I have a Q, I’d really love some opinions if you have the time/interest.
Why is it that overmedication can lead to worsened hypothyroidism in some people? I understand and believe the rT3/D3 debaucle. But I have seen people report similar experiences when on T3-only where rT3/D3 impact will be much lower… is it that if overmedication of T3 is happening then up-regulation of T2 will happen?
Does anyone know the mechanisms at play in this situation? I’d love to know/read anything anyone might know on it.
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radd SlowDragon I hope you don’t mind the tagging, but thought you might have some theories x
Oh SD I think I have misunderstood. I thought it was a well known phenomenon on the forum, where over medication can make you feel hypothyroid… have I got that wrong? 🙈
'is it that if overmedication of T3 is happening then up-regulation of T2 will happen?'
Exactly 👏, becauseD3 doesn’t differentiate between either hormone. It works as effectively to inactivate T3 as it does T4.
Worth remembering there is different metabolites of T2 and if hypo symptoms are felt whilst over medicating T3, then it's obviously metabolising to an inactive form of T2.
I see. And so this sweet spot in terms of dosing, how do you think dose raises are best executed?
For instance, I have raised T3 by 5mcg weekly and found that fine. I have raised by 25mcg T4 at 4 week intervals (and I have used bloods at 8 week intervals for guidance) and ended up feeling quite a toxic mixture of both hypo and hyper - BBT readings are high (36.6-36.8) and energy is astonishing, but I am also sweaty, gaining weight instead of losing it, and very anxious.
I have never, ever seen my BBT above 36.3 prior to HC + thyroid hormone, the BBT makes me think my metabolic rate is rising, BP has also normalized and then recently gone a touch too high.
I think it’s either raising too fast or raising to too much… unsure which.
SlowDragon what’s weird is that when I was first put on levo 10 years ago, I could do a dose change of +\- 100mcg levo in one go and I would notice NOTHING. I wouldn’t feel good or bad, it was like taking a sugar pill. I did it to appease doctors and their blood tests. Now I seem to be much more sensitive but perhaps because I take hydrocortisone im actually metabolizing it finally? I don’t know. It’s a mystery.
I would say (at a guess coz am no expert and have never medicated HC) that it is your adrenals not corresponding to the metabolic raise created by thyroid hormone increase. There are also other hormones such the sex hormones that have to correspond. We know from our cycles how aggressive these hormones can be when in synch and worse when not.
I would also be looking at the ratio of T4:T3 as you raise because you can't raise one and then raise the other to catch up. It doesn't work like that.
The answer to your post question is within the Tania Smith blog on D3.
I would say (at a guess coz am no expert and have never medicated HC) that it is your adrenals not corresponding to the metabolic raise created by thyroid hormone increase.
Appreciate your guess 🙏
I’m a bit stumped because I take HC, so I don’t know what more my body can want. I have tried increasing my HC dose by 5mg up to 27.5mg HC (that’s a significant HC increase) as I thought the same thing - maybe the thyroid demand is now too high for the adrenal input, but I didn’t feel any improvement - in fact felt worse possibly. The only bit of relief I’ve gotten is skipping my T4 for a few days. Pffffft. I am fed up. And I’m getting frustrated by the fact I don’t have a aetiology for my adrenal insufficiency. Lifestyle changes are looking more and more compulsory.
Yes, there are members suffering hypo symptoms through over medication as the common stance is to increase when hypo instead of assessing exacting why meds aren't working.
You will note on many of my replies I type 'if thyroid meds are inadequate or not working' because some might be medicating the exact right amount but meds are inactivated through elevated D3 caused by iron/nutrient deficiencies or chronic autoimmune inflammation.
I have fallen into a trap of thinking the medications will sort it all out and I can just sit around eating wotzits until it makes me better… think I need to start taking some more accountability 🙈 I’m likely fueling systemic inflammation with my lifestyle, and I am know that things don’t work properly in an inflamed environment…
The way I think of it is we have two immune systems - the normal that is helpful killing pathogens, etc and the auto that kills own self 😳. And once a cell gets in that 'auto danger response mode' it is difficult to quell, because inflammation leads to further inflammation as these highly response cells are sending out furtheriand further inflammatory signals.
Sorry just jumping in...there's some good info out there on the relationship (often lack thereof) of diet and fatness that might be worth digging into...perfectly possible to be a very fat and healthy person, so we can't really know what a person's health is like by looking. Also plenty of thin doctors with horrendous views and completely unsound practices. Aubrey Gordon is an excellent source worth knowing, highly recommend her writing x
Radd has put it better than I could, but no, it's not different. 'Morbidly obese' is arbitrary term used to medicalise fatness and is considered offensive by a lot fat people. The BMI is a meaningless way of categorising people - it was created by an astronomer hundreds of years ago as a statistical measure of averages across populations - it was never intended to be used to measure someone's health. It was picked up by early American insurance companies as a way to more easily work out what premiums to charge people. According to it, I am 'obese', but it's genetics and thyroid and a whole bunch of things, and even if it wasn't, it's just a type of body - even very fat ('morbidly obese') people are not wrong for having that body.
'Obesity' was labelled as a disease in itself in recent decades against the recommendations of researchers, and it's all very tied up with funding for pharmaceutical companies and the diet industry. Overnight, millions of people 'became' obese because the criteria were changed - creating many more people who 'need' weight loss drugs, surgery, diets that don't work, etc. The largest review to date has found no evidence of a substantially increased risk of any health problems with being fat - there are, however, huge consequences of bias, with people being denied vital healthcare and experiencing poor mental health due to discrimination and lack of accessibility.
I think it's helpful to maybe think about where our prejudices about fatness come from, because it's very much conditioned by industries and what we've been brought up on. If we fear becoming fat because it's hated by society, then being fat beyond a certain point becomes a moral failing. I say this having had to do a lot of work to unpack things for myself.
Definitely read some of Aubrey Gordon's work. The podcast she does with the journalist Michael Hobbs, Maintenance Phase, is also a good source of well-researched debunking of diet and wellness stuff. Sorry for the info dump, just something I feel strongly about these days! x
I don’t think it is “wrong” to be fat, I am fat myself but I am fat because of my health problems, I can’t ignore that correlation. I would not choose to be fat, it is surely no coincidence that I am fatter the worse my health is, they’re definitely connected no matter what society has to say about being fat (I don’t care about what society thinks of fatness) and I’ve received appalling medical care - misdiagnosed for decades and stuffed onto numerous incorrect treatments etc. I was never fat during those times, I was actually very slim. I think the bias was probably more related to my being a woman with psych issues and the glorification of TSH.
I’m not putting a moral value on being fat or otherwise, it’s not a moral question it’s a physiological one. I certainly don’t desire to be fat for so many reasons - it puts weight on my joints that gives me pain, it gives me chaffing between my thighs that’s uncomfortable, I overheat more quickly, I get out of breath more easily which limits my movement, etc. I don’t want fat around my organs or to have higher levels of inflammatory compounds or insulin resistance risk, as Radd said.
I can see that people have different set points for being healthy with more weight on their frame, but I really think that that is very different to the pathological place of morbid obesity. Datis Kharrazian in live videos often wheezes, and is undoubtedly morbidly obese. I find it very odd that he should be giving advice to women about how to lose weight. Ad hominem arguments always have their weaknesses but there is something incongruent to me about what he is preaching and the body he presents it with, his books are about optimising metabolic function . Jack Kruse is the same.
I’ve read a lot about living healthily in a fat body by Jessica ash wellness, and for a while I tried living inside my fat body trying to ignore the fat part, but I know that isn’t right for me, for me it is definitely a sign of pathology. I guess I personally know that when I am fat it is it because I am hypothyroid and then I am hypothyroid, I am unhealthy and unhappy.
Excess weight, especially obesity, diminishes almost every aspect of health, from reproductive and respiratory function to memory and mood. Obesity increases the risk of several debilitating, and deadly diseases, including diabetes, heart disease, and some cancers.
Does that irony bother me? No, he looks well. More likely bother his wife! 😁.
It is said that weight gain is more likely to increase inflammation and encourage conditions such as insulin resistance but some are genetically more capable of carrying it with a wider window of tolerance.
Going back to your post's original question regarding T3 mechanisms of overmedication, it isn’t just T3 metabolising to inactive T2 but involves other metabolites too.
Just as the outcome of our meds (and Datis's girth) are influenced by infinite factors (other health conditions, environmental factors, genetics, child hood experiences, etc) so are the pathways of the inactivating metabolic processes of thyroid hormones.
‘The body places a very high biological priority on the supply of circulating T3 to the blood stream’ and these systems allow numerous ways to both excrete and retain T3 levels to maintain homeostasis in an ever changing flux.
RT3 is the well known inactivating metabolite but there are actually 12 pathways, (6 for T4 & 6 for T3) and each of these might then metabolise into an influencing 'something else', and so on, numerous times if recycled, and in infinite combinations. Should one be out of kilter (say, through genetics) this can be magnified many times over and over.
And all the basics the forum talks about such as iron, nutrients, cortisol, balanced sex hormones, and healthy life style 😁, etc, allows these systems best performance.
Thank you Hidden for this interesting (though somewhat over my head) thread. radd can you please explain a bit more what you mean by this:
I would also be looking at the ratio of T4:T3 as you raise because you can't raise one and then raise the other to catch up. It doesn't work like that.
When hypo, isn’t raising one at a time best practice (and recommended on this forum) to know which one has what (negative or positive) effect on symptoms, with the goal of eventually finding one’s ideal individualized FT4/FT3 ratio?
Didn’t sleep a wink last night so apologies if I’m misunderstanding something obvious
'Hidden' means the person has sadly left the forum 🙁 but I will reply to your question.
'I would also be looking at the ratio of T4:T3 as you raise because you can't raise one and then raise the other to catch up. It doesn't work like that'.
This is intended for combo med users only. I hadn't followed dfc’s previous dosing regime but here she advises ‘I have raised T3 by 5mcg weekly and found that fine. I have raised by 25mcg T4 at 4 week intervals’ as if regarding each hormone as an individual entity when in fact their influence on each other is great.
It is usual to start with T4 meds but not to only raise T4 levels but raise T3 also. The mechanics of encouraging (better) conversion after years of being left hypothyroid can take a few weeks/months and are dependant upon remaining thyroid gland and adequate/consistence levels of vital cofactors. If improved conversion doesn’t happen, we then add in a small amount of T3.
Adding T3 can up-regulate the conversion enzyme (this is normal) meaning we then accumulate more T3 than we have medicated but this phenomenon can result in ‘excess T3’ as in exceeding our T3 window of tolerance which the body then deals with by deactivation. Hence the forum advocates low and slow T3 introductions and dose raises.
Dfc also had the added factor of cortisol and she claims to have raised her HC dose up to 27.5mg. Thyroid hormones requires cortisol to function well (hence the Paul Robinson 3am protocol) and so again must be factored into the raising of thyroid meds and this new HC dose might have dictated an even slower thyroid hormone dose raise of both hormones and possibly less with higher amounts of cortisol as Dr Peatfield always maintained to address the adrenals first.
Altering the cortisol dose after meds risked altering the efficacy of the meds. For instance changing the speed at which T3 is transported into the cells that creates better activation (energy useable T3) but may also ramp up T3 deactivation if T3 meds weren’t reduced. However, would you reduce T3 or T4 meds? 🤷♀️ Given all the factors explained above you can see its much easier to add meds than to have to start taking away.
It is important to match all systems together and because we each have different metabolic inefficiencies that respond differently to given meds, we each have our own individual ratio that can only be found through low dose raises and sympathetic titeration.
Above 50mcg I had to raise in ~6 mcg increments per ~6 months over a period of years. I had fun trying to get that amount with only 75 & 100 mcg tabs (i need to take the same amount every day). Same story with T3 - very slow raises. And that was only after I fixed my low b12 & low cortisol status
I too was impatient and tried the frequent raises and became very very ill, a mix of hypo & hyper, one of the worst feelings in the world, so i feel you! A bit easier to 'just' feel hypo , even tho that too feels miserable.
It’s funny you say that Jade because I have been saying to my friend I miss the days of being just hypo.
I’m surprised you had to raise so slowly even with your B12 and cortisol “fixed.” But it gives me a bit of hope actually… maybe I have just bombarded my system much too quickly? I have been getting some relief by skipping my T4, never thought the familiar embrace of hypothyroidism would be so appealing 🥴
🤣 sorry for laughing but yes i know exactly what you mean!
I guess 'fix' wasn't the right word because recovery from low b12, especially, has taken years - and as recovery improves, i've been able raise. If i had been 100% right off the bat, i'd probably have been able to raise in a more typucal way.
Yes sounds like too much too quick I may be an extreme case though so maybe you don't have to go as slow as me lol... I also did the dropping T4 for a few days when getting hyper symptoms. When that would happen, i'd know the raise was too soon.
Btw i too did large increases in levo when i first started levo 15 years ago. Got up to 135 mcg no issues! That was before the (functional) B12 issues started!
Yes & no. The Addison's was progressive over many years, in retrospect. I had had hyperpigmentation for many years and some 'mild' symptoms. It finally hit hard about 3? years after starting levo - we moved house, i started a new job, and a new GP said I was overmedicated so dropped my levo to 75mcg. I quickly reupped it back, but crashed bad. Starting cortisone helped a lot but in retrospect the low b12 had already started even before I started levo.
I carried on doing great for the first year on levo & cortisone , ok'ish for the second year, but then started going downhill, getting worse until the final crash about 2 years after that.
Low b12 symptoms were obvious were retrospect but no one recognized them including me, and for the most part i thought it was all low cortisol symptoms and no one on any forum had any idea, until my arms became numb and literally paralyzed along the outer ulnar nerve - had no use of my pinky & ring finger on either arm and no strength at all in my arms (for example I couldn't squeeze a ketchup bottle to save my life) - then someone on an Addison's forum told me about pernicious anemia & saved my life, and i will always be very grateful to her.
Note that right before the paralysis, i could only tolerate 12.5 mcg T3 because any amount of levo and any more T3 caused burning all over my body. My GP insisted that the tingling, pins n needles, and other issues were because i was so swollen from being so hypo. She told me to go to 100mcg levo in one go. Totally against all my better judgement, i said what the heck let's make her happy.
Over 2.5 weeks, the burning increased until one morning i woke up without the use of my arms. I was in bed in agony for 3 days with intense burning all over. Of course i stopped the levo immediately & didn't restart until months later. It helped only marginally.
The 2 months after that are a blur except the GP appointment where I asked for more b12 testing and she shouted at me did i go to 7 years of medical school. Couldn't drive home from crying so hard. The other memory is getting on the PAS forum & deciding to self inject. After my 2nd injection i slept for 3 days straight and finally the burning subsided more or less completely, back to pins n needles etc. I do have memories from after maybe the 3rd month of injecting That was back in 2016, i've been raising my thyroid dose ever since. Finally got to 87.5 mcg T4 & 31.5 mcg T3 only within the last few years (i forget the exact timing).
It's also why i am obsessive about telling people about functional b2 deficiency - if i can spare one person that misery, i will be happy. In October i will have been injecting daily b12 for 7 years and i'm still not 100%, but finally very close now. I was unemployed for 4 years and have still only been able to work part time the last 3. I hope next year i can finally go full time.
Sorry to pop in but my B12 also did not show up as deficiency... I was in range, low but in range. I was very ill... Struggled to walk, blurred double vidion, numbness tingling, tremors, poor memory, processing was hard and do forth. Supplements did nothing for the horrendous symptoms. Daily B12, jabs were transformative. As was having to go GF. Both those two things addressed my uptake so much that I ended up reducing my NDT. My whole body shape changed. Blood test results were useful but did not reflect my symptoms and did not reflect this change.My advice would be to look beyond the blood test rezults. Keep a careful. Log of your symptoms what vits minerals you are taking with your blood test results together. I checked my temp/, pulse first thing as another indicator. Don't do this often now as am stable but it's my go to.
And do not increase/decrease thyroid meds monthly. It's too fast and it's causing your body to be in a constant state of flux because of it. And this stresses the body further, causes a confused picture so in the end you don't know what's dou g what.... And if you change doses do rapidly you will get hypo and hyper symptoms because your body is confused by all the changes and can't keep up..
The snails approach is the way forward. Tedious it is but it does work. I'm no good on the technicals of Rt3 etc I don't believe you have to be tbh to get this balance right. After all thyroid treatment was around long before the blood tests.... But I do agree blood tests can and do add to the picture but in my book are not the main feature. That's just me...
Well yet more theories and experiences around all this. DFC you were good enough to reply on my post recently. I was wondering about the state of my thinking processes but I can see you are experiencing something similar. I don’t want to comment on your journey as such, because I can see, like me (and oh so many of us) we are trying so hard to get it right. Each crisis many of us experience, does give us an opportunity to reboot/reassess and in my case eventually provide some relief by giving up on it for a bit. But it’s all incredibly stressing. I seem to have made some pretty basic but important mistakes - even with all the support, knowledge and advice received on the forum. It’s so far about two and a half years since diagnosis for me. I keep thinking this is much harder work than doing my Master’s degree. Of course we are trying to do all this whilst actually ill! Two and a half years of study and how much time do doctors spend on this subject? One afternoon? Granted (if they can make the connections) their wider education should fill some of the gaps in their thyroid education. We however have to access all that ourselves. No matter how intelligent they think they are, I think we can quite safely say that our knowledge outstrips theirs. Our experience off course is the basis of our understanding, which is entirely absent in most of their experiences. Not comforting at all.
Today I am grateful to live to fight another day. A huge improvement on yesterday!
Wow 😲, so blimmin interesting, thank you for sharing this really informative and interesting discussion. I didn't want the conversations to end. Why is there such a lack of medical knowledge, when levothyoxin is on the top of the list for most prescribed and also free prescriptions for life. Surely with that, there would be more medical research. Thank you for all this info, without this forums help, I'd still be in bed.🥰
As the original poster has left the forum, I'll close this thread to replying.
This is in no way a comment on the contents of the thread - just that they trend to cause confusion. If anyone wishes to raise the same or similar issues, please start a new post - or look to see if anyone else has done so.
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