Hypoglycaemia with hashimotos

I have Hashimotos and currently take a combination of T4 (100mg)/T3 (10mg), my TSH is a little suppressed and my T4 is fairly close to the top of the range. I still suffer from fatigue but I can manage this a bit better since starting on T3. My big problem however is low blood sugar symptoms, these have always been a problem for me but it's now getting to an extent where it's really affecting my life. I have had my blood sugar levels measured several times over the last few years and they have always been in range. I bought myself a blood sugar meter and again my levels appear to be pretty good, they never go too high after eating and are generally about 4 (sorry can't remember units) first thing in the morning. However if I don't eat regularly I get really shaky, weak, fuzzy headed and panicky, sometimes even after I eat something I feel pretty awful for several hours, it's almost as if I left it too late. It tends to be worse in the early part of the day, usually by late afternoon I'm not too bad. Does anyone else have these symptoms? I'm a 48 yr old female btw. Would really appreciate any advice.

27 Replies

  • If blood glucose levels are ok it is sort of reactive hypoglycaemia. So even though the levels are not dropping rapidly your body reacts as it was.

    I have that too but only if I skip potatoes. So I have figured out for me this type of starch seems to be necessary. As long as I eat potatoes I do not crash bad. Resistant starch not only benefits gut bacteria, but it ties sugar and releases it very slowly.

    Maybe your adrenal glands are suffering and t3 might tax them a bit more at first as it starts different type of reactions in your body.

    Do you eat well ? Balanced meals? It might be certain food triggering it for you. I would keep a food diary and see if there is a pattern. I would also support adrenal glands.

  • Hi Justina, thank you for your response. The article is very interesting, I just wish more doctors took that approach. I do eat a very healthy diet, have just started going gluten free, cook all my meals from scratch, no ready meals, home made soup and salad at lunch time, stir fry for dinner etc. However your point about potatoes has given me "food for thought", I will monitor what I eat and see if I can find a pattern. You mentioned supplementing my adrenals, how would I do that? Can you recommend something.

    Many thanks x

  • check out drmcdougall.com/ for advice on high starch diets or Dr McDougall's videos on youtube as to why he believes this a healthier route to take.

    Calories = energy. Proteins and carbohydrates provide about 4 calories, fat provides about 9. Carbohydrates are quickly utilised by the body and account for sugar spikes. Protein is absorbed more slowly so the energy is released more evenly. Fat has the slowest absorption rate so release their higher energy levels over a much longer period. I don't know what kind of diet you adhere to but, particularly if it is low fat, you might want to take the above into consideration.

    Also, fructose in sugars and sweeteners of any description increase the release of insulin by the pancreas but cannot be processed as a food source so can lead to drops in energy that might also go some way to explaining the fatigue episodes you are experiencing.

  • raypeat.com/articles/articl...

    There is a lot of information how all hormones work together. So it could explain why hypoglycaemia appears.

  • Hoovernut,

    What is your T3 result ? This is the most important as is the active hormone and which will alleviate low thyroid hormone symptoms. A suppressed TSH is ok as long as T3 is within range.

    Hypothyroidism can encourage our cells to desensitise to glucose meaning unbalanced sugar levels in our blood. Additionally, if your blood sugar falls below normal (hypoglycaemia) through not eating enough or insulin resistance, your adrenal glands will compensate by secreting additional cortisol (telling the liver to produce more glucose.) Hence we often gets shaky if missing a meal because cortisol is a sympathetic nervous system hormone.

    Because thyroid hormones drive the metabolism, a low level can slow glucose absorption in the gut and the rate our cells uptake glucose. It can also slow the response of insulin secretion and the clearance of too much in the blood.

    You need to eat before you are hungry to avoid the long recovery period you are experiencing after a low sugar period. Eating four smaller meals all incorporating protein, low GI carb and healthy fats will encourage gentle insulin secretion and help stabilise blood glucose levels by keeping you feeling full for longer.

    Protein takes longer to digest and fats slow the absorption of carbs. I snack on smoothies mixed with pea protein and Pulsin' protein bars.I have a few in my car//bag so am never caught out. Eating gluten free will discourage elevated thyroid antibodies.

    If thyroid meds aren't working well it could be because continually elevated cortisol levels can impair the HPT axis by suppressing pituitary function so not signalling the release of enough thyroid hormone. Elevated cortisol levels can also cause gut problems leading to malabsorption of nutrients and iron and levels will eventually become deplete discouraging good thyroid function.

    Type 2 Diabetes can progress onto Type 1 and Hashimotos predisposes us to other autoimmune disease. Type 1 Diabetes is commonly seen in Hashi patients.

    I take 3g Vit C a day to support my adrenal health. Intolerances can be overcome by using a mixed ascorbic powder but you will need to build up slowly to avoid an upset tum.

  • Hi Raad, thank you for your brilliant advice. What you have said is so helpful. Your right about trying to avoid sugar dips in the first place. My T3 is also high end of normal, so think it's ok (whatever that might be!!). Is vitamin C useful for adrenals then, wasn't aware of that, will start taking some asap.


  • Vitamin C like radd said is very important.

    Magnesium for adrenal glands and to help sugar swings. I use transdermal magnesium oil to avoid tummy issues possibly caused by mag. Transdermal absorbs fast and is ready to use right away so I find it very effective.

    Some drink salt water in the morning. Tastes awful tho :D

    Avoiding any stress is good for adrenal glands. Exercising is good way to manage hypoglycaemia, doesn't have to be heavy. Any type of exercise.

    Now that I have figure out that potato works for me I can skip a meal without crashing. I don't skip a meal often, maybe once a week, but now I don't have to worry so much about it.

  • Will give it all a go. You guys on here are so lovely!! Thanks so much.

  • Hoovernut - I have recently come to the conclusion that my own long standing issue with migraine aura is made worse by a problem with low blood sugar issues and have just bought myself a meter to measure things. I too am hypothyroid (20 years) and changed to T3 only some 4 years ago, but had the migraine aura when I was T4 only. I don't get any other symptoms other than fatigue/lack of stamina - I have ME/CFS diagnosis also.

    I have managed to improve things already by making sure I eat something frequently (though have to make sure I don't overeat by doing this otherwise weight will go on!) - for me, especially eating last thing and first thing though as you don't have the migraine aura that might not be so important for you.

    Thank you for posting though - lots of useful advice here for me also! In my case I have checked my adrenals 3 times with a saliva test and they show low cortisol throughout the day, and I have herbal medicine to help with that.

  • Hi Agapanthus, funnily enough I do get migraine aura but I think they are more related to stress and not drinking enough water. I read that magnesium is given to patients with migraine aura as studies have shown many of these patients are deficient. I think it has helped me too. Thanks for all the advice.


  • I get this too, and I have started feeling a bit weird after breakfast, like my blood sugar is low but it can't be! I've been checking the last few days, and it's actually my blood pressure that drops after eating and makes me feel dizzy, tired and zoned out. But like you, it's better later in the day and doesn't happen after dinner. It's only been happening since I've taken T3, I think it is harder for your adrenals to handle. May not be the case for you at all, but something to consider if your sugar levels are normal. x

  • Really interesting mountaingoat83, strange how many of us has these symptoms. It's got to be thyroid related. So frustrating though. Thanks for the info.


  • I have had low blood sugar all my life. I eat far too many carbs to keep the symptoms at bay, if I don't I need food every 2 hours, ive tried all sorts of foods to keep blood sugars level but nothing has worked.

    Its so frustrating as I cant loose the weight I put on when I became hypothyroid.

  • Hi BeverleyB, I share your frustration, weight is a problem for me too. I'm not very over weight but would like to loose some and I just can't with this blood sugar issue. Soooo annoying.


  • hi, Hoovernut, have you have low blood sugars since you had thyroid problems? I am 62 and have had low sugars since I was a teen. I used to be quite active and could keep the weight at bay, but since being Hypothyroid I cant exercise, the 3 stone I put on seems to have stuck!

  • Hoovernut, I'm in a similar situation, get dizzy, lightheaded and nausea related to not eating or eating the wrong thing. All the advice here has been helpful. I don't eat regularly enough. I eat fairly low carb (no bread, pasta, rice, potatoes), but do eat sweet things in emergencies. Am thinking maybe I shouldn't feel so keen to go low carb and accept things like potatoes.

  • Hi Silveradvocado, I agree some great advice on this site and great people willing to share their experiences. What's apparent to me is that we are all different and what works for one person may not work for another, so it's good to get so much advice and try and see which works best for you.

  • when you don't convert well and have a high ft4, the t4 meds, will stand in your way of getting well. It is called reverse t3 dominance. When this happened to me and others, we use t3 only or natural desiccated thyroid.

  • Hi faith63, do you have any more info on this, sounds really interesting. I dont think my GP would be Happy for me to take T3 only, the practice barely tolerate me taking it at all! I don't want to rock the boat. But out of interest, how would I go about replacing the T4 with T3 only. What dose would I start with? Any ideas?

  • start wit this short and easy video..

    i started adding t3 to my 50mcgs t4 and had hyper symptoms. I just stopped all t4 and added the t3 at 6.25, going up every 3 days or so. I had to wait 6 weeks for all the t4, to leave my system, before i could get to my current dose of 37. I am still unwell because i have hashimotos. I am working on putting it into remission and getting off all thyroid meds. I am very inflamed, with lots of pain. I am missing other hormones though too.

  • Self medication is always an option if your GP refuses, which often happens. It's a lot easier then it sounds :p

  • I might have to resort to that!!

  • I have found that caffeine causes hypoglycaemic attacks with me. If I avoid caffeine I am fine.

  • Will give that a try mandyjane, have heard that before. It's decaf for now then!!

  • I have to avoid decaf drinks as they still contain caffeine I'm afraid. I now enjoy red bush and turmeric tea. Apparently organic coffee is not as bad for this and I have found the very occasional organic coffee OK but if I drink it daily I get the hypos again.

  • Ok, thanks. X

  • Yes similar

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