Help With Insomnia When Increasing Levo Please?

[Huddy1234]

Hello all,

I've posted quite a few times recently - in a nutshell, everytime I try to increase my Levo (25 mcg) by the tiniest amount it gives me insomnia - go off to sleep OK but, without fail, I wake and lay there for eternity till I eventually get back to sleep

My Endo has prescribed beta blockers to take alongside but my blood pressure is already on the low side and I know these affect it even more.

He has also suggested taking my tablet last thing at night instead of first thing in the morning as my conversion maybe slow?? Has anyone had the same problem and tried this?

Any suggestions/advice/help would be really appreciated as my biggest symptom of this under active thyroid is fatigue/tiredness so obviously the insomnia is defeating the object!

Thank you x

[humanbean]

I've just had a very quick look at some of your earlier posts. I gather that you have been on 25mcg Levo for several years, with just the occasional attempt to raise dose to 50mcg.

One problem with having low thyroid hormone levels is that the body attempts to substitute for the missing thyroid hormones by creating more cortisol and adrenaline.

In people who are treated for hypothyroidism promptly and their dose increased as necessary to get rid of symptoms, raise Free T4 and Free T3 to a healthy level, and lower TSH to below 1, the cortisol and adrenaline will (probably) go back down to healthy levels without any fuss.

But from reading posts on this forum it seems that the longer someone is left under-treated or untreated for hypothyroidism the more likely it is that the cortisol and adrenaline will get stuck at the high level. When this happens people start to feel as if they are very over-treated with Levo even though their thyroid function test results are still hypothyroid.

GPs rarely think about testing cortisol levels under any circumstances. And the test available to them in the UK (9am serum cortisol) is only really helpful for people with Addison's Disease or Cushing's Disease. The people who have neither of those but who have non-optimal levels of cortisol are of no interest to doctors generally.

(There is no test I'm aware of that can measure adrenaline - and if cortisol levels are improved then adrenaline usually reduces by itself.)

People on this forum who test their own cortisol will usually do a four-part saliva test (there is no benefit in testing more than four times), which should also include DHEA.

The best test I know of that includes all these is this one :

regeneruslabs.com/shop/prod...

For info on private testing generally :

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

Note that lots of companies do saliva testing for cortisol - but few of them include DHEA as well.

If you were to do saliva testing and it suggests that you do actually have Addison's or Cushing's (both of which are fairly rare) then the test results can be used as ammunition to persuade your GP to get official testing done - starting with the 9am serum cortisol. Someone on the forum did this quite recently, and they were eventually diagnosed with Addison's, which requires life-long treatment.

On the assumption that you just have non-optimal cortisol levels rather than anything more sinister then there are ways and means of improving the results with over-the-counter supplements of various kinds.

If you do a saliva cortisol test post the results on the forum in a new post and ask for feedback.

[humanbean in reply to humanbean]

I should have mentioned that non-optimal cortisol will often cause insomnia, whether it is too high or too low.

Also, have you looked into whether or not you suffer from nutrient deficiencies e.g. vitamin D, iron, ferritin, vitamin B12 and folate? If you can optimise these then your cortisol level may improve.

[Huddy1234 in reply to humanbean]

Hi Humanbean,

Many thanks for your reply - I had blood tests carried out in September this year and the result was 327 nmol/L......My specialist didn't seem concerned with that result so assume it was OK.

Also had nutrients you mentioned tested and all were in range.

[humanbean in reply to Huddy1234]

Have you posted the results of your nutrients? With the reference ranges? Just being in range is not informative. There is a big difference in how someone would feel with, for example, a ferritin level of 15 with a range of 13 - 150, and a ferritin level of 140 with a range of 13 - 150. And for most of us the optimal level is around mid-range or a little bit over. So the result and the range both matter - a lot!

[SlowDragon Administrator in reply to Huddy1234]

Also had nutrients you mentioned tested and all were in range.

Exactly what were the results

Within range is not the same as optimal

B12 and folate results

Obviously ferritin is far too low….

My Endo has prescribed beta blockers to take alongside

What’s the beta blocker….is it propranolol?

Have you had thyroid antibodies tested for autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease diagnosed either by high TPO or high TG antibodies

Or by ultrasound scan of thyroid if both antibodies are negative

Have you had coeliac blood test done

If not request it before trialing strictly gluten free diet

[samaja]

Hi Huddy

I think you would find Paul Robinson's latest book "Thyroid Patient's Manual" informative on the subject of cortisol and insomnia and also why taking levo in the evening is actually more in sync with our natural circadian rhythms and preferable to taking it in the morning.

I have not been able to go above 25 mcg Levo either and my sleeping patters are quite erratic - sometimes it is definitely cortisol but other issues can be the cause as well e.g. hypothalamus or pituitary dysfunction (influencing adrenals), other hormones and infections. It's a full time job discovering what is currently affecting the system most! I wish you luck in finding your root cause.

[Huddy1234 in reply to samaja]

Hi Samaja,

I am so sorry for the late reply - i did not get a notification for your message.

Do you take your levo at night then?

Can I ask why you also can not tolerate higher than 25 mcg please?

Look forward to hearing back and I will research the book you mentioned too, thank you.