Hypothyroidism/undermedicated with adrenal problems. What should I treat first?

[DizzyD]

Hi all

At present I take 75mcg of levothyroxine. Put on levo after thyroidectomy 1992 due to cancer. NHS endocrinologist always dosed me with "suppression" being their sole aim. However, long story made short, February 2020 levo was reduced to 75mcg (present dose)...."suppression" was no longer the endocrinologists goal.

Most recent TFT December 2020 reveals:

FT3 35%

FT4 63%T

Clearly FT3 is rather low and should be higher than FT4. Do these figures indicate that I am undermedicated?

If the general consensus is that I am undermedicated I do have a plan to try and resolve this problem ( T3 and perhaps increase levo), which I have to put on hold for now due to adrenal insufficiency issue (morning/noon LOWS evening/night HIGHS which I have been working on for past two weeks, using Holy Basil for the even/night highs which have really helped me get some sleep. Hopefully, given time, the morning lows may pick up but I am getting impatient!!!

From my limited understanding, cortisol affects thyroid hormones and vice versa thyroid hormones effect the adrenal glands. My source of thyroid hormones is totally synthetic (levo), I do need some T3 and perhaps increase in levo. My question is: Would it be okay to introduce small amount of T3 (self sourced) while working on my cortisol/adrenal issue?

My mineral/vitiamin levels are are fine. Gene test, re: conversion issue....negative.

Any feedback would be really appreciated.

[SlowDragon Administrator]

Better to increase levothyroxine first

Suggest you increase levothyroxine dose back up SLOWLY

Initially 75mcg/100mcg

Retest 6-8 weeks later

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

Being under medicated causes adrenals to try to compensate for lack of thyroid hormones

So you need to get dose levothyroxine increased

What dose levothyroxine were you on previously

What were Ft4 and Ft3 results then?

[DizzyD in reply to SlowDragon]

Previous levothyroxine 100mcgTFT October 2019

FT3 21%

FT4 85%

[SlowDragon Administrator in reply to DizzyD]

Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

If yes....then likely best to add T3

Conversion has improved on lower levothyroxine

Often happens

Starting with adding 5mcg T3 in morning (or 1/4 tablet if 25mcg )

Assuming all going well, after week or so adding 2nd 5mcg T3 dose late afternoon

Retest 6-8 weeks later

Day before test split 2nd T3 dose and take 2.5mcg of it around 9pm so that last dose is roughly 12 hours before test

[DizzyD in reply to SlowDragon]

Hello Slow Dragon sorry for late reply. I have heart issue flair up, (erratic, irregular heartrate) since last night, which has put thyroid an adrenal issue on hold for now. Really annoyed because heart has been stable for two weeks, since taking Holy Basil to support adrenals which enabled me to get some much needed sleep so improving stress levels, fatigue etc. Now I back to square one, caught up in heart symptoms (flair up) and consequences...no sleep last night which only stresses adrenal glands further which has a knock on effect to hypothyroid symptoms. To say the least, I am devastated....seem to be caught up in a vicious cycle.In response to your question (first paragraph), I cannot recall if I followed the test criteria recommended on this site, for October 19 test. I did follow it for December 2020 test which was done at 1 30pm though. How would this affect T4 and T3 result?

Despite vitamin levels being fine, I have always had conversion issues. March 2020 test, done after levo reduction, from 100 to 75, reveals: FT3 9% FT4 44%. Apart from time issue, I did follow the test of the recommended protocol for this test.

Clearly low FT3 needs to be addressed. Do believe I have had low FT3 since having thyroidectomy in 1992, but as we all know on this site NHS only acknowledge TSH numbers.

I know this site is for thyroid issues but low FT3 does effect the heart in a detrimental way. What really worries me, plays on my mind, is that the damage is done to heart and T3 may not be advisable and my low FT3 may never be resolved. What do you think SlowDragon?

Sincere thanks SlowDragon. Really appreciate your help and support.

[SlowDragon Administrator in reply to DizzyD]

Starting on extremely low dose T3.....eg 2.5mcg waking ....and 2nd dose 2.5mcg in mid-later afternoon. It will be tiny speck of dust really

[DizzyD in reply to SlowDragon]

Hi SlowDragon re: you last reply I hope you don't mind me asking you the following question. As I only have a limited supply of synthetic T3, which could run out quicker, do you think 1/4 of 30grain efra (morn and afternoon) would provide a similar amount of T3 to the 2.5mcg synthetic you suggested? I have a greater supply of efra than synthetic T3.

Have a rewarding day.

[pennyannie]

Hello Dizzy D ;

Can I just add a fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin plus a measure of T3 said to be at about 10 mcg and a measure of T4 said to be at about 100 mcg. ;

T4 is a storage hormone which your body needs to be able to convert to T3 and maintaining ferritin, folate, B12 and vitamin D at optimal levels will help with the conversion of T4 :

T3 is the active hormone that the body runs on and is said to be about 4 times more powerful than T4 with the average person utilising about 50 mcg T3 daily just to function.

Ideally most people feel at their best when both these vital hormones are dosed and monitored to be balanced with most people feeling at their best when both T3 and T4 are high in ranges and generally in the upper quadrant.