I am new here and would openly appreciate your insight, opinions, expertise, and knowledge. I have been hypothyroid and diagnosed with Hashimotos thyroiditis twenty years ago. Fifteen months ago I was abruptly taken off of benzodiazepines (Lorazepam 1mg once nightly) that I had been on for 10 years for sleep and I was in protracted withdrawal for months and it uncovered a lot of medical issues with my thyroid. My doctor did labs, said they were low and raised my Levothyroxine dose from 112mcg to 125mcg. Labs that he said were low:
Within 4 weeks I had went into dr. induced hyperthyroidism and had severe thigh and arm weakness, heart palpitations, insomnia, hyperactivity wired but tired, heat/cold chills intolerance, irritability, nervousness, shortness of breath, severe tremors, and emotional outbursts. Most of the same symptoms I had during benzodiazepine withdrawal. My doctor then lowered my dose from 125mcg down to 50mcg and most all symptoms disappeared. We did labs again.
Dr. said I was on the low end of normal with T4 and low on T3. He started me on 10mcg of Liothyronine T3 with absolutely no guidance on titration whatsoever. The first week I took my Levothyroxine 50mcg and Liothyronine 5mcg in the morning and felt a rush of energy and heart palpitations came back but I was sleeping better and the heat/cold intolerance was but better after a week. The second week I added a 1/2 5mcg tablet 8 hours later at 3-4pm. 4 days on this added dose and all of my hyperthyroid symptoms returned bad! So, here I am again all screwed up! I eliminated my afternoon half dose and this morning cut my morning dose in half and I am taking 1/2 5mcg tablet in am and 1/2 in afternoon to see if this helps. I was going to stay on this dose for the 4 more weeks and then I have labs again to see where I am at. I have read that T3 can trigger hyperthyroid symptoms, that it's easy to get too much, and it's better to titrate slow with small amounts. I know T3 comes out of your system quicker than T4 and thought I would feel better today but still have tremors and eye twitching like I am getting stuck hyper again. Are the symptoms I am having normal for someone starting on T3? Will they level out and go away? Should I just stay on the low dose for now? What would you do? Any help is appreciated. I am so frustrated and miserable. Thanks for taking the time to read my best seller. Ha! Ha!
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naturegirl3434
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Welcome to our forum and sorry to hear you have been treated so appallingly.
Many with mismanaged hypothyroidism have sleep and anxiety issues caused by adrenal stress hormones trying to compensate for low thyroid hormone.
Although you were feeling hypothyroid symptoms, you were not under medicated as had over-range FT4 levels. However, as your meds were clearly not working, your pituitary was pushing out TSH in an effort to raise thyroid hormone.
Your FT3 was under range and this is the hormone that will brings well-being. A fair amount of T4 should be converted to T3 but there are many factors such as low nutrients and iron that can inhibit this.
Medicating excessive Levo resulting in over-range FT4 levels can make you feel very hyper. When my GP did this to me years ago, my heart went crazy with great big sudden bangs in the middle of the night and my anxiety went through the roof.
It is good your GP has added some T3. You are aiming for a TSH of 1.0 or below and FT3 levels at least over half-way through range. When this is achieved your FT4 levels will eventually become irrelevant and many members levels drop. TSH often becomes suppressed in people medicating T3 as the pituitary now senses thyroid hormones, so reduces secretion.
Most people start T3 on 5mcg and increase slowly as it is usual for the body to only be able to tolerate small increments at a time. You are not “all screwed up”. You just need to increase T3 lower and slower. Your hyper symptoms could also be attributed to some adrenal issues as large rushes of adrenaline and cortisol may have been released in an effort to match your increased metabolism. Remember all hormones try to work together.
If I were you I would increase Levo to 100mcg as you need some thyroid hormone in you, and the T3 may take a few weeks to be tolerated enough to raise. Reduce T3 back to 5mcg until you feel a little better. This may take several weeks because of the low levels your thyroid hormones have been allowed to become, and must not be rushed.
Then increase only by 2.5mcg T3 each week as long as each increment is well tolerated, up to 20mcg T3. Before FT3 levels become optimal Levo may need to be reduced but you should test before hand to ensure levels don’t drop too early, or FT3 isn't getting too high. Splitting your daily dose into two or even three doses will be kinder to your adrenal glands by reducing the rapidity of onset and prolonging the duration of T3's action.
Some find T3 hard to introduce with low iron levels. Ask your GP to test Vit B12, folate, Vit D and ferritin and post results complete with ranges (numbers in brackets) for members to comment.
My Vit D was 26 and I have now got it up to 174 (UK measurements) by taking Dr’s Best Vit D in olive oil, Vit K Mark 7 (soy free) & magnesium glycinate. I take 20,000 Vit D, although most people take 10,000. When I dropped to 10k my level went down.
What are your thoughts about supplements such as Adrenal Stress-Combat by Synergy? It has Vitamin C, B6, Pantothenic Acid, Adrenal Polypeptide Fractions (Bovine,) Betaine, L-Tyrosine, Licorice extract, Adrenal cortex powder (bovine,) and rose hips.
I ordered some powdered magnesium to use for calming me down and muscle aches and pain. Your thoughts on this?
One last thing: When we talk about FT4 reference ranges I noticed that UK's is 10-24. In the US and for the lab I use the reference range is 0.71-1.70 (I understand this to be like 1-2.) I am having trouble understanding the FT4 reference range. Is there anyway you could explain to make it easier for me?
Thanks so much. You are extremely knowledgeable and I respect your thoughts and replies.
You need to be wary of combined supports, as much like a multi vitamin pill you might not receive enough of what you require and end up with stuff that you don’t need.
Considering Adrenal Stress-Combat, it depends what levels your cortisol is at, as the liquorice will encourage higher levels. Also, the liquorice is glycyrrhizinic acid (as opposed to deglycyrrhizinated - DGL) and must not be taken by anyone with elevated blood pressure.
It sounds as if you are having adrenaline rushes, so the adrenal cortex found in Adrenal Stress-Combat is a sensible precaution as it is only the whole gland that contains further adrenaline which may increase anxiety and that hyper feeling.
The Vit C found in Adrenal Stress-Combat is only 150mg. Adrenals love Vit C and I supplement 3000mg daily.
Additional magnesium is good.
Different labs use differing ranges and there is more than one in the UK. It doesn’t matter what the range is as long as you know what it is and consider it when analysing results.
Adrenals suffer terribly in their effort to support low thyroid hormone and keep us going. Have you had Vit B12, Vit D, folate and ferritin tested as optimal levels are imperative to achieving good thyroid hormone function and well being, with iron being paramount.
It would have been more sensible to give you T3 with a slightly reduced dose of levo as it was your T3 that was low, while your T4 was too high. Then he panicked and reduced your dose far too much so your T3 fell through the floor. I think you need NDTor T4+T3. At least he seems to have done the right thing now. Hyper and hypo symptoms are very similar - low T3 causes palpitations and you won't feel right unless your vitamins and iron are also optimal. T3 seems to make deficiencies more obvious. Eye tics and tremors sound more like low B12 and/or magnesium, or possibly low cortisol. You've had low T3 so long it will take your body a while to get used to being normal.
Can't really give any advice as I took to T3 like a duck to water, but I stuck on one dose of 6.25mcg for a month before increasing
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