OK, you don't need to tell me that this is something you shouldn't do with any prescription medication, however the situation needs some context. I don't want to ramble on so I'll try to keep this as succinct as possible.
I'm a 36 year old man diagnosed with subclinical hypothyroidism, but the symptoms have been absolutely crippling. Symptom-wise, we're talking all of the classics, but the most debilitating have been horrendous fatigue, complete loss of mental clarity and concentration, significant weight gain (now almost 3 stone - after I had worked hard to get myself into the shape of my life - 6 pack and everything), a constant sense of anxiety with occasional panic attacks in certain situations, and a brutal depression that has left me close, frighteningly close, to taking my own life. I owe my wife for rescuing me in that instance, but the last three or four years have taken a massive toll on my marriage.
I am conscious that you could attribute many of these symptoms to other afflictions, be it mental or physical, however the way things played out from 2017 onwards, beginning with cold intolerance and white fingers, to struggling of weight management, to the almost complete implosion of my life. I have always believed that there was a physiological reason behind what I've been grappling with, and I've never been more certain than in this moment.
I'd add to all this that things like the depression and anxiety make no rational sense whatsoever. I have a beautiful wife and two beautiful children, aged 7 and 5. My career has never been better; I am in a very senior professional role which in normal times affords me the opportunity to travel the world, and I'm as financially secure as I have ever been. I worked my up from nothing, grafted my way up with no eduction to speak of, to find myself transcending people with Oxbridge degrees within my organisation. I'm trying to write this without sounding crass - that is not my intention. It's just context - I was a fit, healthy, happy, successful man with literally more than I had ever wished for, and then I started to feel cold, tired, ill, forgetful, anxious, sick, down, depressed, panicked, suicidal - just about in that order. It started slowly, and then hit me like a sledge hammer. It's the loneliest and scariest place I've ever been.
Anyway, I've been searching for answers for some time. I've seen various endocrinologists, mostly to little avail, trialled testosterone treatment (also to no avail), and finally found someone willing to treat what was considered subclinical rather than full-blown hypothyroidism.
My T3, in particular was low, and after several months of relatively small doses of levo (35mcg at its highest point), I was prescribed an additional 7.5mcg per day of liothironine.
At the outset, my T3 was 4.3 [3.0 - 6.8], and the levo I'd been taking for months had barely changed this. After a couple of weeks of adding the liothyronine, things had improved for the very first time to 5.38, whilst my TSH was the healthiest on record at 2.51.
Technically progress, but I still felt pretty dreadful. And I had an issue on the horizon. In some respects, the pandemic has helped my in terms of my work. I've been working exclusively from home since March 2020, which has allowed me the extra couple of hours sleep per day I wouldn't have been getting, as well as the ability to get a few moments rest between meetings if I'm feeling burned out or suffered a panic attack - although I've become very adept at hiding what's going on inside me, it doesn't make it any less an unpleasant experience for me.
Last week though I was summoned to three days of meetings in London. My CEO was over from the States, and it would essentially be three days of back-to-back meetings, early starts and late nights with the kind of corporate dinners and drinks that were common place before Covid struck.
I can't lie - I was dreading it. I didn't know how I could get through that. No way I would have the energy, the mental clarity to concentrate for such long periods, or the ability to hide any panic attacks which would inevitably knock on my door in the kinds of high pressure scenarios which have previously been triggers for me.
To make matters worse, my doctor is currently unavailable due to her own illness, so I decided to take matters into my own hands a couple of weeks before. I increased my levo to 50mcg per day and my liothyonine to 15mcg per day - double my prescribed dosage. I know this was potentially irresponsible, but the alternative was that I either didn't end up going and put my career in jeopardy or went and found myself asleep after three hours of meetings (with the same end product).
I've been keeping a close eye on any symptoms and potential side effects from over-dosage, and the only effects seemed to be positive. I also kept monitoring my bloods, and my latest FT3 was 5.96 with a further reduced TSH of 1.76.
I have to say, I've felt as well in this last week or so as I have in at least two years. Not perfect, but much improved without a shadow of a doubt. I was able to get through my week of meetings feeling something like myself, albeit a little heavier and a little more tired, but at times it felt like the past few years hadn't even happened. It was a great feeling, and it's a long time, genuinely, since I've experienced positive emotion.
My gut feel is that, having taken it upon myself to increase my dosage, that I'm closing in on where I need to be. However, I now have a different problem.
Of course, I don't have sufficient medication to maintain this dosage in the long-term, so I have to come clean to my doctor - someone I respect so much as I feel like she is the only person who has ever taken me seriously and tried to help. I don't want to damage that professional relationship; she simply wasn't available at the time when I needed to make a call, but I recognise I have tried to play doctors here and that may not go down well.
This really was, honestly, an act of absolute desperation on my part. The last roll of the dice with the walls closing in. If things had gone horribly for me, I'm not sure where that would have left me or what might have followed. At the back of my mind was an itching concern that I was about to be around train and tube stations for the first time in nearly two years, and I didn't want to be there having just ruined my career.
But I did what I did, and technically I shouldn't have. How would you explain that away?
Really sorry this has been so long-winded - I just needed to get this off my chest and think about next steps. I feel like I'm closer than ever to ending the nightmare that has enveloped my life, but at the same time I'm risking alienating the only medical professional who has really helped me over the course of several years.