Has anybody noticed activation of HPA axis with liothyronine use ?

[Caesard]

While adding T3 to a substitution mix after TT, soon after (6 years ago) had an extensive test battery that brought back an increased ACTH, with higher but still normally ranged blood cortisol.

Also, the substitution mixed kept my TSH supressed, but FT3 within limits, though in the upper side of the range.

I've felt good, brain fog supressed as well, depression bouts gone.

That activation via ACTH has been confirmed multiple times over the years, together with some ferritin and serum iron increase a bit over the range, possible causes of a mild exogenous, mild thyrotoxicosis, while serum cortisol never went above range, urinary cortisil was normal and a multi-point cortisol test looked a little bit on the lower side.

Dexa supression test performed two times, came back normal, as well as glucose tolerance tests.

Hypothalamus scans were normal. Other causes of ocult acrivation via ACTH were excluded (ex exogenous tumor acth production/SCLC)

Long story short, that ACTH stayed about 10%-25% over the max threshold for 6 years, while adding between 20 and 30 mg of liothyronine to 100-150 levothyroxine. So did the iron serum and sometimes ferritin.

Now, this year, decided to decrease liothyronine to 10 mg and kept the t4 to 150.

Magically, it all came down to normal in 2 months. First time normal ACTH, normalization of serum iron and ferritin, serum cortizol a little but lower, but within upper quarter of the range.

Therefore the question - have you ever noticed ACTH/HPA activation with liothyronine or slightly supraphysiological doses of thyroid hormones?

[radd]

Caesard,

Yes, adding T3 miraculously raised cortisol levels that had been on the floor for years. Also DHEA and aldosterone normalised. I don't think it's just the increase in metabolism created by T3 but having its actually presence induces many biochemical changes not understood by hormone specialists.

All hormones work together and are reliant upon one another. Therefore a deficiency in one hormone eventually will effect all bodily systems, and adding T3 lifted my brain fog almost immediately, and improved bone density over several years.

[Caesard in reply to radd]

Hey there, I've noticed the same great effects in cognition and even metabolism, but my concern is that T3 (probably in conjunction with T4 too) and related, prolonged, (mild) hyperthiroidism might negatively affect the HPa activity or balance in the long run. - therefore my enquiry about ACTH, cortisol levels exceeding thresholds.

[radd in reply to Caesard]

Caesard,

Are yout TFTs massively over range then?

Our sweet spots vary and a suppressed TSH isn't always an indication of overmedication. Some have actual dysfunctional HPT/HPT axis, whilst others, eg Hashi conditions or unmanaged hypothyroidism can induce dysfunction as in my own case but the treatment is the same and that's to replace the missing hormones.

[Caesard]

Actually the HPT axis looks great, aside suppressed TSH which is a direct side effect of liothyironine use.

Decreasing the intake of T3 made it look even better, as the TSH moved from the bottom ththe FT4 increased whike FT3 remained near the begining of the superior 1/3 of the range.

Probably T4/T3 conversion was tanked...I presume.

I've kept an overly supressed TSH for the last 5-6 years, using between 20-30 mcg T3 and 125-150 mcg T4 daily.

Now I am running with 150 T4 and 10 T3 and my constently above limit ACTH came back to normal for the first time in years, while I am still doing good from a symptom relief point of view.

[radd in reply to Caesard]

Caesard,

Then stick with this dose. Thyroid hormone replacement meds are about alleviating symptoms and not trying to remain with a TSH in-range.

If you read further posts on the forum you will quickly see a large proportion of unwell members being prescribed inadequate amounts of meds by doctors held ransom to the TSH level.

Look further and you will see many papers written and posted by Diogenes, our Independent Analyst and also by the American specialist Antonio Bianco that evidence a suppressed TSH is of no consequence as long as thyroid hormones remain within range.

[Caesard in reply to radd]

That's the plan, thanks! I was on the other side as well, being treated by TSH and that was a living nightmare...this is how I've ended up with the liothyronine in the first place But now it seems to point out that too much of it might be disruptive of other hormone's balance.