My father gets a rapid heartbeat at night for years now. His pulse gradually increases starting around 7pm each night, from a good resting rate of ~65 bpm up to 90-120bpm around 2am, even when he is just lying in bed. He can't sleep, and if he does, he huffs & puffs so his breathing can keep up with his heartrate.
He has secondary adrenal insufficiency and hypothyroidism due to a pituitary tumour years ago. He takes 25mg Slow Release Hydrocortisone before bed, and 100mg T4 (Levo) with 35mcg Slow Release T3 in the morning.
He's 72, eats well and maintains a good weight and fitness level. He's tried Cal / Mag, vitamin D & B supplements, and eating protein before bed. He doesn't drink coffee. His ferritin, RBC, WBC, iron and vitamin results are in range. His doctor tested his heart, no issues. His pulse is normal during the day.
His latest thyroid test results are all in range: Free T3=340 (230-420), Free T4=1.2 (.82-1.77) and Reverse T3=19 so FT3/RT3= 18 (>20) which is low. In the past his results were always low; he's mostly been hypothyroid, so yay for the test results but he's miserable because he can't sleep.
My latest theory is that the T3 he's taking at 7am is suppressing his conversion of T4 (the Levo) to T3 later in the evening? So when he has no T3 at 2am and his metabolism drops, his adrenals release adrenaline to compensate and he gets an increased heart rate to keep everything moving like it should. That explains why the heartbeat only happens at night (vs. hyperthyroid all the time), and I've read that T3 suppresses conversion.
If that sounds possible, would splitting the SR T3 dose into twice daily help, or would that further suppress the T4 to T3 conversion, so he needs to also raise his T3 and lower his T4?
Or should he move to NDT instead of the Levo/ SR T3 combo help? Does the T3 in NDT have a suppressive action like SR T3?
What about Dr. Lowe's theory that people should take 1 big dose of T3 (regular release, not slow) once a day - how does that last over the 24 hours with such a short half-life?
Does his low FT3 / RT3 point to an increase in T3 or a decrease in T4?
Sigh, finding the right thyroid balance is tricky! Thanks for your thoughts.
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Thanks for the thought, but he was taking the cortisol in the morning like the other meds and still had the same fast heartbeat overnight problem. He switched to taking the cortisol before bed 2 months ago to make sure that low cortisol overnight wasn't the problem. Nope, not it.
I have t a clue but I take NDT and take it all at once though I have read someone wondering if my brand was slow release as, like me, they take it all at once will no ill effects. I've also read that when regularly taking a form of T3 then there is always 3 days stored so that may account for it but never seen anything that states that rather than suggests that. Have you tried cutting the T3 back a little?
Hi SilverFox, thanks for the reply. He's tried cutting back the T3 but that results in fatigue and all his thyroid test results drop out of range low. So it seems like he needs more thyroid to feel better, and the results support that. The trouble is that he can't sleep when he's taking more appropriate doses, so he actually ends up feeling badly on higher doses too!
Thanks Joesmum. That does seem like the obvious easy thing to try next. Good to hear it helped you. Are you also on Slow Release T3, or the regular stuff?
Is it usual to take the hydrocortisone at night? Just interested. I wonder if that’s causing the racing heart as it hits his system?
But I would definitely try splitting the T3 dose to see if that helps calm the adrenals down because I agree with you...I suspect he’s getting an adrenaline surge to compensate for lack of T3 at night?
No, definitely not usual to take the HC at night, but we thought that low HC might be causing the pounding heartbeat. So he moved it from 7am to 11pm, just to see if it helped. Nope, no help.
Yes, I agree, I think it's adrenaline due to low T3, so I'll recommend that he split his T3 dose and take some before bed. He's on SR T3, but this problem was around when he was just on Levo too, no separate T3 dose.
Paul Robinson's book on T3 might be useful to you. Think it's called Recovering with T3. And there's a second book by him as I remember which I think was about adrenals and T3
"My latest theory is that the T3 he's taking at 7am is suppressing his conversion of T4 (the Levo) to T3 later in the evening?" A persistant exogenous over-supply of both T4 and T3 can cause a reprioritisation of T4 to T3 conversion, to RT3 (as can non-thyroidal ilness of course) ; but doesn't seem to be happening in your father's case as he doesn't have elevated levels of either RT3, or FT3/4. However, I've never read that routinely taking a daily dose of T3 temporarily suppresses T4 to T3 conversion, in the cyclic way you suggest. On the other hand, slow release Liothyronine does seem to cause its own problems, and for instance, it is expressly advised against in terms of Paul Robinson's T3 protocol.
"how does that last with such a shorter half life" - you are maybe confusing half-life with the effects of the drug. Yes, T3 has a shorter half life than Levothyroxine ie the time it takes for the level of ingested drug to be reduced by half, but a drug's effects persist beyond the time it takes to do that, and in any case a drug takes c5 half life periods to be gone completely from the system. A 2016 study found that "A single dose of liothyronine has both short term and longer term effects. There is clearly a different lag time between the serum concentrations of triiodothyronine and its effects on the heart and pituitary respectively. The increase in serum triiodothyronine concentration occurred with hours and was then followed by an increase in heart rate. The increased heart rate was transient and was followed by a reduction in thyroid stimulating hormone concentration. The suppression of thyroid stimulating hormone was delayed, but was more sustained. Thus, sustained thyroid stimulating hormone reduction beyond 24 hours was achieved by a single dose of liothyronine that produced only brief increases in serum triiodothyronine levels and transient increases in heart rate."
"Does his low Ft3/RT3 ratio point to an increase in T3 or decrease in T4" - neither, for that reason. However, irrespective of his RT3, he may benefit from an increase in meds. Ingesting T3 it's to be expected that FT4 drops lower in range, and for some, very low. Whether this is okay, when FT3 is optimal, depends on the individual. Your father's FT4 is just below midway in range and this may be too low for him. His FT3 is relatively better, as a percentage of the range, but again, may be too low for him to feel well and be symptom-free. So there's scope for increasing either/both but again, it's an individual thing, which to try first. If it were me, I'd also consider swapping from slow release T3.
Thank you MaisieGray. That's some interesting information you shared, good stuff. Yes, you're right, i was thinking just of the T3 in the blood in the first ~4 hours. So in the hours after that, T3 has its effect on the rest of the body, got it. Do you have a link or search terms for that 2016 study? Sounds like the suppression comes after 24 hours? Hmm.
I've definitely read that low TSH slows that conversion, but also a few places that T3 can negatively impact that conversion also. Either way, my dad has low TSH all the time because of his pituitary was damaged; that's why he's on the thyroid meds. He must be able to convert T4 to T3 anyway (at least somewhat) because he was on Levo (T4 only) for awhile (not very successfully though).
Anyway, he was hyperthyroid earlier this year, from increasing his meds too much at once, and from his description, it sounded like a different feeling from the fast heartbeat at night. He said he felt enervated and twitchy all the time. So that's why I was thinking he's getting an adrenaline rush at 2am, from a lack of T3, but it's just a theory...
Do you have some links that explain the concerns with Slow Release T3? I will check Paul Robinson's site too. People talk about dosing multiple times a day to spread the impact of T3 and it seems like "slow release" would help with that. My dad is not great at remembering to take pills multiple times a day, so that's how we ended up with the SR. Plus two doctors recommended it for sustained action of cortisol, T3.
I was thinking he could try increasing his T3 dose or splitting it up into two doses in AM and PM to see if that helps...
Yes low TSH can negatively impact T4-T3 conversion; I can't though, dig up a memory of reading that routine daily exogenous T3 at the correct dose, has the same effect. Hopefully someone can definitively prove or disprove it, to clarify one way or another.
Re. SR T3, Paul Robinson wrote this:
"General use of T3
If only a tiny amount of extra T3 is required, then some people can do well with slow-release T3, and others do better with standard T3, i.e. it would be a matter of trying the slow-release T3 and seeing how it worked.
For those people who need much more added T3 (with or without any T4 meds), there are two goals:
a) to avoid causing hyperthyroidism in any of the different tissues of the body due to too much T3
and
b) to use enough T3 to overcome the cellular issues which have caused the problems in the first place.
To achieve these two goals different amounts of T3 will be needed at different times of the day. Most people using standard T3 need different sized divided doses to provide only as much T3 at any given time as is required. With slow-release T3 it can be difficult to provide enough T3 without either having too much or too little. It is difficult for most people to find a slow-release dosage that achieves these goals so that they remain euthyroid at most times with no evidence of hyperthyroidism.
For the thyroid patient who simply wants to add a small amount of T3 to a mostly T4 based regime, slow-release T3 may work well.
T3 for CT3M Use
For the circadian T3 method (CT3M) there is no question that standard T3 swallowed in one go is the only sensible way to implement it. CT3M needs the entire circadian T3 dose to be absorbed in one go and as quickly as possible. We want the entire T3 dose to reach the pituitary gland as fast as possible, and we want to be able to titrate the dose size and timing and control cortisol levels with as much sensitivity as possible. Slow-release T3 would provide none of this. The CT3M requires standard T3."
Thanks Maisie. I will try to find the reference to T3 suppressing. I stumbled across it somewhere, twice, but it's not commonly mentioned, I agree.
On the Paul Robinson approach - do you know why one big dose of regular release T3 would be different from one dose of SR T3 in the morning? I mean, if my dad's seeing some kind of suppression of T3 at 2am with SR T3, wouldn't that also happen with regular T3, even if it's a larger dose? Regular T3 has a shorter half-life I'd guess that the adrenaline rush would just come on a little earlier?
I'm open to trying it, just trying to understand it.
My dad's doctor really likes SR T3 (She's part of Holtorf Medical, Dr. Kent Holtorf's T3 for CFS/ME treatment philosophy).
Also, my dad had this problem before he started SR T3, when he was just on Levo.
Sorry to jump in on this but an email arrived notifying me that you, thecat68, posed a question and for the life of my I cannot find it on this page.
Someone somewhere (oh, I wish I could find it in one of the threads) offered that an endocrinologist started her on tiny doses of LT4 and thereby acclimated her to a regular dose over time. She had been unable to tolerate LT4 otherwise.
I have just returned from the gym, where I had 50 minutes of vigorous exercise, including 25 minutes climbing 47 flights of stairs. I feel great.
For the past 10 days I've been taking 6 mcg of LT4 at night.
After a time at 15 mcg that showed TSH 7.15 (0.4 - 4.5), FT3 2.8 (2.3-4.2), I fiddled with doses between 20 and 25 mcg. When I tried taking the LT3 at night, I could barely drag myself around the house the next day.
I've settled on 22.5 mcg LT3 in the morning when I wake up. I let it dissolve in my mouth and avoid swallowing for a good five minutes.
It's magical.
And everyone is different.
Which explains why so many physicians avoid taking on thyroid patients, but brush it aside with "it's all in your head." Technically speaking, they're close: it's in the neck.
By the way, my endocrinologist asked me to have the blood drawn between six and eight hours after taking the LT3. I showed up at the lab 7.75 hours after dosing. I told him I've cut up some 25 mcg tablets of levothyroxine and am waiting to hear if he's familiar with the idea of titrating it up slowly, so as to sneak up on the conversion issue.
Yes, sorry, I did but then saw that you had already answered that question (how much you were taking of each hormone) in an earlier post so I deleted it.
Sorry, I'm confused... you said you're taking 6mcg T4 at night, but then in another post you said "Pursuing the premise that nighttime dosing optimises T3 levels in the morning turned out to be a very punishing dead end for me."...
Are you taking it both in the morning and at night? That might explain both statements
And it's working well for you, 22.5 in AM and 6mcg before bed?
Sorry for the extensive delay but I was conducting the T4 experiment for my endocrinologist. I tried taking 6 mcg (1/4 of a 25 mcg) at night for 11 days. I felt like rubbish by day 11. Then, just to be certain it was the levothyroxine, I took 1/2 of a 25 mcg tablet for a further nine days. I might have done just as well hitting myself in the skull with a club each day.
I have found that taking a small bit of T3 at night does seem to help with sleep. After fiddling with taking the T3 in three evenly-spaced doses across the day, I've confirmed taking the whole lot at dawn is the most effective for me. I might not sleep well but I can function through the day.
The brain injury makes me think in circles and write things out of order. Sorry.
Just to let you know that in my experience my t3 dose in the morning definitely down regulates my t4 conversion and I used to wake up very hypo until I started taking a small amount of t3 before bed to keep my free t3 in range overnight. You’re right it’s all a tricky balance-I can only take a tiny amount of t3 at night or it is too stimulating to get restful sleep but also without it I don’t feel rested and my test results bared that out with under range free t3 first thing in the morning.
Thanks Goodlife1! Good to know that worked for you because I'm thinking that's the next thing to try. Are you taking the Slow Release T3 or the regular stuff?
Standard t3 by Mercury Pharma. My research on slow release t3 is that it isn’t particularly very prolonged release as the technology isn’t there yet, so that would bare your theory out even more, that the t3 has maxed out earlier in the day and then the peripheral t4 to t3 conversion is reduced overnight too.
There's an interesting article in the Journal of Clinical Endocrinology and Metabolism about a study done to attempt to find a more physiologic replacement for thyroid hormone.
The study was performed in South Sheffield, and employed 33 healthy subjects, men and women, with a mean age of 22.8 years (oldest subject was 56.5 years).
One chart, in particular, stands out, in that it that shows the circadian rhythm of T3 production alongside TSH and T4: academic.oup.com/view-large...
The study was conducted in a hospital and blood draws were every 20 minutes. It was noted that some individuals had a fairly flat sinus wave for their diurnal rhythm, while others had very pronounced delta between the peak and the nadir. (Figure 2 in the full article at: academic.oup.com/jcem/artic...
I've had loads of tests of everything under the sun, owing to a brain injury on top of having been undiagnosed hypothyroid for ten years or more, and finally began being treated with LT4 and LT3 in many combinations and schedules over the past year.
I have always been a night owl, not a morning person, and my heart rate and body temperature rise in the evening. Always. If I have felt crappy all day long, being either overmedicated or undermedicated with thyroid hormone, I can be assured of feeling perky by 7 pm and ready to conquer the world by midnight. The other side of this is getting really low by noon and nodding off around 5 pm, whether my plasma hormone levels are optimal or not.
This study suggests to me that there are further, deeper layers of rhythmicity of deiodinase action at the peripheral level that have yet to be studied. As this cannot be measured in humans at this point, it leaves us poking around in the dark trying to minimize discomfort.
Wow, that study is a great find, thank you RockyPath! That's interesting. My dad is similar, he feels tired during the day and ready to lift weights by 2am. His pituitary was damaged by the tumour that grew, that's why he's on thyroid meds and cortisol. I've read about how the hypothalamus and pituitary control our body's clock... so maybe that's part of it too.
Can I ask if you've found a medication combination that works for you?
Levothyroxine is tolerated by my body only briefly (10 days) before the rT3 overwhelms me. I may speak to my endocrinologist about prescribing some 25 mcg tablets so I can cut them up into 5 mcg pieces -- I'm grateful to have found advice about acclimating ever so S L O W L Y to LT4.
Right now what works can only be judged by what offers the least amount of ill effects, and so far that is less liothyronine, rather than more -- 5 - 15 mcg per day. I'm not sure I can tell a distinct difference at this range of doses. Perhaps my body likes the erratic approach. I have taken larger doses, once a day, at a consistent level for an extended period of time and the lab results have always been safely within appropriate ranges, with the exception of the SHBG, for which I have no baseline, but which is always high.
My brain injury comes with attention deficit, extreme distractibility, and difficulty remembering mundane details from one hour to the next. I try to take notes on signs and symptoms, and I succeed for a while. But so far, I've only excelled in the department of collecting interesting research articles and keeping a close record of what I take, how much, and how often.
It seems as though I did better on 10 or 12.5 mcg of LT3 once a day, but my wife died on New Years Eve and the months leading up to this event, as well as the months since then, have been a bit more unstable than usual. I now lack adult supervision in the home, and I have a propensity for experimenting with thyroid hormones the way a small, pyromaniacal child plays with matches. But I'm still here, so no harm, no foul. I had blood samples drawn on Friday morning, after ten days on 5 mcg three times a day (8 hours apart). I was feeling overmedicated, but this nuance only came through REALLY overmedicating myself and paying attention to all the ill effects, and then looking for them with much more care and focus, at the much lower doses.
If I were your father, all other bodily functions assumed to be receiving appropriately timed and dosed treatment, I'd tone down the liothyronine significantly and see how that goes. The nice thing about LT3 is that you can stop completely and see how things feel for a day or two. In my state, two days off T3 is perfectly uneventful.
Stopping completely was how I concluded I was simply taking too much in the quest for an upper quartile FT3 rating. Every body is different and plasma testing tells next to nothing about how the cells are using T3. Research has proven that most conversion of T4 to T3 occurs through two different deiodination processes at the tissue level, throughout the body. I've read Werner & Ingbar's The Thyroid: A Fundamental and Clinical Text, 10th edition. It's a general textbook for an endocrinologist, so it doesn't go much into medical management, but does explain hormone synthesis, conversion, and the cellular processes that use T3.
I haven't tried for the 11th edition to see what's been updated, or for a different medical text (suggestions would be appreciated). So far, I haven't found anything suggesting that anyone really understands the details of how exogenous T3 is utilized by the cells. And therein lies our problem of trying to feel decent when the thyroid has been so battered by the immune system and by the soup of chemicals and hormones now ubiquitous in our environment, food, and water supplies, that it stops working as it should, throws up its tiny butterfly hands, and sits down in protest.
Thanks for sharing RockyPath. I hear you on the struggle to figure it out. My dad would laugh at what you wrote, I like the "pyromaniacal child" line especially. He is similar, except that he quickly gets bored with keeping track of the details.
He did try lowering his T3 once before, but it left him really fatigued, the pounding heartbeat got a bit better then came back, and some key test results (cholesterol, inflammation markers) went higher, and his thyroid results all went even lower out of range. Sigh.
I think I will suggest he try splitting the dose across the day for starters, as a quick and easy thing to try.
I hope you find a good combination that works for you. And I'm sorry to read about your wife; that sounds tough.
Pursuing the premise that nighttime dosing optimises T3 levels in the morning turned out to be a very punishing dead end for me.
I pop the whole collection of tablets, adding up to 22.5 mcg, in my mouth when I awaken and let them dissolve. The pharmacist said I could take it sublingually, and that seems to work quite well. I go to the gym and climb stairs for 30 minutes afterward.
Clearly the bit that the pharmaceutical company writes about how long it takes for the effects of the hormone to be realized is based on an average from tests that were performed on beings who are metabolically different from me. Perhaps they were testing on snails or mice during this phase.
So you pop the pills sublingually when you wake up, then head out to work out and what happens - no energy? It takes much longer for the T3 to hit your system? I wasn't sure I quite understood.... but sorry it didn't work for you, that's too bad! Maybe you need some food too before working out?
Anyway, hope you are feeling better. There is also the school of thought to take T3 before bed. That apparently works for some folks well, better than in the morning. Apparently the circadian rhythm for T3 peaks at 3:30am (TSH around 2am), then cortisol at 8am.
No, no, the magical part is I pop the pill in my mouth when I get up, head out to the gym, and I have loads of energy. I got home this morning after an hour and cleaned house for an hour.
When I took it in the evening, I was incapacitated the next day.
From your second link: "We have now demonstrated that FT3 levels peak approximately 90 min after TSH levels at around 0404 h and remain above the median level from 2200–1000 h."
Is it my imagination, or does that academic paper suggest that we should be taking T3 at about 9pm (assuming it peaks in your system after 6-8 hours) to try to get as close as possible to a normal rhythym?
Good question morebeans! Just FYI, I have also read elsewhere that TSH peaks at 2am, T3 at 4am and cortisol at 8am (with variations for individuals and of course these are ranges). Some people write how they do very well taking their T3 at night; others say it revs them up too much to sleep.
Ah ha! You are the thyroid patient I was hoping to find on here! I also have Delayed Sleep Phase Disorder, and my body follows the same pattern as yours. I have been wondering since I started really learning about thyroid treatment how that affects medication.
I am self-medicating with 30 mcg T3/75 T4 (my prescribed dose is 20mcg T3/75 T4 daily) and feel human for the first time in decades. But...now I can't sleep. I don't mind that much yet, as I have slept a LOT for the last 20 years, but ultimately, we need sleep, so I will have to figure it out. I am going to read all your posts to see what is working for you!
I'm so sorry your father is going through some tough times . I'm sure It's very reassuring for your father to have a caring child as yourself .
Very low TSH can inhibit T4 to T3 conversions . Would you have your fathers latest FT3 FT4 TSH values ? The lab values may have some of the answers of your fathers breathing discomfort . High levels of T4 can put some into hyper position making it hard to add T3 to already hyper situation . Splitting the T3 into small doses several times a day can benefit your father too . Mean time I would suggest that your father supplement if his not already on with magnesium fish oil . It helps calm palpitations . For adrenal support vitamin "C" , B-Complex , B-5 , Celtic Sea Salt for adrenals/Electrolytes . Low level Iron can cause palpitations as well .
Wishing your father fast resolutions and wellness .
Thanks for your kind reply and concern. I did actually include his latest thyroid results in my original post, take a look about half way down. He's in range (finally!) for FT3, FT4 and Reverse T3. We don't pay any attention to his TSH because of his pituitary tumour, it doesn't really work.
I think splitting the T3 dose is a good idea, thanks!
You've received lots of good information above. Three other things to consider...
Has your Dad been checking his blood pressure? You can buy an inexpensive blood pressure wrist cuff on amazon. He should check his pressure throughout the evening and also when he wakes at 2am with a pounding heart. He needs to write his numbers down to track them. I sometimes get a pounding heart late at night (for the past 7 years, I have on T3 only due to having Adrenal Insufficiency - I also take hydrocortisone (not extended release) 4x a day to match a normal adrenal pattern).I get a rapid heart rate late at night, or early morning, once in a while. When my heart rate is high (mine has gone up to 150!), my blood pressure is also low, when your pressure is low, your heart has to work much harder to pump your blood! Taking 1 teaspoon of Celtic Sea Salt in water (I have to split it into two glasses to dilute it, but it does taste good then) will raise my blood pressure enough to let my heart calm down to a more normal rate. It can take about an hour to work. If your Dad's blood pressure is low (which is very common with Adrenal Insufficiency), he might just need some regular sea salt in water before bed. Having the readings from the cuff is very important though.
Also, taking 25mg of extended release hydrocortisone, sounds like a very bad idea to me. The adrenal glands need hydrocortisone every 4 hours (4 doses a day) starting from when you wake up in the morning. The last dose at night should be the smallest. You are trying to match a functional healthy adrenal pattern. Taking an extended release form gives you absolutely no control of how much is being absorbed, and at what times.
Another thing that can raise my heart rate late at night (or early am), is what I had for dinner and/or a late night snack, and what time I ate it at. I have found that every time I have a carby meal after 7pm I have a much faster heart rate for hours after eating. As our bodies digest our food, our heart rate goes up to aid with the digestion. Different foods can have different effects.
I have asked my dad about his BP when the heartbeat is happening and he says its normal for him. I will double-check though and ask him to take it before it happens and after as well to confirm. It does seem like BP must be doing something different to prompt the crazy fast heartbeat. His went up to 120, but wow 150, yikes!
I believe he's tried the salty water fix before, but I will double-check and tell him that it can take 1 hour.
We moved the HC to 11pm just to test the idea that low overnight cortisol was causing the fast heartbeat. He was taking it at 7am. I agree, it should be broken into at least two SR doses or 3-4 regular doses. He's just not great at remembering to dose at certain times during the day, and his doctor like SR.
That's a good thought about what he eats too. I'll pass that on.
I take my T3 2 x a day (First thing in the morning, and again right before bed in different dosages). It works well for me. I have to take T3 only, as I had a reverse T3 problem about 7 years ago due to adrenal insufficiency and can not take any T4 (I used to take natural dessicated thyroid) or else the problem will happen again. I love my T3!
I keep a small notepad on my kitchen counter (or in my purse if I'm out an about) and make a check mark for the times I need to take my hydrocortisone throughout the day. I have also set my phone alarm as we;; when traveling so that I don't forget. It is pretty easy to take it 4 times a day once you work out a system.
I take quite a bit more than most people do, as I seem to be very thyroid hormone resistant. I take 115mcg extended release T3 2x a day (it is prescribed by my Doctor and made by a compounding pharmacy locally), I also take an additional 75 mcg of Mexican T3 1x per day (the morning). Up two weeks ago I also used to take a very small amount of generic Armour (1 grain) split into two doses in order to get the T2, T1 and Calcitonin, but after reading about the rapid heartbeat at night (and getting it myself sometimes) and offering some suggestions for her Father above, I decided to do an experiment and stop the Armour completely. Even though it is a small amount of T4 (38mcg per grain of Armour (or NDT)) I was wondering if I can not tolerate any T4 at all? I did have a Reverse T3 problem about 7 years ago and that's when I started Hydrocortisone. It's only been about two weeks so far, but my heart rates are very consistently between 75 - 102 (the high side after walking around or doing chores) beats per minute so, so far it looks like I am going to do better without any T4 at all. That's one thing about the hypothyoird journey, it never ends! Once you have it figured out for a few years or so, I have found that I have to do a bunch more research and figure out some new things to try and adjust....
Thank you for sharing Alise! That's interesting. I hope it continues to work out well for you. My dad first had his issues start around the time when he switched from Armour (NDT) to Levo, and before he tried Slow Release T3. So maybe there's something there...
It's possible his T4 dose is too low and T3 dose too high. A simple test to try: take the 100 mcg T4 when he wakes at 2 am and see if that puts him back to sleep. If it does, he needs a higher dose of T4. It's not covering him for 24 hours; IOW, he's getting too low by 7 pm. I personally find T4 helps with my sleep and T3 interferes with it.
Hmm, that's an interesting idea. I thought that T4 has a half-life of like 8 days though, so would taking it at 2am have any immediate impact? I've read that changing T4 dose takes at least 2 weeks (6 weeks?) to be felt by a person, so I don't think it runs out at 24 hours, does it? I am open to new information
Also, I think you are right about either thyroid being either low or not lasting long enough, I just thought it would be the T3, since it's more "volatile", as in shorter half-life.
Since there's nothing to lose, I would just try taking the T4 at 2 am. You would think it's the T3 running out, but it could be the T4. They work like yin/yang. T3 is stimulating and T4 is calming to the brain. His brain needs to calm down if he's going to get any sleep, which is why I suggested trying the T4. It works for me anyway. Have you seen this article about T3 bedtime dosing? tiredthyroid.com/blog/2018/...
I have a follow-up question about your father's pituitary. I'm sorry I haven't the attention span to read through everything you've replied to everyone below. Perhaps what I'm seeking is is there. Would you associate the 2am circadian rhythm problem you described, (or the increase in magnitude of the pattern so that he's extremely "wired" at 2am), to the onset of the pituitary condition .... possibly? It probably took years for the pituitary tumor to be found. Do you think the struggles at night and lassitude during the day might have started at the same time as his pituitary started suffering interference?
I'm asking because I noticed all sorts of weird things changing after my brain was unceremoniously twisted like a sponge (an exaggeration, but it was subjected to twisting forces of a shockwave), and I tried pursuing pituitary and hypothalamus injury at the axonal level with specialists and they shrugged (the way GP and some endocrinologists do with hypothyroidism) and said either the tests indicated normalcy (just as thyroid labs say you're normal when you aren't), or in their experience, patients with brain injuries didn't have this problem.
I'm grasping for any thread of an idea to take to my next visit with the neurologist.
His pituitary tumour basically squashed his pituitary as it grew. So it blocked the release of cortisol, and that caused a few "adrenal crises" as they call them, trips to the hospital. It also got big enough to press on his optic nerve, so that there was a blind spot in the middle of his left eye. Anyway, a 104 degree fever (another adrenal crisis) and 3 days in acute care and they finally figured it out and did emergency surgery.
After surgery, he had to take cortisol daily. He resisted everything else at that point, wanting to give his organs time to recover.
I am pretty sure he didn't have the pounding heartbeat until he started on Levo, so maybe 10 years after the pituitary surgery?
Sorry, that's probably not what you wanted to hear, but hopefully helps.
indicates several reasons why symptoms of hyperthyroid associated with hypothyroid
symptoms with increased adrenal gland cortisol levels can occur. Both iron levels and cortisol levels may be affected in some people. When the body is at rest T3 levels go down and this also occurs with stress and anxiety when cortisol levels raise.
Selenium is indicated for help with the thyroid gland hormones as well as sufficient iron levels. Expect you have read this already. Have found thyrotoxicosis affects the heart rate, and gives rise to insomnia. Years later have been diagnosed with a sleep disorder
and have to take a sleeping pill or am up all night long. It goes against the grain to take them but it has helped me to get a good night sleep. I also believe in body rhythms which
can affect our reaction to light. There is research from the States where special grey or coloured lenses are used to calm people during the evening. At night light should be minimal so the brain creates melatonin in the hypothalamus. Melatonin supplements are said to be very helpful to induce sleep.
Thanks Hawii60, I will read those articles again to be sure. His RT3 and iron are within range on his test results and his FT3 is just normal, not high. I will confirm Selenium though, thanks for your thoughts. Yes, he's tried sleeping pills and melatonin and even CBD. They help sometimes, but not consistently.
Further information from thyroid unlocked uk suggests to help adrenal insufficiency high doses of vitamin C of 1000 mgs a day can help boost the immune system.
I have found the combination of 1000 grams of vitamin c dissolvable tablets orange or lemon tablets with zinc helpful. Some supplements contain selenium zinc and vitamin C such as Redoxon.
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T4 to T3 conversion
T4 to T3 conversion
T3 and it's impact on conversion of T4 to T3...
T4 to T3 conversion question
High TSH at 17.66 with extremely low T4/T3
