undermedicated but can't raise T3 by even 1mg at a time - fixing low but in range cortisol?

[liaratsoni]

Hi everyone,

I am at a complete loss of where to turn in regards to my thyroid treatment. I am stuck on a dose of 6.5mcg of T3 and am undermedicated (last blood test showed FT3 4.8 range 3.5-6.5) with symptoms that make my life unliveable - awful fatigue, lightheardedness standing for periods longer than 10 minutes, periods of anxiety, almost constant uncomfortable internal vibrating, acid reflux, constipation, periods of high heart rate and palpitations, bloating etc the usual stuff. Previously at the start of this year I was on 10mcg T3 and 75mcg T4 and had a period of doing really well and feeling almost normal. I had no issues moving T3 doses up by 5mcg with only a little internal vibrating and minor raised heartrate. Then I worsened slowly became gradually less able to tolerate the T3 and got more and more periods of high heartrate and what seemed like low blood sugar/adrenaline rushes. I had to come down to 5mcg and found out my vitamins and iron had become deficient again so started working on them. My ferritin is improved and my vitamins are very good again and after 7 weeks on lower dose of T3 and doing ok just very hypo I have started having more frequent periods of high heart rate and anxiety and nauseousness again. I tried an increase of 1mg as I am very scared with how poorly I tolerate it now but on the fourth day of a 1mg increase the heart rate, palpitations and internal vibrating is unchanged if not a little worsened and I feel just as awful like I am constantly background running on adrenaline, palpitating frequently and its gets way worse after eating.

I feel very scared and lost as I just don't know how to deal with this. I can't understand how I was fine on sloppily chopped up 10mg with only sporadic supplementing and now I have to weigh my tablets exactly and can't seem to tolerate even a 1mg increase? I had a saliva cortisol test done 3 months ago when my FT3 level was the same as my recent blood test which showed low but in range cortisol in the morning and afternoon and slightly high cortisol in the evening. I am really unsure how to deal with this and its been going on since april. Is a 1mg increase even enough to cause such symptoms?! I wouldn't feel happy taking any adrenal cortex and the cicradian t3 method didn't help either. My family are trying to get me to just go up to 10mg but its very easy to say when your not the one with constant and at times very frightening palpitaitons, internal vibrating and a pulse of 90 on only 7mg. Any help would be so hugely appreciated - I have been stuck practically bedbound for a year and a half now and though I try to be optimistic I've been ill since 16 and at 23 I feel like I'm watching my younger years slip away. Thank you.

[Hidden]

This is how I figured out what was going on with me after I added T3 to T4 (after feeling dreadful on levo only, with top of range T4 and barely midrange FT3):

stopthethyroidmadness.com/a...

A word of caution: most doctors don´t recognise adrenal fatigue as a medical condition, and it´s also a controversial topic in some patient forums. However, to me, it´s very real. When I read the article above, it could have been about me.

I have been self-treating with hydrocortisone (self-sourced) and I am feeling so much better. I have been able to raise T3, I am still trying to find my optimal dose and ratio of T4 and T3, but some symptoms which made my life miserable are gone, like feeling constantly irritated, tired and wired at the same time, problems falling and staying asleep, sugar cravings, constant need for caffeine and other stimulants.

There are three stages of adrenal fatigue according to practitioners who treat this condition: 1. highish cortisol throughout the day, 2. a mix of high and low cortisol, often lowish in the morning when it should be high and highish at night when it should be low, 3. advanced adrenal fatigue with suboptimal (yet in range) cortisol levels throughout the day.

So, according to this theory, you´d be stage 2, which is where I was when I self-diagnosed adrenal fatigue using a 24 h saliva test.

I realise this is a controversial subject, and I am not telling people to just start taking hydrocortisone (or supplements) if they don´t feel optimal on thyroid meds.

First of all, you need a 24 h saliva test - you should never guess that you have low or high cortisol as symptoms can be confusingly similar.

Secondly, some successfully use adaptogens and/or adrenal cortex/glandular. I opted not to use glandulars as they contain adrenaline, and I read that people with lowish cortisol tend to have high levels of adrenaline (compensation mechanism).

The reason I chose HC rather than adrenal cortex (which does not contain adrenaline) was simply because I thought I could start on HC, see how I felt, then wean off it slowly (as recommended for instance by Dr. Durrand-Peatfield in his book "Your Thyroid and how to keep it healthy"), and maybe switch to adrenal cortex as a long-term solution for adrenal support. However, I felt so good on HC that I´m still on it after eight months.

There are also diverging opinions among doctors who treat adrenal fatigue: some say treatment should be short-term, while others say it may require life-long treatment. One theory I´ve found is that being hypo for years (which people with Hashimoto´s often are) will put so much strain on the adrenal glands that they never fully recover. Others, as I´ve said, will claim that the adrenal glands only need short-term relief (provided by taking cortisone so that they can get well-needed rest), and then they will start working optimally again when you wean off it.

So, it´s not an easy subject, given the diverging opinions not only between those who believe in the condition and those who don´t, but also because even doctors who do treat it disagree among themselves as to whether the condition is life-long or reversible.

[liaratsoni in reply to Hidden]

Hi and thank you so much for the reply!

The adrenals seem to be such a underresearched and even less understood subject! I can understand why my adrenals might be knackered - my endo thinks my hypothyrodism started as a teenager and indeed in 2013 at 16 I had a sudden onset of anxiety issues almost out of the blue that my endo thinks was the first major signs of thyroid problems. I then had to deal with symptoms that now on reflection would suggest adrenal issues all through college so not exactly a stress free time to be dealing with it! I was only diagnosed last year at 22 because I have secondary and it was missed for years so I have had issues for probably at least 6 years. Its just so incredibly frustrating that I was on 10mcg t3 earlier this year with no issues and even trialed 15mcg at times but always had to come down and even then the symptoms werent as bad as now! I think I need to get another adrenal profile and go from there. I just wish there was a concrete way of how to deal with this but as with all things related to hypothyroidism it seems very complicated and very individual! Thank you