I’m having masses of hot flashes and I’m really tired. I’ve lost 10kg over the last three months (deliberately through low carb diet) but I’m thinking that might mean I’m now over medicated because I am less kilos than before. The other possibility is that I’ve not used my hrt patch for a few weeks. I’ve put one on now but it will take a few days to have effect and I’m not inclined to wait before reducing my 20 mcg t3 to 15 mcg leaving levo unchanged at 125 mcg.
Any thoughts please ? What other symptoms of over medication might distinguish it from omission of hrt?
my hands are not shaking, I think. Bowel is a bit loose but not majorly so.
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Pearlteapot
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You need carbs and calories for efficient conversion t4 to t3. It might be that your ft3 has dropped because of the more restrictive food intake. Reducing your liothyronine t3 dose if this is the case would cause more problems.I would get blood tests to check ft4 and ft3 before making any dose changes just to be sure you are making the right ones
Thanks. I’m doing blood tests. I do eat carbs in lentils and vegetables but not a huge amount. I’ve been fine on this diet for three months. Perplexed why I feel awful so suddenly.
Well I'd say skipping your HRT is the most likely culprit. It will have taken a little while for the hormone levels to drop. Why did you skip it?
Personally, if this were me, I'd slap that patch on and keep them changed as recommended and wait. Don't reduce your thyroid dose. As your oestrogen level comes back up a bit your thyroid needs will go back to what they were. Oestrogen means that thyroid meds can be bound to Sex Hormone Binding Globulin. So by skipping the patch not only are you feeling horrid without it, you have more available thyroid hormone swimming around. But by replacing the patch that excess hormone will get mopped up again. Hence my saying don't reduce the dose. Just get the patch back into play.
Thanks Alison for that interesting link. I have read similar articles that suggest in healthy people on a low carb diet T3 drops because less T3 is needed. Also important is that low carb is widely accepted as the best way to reverse pre-diabetic high circulating insulin levels and insulin resistance. That is the reason I changed my eating habits. If the thryoid itself or conversion of T4 to T3 in peripheral tissue demands carbs but the pancreas and liver say no thanks, we are suffocating in excess glucose converted to fat, there is a conundrum. One of the reasons that low carb is recommended for pre-diabetes is that a pre-diabetic liver and pancreas is overloaded with carb which has been converted into fat which impedes the functions of those organs. Depleting that fatty reserve is a key to reversing diabetes. In the absence of dietary carbs the liver converts non-carb food sources such as protein into the glucose that the body, particularly the brain, needs. If the brain can get glucose without eating carbs then I would assume the processes for thyroid conversion can as well.
That said, I'm not actually eating Keto, there is a fair amount of carb in the veg and pulses that I eat. Not sure if it is over the 100g mark.
If lack of carbs was my problem I think I would have felt ill within a month of starting low carb, which I started 3 months ago. It's more likely to be too much T3 which is no longer needed now that my cells are working better and I'm carrying less weight. I'm not sure that blood tests will give me much help on this as they only show circulating serum levels and don't give me any idea how much I actually need on a cellular level. I'll wait for them anyway.
when are your next blood tests due? I’d recommend finding out where your levels are.
I felt a bit hot and occasionally sweaty and found I was way over range. My weight had dropped steady 1kg a month but was staying off a bit too easily if I’m honest looking back.
I’m still in project reduction but went from 125mcg Levo and 5mcg T3 to 100mcg Levo 5 mcg T3 and was even more over range so have dropped again and signs are I’m just coming out of it. Could be a Hashi flare, could be ferritin supplement improving conversion could be weight loss, I’m lucky I’m being closely monitored. I’m watching my resting heart rate and HRV on a watch closely, it’s been about 20 beats a minute too high for me and I now down to normal resting for me in the mid 50s, previously I could hear my own heartbeat at bedtime, I didn’t know that was palpitations. my HRV dropped to 20 which is very low for me and is now back up in the 50s. Waking temperature is another thing to check, normal for me is 36.2, I’ve been up to 36.5 so am watching that come down.
I did a blood test today but not at my usual morning time pre-medication. I did it at lunch time before taking second dose of t3 to see what my levels were 5 hours after last t3 dose. I’ll get the results Thursday I hope. My hrv is all over the place. rHr likewise although today back in normal range which is also mid 50s. I’ll try my temperature tomorrow. Do you mean a regular thermometer (forehead) or is there some other method? I feel horrible. It’s weird because I have been totally well for the last month on this diet and this dose. It’s come on suddenly.
losing 10lbs can have an effect on how much Levo you need. I'm on the opposite side. I had to increase my calories because low calorie was wrecking my T4/T3 conversion so I put on 20lbs. I had to increase my Levo by 25mcg!
With autoimmune disease very low carb and low calorie diets can be harmful. Only you’ll know how low carb and calorie your diet has been. If you take the body’s perspective it’s been plunged into calorie deficit and perhaps responding thinking it might be a famine. So it starts to restrict calorie expenditure only to the most vital organs.
I was low carb for a few years and initially I felt and looked great but I had an awful flare of autoimmune eye disease and other stuff going on. Basically anything drastic or rapid isn’t good for us. Slow calorie reduction and just nipping back on excess carbs and anything that puts the body into stress I find works best. Our gut bacteria also need good carbs. Exercise is vital but again it’s hitting the sweet spot and not going at it too much so extreme fatigue kicks in and our bodies go into panic mode.
I would experiment with calming the body down with good food, doing an exercise you enjoy and consider breathing / yoga to get your body back in safe mode.
Not changing the hrt patch in a timely manor will cause hot flashes. You know this, right? I think it is dangerous to mess with thyroid meds without a lab. Thyroid hormones are much harder to balance than menopause hot flashes if you mess them up.
It is also correct that food is needed for thyroid meds to work properly. Just not with in 30min to an hour of taking them.
I just forgot about the patches because I've been travelling and got out of my usual systems. For some reason I didn't think the hot flashes would be due to that because I am 61 and well past menopause, so I went to T3 as the likely cause. But you're right, it could easily be the absence of HRT. I just read a web page about cessation of HRT ....
Some people never stop having symptoms of menopause like hot flashes. People who have never used HRT. Women in their 80's and 90's can still be suffering them. HRT doesn't put off the symptoms until later. If you stop HRT and find you still have symptoms, you would have had them anyway still, without the HRT. There is no need to stop HRT. But stopping it will affect your thyroid hormones.
Thanks FancyPants54 . I think you’re right I need to see how I feel now that I’m back on my hrt and give it some time. I’d actually forgotten how terrible I feel without it ( including insomnia). In my mind it had become a minor player in the symphony of hormone disregulation. Wrong!
However as far as its effect on circulating thyroid goes, I thought it’s only oral hrt that does that? I thought that was a reason for choosing a patch rather than tablet. Is that incorrect?
Well I only used transdermal HRT for a long time and I got very noticeable changes in thyroid need. We mostly aim for transdermal because it carries no risk of blood clot. The more oestrogen we have the more SHBG we have.
I use a mix of Lenzetto spray and Bijuve capsules. I tried reducing my sprays of Lenzetto by 1 a few months ago. It took a couple of weeks but goodness I felt grim. So depressed and not sleeping at all well. Needless to say I put the missing spray back and determined to just stay as I am for as long as I need too.
wow. One less squirt and such an effect. Are you feeling better now that you have re-instated it?
Before this, I had been mulling over going to see a HRT specialist because of reading about the possibility of needing more progesterone than a standard dispensed patch provides.
If anyone has a recommendation for a HRT clinic or adviser in London I'd love to hear. I searched a while ago and wasn't convinced by what I found (but will have another look.)
Oh I was fine again within a week when I went back to the dose.
I use the Newson Health Clinic in Stratford upon Avon. They now have a clinic in London. They are not cheap but the knowledge is excellent. Look up the web site for details of the outreach clinics.
New-ish in the UK. Been around on the Continent for some time. I really like it. It's the first time they have made a combined HRT product with Utrogestan.
You will be fine on the progesterone in the patch, but it won't be a bioidentical progesterone because there is only Utrogestan that is. So if you wanted to try it you would use an oestrogen only patch and take a nightly capsule.
I'd just like to say how much I appreciate all the comments here. In some ways it should be obvious to me, e.g. inadvertently stopping HRT... or obvious that it's T3... but it's really really helpful to hear everyone's views to help me be more systematic..
I tested midday, 5 hours after last dose of T4 andT3 and just before when I take my second dose. I usually test at 8.30am fasted so this is not a comparable test for T4. I did it to see what my circulating levels are during the day in normal life, following a discussion with Lalatoot a couple of months ago.
None the less -
T3 = 6.7 (3.1 - 6.8)
T4 22.7 (12-22)
I think I am overmedicated with T3 and very likely T4 even though the test was only 5 hrs after dose rather than the usual 24 hrs. I think I'll reduce T4 from 125 to 112.5 and T3 by 5mcg.
Does that sound sensible?
My next endo appointment is end of the month. He wont' be best pleased by me messing around solo with my doses but I think given my weight loss of 10kg I can justify reducing
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