Too much mental concentration

[Rosebud1955]

Hi All,

Can mental exhaustion deplete thyroid hormone? My levels are not as high as I would like them to be, although my Endo thinks they’re perfect. I suffer from daily headaches, skin awfully dry, daily weight although I’m eating as healthy as I can, avoiding sugars etc. I take 100T4 & 7.5 Cytomel at 0600hours.

Today I pushed myself To complete my income tax. A couple hours after completion, I started having headaches and head pressure, then nosebleed, and my blood pressure was high. Could I have overexerted my brain with this suboptimal thyroid levels? I’m concerned and is wondering if I should increase my dose. These are my latest results. (February 2020)

Folate : 27.5. (>8.7). Ferritin: 132. (5-272). B12 : 1436. (138-652 ) supplementing. TSH: 0.02 ( 0.32-4.0). FT4 : 12 (9-19) FT3 : 4.3 (2.6-5.8) vit. D 161. (75-250).

Does low thyroid function causes hypertension? I would appreciate some input as I’m at my wits end with this disease. I can’t seem to make any strides, very frustrated.

Thank you all, hope everyone is staying safe and doing well.

[Lalatoot]

The brain and gut are the biggest users of thyroid hormones. And yes lack of thyroid hormones can cause what you describe.

[SlowDragon Administrator]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Ft4 is only 30% through range

Ft3 53% through range

chorobytarczycy.eu/kalkulator

Helpful calculator for working out percentage through range

[Rosebud1955 in reply to SlowDragon]

Thanks! Yes, I follow the guidelines when doing bloods. (24hrs, 8-12hrs). In this case, I did 24hrs & 8hrs, fasting.

[greygoose]

I don't know about concentration 'depleting' your T3. T3 doesn't actually get used up, as some people think, but you do need to have good levels to support any sort of activity. Could very well be that your FT3 isn't high enough for you.

Being hypo certainly can cause hypertension, though - although you might have a job convincing your doctor of that. As far as doctors are concerned, hypertension = hyperthyroidism and hypotension = hypothyroidism. Because that's what they learnt in med school!

[Rosebud1955 in reply to greygoose]

Thanks for your reply, yes, my doctor tells me I have too much thyroid hormone on board, that’s why my blood pressure spikes. It’s so confusing and frustrating, I wish they tell us the real truth, or maybe they just don’t care about thyroids. How can we ever get well with doctors that don’t want to be bothered?

[greygoose in reply to Rosebud1955]

Your doctor is an idiot. Your blood tests do not tell you that you have too much thyroid hormone. He is only looking at the TSH, and doesn't know enough about thyroid to understand that it isn't even a thyroid hormone, and is low because you are taking T3. You can expect TSH to be suppressed when taking T3, even if you're not taking too much. And, when taking T3, suppressed TSH is not any sort of a problem. Don't let anyone tell you it is.

I don't think over-medication causes blood pressure spikes, either. If you were over-medicated you might have constant high blood pressure, but not necessarily. But, you can have high blood pressure with hypothyroidism, too. So, that is not a fool-proof indication of either.

They don't care much about thyroids, it's true. But, neither do they know much about it, which is why they can't explain things to you. They just don't know.

[Rosebud1955 in reply to greygoose]

Agree 100%. Most of them are idiots! They pretend to Gods when they have a discussion about anything medical. They are narrow-minded!! My blood pressure will go up to 169/90, then within a minute it goes down to 110/70. Cardiologist try to start me on blood pressure pills but unsuccessful, because my blood pressure will drop too low. I tried to tell him that it’s not a true high blood pressure, that something is causing the elevation for a short period to time. I asked about my adrenals and kidneys, he looked at me as if I was crazy, in a condescending manner, as it to say “ I’m the doctor”. They can make patients feel so inferior. I’m afraid of all of them, I wish I could totally avoid them. They’re hurting too many patients because of their over inflated egos. I hope I’m not the only person that feels this way. Very sad!!

[greygoose in reply to Rosebud1955]

Well, I totally agree with you! I do avoid them as much as possible. I self treat. And things get worse instead of better. I had to take my granddaughter to the doctor a coupe of months ago. He was just a young chap, not long out of med school, I imagine. So arrogant! Never once cracked a smile. Even for a child. Horrible experience.

[Rosebud1955 in reply to greygoose]

Yes, I will be avoiding them in the near future. I will go to the emergency room when I have a problem, I can probably tolerate their arrogance, won’t see the same one more than once.

Have a good evening and stay healthy!!

[greygoose in reply to Rosebud1955]

Thank you, you too.

[jimh111]

I see so many posts with results like these. The fundamental problem is your TSH is too LOW. 'too low' not 'suppressed'. With low normal fT3 and fT4 we would expect a high TSH, this is why TSH is so good at giving an early warning of a failing thyroid. In your case TSH is not reflecting your thyroid hormone status, in other people the TSH would be around 10 with these fT3 and fT4 figures.

I term this 'subnormal TSH secretion' because it is not true central hypothyroidism, it is most unlikely the pituitary is damaged as it can be in central hypothroidism. There can be many reasons for a subnormal TSH, most likely is that you had a period of thyrotoxicity which you may not have noticed possibly due to the thyroid cancer. High levels of thyroid hormone can down-regulate the 'hypothalamic pituitary thyriod axis', the axis fails to fully respond to low hormone levels and secretes too little TSH.

This can have knock on effects on deiodinase (T4 to T3 conversion), especially type-2 deiodinase (D2) which occurs in the brain and skeletal muscles. TSH stimulates D2 activity. The brain is highly dependent upon D2 for regulating its T3 levels. The brain derives 80% of its T3 from T4 via D2 activity, it takes only 20% of its T3 from the bloodstream. Clearly if TSH is abnormally low there will be reduced D2 activity and consequently brain hypothyroidism, even if blood T3 levels are normal. The fundamental problem is the subnormal TSH.

The low TSH leads to reduced deiodinase which is reflected in comparitively low fT3 levels. Whilst it seems perfectly reasonable to restore fT3 by giving a little liothyronine (L-T3) this doesn't work. The problem is that normally much of serum T3 comes from D2 activity in organs such as the brain and muscles that express D2. If you simply normalise serum fT3 by taking L-T3 (or NDT) it doesn't do much for those tissues that derive their T3 via D2. Unfortunately to restore brain euthyroidism you need to elevate serum fT3 so that the brain can take more T3 from the blood. This may be too much T3 for other organs such as the heart, the good news is that studies show that this risk is small, patients on moderate doses of L-T3 do not have worse cardiac outcomes.

So, in your case I would suggest that your Cytomel is increased and perhaps you levothyroine gradually descreased. This is an unnatural balance but there is no other way to get T3 to the brain as long as your TSH remains subnormal.

I'm in a similar situation because I needed very high doses of thyroid hormone for 10 years (long story). Now I need to take 50 mcg levothyroxine plus 50 mcg liothyronine to be able to function mentally. I find it difficult to sustain concentration for more than 20 minutes doing some activities such as reading text or studying. Other activities such as exercise or typing this are no problem. It seems that the brain needs extra T3 for certain mental activities. I wonder if the brain prefers to take in T4 so it can act as a reservoir and be converted to T3 as and when the brain requires it. In practical terms you may find you will need to space out those cognitive activities that tire you.

I strongly recommend you try and increase your L-T3 and in time reduce the L-T4 a bit. I would also recommend you take at least half your daily L-T3 at bedtime. This may seem strange but the brain works incredibly hard during sleep, reorganising memories and clearing itself out. I have found the bedtime dose essential to having a clear mind the next day. I also find that on the optimum dose of L-T3 I am able to get to sleep reasonably quickly and do not wake up multiple times, my dreams are also more vivid and in focus.

[wellness1]

When taking liothyronine at bedtime, is it possible to take anything else, e.g., melatonin, at the same time? If not, how much time would need to be left between the two?

[jimh111 in reply to wellness1]

Liothyronine is much better absorbed than levothyroxine. It should be possible to take other medicines at the same time provided they are not ones that alter stomach ph or impair absorption. I would say it is better to sort out hypothyroidism to restore normal sleep rather than take drugs such as melatonin.