What to do about T3 anxiety?

[KarmaMaya]

Hi Everyone, I was Diagnosed with Hashimotos in 2011. Started with 25mcg Synthroid, over a number of years settled on 80 mcg Levothyroxine compounded SR with 12 mcg Liothyronine. Had thyroid lobectomy in November 2021 and my new endocrinologist switched me to 88 mcg Tirosint and 5 mcg Cytomel. I am experiencing some increased anxiety, shakiness and irritability. I really liked the SR compounded version of the T4T3, but my endo says that the compounded drugs are too inconsistently absorbed and hard to monitor. He refuses to prescribe SR T3 for me. I am wondering about spliting cytomel doses (or maybe I should just stop the T3)? I can always abandon ship with this endocrinologist and go back to my integrative health nurse practitioner who will prescribe SRT3. But I want to give him a chance. Any ideas?

[Alejandrita17]

Why did they prescribe t3? Did you have poor conversion?

[KarmaMaya in reply to Alejandrita17]

I wasn’t feeling well just on the synthroid so did some research a number of years ago and found some people feel more energy and clarity with a little T3. Added it in a compounded SR version. Felt noticeably better.

[Alejandrita17 in reply to KarmaMaya]

Which is your t3 level? T3 also acts as a stimulant, so it's not uncommon that you feel more "energetic". If you took drugs, you would feel more energetic too. I think the fundamental question here is: do you REALLY need t3? Is t3 the real cause of your not feeling well? Which is your current level?

What about nutrient levels? What about other comorbilities? What about your gut and liver health?

[Hidden in reply to Alejandrita17]

I am interested in your choice of words: "if you took drugs, you would also feel more energetic". In English, the word drug simply refers to medication. It does not refer to anything illegal.

In many languages, that same word refers to illegal substances.

So, when you say that "drugs" can have the same effect on the body as T3, do you mean "medication" (of any kind) or illegal substances? That is an important distinction.

[shaws Administrator in reply to KarmaMaya]

I couldn't improve at all on levothyroxine (T4).

T4 has to convert to T3 but some people cannot do so effectively. I had severe palpitations on T4 and the cardiologist was puzzled why.

I felt much better when T3 (liothyronine) was added to T4 and then I went onto T3 alone and health was restored. I no longer had to consult the cardiologist.

I have had no clinical symptoms on T3 only and it isn't a high dose. I am symptom-free

[humanbean]

I am experiencing some increased anxiety, shakiness and irritability.

I'm just repeating my own experiences (I'm not a doctor), and they might not be relevant to you.

My anxiety got fixed by treating my very low iron and ferritin (iron stores).

Another factor was that a 4-part saliva test showed my cortisol levels were very, very high. I tried lots of suggestions from the internet on how to lower cortisol (this was several years ago now and I can't remember everything I tried), and the one that worked for me was Holy Basil by Swanson, specifically this one :

lifestylevitamins.co.uk/pro...

We would need to know your results and reference ranges for a full thyroid function test (TSH, Free T4 and Free T3) to have an opinion or a suggestion on what you should do about your T4 and T3 doses.

[KarmaMaya in reply to humanbean]

Thanks for the holy basil tip. What time of day do you take it?

[humanbean in reply to KarmaMaya]

Just before bed.

[humanbean in reply to KarmaMaya]

Please don't take anything to lower cortisol unless you know that your cortisol is high. Lowering cortisol if it is already low will make you very unwell. The other problem with cortisol is that "diagnosing" low or high cortisol based on lists of symptoms doesn't work because the symptoms for low and high cortisol have a lot in common.

I had to test to find out my cortisol status. I used a saliva test where I spat into four tiny tubes at specific times of day and sent them off for testing. You need a test which tells you about cortisol levels and DHEA levels. DHEA results are usually averaged over the day and you get one result or you get given a morning and afternoon result, it depends on the company doing the test.

[SlowDragon Administrator]

Get bloods tested 6-8 weeks after any dose change

Suggest you test vitamin D, folate, ferritin and B12 levels too

[radd]

KarmaMaya,

The lobectomy will have caused trauma to your body at the same time your new endo has changed your meds. ‘anxiety, shakiness and irritability’ are often signs of struggling adrenals.

(80 + 12 = 80 + 36 = 116 SR) (88 + 5 = 88 + 15= 93 non SR)

As you are on a small dose of T3 if we use a ratio of 3x, you are slightly under-medicated and not able to spread your T3 over the day as SR previously allowed. You could try splitting your 5mcgT5 into 2.5mcg to take am & pm.

Alternatively if you have recent TFT’s which show there's room for an increase you could ask endo for another 5mcg T3 so you could split dose am & pm.

Whatever, I would ensure iron and nutrients are optimal as this will help both thyroid meds work better and support the adrenals. You could also try some adrenal supports such as an adaptogen or adrenal glandular.

Post recent TFT's complete with ranges (numbers in brackets) in you wish members to comment.

[KarmaMaya in reply to radd]

Hi, my last TSH number post surgery was .008. Way over medicated. So at that point my endo lowered my dose from 100 mcg T4 and 10 mcg T3 to 88 mcg and 5mcg. So I went from 80/12 SR compounded with a TSH of 4.53 to 100 tirosint 10 cytomel with TSH of .008, to now 88 tirosint 5 cytomel and I will get tested again next week. I will let you know. Thanks for your support. Been here before and it is a bummer. I am so moody and irritable 😠

[waveylines]

I didnt get on with synthetic T3 when added in because I found I eould have spikes of feel anxious that even splitting the dose didnt get round. I found a ndt worked much better for me and on it I felt normal, on an even keel. If the SR worked for you it makes sense to get back on it. If necessary see someone else who does agree with prescribing a SR. Different meds work for different people. Its always a question of getting what works best for you which is why people often also have brand favourites. Dont let this endo put you down you know what you feel best on.

[KarmaMaya in reply to waveylines]

Hi, thanks for sharing your experience. What is ndt? Are you taking just straight levothyroxin? How much? Do you have hashimotos?

[waveylines in reply to KarmaMaya]

Ndt =Natural Dessicated Thyroid Extract You are on Armour that is a ndt. Others are Erfa, Thyroid S. & a couple more whose names can't remember lol.... 🙂

[DippyDame]

Without full thyroid results it's difficult to commentYour FT3 should be within range to avoid overmedication

Too much T3 can cause "increased anxiety, shakiness and irritability"

Was T3 added due to poor T4 to T3 conversion?

Dosing by TSH alone does not give the full picture

[KarmaMaya]

Yes, we added T3 years ago to increase my energy and clarity. I was in range but still sluggish and depressed just using T4.

[greygoose in reply to KarmaMaya]

If this is a reply to DippyDame , she won't have seen it because you didn't click on the blue 'Reply' button under her comments.

It's pretty meaningless to say your FT3 was 'in-range'. Just being 'in-range' is not the same as optimal. If you had had a conversion problem, your FT3 would have been low in-range, causing symptoms like sluggishness and depression. Always best to give the actual numbers if you want people to help you: results and ranges. Then you'll all be singing from the same hymn sheet!

[DippyDame in reply to greygoose]

Thank you greygoose...

[greygoose in reply to DippyDame]

You're welcome.