Taking T3 - can't sleep

I've been taking 5mcg of T3 (Liothyronine) with 75mcg of Levo since Tuesday morning but I couldn't sleep last night. I took my second dose of 5mcg today but I'm dreading what might happen tonight.

Yesterday I also felt so sleepy and almost faint about 5pm but I couldn't sleep for hours later that night. I was also boiling hot despite using a fan. What do I do?

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  • What were your bloods like before adding t3 and was your levo reduced? In other words, were you so close to the top of the range that a little bit of t3 could put you over the top? 5mcg is such a tiny dose, it's hard for me to imagine it being a factor unless you were already close to being overmedicated. It is equivalent to an additional 15-25mcg levo.

    What are your pulse, temp and gut like?

  • Pulse was in the 70s this morning so higher than usual. I've been bloated as it is for the last few days so no change there. Temperature was 36.7c in the morning for the last few days anyway. This morning it was 36.6c.

    My T3 and T4 levels are lowish anyway.

  • So as others have said, maybe it's just that there is something in the t3 that doesn't suit, or maybe you're coming down w a bug. I think Clutter's suggestion that you stop it for now and try again later is a good one.

  • Did you start with just 1 dose of 5mcg daily to start with, as suggested by both Clutter and myself? If so, it's a bit early to increase after just one day, it was suggested you wait a couple of weeks.

    And are they 20mcg or 25mcg tablets?

  • Serendipitious,

    You shouldn't have increased to 2 x 5mcg if you don't feel well on 5mcg. If you can't sleep tonight I would stop taking T3 for a couple of weeks and then try 5mcg again. If it happens again you might want to try another make of T3 in case the filler ingredients in your current brand are upsetting you.

  • Clutter I'm on Thybon Henning. I thought this was the least likely brand to cause any side effects as it doesn't contain Lactose? I tried 5mcg yesterday and then another this morning. Could it be the brand or is the dose too low?

  • Serendipitious,

    If dose was too low you would have had the symptoms before taking T3. Could be the brand, or could be T3 doesn't suit. 2 doses really isn't enough to tell. It's possible you have a bug and it's nothing to do with T3 which is why I suggest you stop taking T3 and try again in a couple of weeks.

  • Serendipitious,

    I think I misread your question and today is your 2nd dose of 5mcg. T3 should be completely out of your system 2-3 days after last dose so don't take any more and hopefully sleep will be restored in a couple of days.

  • Ah, I read it the same as you Clutter . Now you've said that, it does seem that Serendipitious has taken just 1 x 5mcg dose on Tuesday morning and 1x 5mcg this morning.

    Sorry Serendipitous, I misread it too. I'd do as Clutter suggests as it seems that one might not suit you for some reason.

  • Sorry if my post was confusing. Yes I took 5mcg of Thybon Henning on Tuesday and another this morning. I'm out at the moment but my T3 levels are in older posts and they are low.

    Has the medication not suited me? Could it be the brand? Is the dose too low? I thought a low dose to start with was recommended.

  • Yes, a low dose is recommended to start, and build up gradually.

    Have you checked the ingredients, is there anything you are sensitive to that might be in it?

    Did you take the T3 close to any other meds or supplements that it might have reacted with?

    I don't think any of us can tell you why it happened, just work through possibilities.

    You could leave it off for a couple of days and try again. Or you could try a different brand. It's all trial and error.

    However, if you go back to my first reply to your thread about your thyroid urine test healthunlocked.com/thyroidu... then you will see that from your blood test FT4 : FT3 Ratio was 4.0 and I said good conversion takes place at 4 or less, so your conversion is reasonable. Also, regarding the urine test I said there is very little T4 and virtually no T3 getting into your cells.

    "At this point, my opinion is that I don't see any need to add T3 as your conversion is reasonable. What I do see, from both your blood and urine tests, is that an increase in Levo is needed - your blood test most definitely shows this and if your private London Professor endo knows his stuff he should know that a treated hypo patient generally needs TSH around 1 or below or wherever it's needed for FT4 and FT3 to be in the upper part of their respective reference ranges. A tiny bit of T3 might be useful but a higher dose of Levo means that more will be converted anyway."

    You have a lot going on -

    High cortisol/low DHEA - what's happening about this?

    Hashimoto's - did you start supplementing with selenium?

    Your Ferritin was 19 - how much did it rise after the iron infusion and what is the level now?

    What are the results of the other vitamin and mineral tests - Vit D, B12, Folate?

    Vitamins and minerals need to be optimal for thyroid hormone to work properly. Adrenals need addressing, as does the Hashi's.

  • Right I've managed to crawl home.

    SeasideSusie I'm having trouble translating the leaflet as it is in German so I'm not sure if there's anything I'm sensitive to.

    I took T3 at 8am with 75mcg of Levo. I ate about 90 minutes later and took some Zinc and Selenium with my breakfast.

    About the High Cortisol/Low DHEA, I thought it was best to address thyroid medication first. I've recently started Ashwaganda in the last few days. I take Relora to help me sleep with dinner. I'm not sure what else to do at this point. Professor C suggested DHEA but I'm not too sure about taking it. Should I take some other adaptogens?

    I'm taking 200mcg of Selenium each day for almost a month now.

    Ferritin is now 150ug/L measured in January. I had an iron infusion in November that raised it from 19.

    January 2017 (75mcg Levo)

    Serum Folate 23mcg (3.1 - 19)

    Serum B12 2000 ng/l (187 - 883)

    Vitamin D 68nmol/L (51 - 75)

    Serum TSH 2.86 mlu/L (0.34 - 5.6)

    Serum Free T4 11.70 pmol/L (7.5 - 21.1)

    I hope that's everything. I'm very tired right now so I might have missed something.

    Are you saying I don't need T3 and I should just increase Levo to 100mcg? Dr P said I needed either T3 or NDT and Professor C wrote a prescription for 10mcg of T3.

    I was on 100mcg of Levo back in March 2016 for the last 3 years. A blood test showed the following:

    March 2016 (100mcg)

    TSH 0.05 (0.34 - 5.6)

    Free T4 14.8 (7.5 - 21.1)

    So even on 100mcg my Free T4 wasn't much higher but TSH was close to 0.

    I didn't feel fantastic back then but I've felt awful since being on 75mcg. I've also gained 6kgs! I don't know why my GP reduced my dose. I honestly don't know what to do now.

  • Serendipitious I honestly think you've got too much going on as far as doctors/practioners involved. You did say in a previous post about it might be a case of too many cooks. I think you need to decide who you want to trust with your health and stick to it.

    As far as I am aware, Dr P advocates addressing adrenals first then thyroid. I'm afraid I'm not qualified to say what you should be taking regarding your adrenals. Do you have Dr P's book "Your Thyroid and How to Keep It Healthy"? If not I highly recommend it, it's an easy enough read and he explains about the adrenal/thyroid connection.

    From your current results above, it's clear that your TSH is far too high and FT4 is far too low. You probably know from other posts that the aim of a treated hypo patient (when on Levo) is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges if that is where you feel well. You are a long way from that, and you don't feel well. Added into the mix is your Hashimoto's which, as you know, symptoms will fluctuate as and when antibodies attack.

    Plus, without an FT3 it's not possible to say, from those results, whether you need T3 because we can't see how you're currently converting.

    So those results do show you need more thyroid hormone and if they were mine I would be increasing Levo at this stage and after 6-8 weeks getting a new test which includes FT3, it's an absolute must if you are considering adding T3.

    But you could also try NDT, which Dr P has suggested.

    You say "I've also gained 6kgs! I don't know why my GP reduced my dose." Did you ask? With those results, and the fact that you feel so unwell, you need to ask questions when a dose reduction is mentioned, challenge your GP to tell you why he wants to reduce the dose, come back with reasons not to.

    Does your doctor know you are consulting with Dr P and the other doctor?

    You probably also know that thyroid meds should be taken on an empty stomach, one hour before or two hours after food, so you may not be leaving it long enough after breakfast to take your meds.

    From a very quick look at some of your other posts, you are also talking about sex hormones, plus you have a personal trainer and seem to do a lot of hard exercise which might not be a good idea whilst your thyroid appears to be in such a mess.

    Ferritin level should now be maintained, either by a maintenance dose of an iron supplement or by eating liver once a week. Don't allow it to drop back so low that you need another infusion, constant yo-yoing of the level won't be doing you any good. You've got it up to a good level now, keep it there.

    Folate and B12 are fine. If you're supplementing B12 you might want to lower the dose a bit, at that level you are peeing out any excess and that's money down the pan.

    Vit D needs to get up to the recommended level of 100-150nmol/L. If you're not supplementing then I'd suggest 5000iu D3 daily for 6-8 weeks, then reduce to 5000iu alternate days. Retest in the Spring. And don't forget that D3 has important co-factors so K2-MK7 and magnesium are required when supplementing with Vit D.

  • One possible cause of excessive sleepiness after adding T3 could be related to cortisol levels.

    You need adequate cortisol to be able to tolerate T3. If your cortisol levels are low then you might struggle.

    Also, if your levels of cortisol are too high, this can cause sleepiness or even hyper symptoms.

    It would probably be a good idea to look into the website and facebook page of Paul Robinson. I think he might have a private Facebook group too, but I'm not sure about that. I don't use Facebook.

    recoveringwitht3.com/

    en-gb.facebook.com/recoveri...

    Paul Robinson really concentrates on using T3 when adrenal function is low. It might be worth investigating.

  • humanbean my cortisol is slightly higher than expected.

    See here: healthunlocked.com/thyroidu...

    Do you still think Paul Robinson's advice would be suitable for me?

  • No I don't think so. Paul Robinson's protocol is only for people with low cortisol. :(

  • SeasideSusie

    I have got Dr P's book and I have read the Adrenals chapter (I'll reread it) but I need to finish reading the rest of the book. I have a FT3 result from November 2016 which was done at the Professor's clinic at 6pm. I had taken Levo at 8am that morning. It shows that Free T3 is low:

    November 2016 (75mcg)

    TSH 1.75 mU/L (0.27 - 4.2)

    Free T4 17.4 pmol/L (12 - 22)

    Free T3 2.7 (L) pmol/L (3.1 - 6.8)

    Isn't this enough to justify the use of T3? The Professor also said in January 2017 that I should take Selenium 200mcg for 6 weeks and then re-test TSH, Free T4, Free T3 and DHEAS. At the same time he also wrote a prescription for Liothyronine. A bit confusing too. I know I have too much going on but right now I'm trying to follow what the Professor says.

    Might be a stupid question but doesn't the Urine Thyroid Profile show a Free T3 result? It's also on the low side. I know its Urine T3 but isn't that the same thing?

    If my Free T4 didn't go much above 14 and TSH was 0.05 on 100mcg of Levo, is it still safe to raise Levo to 100mcg again? Or does it mean Levo should be raised even further but then I might end up with a negative TSH! Now that I think about it at the time the GP was saying that I could alternate between 75mcg and 100mcg but then she changed her mind to just 75mcg. I wonder if that would help?

    I always take Levo at least one hour before food. Can you please tell me what is the earliest time to take any vitamins/supplements? If I'm taking them with breakfast is that too early?

    I'm trying to keep my iron elevated with tablets here and there at lunch but they do make me too warm or constipate me sometimes.

    I was supplementing B12 and Folic Acid but clearly it was too much so I have now stopped.

    I'm taking 3000iu of Vitamin D3 each day with lunch. However, your range looks higher than mine. Am I not close to the upper end of my range?

  • Serendipitious As far as Vit D is concerned, HumanBean posted this a few months ago

    From Blue Horizon testing :

    <25 nmol/L : Severe Vitamin D deficiency

    25 – 75 nmol/L : Borderline ranging to insufficiency

    75 – 200 nmol/L : Optimally replete

    >250 nmol/L : Possible toxicity, if sustained

    From NHS testing :

    Less than 15 nmol/L : Deficiency

    15 – 50 nmol/L : Insufficiency (consider supplementation)

    50 – 140 nmol/L : Adequate

    So your level at 68 doesn't reach Blue Horizon's replete range but is in the "borderline to insufficient" range, but is in the NHS "adequate" range. However, according to the Vit D Council, the recommended range is 100-150nmol/L. You would be better aiming for the recommended range.

    You will need to recheck your B12 and folate at some point, it's best to maintain the optimal level rather than plummet and have to build up again.

    As you probably know, optimal nutrient levels are needed for thyroid hormone to work properly.

    Many iron supplements cause constipation. Solgar Gentle Iron is supposed to be non-constipating. The easiest way is to eat liver.

    Continue taking your Levo at least one hour before food (sorry, I misread that part of your post earlier), keep iron away from thyroid meds by four hours. Zinc and selenium are minerals and it's normally advised to take minerals in the evening, you could take them with your evening meal. B vitamins should be taken no later than lunchtime as they can be stimulating. I don't know what else you take.

    The urine thyroid test is measuring how much thyroid hormone is reaching the cells throughout the 24 hour period and can't be compared with the blood test which doesn't show what's getting to the cells, only what's in that little bit of blood at the time it's taken. Your urine test shows, as explained in the thread about it, that only a small amount of T4 is getting to the cells and not much T3 is getting to the cells either, but they are balanced (albeit at the low end of the range) so some conversion is taking place. Did you show that test to either Dr P (who I believe recommends the test) or your London professor?

    When taking thyroid replacement hormone - thyroxine - it means that the pituitary gland recognises that thyroxine is being provided so it doesn't signal the thyroid to produce any; therefore Thyroid Stimulating Hormone (TSH) isn't needed so isn't produced, so when taking thyroid meds TSH will go low, even under range, but this isn't important, it's the levels of FT4 and, most importantly because it's the active hormone, FT3 that are important.

    As far as your November results are concerned, we discounted these in an earlier thread because your blood was drawn at 6pm. We focused on your October results which were as follows (copied and pasted with my comments)

    "October 2016 (75mcg)

    Total Thyroxine (T4) 144 nmol/L (58-161) - A decent amount of T4 is showing in your blood.

    TSH 2.01 mIU/L (0.40-4.00) - Too low for a treated hypo patient

    Free Thyroxine (FT4) 17.0 pmol/L (11.5-22.7) - 49% through range (upper third is usually best)

    Free T3 (FT3) 4.2 pmol/L (2.8-6.5) - 38% through range (upper quarter is usually best)

    FT4 : FT3 Ratio 4.0 (2.0-4.5) - Good conversion takes place at 4 or less, so your conversion is reasonable

    ...........

    At this point, my opinion is that I don't see any need to add T3 as your conversion is reasonable. What I do see, from both your blood and urine tests, is that an increase in Levo is needed - your blood test most definitely shows this and if your private London Professor endo knows his stuff he should know that a treated hypo patient generally needs TSH around 1 or below or wherever it's needed for FT4 and FT3 to be in the upper part of their respective reference ranges. A tiny bit of T3 might be useful but a higher dose of Levo means that more will be converted anyway."

    What you really need is a new thyroid test with TSH, FT4 and FT3 all done and take it from there.

  • SeasideSusie I'm sorry if my posts are frustrating but I do appreciate the help.

    I'll try and keep it short, so until recently I didn't know that T4 should not be taken less than 24 hours away when taking a blood test? When I did the October 2016 test I'd taken my Levo an hour or two before the test. Do you think it invalidates the result? The only test that was done in this correct way was in January 2017 but that doesn't include Free T3.

    I've shown the Urine thyroid test to Dr P. I'll carry on taking D3 and ensure I take vitamins/minerals away from Levo/T3.

    I'm going to definitely get TSH, Free T4, Free T3 done again as even Professor C wants to see this before I do anything else. Do you think it's worth doing Reverse T3?

  • Serendipitious As your levo was taken just an hour or two before the October test, they're not giving a true picture. It would be best to get a new test under all the right circumstances:

    I imagine you'll do a private test as your GP probably can't get FT3 done.

    1) Do blood draw early in the morning, no later than 9am

    2) Fast overnight, you can have water

    3) Leave off Levo for 24 hours and if taking T3 leave that off for 12 hours

    4) Take thyroid meds after the blood draw

    What did Dr P say about your urine test?

    I personally wouldn't bother with reverse T3 test. Indicators for rT3 are high (usually over range) FT4 and usually low FT3 because the T4 is making rT3 rather than free T3. On your January results your FT4 isn't high enough to suspect rT3 (in my opinion).

  • SeasideSusie I spoke to my GP and the phlebotomist about getting Professor C's recommended blood tests done at the surgery. He wants TSH, Free T4, Free T3 and DHEAS done 6 weeks after taking 200mcg of Selenium/day. The phlebotomist has booked me in for later this month to have all these tests except DHEAS as she couldn't see that in her system. Whether they can actually do Free T3 is another thing. If not I'll have it done myself. I'm not sure if taking Selenium for 6 weeks is really going to bump up Free T3 or Free T4. Maybe I should just do the test now myself instead of waiting another couple of weeks.

    Now last night I managed to make up the lack of sleep I suffered from the night before and I ended up waking up at 7am so I thought I'll try the Levo/T3 again. However, as soon as I took it I felt an incredible urge to go to sleep. I slept for another 2 hours and forced myself to wake up because if I sleep too late in the morning I have trouble getting to sleep in the evening as a general rule. I now feel incredible drowsy and sleepy. Maybe I will stop taking it and try later as Clutter suggested. I found a post by humanbean from a few years ago and I wonder if it has any relevance to me: healthunlocked.com/thyroidu...

    Will the T3 effect completely leave my body in a few days?

    I can't recall what Dr P said exactly about the Urine Thyroid Profile but he kept saying that I am under medicated and I need to take either NDT or T3. I don't think he likes Levo very much.

  • Serendipitious That's a really interesting thread you found! It just goes to show how we're all different and react to the different meds and ways to take them. There are some members who take their T3 at night. I wouldn't mind trying that but I'm an evening snacker so there's no way I'll have finished snacking two to three hours before bedtime. Maybe I need to practise self discipline so that I can try it.

    I don't know whether taking selenium and retesting after 6 weeks is going to show anything. I can't see that selenium will bump up FT4, what selenium supposedly does is aid conversion of T4 to T3, so maybe there would be an improvement in FT3, and it apparently helps reduce antibodies.

    An NHS lab is more likely to not test T3 than test it, they only seem to do it when there's something drastically wrong with TSH/FT4. Despite what the doctor requests, it's usually the lab who decides if it's done.

    If you're going to do FT3 testing yourself, you really need FT4 and FT3 done from the same blood draw, not a separate one done at a different time/different day. Whatever you do, if you've changed your dose of meds then make sure you leave it 6 weeks before testing.

    I've only ever done saliva adrenal tests so can't comment on a blood DHEA test.

    T3 has a short half life, unlike levo, so it will be cleared after a few days.

    I got the impression that Dr P isn't a fan of Levo. When I saw him, many years ago, it was NDT, NDT plus T3, and T3 only that was tried, Levo never came into the picture.

  • I think my strange sleep and fatigue pattern on T3 shows that perhaps my cortisol levels aren't right. Dr P said they aren't too bad but clearly something isn't right if I can't sleep at night or I'm too hot to sleep or I want to doze off during the day whilst on T3.

    I need to address this along with running the correct thyroid tests to ascertain the exact status of Free T3 along with Free T4 and TSH. I've heard that stressed adrenals can also raise TSH.

    It's possible that I'm not tolerating T3 due to a cortisol issue. I probably need to try some adaptogens.

    This is proving to be a never ending and mysterious problem!

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