Thyroid meds causing insomnia?

[Rock_chick1]

I used to sleep really well but for the past few months every night I am waking every hour. This is just getting crazy and really adding to my existing crushing fatigue. I m thinking that it could be the levothyroxine. I now take 75mcg at 6.30am Liothyronine also 5mcg at 6.30am, 10mcg at 11.30 am and 5mcg at 16.30pm.

[SlowDragon Administrator]

Try taking last 5mcg T3 at bedtime ….spreading 3 doses wider apart - waking, mid afternoon and bedtime

Or

You might try 10mcg dose T3 waking

or

10mcg T3 at bedtime eventually…if 5mcg at bedtime improves sleep

Or

You could also try splitting Levothyroxine into 2 doses waking and bedtime….

or

try taking levothyroxine at bedtime

Only make one change at a time….otherwise you can’t see what’s helping

[Rock_chick1 in reply to SlowDragon]

Thank you. I will implement these changes one at a time and keep a record of it in my diary. Wish me luck! 😊

[SlowDragon Administrator in reply to Rock_chick1]

You might find my profile info helpful

[Rock_chick1 in reply to SlowDragon]

Just read your profile info. Sounds just like me and your success helps inspire me to keep at it!The 'heart' stuff is just awful. I never feels right on a daily basis. It pounds, skipped beats, often huge ones, rapid one minute, weak the next. I suspect an adrenal problem also as I lived on my adrenaline for years due to constant stress and trauma. How did you help your adrenals?

By the way when I try the night time dosing, how much time do I leave from taking the Hrt please?

[SlowDragon Administrator in reply to Rock_chick1]

Never taken HRT

….general advice is HRT minimum 4 hours away from levothyroxine

Propranolol helped with adrenal exhaustion

[Rock_chick1 in reply to SlowDragon]

Ok, then I will need to re assess the time I take that aswell. I'm taking a very very low dose of bisoprolol and it does seem to be helping

[Hidden]

I do same as Slow Dragon. The last 5 mcg T3 is calming and I wake up brighter

[Rock_chick1 in reply to Hidden]

Thank you. What time do you take your night time dose?

[Hidden in reply to Rock_chick1]

10 pm

[Rock_chick1 in reply to Hidden]

Thank you 😊

[Eddie83]

Have you considered whether your dosage fits within the full-replacement-dose guidelines? The full-replacement-dose of levo is 1.5-1.7 mcg/kg body weight. In addition, 20mcg liothyronine every day is roughly equivalent to 60mcg levo every day, assuming a T3 "power factor" of 3.0. So your total levo equivalent is 75+60=135mcg per day, which is a pretty large dose unless your weight is in the 80-90kg (175-200 lbs) range. Also, a T3:T4 ratio of 20:75=1:3.75 is quite a bit of liothyronine, even more than the 1:4 ratio seen in natural dessicated thyroid. If you have access to testing, I would love to see your TSH/FT3/FT4; bet you are getting into hyperthyroid territory, unless you weigh over 175 lbs.

[Rock_chick1 in reply to Eddie83]

Thank you. I never really thought about the body weight ratio. I thought that the dosing was very individual for all of us. Also how well we absorb and how well we convert. I am 79kilos in weight. You are welcome to look at my results below. Ft3 I'm told is slightly below range and FT4 pretty low hence the reason for increasing the levo from 50 to 75

Test results

[Eddie83 in reply to Rock_chick1]

According to these results, your FT3 is well up in range: 5.6 where range is 3.1-6.8. I.e. you are 67% up in range. And your FT4 is below range. So I would take this to mean that you need to reduce your T3 dose, and increase your T4 dose, esp. since your TSH is only 0.02 (quite low) and your FT4 is below range. For comparison, I weigh about 77 kilos and am currently on a daily dose of T3=7.5mcg plus T4=100mcg. I make it a policy to keep my TSH in the 0.1-1.0 range so if I have to switch docs, the new doc won't do a total freakout. I agree that individual variations and absorption are an issue; when I had gluten enteropathy, my gut was so bad that no dose seemed to work right, but the dose I'm on now, if not ideal, is close to ideal. Unfortunately, when one has been hypothyroid for a long time, that tends to hike nighttime cortisol, and that condition can interfere with sleep even after thyroid is properly treated. What I would suggest is, try to get your FT4 into the normal range (doesn't have to be way up in range) and FT3 within the normal range; middle of the FT3 range is good enough. Once you have done that, and if you still have sleep problems, try an herbal solution. Naturopaths commonly recommend Ashwagandha to suppress night-time cortisol, and yes it does work (for me, and many others). My specific program for sleep is: take one cap of MegaFoods Herbal Sleep (valerian,ashwagandha,passion flower,hops) at bedtime; take 1 cap of Physician's Choice ashwagandha (650mg) at bedtime; and take 1 cap of Physician's Choice ashwagandha (650mg) when I awake in the wee hours. I suffered badly for decades with middle insomnia, but now, these herbals help me sleep enough, that I feel good every day. Also, should you be in a country where cannabis is available, a low dose of a CBD+THC strain at wakeup time, can help get one back to sleep quicker than with just the above herbals alone, so long as you don't use cannabis very close to your morning wakeup time.

BTW, I no longer have the issue of being unable to do T4->T3 conversion. But when I still had gluten enteropathy and my gut was a mess, I could not get my FT4 up into normal range because taking T4 would cause extreme anxiety. There are patients who have T4 side-effects because they won't get off dietary triggers (e.g. gluten, dairy) and/or they are deficient in critical minerals like selenium and zinc. When I was in that state, I treated myself with T3-only. If T4 tends to give you negative symptoms like anxiety, putting yourself on a trace mineral supplement might help.

I have no financial interest in either MegaFoods or Physician's Choice. I mention those brand names only because they work very well, at least for me.

[Rock_chick1 in reply to Eddie83]

Than you for your advice. It's so interesting to hear what works for others