T3 and dropping cortisol levels

[Pearlteapot]

Since starting on T3 6 weeks ago my morning cortisol level has dropped. I know that Paul Robinson says that taking T3 cannot affect cortisol levels. I am trying to understand what might be going on before I see my consultant next Thursday.

I am here talking about 9am serum tests because that is what my consultant regards as reliable rather than a saliva test. I will do a saliva test soon anyway for my own purposes.

16 November 2022 353 n/mol (172-497)

24 January 2023 263 n/mol (same range)

I take 125 Levo at bedtime. 5mcg T3 at 4am and 5mcg T3 at 1pm. I usually sleep deeply after taking the morning T3, my heart rate goes low and I wake up feeling very refreshed, usually. The day of the test I hadn't taken T3 at 4am as I usually do because I wanted a 9 hour gap between T3 and testing. I had slept badly and felt awful. Perhaps that alone could explain the drop in morning cortisol?

I'd like to think so, however, I also feel awful in the afternoons. Really deeply fatigued and a bit headachey. I'm not sure if it is because I need more T3 or because of low cortisol. My instinct is that this is a cortisol problem as I'm now very familiar with the feeling of being undermedicated on T3. How will I know what is what? Paul R suggests that adding T3 can improve cortisol levels. Again, I'd like to hope that will be the solution, but my cortisol levels have dropped rather a lot.

My last Thyroid results on 24 January were

T3 5.6 (3.1 - 6.8)

T4 20.7 (12.0 - 22.0))

TSH 0.04 (0.30 - 4.20)

I expect my consultant will order a SST Test, but I'm trying in the meantime to understand what might be the relationship between having started T3 and the drop in my cortisol levels. I really don't want to be starting on hydrocortisone so I'm hoping this is some kind of temporary blip.

[Pearlteapot]

healthunlocked.com/thyroidu...

Here is an example McPammy whose cortisol levels rose after introducing T3

[PiggySue]

Hi Pearlteapot

I think in fact that Paul Robinson says that for some people cortisol levels drop ( at least when on T3 only). That is why he says that some people improve on the CT3M. The circadian T3 method (CT3M) asks you to follow your vital signs (BP and pulse) to check when you are getting the best from your T3. A very early dose of T3 (say at 3.30am) can mean that by the time you wake your cortisol is raised enough (for those with low cortisol) that you find it easier to have the energy to get up. He recommends starting systematically and finding the optimal time to take the first dose over several weeks or months.

T3 can also raise cortisol in some people. We are all individuals and our response is very individual as well.

You would need to read his 'Recovering with T3' book to really follow the method properly.

I have had such low cortisol that I have been sent for tests to see if I had Addison's but luckily I don't. I am not sure that I have got it correct yet, but settled with 5.30am for my CT3M dose and feel a bit better for it.

His books are really useful and informative and he does take private consultations (not that I have had one, but I have considered it).

I hope you find an answer!

[Pearlteapot in reply to PiggySue]

thanks for the detailed comment. I have started looking at his website and can see I may well need to start understanding and applying his method. I take my 4.00 am dose in a vague attempt at circadian rhythm, it feels good but is a bit haphazard as I don’t test anything except my heart rate. More studying needed

[SlowDragon Administrator]

I would suggest you might want slightly less levothyroxine and add a third dose T3

Only change one thing at a time

Perhaps try reducing levothyroxine to 112.5mcg 4 days week and 125mcg 3 days

After 6-8 weeks retest thyroid levels

Then try increasing T3 to 3 x 5mcg

Dose times - experiment……but initially perhaps 6am, mid afternoon and bedtime

Are vitamin D, folate, ferritin and B12 levels optimal

[SlowDragon Administrator]

As you have Hashimoto’s are you on absolutely strictly gluten free diet and dairy free diet?

Get coeliac blood test done BEFORE trialing gluten free

[Pearlteapot]

Yes I was thinking of reducing T4 and adding another dose of T3 but it’s the dropping cortisol that has confounded me. I don’t want to add more T3 if it makes cortisol drop further. I was going to drop T4 to 100 but prefer your suggestion of a very small drop.