Levothyroxine and cortisol/supplements timing

[seveneleven]

Hi everyone, finally had an appointment with a private thyroid specialist who has prescribed a starter dose of Levo (75 mcg), which I'll start next week. Have Hashimoto's and currently taking supplements to improve vits etc. I have very low cortisol most of the day (from Regenerus test) so have been taking adrenal cortex the last month (very gradually increasing and now settled on 300mg first thing in morning and 150/200 before lunch). The cortex has definitely helped, and my understanding is that supporting the HPA axis for a little while before starting thyroid meds can help avoid crashing the system. I'm not sure though how to approach Levo timing though with cortex and supplements, and not over-stressing adrenals.

I know it's very individual morning vs night but wonder if anyone has been in the same boat taking Levo with low cortisol and could comment? Should I be splitting the Levo dose to make it gentler, or does it not make a difference? How long would I need to leave between Levo and other supplements if I took it in the morning? Recent bloods and supplements below.

April 2023 Medichecks (8am):

TSH 6 (0.27-4.2)

Free T3 4.6 pmol/L (3.1-6.8)

Free T4 16.3 pmol/L (12-22)

TgAB 261.2 kIU/L (0-115)

TPOAb 286.2 kIU/L (0-34)

CRP HS 1.06 mg/L (<3)

Ferritin 30 uh/L (30-150)

Serum folate 8.8 (8.83-60.8)

Active B12 84 pmol/L (37.5-188)

Vitamin D 69 nmol/L (50-250)

Supplements

First thing in the morning (about 45 mins to an hour before breakfast):

Adrenal cortex (300 mg), heme iron, B complex and extra folate, vit C (magnesium ascorbate), D3 + K2 spray

Before lunch:

Adrenal cortex (150/200 mg depending how morning has been)

[SeasideSusie Remembering]

seveneleven

Levo should be at least 2 hours away from other meds and supplements (4 hours for Vit D, magnesium, iron) so that nothing affects it's absorption.

You should take your iron 2 hours away from another other supplements, iron affects their absorption.

When I took adrenal supplements I didn't split my Levo, but you could try and see if it makes a difference, if it doesn't and it's not convenient then go back to once daily dosing. I always take my thyroid meds around 3-5am when I regularly need the bathroom.

[TiggerMe Ambassador in reply to SeasideSusie]

The joy of heme iron is that it isn't an issue to other supplements like ferrous fumarate is 😅

[seveneleven in reply to TiggerMe]

Ah of course, yes! Though now you've said about C and B, seems sensible I move the iron to lunch time anyway so it can still be friends with the C.

[seveneleven in reply to SeasideSusie]

Thank you - I didn't know that about iron, so will move iron and C to lunch time. I suppose just trying once daily at first for Levo make sense and then see what happens...splitting might be a pain because I'll have 25+50 tabs (didn't want Teva), but will see. My sleep is quite light, so I try and avoid doing anything except going to the loo almost eyes closed so I don't start thinking and wake up too much 😑

[TiggerMe Ambassador]

Hmmm... first I'd suggest moving your Vit C away from your B complex as I seem to remember they effect each other... I think C's tie up B's or the other way around 🙃 (that's why multi vits get shunned here)

I think the low cortisol is more of an issue when adding T3 as it is like an instant hit of active hormone where as T4 is a slow burn storage hormone that needs converting and as you know works better with good levels of B12, Vit D, Iron and Folate etc which you've got covered.

So if you don't want to mess up your current regime I'd suggest taking it at bedtime as it really want so be 4 hours away from any other supplements and on an empty (2h after eating) stomach 🤗

[seveneleven in reply to TiggerMe]

Thanks Eeyore, will move my C to lunchtime with the iron. Seems to make sense taking it before bed...I guess I'll find out pretty quickly whether I need to split or if night time doesn't work!

[seveneleven]

Hi, I'm using Adrenavive II (150 mg caps) but have used Nutricology as well, both good, though I think Adrenavive for me is a little stronger, and some people seem to react differently to the two. I'm taking 300mg first thing in the morning and same again before lunch, around midday - this is a high dose though because my cortisol is extremely low, and I went slowly, starting with Thorne brand, which is 50mg, and going up in 50mg increments until I felt some improvement. Morning temp tends to be around 36 and late evening anywhere from 34.5 to 35.5. Wouldn't expect improvements in temp for a while though because of only being on a starter levo dose, so it's a bit chicken and egg.

[Sneedle in reply to seveneleven]

Hi seveneleven,

You just replied to me on another thread (Pj16 I think) and so I looked up your 'Cortisol Journey' as it has parallels with mine. Unlike you, I had a 509nmol GP AM cortisol reading, but like you I have low cortisol on the Regenerus test - also Phase 3 fatigue. The 509 has got me confused with some members here suggesting it's a good indication my adrenals are working fine, and others suggesting I need to speak to the GP about a synacthen test.

I''m interested to see you took Thorne adrenal cortex 50mg for a while - how long did you take it for, and how quickly did you increase by 50mg - every few days, once a week? What was the highest doese of Thorne you reached before starting Adrenavive?

Which dose of Adrenavive II did you start on?

Thanks!

[seveneleven in reply to Sneedle]

Hi Sneedle,

Welcome to the cortisol club! I think with synacthen, if you can get one, great, but with a high serum reading your adrenals may well be OK in terms of capacity to produce cortisol, just knackered. Very unlikely GP would refer - I couldn't get one, and my serum cortisol was just below range. DHEA is important as well.

I didn't get anywhere on the adrenal cortex - got up to 700mg a day. I went slowly, starting at 50 Thorne then switching to Adrenavive II, increasing every week as long as I didn't feel any negative effects. Some people do really well on it - just have to try and see, and go bit by bit, paying attention to how you feel and things like heart rate and temperature. I'm now on hydrocortisone 25mg a day, and it's made it possible for me to tolerate T3. Early days still though, and COVID has now knocked me back, but before that, my HR was increasing nicely (from 40s), and body temperature becoming more like a human than cadaver finally. I've also started LDN, but that will take quite a while probably to see any impact.

[Hidden in reply to Sneedle]

Sneedle, saliva is unbound and available, blood is bound. It is a bit like when you see total T3 on the thyroid blood panel and you just ignore it, finding “free T3” far more useful.

It is about transporter proteins and I seem to remember humanbean having some great resources on it.

pubmed.ncbi.nlm.nih.gov/631...

[seveneleven]

Aye it was 'normal', but only just within the range. It's stage-3 dysfunction because the overall pattern is low then slightly up at night, even though the 'up' would still be low for most people! My low temp is also because of years of untreated thyroid, so would expect it to stay low for a while - temp certainly hasn't changed since taking cortex, but they all need time!