Has anyone else noticed hormone requirement changing once you reach end-stage Hashimoto´s?

I expected to required T3 and T4 at this stage, but not only do I only seem to require T4, but also lower doses now than 20 years ago when I was diagnosed. Back then, an ultrasound showed my thyroid gland was of normal size, but that there was already extensive damage to the hormone-producing cells. An ultrasound in November 2020 showed an undetectable thyroid gland so the radiologist concluded end-stage Hashitmoto´s (the ultrasound was ordered by my new doctor who questioned the original diagnosis as my anti-TPO and anti-TG levels have been in range for the past couple of years).

I recently switched from Euthyrox (which I did not feel optimal on) to L-Thyroxine by Takeda, and the difference is enormous. The Takeda brand seems to much more potent and also much more stable. On as little as 15 mg of Erfa, however, I had terrible hyper symptoms such as racing heart, profuse sweating, insomnia, and restlessness.

The doctor said this is due to low cortisol and that the symptoms are caused by high adrenaline/low cortisol and not by high FT3. However, every time I go off anything containing T3 and take levo only, I feel so much better.

I have a colleague who after a total thyroidectomy 13 years ago has been stable and feeling well on levo only, so not sure how much credence to put in all that talk aboout people needing T3 in addition to T4 if you no longer have a thyroid (my doctor said an ultrasound showing an undetectable thyroid gland puts me in the same category as someone who´s had a TT).

Adrenal fatigue is a controversial diagnosis so not sure I want to go down that road...my doctor wants me on 2 mg of Medrol daily to support rather than suppress my adrenal glands.

But, the problem with unconventional doctors is that they seem to think nobody can do well on levo only...!

One thing that bothers me about studies on the efficacy of combined T3+T4 treatment is that they were performed on mice and rats that are much smaller than humans, produce T3 and T4 in a different ratio and also have a much faster metabolism. I believe to have read the reason NDT fell out of flavour in the 1970s was because reasearch showed that humans almost exclusively produce T3 from extra-thyroidal conversion....whereas rodents´ thyroid glands produce much more direct T3. The same seems to be true for pigs and cows, BTW.

Anyway, I´d be interested in finding out if others have noticed their hormone needs changing/decreasing with end-stage Hashimoto´s. I really cannot expect why my body suddenly seems happy with levo only, but it´s hard to accept taking T3 and feeling horrible while being told by doctor that this is due to adrenal fatigue.

[guysgrams]

I still have some what of a thyroid (last ultrasound showed signs of atrophy) but certainly do need the T3 along with T4 for me anyway. I can tell and don't want to ever be without T3 again if at all possible.

[Confoozled]

I was wondering this. I've just posted a question on here which you may want to read. I've never had a successful thyroid replacement protocol in my view despite trying every combination. The only thing I know is that early on T4 only made me very very ill. But now I'm like you, end-stage Hashi. I posted here: (3) Ideas needed to balance TSH and T4/T3 - somethi... - Thyroid UK

healthunlocked.com/thyroidu...

I think it may be because of the stage I'm at. My current treatment, mentioned in the post is the most successful I've ever been on. Throughout Hashi I've had tachycardia. Any thoughts?

[waveylines in reply to Confoozled]

Low B12 causes a racing heart.

[Confoozled in reply to waveylines]

I did not know that

[waveylines]

Am definately end stage and have been for well over ten years. I also need the combination of T4/T3 and have done for years. Without it I would be very poorly. So you are one of the lucky ones if you do well on Levothyroxine.

[Hidden in reply to waveylines]

My problem is that my current doctor thinks that adrenal fatigue so low cortisol is causing me to react badly to T3...but I don´t want to take Medrol. I am afraid that once I go on it I will never be able to go off it. The doctor said that if I take 2 mg daily it will only support my adrenal glands but not shut them down, but I am not sure about that...some articles I´ve read say that any amount of exogenous cortisone risks shutting the adrenal glands down.

[waveylines]

I was on adrenal support for a while......about a year to 18months. Havent needed it for over 8 years. Your other option is to look at Paul Robinson & the Circadian Rythmn. By taking your ndt or T3 early it helps to trugger your body to produce more cortisol. Its extremely powerful so be very careful!!