if the adrenals are in a bit of trouble nothing works particularly well other than physiologic doses of the adrenal hormones. Possibly though you could try some adrenals glandulars.
I have looked at Dr Lam's site and he offers very in depth advice, but what he misses, in my view, is that increasing numbers of people in our society are experiencing adrenal insufficiency and if this is the case then any amount of supplements won't actually solve the problem.
I would suggest that you try removing gluten from your diet for a while at least, not because it is the fad at the moment, but because it can affect absorption of nutrients and low thyroid reduces stomach acids thus affecting availabilty of nutrients. Also make sure that you are getting sufficient protein, as this feeds the adrenals. Our diet is so dependant on wheat based products that it is very common for people not to eat enough protein and far too much gluten containing products, ie cereal for breakfast or toast, a sandwich for lunch and pasta or pizza for supper - lots of wheat based stuff and little good protein. Also make sure you are getting good quality fats too as these help the nervous system, olive oil, coconut oil, butter.
Good luck with it all, there is light at the end of the tunnel. Unfortunately it isn't held by NHS GPs unless you are extremely fortunate.
Finola
Thank you all for your support and advice, I really appreciate it! I am avoiding gluten, have a good diet with plenty of protein and have tried so many things and am so choked as I was feeling great now I am dizzy and spaced out and feel I am going mad. Just don't know what to do as GP would suggest I come off NDT completely and would say this is the cause and put me onto Levo again, which I don't want to do. My only hope is find an Endo who understands NDT, T4 and T3 in the Dorset area.
Many thanks.
Just had another look at your blood results and there is no harm in increasing your dose and watching the signs and symptoms and see how you feel. Getting the ferritin, and B12, and any other minerals they could measure for you, would be really helpful.
Finola
Bear,
Sorry to be a downer on things for you but the real problem here is that it is unlikely that you will find an endo who knows very much about NDT, importance of mineral levels and how the endocrine system really works. I hope you do though because it will make it easier for you and a lot cheaper.
I have been through a 10 year odyssey to find answers for my own ill health and then my sons issues and had to resort to self medicating in the main. Luckily by the time it became clear my sons had endocrine issues too I had enough knowledge that I was able to take them to the people who know how to treat hormone problems effectively and fully.
Glad your diet is already good. Don't underestimate the value to your overall health of good ferritin, B12, magnesium and D3 levels amongst others. I did underestimate the effect that low iron and B12 would have and so did my GP and I suffered needlessly for several years. I was (wrongly) diagnosed with motor-neurone due to neurological issues caused by low B12. Apparently many elderly people who are diagnosed with dementia actually have very low B12 and if it is corrected their symptoms of dementia disappear.
You will be able to sort out the dizziness and spacy feelings, so take some comfort from that.
I would suggest that you don't mention the dizziness to your GP just ask for the iron etc to be tested so that you have a clear picture.
The Pernicious Anaemia Society think that the normal range for B12 is far too low and that the top end of it should be as high as 2000. Their view is that very many people are actually borderline anaemic but it is not being recognised by the medical profession.
Sorry for rambling on.
Best wishes
Finola
Dear Finola,
Thank you so much for taking time out of your bank holiday to help me. I will get my B12 and Iron tested if I can by my GP. You are not rambling on I have found your posts very helpful especially as I am feeling so awful at the moment and could easily burst into tears right now as I am just so fed up with dealing with this.
Bear,
It's tough alright. There's no harm in having a bit of a cry - it will release a bit of tension and afterwards you'll (hopefully) feel a bit better. What you are going through is horrible and very lonely because other people can't see how you feel.
My husband dealt with my problems by laughing at me - and it helped actually because in my mind it was terrible that I couldn't walk steadily because of dizzyness but him making a joke of me needing to hold onto things made me laugh and that releived some tension too.
I found it really helped me when I was real with myself about how horrible the whole thing was - pretending that everything is ok is really tiring. So feel sorry for yourself, have a cry and tomorrow get on the phone to the GP.
Finola xx
Finola, have your other blogs talked about this problem?
I cannot help very much but maybe if you reduce by 1/4 tablet it might help. Your blood tests look fine but if the reduction (after about 2 weeks) doesn't make any difference go up again by 1/2 tablet.
I too am on NDT and dizziness for me can be a symptom of too much or not enough thyroid hormones. Based in your results though I think it is more likely that you need an increase rather than a decrease. However it would be useful to know how long before your blood test did you take any NDT?
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