Seriously hyper peaks but labs show hypo. Please advise on bloods/meds and or symptoms thank you.

[helbell]

Hi,

getting in a bit of a pickle with my meds V symptoms. On NDT trying to maintain 3/4 - 1 grain a day (48.75 - 65 mg) Nature Throid.

Even on half a grain when the dose peaks my metabolism is off the scale: sweating, jitters, energy plus weakness, sharp awareness, loose frequent motions. Then it calms down for the rest of the day. I tried yesterday's dose before bed and slept very well only for it to peak at mid morning again when I was active. I have missed odd days medication because I feel so hyper and wait till it all floods out of my system...or that's how it feels. Heart feels great, ironically, as it always plays up when I am actually feeling hypo. I have to sit out the rushes for about three-quarters of an hour as I'm racing so much I feel swimmy aggravating my existing balance and vertigo issues.

My lab test in early April showed reasonable TSH but low serum thyroid hormones and I was struggling then with swings between hyper and hypo - but more hypo than now. The first set of results below was from latest blood draw on the 19th (quick turnaround) In relation to the second set taken in April, it shows high TSH, slight raise in ft4 and slight drop in ft3 (which I guess corresponds with t3 in NDT) and ferritin the best it has been throughout.

B12 very high as supplementing with 5 mcg sublingual.

On the following results, my last thyroid hormone dose was 36 hours before blood draw:

July 19th

CRP 1.60 <5.0 mg/L

Ferritin 88.0 20 - 150 ug/L

TSH H 4.52 (0.27 - 4.20 IU/L

T4 Total 74.1 (64.5 - 142.0 nmol/L

Free T4 12.05 (12 - 22 pmol/L

Free T3 4.63 (3.1 - 6.8 pmol/L

Anti-Thyroidperoxidase abs H 175.4 <34 kIU/L

Anti-Thyroglobulin Abs H 168.7 <115 kU/L

Vitamin B12 H >1476

Serum Folate 23.12 10.4 - 42.4 nmol/L

>>>>>>>>>>>>>>>>>previous - April 4 (same ranges as above)<<<<<<<<<<<<<<<

TSH 0.99 (0.27 - 4.20 IU/L

T4 Total 77.1 (64.5 - 142.0 nmol/L

FT4 Low 10.34 (12 - 22 pmol/L

FT3 4.68 (3.1 - 6.8 pmol/L

Anti-Thyroidperoxidase abs 224.5 <34 kIU/L

Anti-Thyroglobulin Abs 295.4 <115 kU/L

Vit D 121 nmoI/L

B12 1077

Folate 28.44

Am I over reacting to the T3 and should I try T4 only - straight swap and start at what dose (damn it!..recently stocked up)?

Or...try minuscule frequent doses of t3 only, or break down NDT dose?

I am amazed at lab results feeling convinced they would come back over-replaced but clearly sliding down.

I see they have missed out my vit D but looks OK on previous test. Would be grateful any advice. Lost the plot temporarily....again x

[humanbean]

Since you have results which suggest you need more NDT not less but you can't tolerate more, the other obvious thing to think about is your cortisol levels and adrenal function.

Sadly it isn't possible to guess whether you have low or high cortisol based just on symptoms, you would need to do a spit test. Have you ever done one?

[helbell in reply to humanbean]

No...but I will. Thank you

[helbell in reply to humanbean]

I am also hypoglycemic which, I think, fits in with cortisol issues, too.

[greygoose]

I think you left too long between the last dose and the test, which is making your T3 look artificially low. It is recommended to leave just two hours. But l agree with HB about the cortisol.

[helbell in reply to greygoose]

OK, thanks. So maybe my symptoms could be truer than I thought.

[greygoose in reply to helbell]

Well, I'm not sure it would make that much difference, not the difference between hypo and hyper. But you do have Hashi's, so it's quite possible to have hypo and hyper symptoms at the same time.

[helbell in reply to greygoose]

Makes sense. Thanks again. Just about to order adrenal stress test. And reading about how hypoglycemia is v common in adrenal fatigue.

[humanbean in reply to helbell]

I assume you know where to get info on ordering, but just in case :

thyroiduk.org.uk/tuk/testin...

[helbell in reply to humanbean]

Thank you. I couldn't find the page. Right now I have crashed post a rush of hyper s symptoms. Resting now and will be ringing doc for urgent app next week. I will probably have to take Levo so they will support me through we work up. I went on ndt through the side by briefly being under a private endo who liaised with my surgery. I stopped seeing him as the only difference in treatment is that he would work with patients on ndt. My surgery was good enough to continue t3 testing only. I need more help than that now, I think. Thanks again.