Thyroid UK
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Phosphatidylserine - going hyper? - urgentish

Hello hope everyone is ready for Christmas!

I have a quick question - I have been doing OK on 125ug T4 for the last year or so, but have been trying PS to reduce cortisol (over 6 weeks ramping from 100mg to 300mg x2 per day) and started to have anxiety symptoms occasionally so stopped two weeks ago, not quite felt right since, but the last few days I have had quite unsettling symptoms (tight chest, shortness of breath, palpitations) in the mornings and gone off sick from work and it usually subsides by the afternoon, hot flushes 4-7pm.

Went to see the walk in GP today as mine is useless and he could only take my pulse and blood pressure and say I'm fine, go to A&E if it happens again, which is what I am worried about tomorrow. I think it is that I'm going hyper due to lowered cortisol and increased T4->T3 conversion as I also feel quite hot and have had a few hyper symptoms before when titrating my original dose, I tend to stick at the top of the range to stop getting too tired in the evenings (last test from October was TSH 0.1, FT4 21.24, FT3 5.0)

So the question is, what is the quickest and safest way to reduce my T4 pool and not feel too bad. Should I skip a dose tomorrow before going down to 100ug or just go down to 100ug and wait a few days? I'm planning in staying on 100ug for a few weeks until my next blood test to see where I am.

Any help this evening would be appreciated!

I can feel some palps now so going to take some magnesium...

9 Replies

Hi Fuzb,

Caution - I am not an expert on this - but here is my pennyworth!

Is it possible you have lowered your cortisol too much so you are now deficient? As per this post that could produce the symptoms you describe -not actually hyper,rather hypo but easily mistaken as a lot of them can be common to both. You said T4 pooling, yet this suggests it is actually T3 pooling rather than being taken up by receptors, hence reducing your cellular T3 level and making you more hypo. So if you were to reduce your T4 dose it would just make your symptoms worse- and probably add in more besides! Where did you come across your theory of lowered cortisol causing extra conversion?

Also - did you have cortisol tests done before starting the supplements and what did they show? Would it maybe be worth repeating them now as a proper diagnostic measure?

To me your flushes sound like a possible Hashis attack - that is the first sign I recognise as such in my case. What are you doing to try to counter that? Gluten-free, selenium etc?

I hope you get on top of this and feel better soon.


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Where did you come across your theory of lowered cortisol causing extra conversion?

High cortisol reduces output of TSH. Lowered TSH reduces T4 to T3 conversion. So lowering high cortisol will improve output of TSH which then improves T4 to T3 conversion.

See this post from another forum :

See point 5.

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Ok, but in someone who is on T4 only, then surely the feedback loop would then reduce the Tsh because there is enough T3 in the system and hence no over-medication symptoms would result? Or have I maybe got this totally wrong lol?!!



Sorry, my brain has gone into a spin with that question.


In a healthy person who didn't need Levo the amount of T4 produced is adjusted by the TSH minute by minute and hour by hour.

If this healthy person was stressed for some reason, then cortisol would increase, TSH would reduce, T4 production would reduce as a result of the lowered TSH, and so would T4 to T3 conversion.

When the stressful period ended, cortisol production would reduce, TSH would rise, T4 production would rise in response to the increased TSH, T4 to T3 conversion would rise, and equilibrium is restored.


In a person who takes Levo the amount of T4 available is fixed by the dose. So the sequence of events has to be slightly different.

If the person taking Levo became stressed and cortisol rose, then their TSH would reduce, their T4 dose stays fixed, and T4 to T3 conversion is reduced by the lowered TSH. Presumably Reverse T3 production would increase to get rid of the excess T4, making the person feel more hypo, and their lowered T3 might make them feel more hypo as well. But the problem is that being more hypo makes people create more cortisol. So the feedback loop goes haywire.

If this person's stress levels then reduced, what happens? At the end of the stress their reverse T3 is slightly higher than the healthy person's and so their cortisol level may stay a little bit higher than it should do. Their TSH won't return to what it previously was because of the extra cortisol. Nothing returns to normal because the feedback loop is always hampered by that fixed T4 dose.

Any feedback loop is going to screw up if one of the factors that affects it is fixed, when it should be variable.

I am not going to make any guesses about what happens if the cortisol is reduced by force (i.e. with supplements like PS and Holy Basil). There would be too many ifs, buts and maybes! But one thing I can say is that it wouldn't match what happens in a healthy person.


I'm framing that! Best explanation and theory of fixed dose and hormonal variables I have seen do far. And another good reason why doctors should understand that achieving within range from replacement does not equate with 'normal'.

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Like startagaingirl I wonder if you knew for certain that your cortisol was high.

And assuming you did, have you overdone it and got low cortisol now?

Assuming you haven't overdone it then you may need to reduce your dose of thyroid meds, or increase them, depending on your circumstances. (I know that deserves a prize as woolly statement of the year, sorry, but read on...)

I have high cortisol and I take T3 only. I found that I couldn't take a high enough dose of T3 to eliminate hypo symptoms because my heart would speed up a lot and I got palpitations and arrhythmia.

In recent months I have been taking Holy Basil. Since doing so I have been able to increase my dose of T3 twice (only by quarter of a pill each time), without getting any obvious over-dose symptoms. And I'm feeling less hypo.

If you were living with hypo symptoms on your Levo dose because you couldn't raise it any higher because of the kind of problems I had then you may want to raise your dose.

However if you didn't feel hypo on your current dose before taking the PS then you may need to reduce your dose.


Hello, thank you for the replies - miraculously I managed to sleep in a bit this morning.

I decided to skip my T4 today and so far I don't feel as bad as yesterday but still have a bit of a tight chest, slight difficulty breathing and bit of headache but heart is feeling OK no palps this morning. The Magnesium kicked in after 30 mins last night.

Will start on 100ug tomorrow, I did trial 100ug earlier in the year for a few weeks but got too tired, no other symptoms, I have occasionally gone up to 137.5 for a week or two as well without any issue. Last time I tried 150 I got all sorts of heart issues for a few days so not going back there. My under tongue temp was 36.20 this morning which is about normal.

I had an Genova Saliva cortisol test in August and the 8am was 58 (should be under 32) midday was 9.9 right at the top, afternoon and evening were low, 2.8 and 0.81 (DHEA 2.0 and 0.4, just in range) - I did a previous test in 2015 where you didn't have to freeze the samples and that was flat line, so I guess that wasn't as good. Dr Kharrazian's book is very good I have a copy and skimmed through it cover to cover although I'm not so good at remembering it, a very useful reference. #13 relates, I did have an rT3 test last year and it was very low (0.3 I think).

In the notes from the Functional Nutritionalist I saw it said; "Previous individuals have noticed that drops in inflammation have resulted in increased sensitivity to thyroid medication. This can result in the signs of hyperthyroidism (eg. palpitations, anxiety, insomnia). If you notice this, you should speak to your doctor about reducing your dosage"

I suppose it isn't conversion but sensitivity, but I can't find much information on the effects of PS on cortisol especially longer term as I have stopped since 11/12 so would have thought any immediate effects had worn off but if it has reduced the feedback loop down I guess that might be a good thing as long as it wasn't too far.

I have been on no Gluten/Sugar/Milk/Alcohol since the beginning of November (with the odd few days off) while taking PS and had the odd issue with anxiety in slightly stressful situations like travelling on the tube, but thought it is was down to gas.

The only other thing I did in the last week that was different was to take Turmeric with coconut milk for 4 days (stopped when I had first symptoms). I read that that can cause palpitations as well. This seems to have helped my guts though as gas is much reduced, did SIBO and parasite/gut microbe population samples last weekend so will see.

I take 200ug Selenium a day (meant to help with antibodies - last test in Oct was TPO 106 TG 187, but I changed brand of Selenium since last time. They were down to 86 and 68 in May changed back now so will see on next test).

I can feel some palps starting while writing this - might have to head over to A&E and see if they can do some blood tests today.

This thing is really spoiling my Christmas :(


Hi Fuzb,

Again I am not an expert and please @humanbean correct me if I am off, but I suspect what you actually have is borderline adrenal fatigue with your cortisol about to deplete rather than a pure high cortisol issue. This would then facilitate a dose increase of levo. That would explain why you have had trouble when trying to increase dose of levo previously. Your body has been trying to compensate for your hypothyroidism and need to be supported and balanced rather than suppressed by PS. So what has happened recently is that you now have less cortisol available to compensate for under-medication and hence your hypo symptoms are getting worse. You may have a temporary relief with reduced levo but that is all it will be. I am not an expert on supporting adrenals or how you recover from the suppression being caused by PS, but I suspect you have the resources and capability to figure that for yourself.

In another slant - how are all your other nutrients? If they are less than optimal then you won't be able to use the levo efficiently and that in itself could be adding to some of your problems.

Good luck


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Thanks for the info, there is certainly some compensation going on I'm feeling less tight in the chest today so think the dose reduction is starting to kick in. I went to A&E yesterday and they did a 10 lead ECG, BP, etc. and said all was fine and to push through Christmas and see my GP. I had to ask them to take bloods to get my thyroid results, but they didn't phone back last night. (they had to take two lots as they lost the first ones!)

Once settled I'll ask for another cortisol test to see where I am and I have a Thyroid plus 10 on my desk from their 20% off sale the other week that I'll do in about 3 weeks once this dose has stabilised.

As for other nutrients - my last Vit D was 106, Total B12 390 which are both optimal - I'm taking stress B complex (all the B's and C) and magnesium before bed on and off (I found it can speed things up shall we say after a few weeks use!) Also on Betaine HCL 2x650 with protein meals to help absorption of amino acids and methylation - this really helps with brain fog.

My ferritin is still high at 570, that's what this guy is trying to target reducing the cortisol and inflammation hopefully. He has also done a methylation profile from my 23andme DNA results and suggested Methyl folate because of various mutated genes - once I'm stable that is probably the next thing to fix.

Thanks all again - it is so comforting to have a community to talk to that has an understanding of what is going on more than most doctors!


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