My dad is 72 years old and struggling with secondary adrenal insufficiency and hypothyroidism. About 25 years ago, he had a pituitary tumour and came out of hospital with only a partially functioning pituitary. He's taken coritsol ever since, and added Levothyroxine (T4) a few years later, and then also testosterone.
Being on T4 only (Levo) left him extremely fatigued and his thyroid tests all came back low out of range. So his endo added Slow Release T3. First he had to increase his daily cortisol from 15mg to 25mg to support the extra thyroid meds, and then the T3 helped.
His highest T3 dose was 50mcg around 4 years ago, and it made his blood tests look good, including his cholesterol. He felt better too! He lowered his T3 dose after that though, because he was getting this fast pounding heartbeat at 2am (pulse of 110 bpm) that would last for a couple of hours. We thought he must be hyperthyroid on too much T3.
Now he takes 27.5 mcg Slow Release T3 (made at a compounding pharmacy) and 75mcg Levo along with his daily Sustained Release 25mg cortisol each morning. He only doses once a day due to the slow / sustained release compounding. (His cortisol saliva test from 2 years ago still shows some activity around 2am too, so maybe it's still making some cortisol?)
Here's the problem though: he's hypothyroid again, according to his blood test results for the last 2 years: low T3, low T4, very high cholesterol, signs of kidney disease, etc. He has the symptoms again too: very tired, depressed, easily stressed and I think he has some brain fog.
He needs to increase his thyroid doses. His endo gave him scripts to add 25mcg to the T4 (from 75 to 100) and 7.5 to the T3 (27.5 to 35), but about 10-14 days in, he got hyperthyroid: high pulse and bursting with "heebee jeebees" and a twitchy crazy energy. His temperature was finally up a little to 98.4 (usually 96.9) but he felt awful!
After a rough month, he's now back to his original doses and he needs to try some kind of increase again.
What is the best way to increase his thyroid dose - T4 or T3? how much of each? how long before the next increase?
Any idea what causes the high pulse and pounding heartbeat? I think that's also still going on.
Other possibly unrelated things going on:
- He has a very hard time going to sleep each night and getting enough sleep.
- When he works out (weight training), it takes him 2-3 days to recover.
- He gets really bad headaches that last a few days, mostly when something stressful is about to happen or just happened.
- he has a hard time sleeping before 2am.
Thanks in advance for your help!