Awful night sweats: hyper, hypo, other?

[Decant]

Hi.

I have pretty awful sleep, possibly worse since recently starting Testosterone Replacement Therapy (HRT for men if you like). I'm a 56 year old man.

I've been a long time member here and have had great advice about dosing and blood tests so I'd rather not post my results or detailed medication as that's not directly relevant to my question, but I'm on T4 and T3 and various supplements including magnesium and B complex amongst others. I have fairly decent sleep hygeine though it could be better.

I only sleep a few hours, waking about 2 ish really hot and sweating. I regularly notice that my sports watch that measures heart rate shows a sudden and significant drop (maybe 10 beats per minute but I've not measured) when I have these hot "flushes".

I struggle to drop back to sleep for hours, possibly related to my ADHD (2022 diagnosis).

So, are these hot flushes and heart rate drop indicative of going hypo or hyper, or maybe something completely different?

Thanks

[Lalatoot]

Woken up like that when I was hyper and after RAI, when I was undermedicated hypo so it's anybody's guess.

[Decant in reply to Lalatoot]

Oh! I had RAI 18 years ago so that could be me! I know there's room to increase both fT3 and ft4, but I don't know whether to increase or decrease. I suppose I should stick until my next bloods in about a month.

Thanks!

[Jaydee1507 Administrator]

I would check your thyroid numbers + key vitamins to make sure where they need to be first. If all of those are in the right place then perhaps it could be your ADHD. Sleep issues are very common with ADHD.

If this is something that has been ongoing then you could ask for a referral to a sleep clinic.

[bagpuss61]

Hot flushes are a sign your liver needs to detox. it does most of it detoxing in the middle of the night. Clean up your diet and take a small amount of milk thistle before going to bed, plus freshly squeezed lemon in cool water first thing in the morning, 20 mins before breakfast.

[helvella Administrator Thyroid UK in reply to bagpuss61]

Milk thistle has often been suggested but there are some specific effects it can have on our thyroid hormones. I would avoid it entirely.

This is a link to my blog entry about it:

Milk Thistle - Silymarin and Silychristin

We need to be careful regarding Milk Thistle. There have been many claims for Milk Thistle over the years. Often suggested for people with liver-related issues.

But the only person I know who tried it felt unwell from taking it. So I have long been cautious.

helvella.blogspot.com/2023/...

[RedApple Administrator in reply to helvella]

Comprehensive article on milk thistle on Thyroid Patients Canada, which specifically discusses it in relation to thyroid hormones thyroidpatients.ca/2022/01/...

[helvella Administrator Thyroid UK in reply to RedApple]

Have added that article - which is, as usual, excellent - as a link from my blog.

[Blissful in reply to helvella]

Milk Thistle - Silymarin and Silychristin

For me, this is indicative of isolating something (a studied active ingredient)wherein the whole plant is designed by nature to work synergistically.

I like A Vogel's Milk Thistle Complex Tincture - it's a combination of Cyanara (Artichoke) Dandelion, Boldo, Peppermint leaves. It's organically grown.

[helvella Administrator Thyroid UK in reply to Blissful]

It is, of course, entirely up to you whether you believe in the investigation, or not. And whether you take milk thistle products, or not.

At least by my and RedApple 's replies, you have the choice to believe or not.

[Blissful in reply to helvella]

At least by my and RedApple 's replies, you have the choice to believe or not.

I didn't mean or imply otherwise.

[Decant in reply to bagpuss61]

I've just checked my latest liver results (late May) and they are all normal. I've attached the results as an image.

[Decant in reply to bagpuss61]

I've just checked my latest liver results (late May) and they are all normal. I've attached the results as an image.

[Decant]

Results from 12th June (according to protocol):TSH 0.02 mIU/L (0.27 - 4.2) -6.4%

Free T4 (fT4) 14.2 pmol/L (12 - 22) 22%

Free T3 (fT3) 5.84 pmol/L (3.1 - 6.8) 74.1%

T4:T3 Ratio 2.432

I know there's room for an increase in ft4 but hyperthyroidism is one cause of night sweats so perhaps the sweats indicate I'm already going hyper.

I'm currently on 125 mcg T4 and 18.75 mcg T3.

Until trial stopped in 2017 I was on 75mcg T4, 20mcg T3.

SSRI's are another cause too. I'm taking 10mg Citalopram.

I'm waiting until 3 months (early September) after commencing TRT before testing again.

[SlowDragon Administrator in reply to Decant]

you might need slightly more Levo, possibly less T3

Do you normally split T3 as 3 x 1/4 tablet with last 1/4 at bedtime

What were most recent B12 and folate results

[Smorzando in reply to Decant]

My first thought when I read your post was to wonder if you were on an antidepressant.I had the most awful night sweats on a low dose of Sertraline and when on higher doses of Venlafaxine.

The night sweats stopped completely when I stopped taking Sertraline, and also when on a lower dose of Venlafaxine.

Is there a possibility you could look at switching to a different SSRI to see if it improves matters?

[Decant in reply to Smorzando]

Yes, I recently started Citalopram, but already tapering off as I don't like some of the side effects. TBH my sleep was bad before them, including a degree of night sweats, so they may only be part of the answer. They're not really helping anyway. Thanks!