Exercise, overtraining, liothyronine and reverse T3

[Zazbag]

I've been trying to exercise more, and I'm used to pushing my body very hard, so I have a tendency to overtrain that I am trying to mitigate. I thought that because I take liothyronine now, I can somehow avoid this problem, that the liothyronine would help me recover, but I've noticed extreme hunger, fatigue, poor sleep and depressed mood the more exercise I do. I didn't really link it to my exercise or to my thyroid until just now. But am I right in thinking that, if I am overtraining, my body will convert T4 to reverse T3 which will block the T3 receptors and stop my body from being able to use liothyronine? Could this explain why I am feeling so fatigued and depressed and hungry at the moment? Thanks!

[greygoose]

I have never heard that over-training causes T4 to convert to excess rT3. But, even if it did, rT3 is not a problem. It does not block T3 receptors - it used to be thought that it did, but recent research has shown that it doesn't. It has its own receptors. So, doubtful if excess rT3 is the cause of your symptoms.

Could very well be that you are just under-medicated, and not taking enough T3 to raise your FT3 to the level required by the demands you make on your body. But, we cannot know if you don't tell us how much you are taking - and it is T3 only? - and posting your latest blood test results and ranges.

[Zazbag in reply to greygoose]

Hi greygoose, thanks for replying.

I heard that from a few places but can't remember where.

I'm on 150mcg of levothyroxine and 20mcg of liothyronine at the moment.

My last blood test results from 17th February, I was on 150 mcg levothyroxine and had lowered my dose to 15mcg liothyronine because it had been too high:

TSH: 0.02 (0.27–4.2)

T4: 17.2 (12–22)

T3: 7.4 (3.1–6.8)

Despite my T3 being high, the NHS endocrinologist advised me to stay on 15mcg and not lower it anymore if I feel good. In truth I felt worse on 15mcg than I did on 22.5mcg, so I increased my dose to 20mcg and that made me feel better again for a while, but for the past month I've felt depressed and fatigued and demotivated. I don't know if it's to do with my thyroid but I have a feeling it is.

My T3 and T4 results seem off. My T4 has been going down steadily since last year despite being on same dose of levothyroxine the entire time. My T3 has been fluctuating but has been 6.8–8.1 consistently since I added liothyronine. It's strange because I was on 17.5mcg when I got 6.8 but then I decreased to 15mcg and then it was 7.4. I definitely feel like something is off with my dosing but I can't figure out how to correct it. I do also get heart palpitations sometimes and my resting heart rate is 82(!) which feels very fast. I'm not sure what to do and I feel like doctors don't have a clue on what to advise.

[greygoose in reply to Zazbag]

It's true that doctors don't have a clue - they don't learn much about thyroid in med school. But, I don't think I do, either, in this case.

I don't think your FT4/3 results are 'off'. Taking T3 does lower FT4. Maybe it's too low for you, but it can be difficult to raise.

How do you take your T3? Do you split the dose? Take it on an empty stomach or with food? Are you always consistant in the way you take it? Because it probably shouldn't vary quite as much as you say it does.

[Zazbag in reply to greygoose]

Oh okay I didn't realise it lowers T4, is this because it suppresses TSH? Does that mean I should increase my dose of levothyroxine?

I take my liothyronine in two doses, the first 10mcg when I wake up, and I wait 30 mins before I eat breakfast or have my morning tea. Then I take the second 10mcg two hours after I eat lunch and I wait at least 30 min before eating again. I am pretty consistent although last week there were a couple of days where I was so hungry that I ended up eating too much in the middle of the day and had to wait two hours to take it so took it later than usual, around 6–8pm. But usually I take it at around the same time and always at least 2 hours after food and 30 mins before more food.

[greygoose in reply to Zazbag]

Nobody seems to know why taking T3 lowers the FT4 level. There have been several discussions on it, on here, without any answers. But, I don't think it has anything to do with the TSH.

Whether or not you should take more levo is impossible for anyone else to say. It's a very personal thing. Some people need high levels of T4 when taking T3, others don't need any at all. You could try, perhaps and see if it helps.

So, it doesn't sound as if the way you take your T3 has anything to do with the problem. Do you have Hashi's?

[Hidden]

Exercise raises cortisol which is why people with high cortisol (from stress etc) are told to exercise gently and prefer walking to running.High cortisol causes hunger and cravings as it raises blood sugar levels.

From what I´ve read, strenuous exercise uses up free T3, and if the body cannot respond and convert more T4 to T3 fast enough, that could explain why you feel the way you do. You could try to add a little T3 after exercise and see if that makes a difference.

[Zazbag in reply to Hidden]

Thanks for replying! I'm on 20mcg liothyronine and I think that might already be too high as I get heart palpitations sometimes and my resting heart rate is about 82. Do you think it might be better to change the timing of my doses (currently once when I wake up and second around 3–5pm) so I am taking some liothyronine straight after my workout? If it is a cortisol problem do you know how I can improve that? Is there a test that can tell me if I have high cortisol, I think I've read stuff about the 24-hour saliva test... thank you!

[Hidden in reply to Zazbag]

I recently read (on the website of a German alternative doctor who comes highly recommended by German thyroid forums) that erratic cortisol levels in hypothyroid patients are not caused by damaged or dysfunctional adrenal glands, but by low T3 levels at night. So he recommends taking T3/NDT at bedtime when it is of most use to the body. He only recommends hydrocortisone in patients with Addidon’s disease. I think you may need to experiment to see what suits you. Some take T3 in a single dose, some two or several times a day. But if you feel more tired after exercising it might be worth trying to add a little T3 to see if you feel better.

[Zazbag in reply to Hidden]

This is very interesting! I'm going to try splitting my dose into three and taking the last 5mcg before bed. I remember SlowDragon mentioned this can promote good sleep which makes sense if it's lowering cortisol. I take my levothyroxine at night, I guess it's not converting to enough T3?

[Hidden in reply to Zazbag]

Yes, if you have poor conversion which is guess you do if you take T3.

[Hidden in reply to Zazbag]

I should add that raised cortisol levels during exercise is a normal physiological reaction. Normally, cortisol levels should return to normal afterwards.I think it’s impossible to know for sure if you have high cortisol without a 24 h saliva test. Symptoms of high and low cortisol overlap.