I had gradually reduced down my NDT to 1 grain and been adding T3 in 2.5mcg increments (couldnt tolerate more than this amount at one time) over last 3 months, checking pulse, blood pressure before meds, and 2 hour after ,and all has been going well till last weekend. I am now experiencing a fast pulse for me , with my lowish blood pressure ,enough to give that horrid radiating warm pain in the chest and feel a little dizzy sometimes. I am monitoring it and its not above 85 sitting or a 100 standing. At first i thought ok additional stress ,we are all in a pandemic, maybe cortisol is up a bit and absorbtion of meds is down, or maybe my iron levels have dropped down too much...... so i have ordered a iron blood test and some B12, D testing etc. Meanwhile this result came back today which is why i despair; oh i am DIO2 positive and have Hashis, which was why endo suggested reduce down NDT to 1 grain and start adding some T3 till symptoms reduce, he gave a 20mcg daily to work up to if needed.
27/5/20 taking AM 1 grain NDT + 2.5 mcg T3
(6hr later) PM + 5 mcg T3
TSH 0.013 (0.27-4.2)
FT3 13.3 (3.1-6.8)
FT4 11.7 (12-22)
1/4/20 taking AM 3/4 grain NDT + 2.5mcg T3
PM + 5 mcg T3
TSH 0.058 (0.27-4.2)
FT3 3.55 (3.1-6.8)
FT4 10.5 (12-22)
27/2/20 Taking AM 1 1/4 grain NDT
PM 1/4 grain NDT
TSH 0.021 (0.27-4.2)
FT3 3.69 (3.1-6.8)
FT4 16 (12-22)
Does anyone know why this would be please, is this perhaps 'pooling' from low iron or elevated cortisol? my cortisol was too high in the morning back in January's saliva test. Looking at these results today, it looks like i need more T4 even though i have a conversion problem, it loks too low....... any thoughts on this too please would be very gratefully appreciated.
Every best wish
G.
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Gillybean1
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Seems to me it's the Hashi's to blame - a Hashi's 'hyper' swing, perhaps? It's not logical to think that an increase of 1/4 grain of NDT - which is 2.25 mcg T3 - is going to send your FT3 from 3.55 to 13.3. That's just too much of an increase. One would have expected the FT4 to rise too, but who knows! These weird things happen with Hashi's. If I were you, I would stop the T3 for a few days, see if you start to feel hypo again. Because if it is the Hashi's causing this rise in level, it will go down again. But, I would do it on my own, without involving the endo at this point, until you know what's going on.
is this perhaps 'pooling' from low iron or elevated cortisol?
There's no such thing as 'pooling'. T3 has a half-life of slightly less than 1 day, it doesn't hang around whether your cortisol/iron is high or low. If it doesn't get into the cells, then it is slowly excreted.
Thanks again for your swift response to help me. The 'pooling' question was whether any T4 that couldnt get converted or utilised was being into the blood(DIO2)...? and showing the T3 high.
Its true to say prior to this epsode i still felt undermedicated and wasnt at the illusive 'sweet spot' yet , but this seems to have come on fairly suddenly or so i think....difficult to say definitely as the weather has got hotter and i havnt adjusted yet. But this feels like a backward move.
The T4 went up a teeny tiny fraction with that 1/4 grain increase.
So would it be best to drop all the added T3, AM and PM doses for a couple of days ? Or longer. And keep the NDT dose, or stop all meds for a couple of days ?
The only thing i have done different in the last month, is to add a little dairy (butter) back into my diet,first time in 8 years, ........... Hashi's ???
Would low iron stop T3 getting absorbed ?
B Pressure typically 97/67 pulse 72 - 82 higher when i stand.
Temp 36.6 mostly, higher during day to 37, lower in evening and mornings .
Thanks again for your swift response to help me. The 'pooling' question was whether any T4 that couldnt get converted or utilised was being into the blood(DIO2)...? and showing the T3 high.
I think maybe you missed a few words out in that sentence because it doesn't make sense. But, I'm pretty sure the answer is no. FT3 will only show high if the level of T3 in the blood is high. Any T4 that doesn't get used or converted is excreted after about a week.
Its true to say prior to this epsode i still felt undermedicated and wasnt at the illusive 'sweet spot' yet , but this seems to have come on fairly suddenly or so i think...
That's the nature of a Hashi's 'hyper' swing. It does come on quickly. The dying cells of the thyroid dump their stock of hormone into the blood, causing levels to rise suddenly.
So would it be best to drop all the added T3, AM and PM doses for a couple of days ? Or longer. And keep the NDT dose, or stop all meds for a couple of days ?
You could stop all meds for a couple of days, yes. Then see how you feel.
The only thing i have done different in the last month, is to add a little dairy (butter) back into my diet,first time in 8 years, ........... Hashi's ???
Adding butter to your diet is highly unlikely to increase your FT3 level - if only it were as simple as that!
Would low iron stop T3 getting absorbed ?
Possibly, I don't really know. But, you didn't suddenly get low iron, did you. So, it wouldn't cause your FT3 to suddenly rise like that.
Yes, sorry it didnt make sense, brain fog methinks. I must have got this wrong in my mind... i thought the STTM and P Robinson reference to 'pooling' was describing the unconverted T4 ( as a result of DIO2 faults) or not having the optimal cortisol or iron levels to make a good conversion, meant that unconverted stuff got dumped into the blood instead of the cells ,giving a false elevated T3 in some cases......have i got that completely wrong ? Or would this give elevated RT3...? is that where ive muddled it.?
My iron levels do tend to be on the low side despite taking Betaine and Enzymes, so i have to manage that constantly and i could have lapsed.
My reference to the 'butter' was whether it has caused a Hashi's flare being dairy, or possibly a supplement ive been taking to help me digest fats better has 'soya' in it,another thing i omitted 8years ago.
I have to say, my first thought was that it was a lab result fault, but i guess thats extremely unlikely given my pulse, and lousy feeling.
I will take your advise and stop the T3 from now for a couple of days.
Just a funny feeling i have, but have you ever heard of anyone taking NDT at the same time as T3 feeling like they clash when taken together ?
i thought the STTM and P Robinson reference to 'pooling' was describing the unconverted T4 ( as a result of DIO2 faults) or not having the optimal cortisol or iron levels to make a good conversion, meant that unconverted stuff got dumped into the blood instead of the cells ,giving a false elevated T3 in some cases......have i got that completely wrong ? Or would this give elevated RT3...? is that where ive muddled it.?
Goodness! I hope you have got that wrong because it doesn't make any sense. Whether or not T4 is converted, it still only has a half-life of 7 days. So, as your take more every day, there's a constant in and out of T4. It isn't 'dumped' anywhere. And, even if it were, how on earth would unconverted T4 elevate levels of T3 - false or otherwise? Even if you don't convert T4 to T3, it's half-life is still 7 days, it wouldn't hang around any longer than that, so couldn't be described as 'pooling'. I think, maybe, you're muddling your T4 with your T3, and confusing thyroid hormone resistance with so-called 'pooling'.
Whether or not your T4 converts to elevated levels of rT3, depends on the level of your FT4. If it is too high, T4 will be converted to more rT3 than T3. But, even that wouldn't cause any of the effects you're describing. rT3 is only in the system for a couple of hours, and then converts to T2. That doesn't hang around, either.
My reference to the 'butter' was whether it has caused a Hashi's flare being dairy, or possibly a supplement ive been taking to help me digest fats better has 'soya' in it,another thing i omitted 8years ago.
I've never heard of dairy causing a Hashi's 'hyper' swing. I know anything's possible, but I rather doubt that.
As to the supplement you're taking, it doesn't sound like a very good idea! Soya has the effect of stopping the thyroid hormone getting into the cells, true. But, even so, it's rather difficult to imagine that it would cause your FT3 to go that high! The difference between the two results is just too great, and sounds more like a Hashi's 'hyper' swing. But, you don't need anything to cause the attack, the immune system just attacks.
I have to say, my first thought was that it was a lab result fault, but i guess thats extremely unlikely given my pulse, and lousy feeling.
That is always a possibility. Do you take biotin? Or a B complex?
Just a funny feeling i have, but have you ever heard of anyone taking NDT at the same time as T3 feeling like they clash when taken together ?
I've never heard of that, no. And why would they? They're not different substances. And what form would this 'clashing' take, anyway? Not something I can easily imagine.
Yes my brain is scrambling stuff, i will re read on a good day.im muddling thyroid hormone resistance.
I do take B Complex but left it off for 5 days prior to test.
The clashing i feel comes only in the morning dose combining NDT with T3, a whizzy head 20 mins after taking them, i dont get the same with the T3 only afternoon dose, and i didnt get it previously when only taking NDT. It doesnt whizz for long maybe an half an hour, too soon in to be the active ingredient so i presume it might be fillers on an empty stomach in the morning.
Finally, if i leave off the additional T3 for a couple of days to see if the pulse settles down, do i need to do another blood test, or just reintroduce the T3 again slowly monitoring BP/HR/TEMP ?
Ive seen comments before about staying on too low a dose of T3 for too long can cause a Hashis flare.....how is this,do you know ?
Thank you again for your care,patience and support,
Ive seen comments before about staying on too low a dose of T3 for too long can cause a Hashis flare.....how is this,do you know ?
Hmmm… Well, that all depends on your definition of 'flare'. I don't like that word because people tend to mean different things when they use it, so I'm never quite sure how to answer. So, what you you cal a 'Hashi's flare'?
No. I really don't think so. I was talking about a Hashi's 'hyper' swing when I said that - some people call that a Hashi's flare, but as I said, that's confusing. These swings are totally random, as far as I can see. There are all sorts of theories about gluten, and things, but no hard prove that I've seen. I certainly don't think one would be caused by staying on too low a dose of T3 for too long - although that, in itself, would be a bad thing.
A Hash's 'hyper' swing is when the immune system launches an attack on the thyroid, and the dying cells dump their stock of hormone into the blood, causing levels to rise sharply. As, I said before, if it were that, one would expect the T4 to rise, too, but… who knows. But, I don't think it was anything you did - or didn't do - that caused that sudden leap in the FT3 level. You'll just have to see what it is next blood test.
Thank you for your reply GreyGoose. Im all over the place today worrying what to do for the best, i had reduced the T3 part down Mon to Wed and dropped it completely yesterday afternoon after your advise, just not sure whether to leave out NDT dose this morning .or whether that will be too much of a shock to the system........i wish i didnt agonise over things so much....
If that figure T3 13.3 ' had ' been a typo i would have just regarded the fast pulse as too little meds, needed to increase T3 to support my adrenals that hate the hot weather, BUT because im regarding the blood test as accurate, ive given myself a whole load of extra angst because i felt dizzy with the fast pulse......im being cautious, even though it does seem a massive jump from one test to another in a short time and very little increased meds.
Im not giving up.......just when i thought i was doing so well too.
Can i also ask you, something else i read, that if T4 is not totally converted and used, that it can block the T3 receptors...? would that push up T3 only or would that put T4 up too? G
Oh dear. I don't know where you've been reading, but you've been reading some pretty peculiar things! T4 is never totally converted. There will always be some that is just excreted. But, it wouldn't go anywhere near T3 receptors. It has its own receptors. I think, once again, you're muddling it up with the old ideas about rT3. People used to think that rT3 blocked T3 receptors. But, that too, has its own receptors. As far as I know, nothing is going to block T3 receptors.
Even if T3 receptors are perfectly clear, there is still something called 'thyroid hormone resistance', where people have to take huge doses of T3 just to get a little into the cells. But, even with that, it wouldn't happen suddenly, and suddenly cause your FT3 to jump up like that. And, you wouldn't have hyper-like symptoms, because it's not getting into the cells. So, that wouldn't have accounted for your fast pulse. And, the thing is, you're not taking a huge dose of T3, anyway! You're taking quite a modest dose. Your dose is too small to account for that high FT3. So, it's either a laboratory error, or it's a Hashi's 'hyper' swing.
you are a sweetheart GG, and a voice of calm reason. Once upon a time i had a smart brain...these days i muddle the whole lot up with the pickled one i now have.
My pulse was alot more steady first thing this morning and i did take a 1/2 grain of NDT this morning albeit much later, 3 hours on from it the pulse went up a little and i felt weak in the legs again but nothing major.
I did ring the test company this morning, to ask about the possibility of a typo.....no response as yet, although they did look at the last few test results with them and thought it seemed odd, so i wait to hear back from them.
Re adrenals, meds and heat, 'i' found that the more NDT i put in ,the better i tolerated warmer weather.....the only explanation i could think was that the my thyroid was getting meds which supported the strain on my adrenals, and that helped me to tolerate heat. I had found that 'if' i got a good unbroken nights sleep, i didnt get the legs buckling feeling in the morning and i tolerate the heat ok ish.........BUT a bad gut night,poor sleep =weak legs in the morning, cant cool down and air hunger........yes i just had to be different !!
Take care GG, i hope you are doing ok yourself in these unusual times ?
I'm not sure the adrenals have anything to do with heat tolerance. The thyroid is the body's thermostat. So, you do need to be adequately medicated to support the heat.
Being hypo badly affects the brain because it needs a lot of T3. It will take time to recover. But, I'm sure you'll eventually get there.
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