T3&T4 combo - continued ...: I posted 5 days ago... - Thyroid UK

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T3&T4 combo - continued ...

hobbycat profile image
38 Replies

I posted 5 days ago and I just want to thank all the amazing people for sharing their time, advice and experiences. There is a lot of information about my situation on my previous post so please do take a look there too.

Long story short, I have been messing around with my T4 and T3 dosing and everyone quite rightly has recommended I stay on a dose for 6 weeks before making any further changes.

However, I am now on my second day of feeling horribly overmedicated and my test results from 02 Dec were TSH - 0.01. T4 - 18.90 (9.01 - 19.05) . T3 - 7.00 (2.63 - 5.7) To note this blood test was unexpected and was taken 1.5 hrs after my 118.75 T4 and 10 T3. (I then take 8.75 T3 at 2pm).

I had gone at 8.45am for other tests, namely a cortisol 9am test (284 range 101-536) and Vit D (92.4 range 50-150) and magnesium (0.86 range 0.7 - 1.0) and serum prolactin (609 range 109-557).

DO I stay in this overmedicated place for another 6 weeks ?? It seems crazy to do so.

I am anxious about my heart as out walking today I had a couple of dizzy moments and my body is saying don't do anything. I will post this to my GP and Endo but their response time is very snail-like.

(For info, my starting point in June/July23 on 118.75 T4 and 17.5 T3 was TSH 0.01. T4 13.60 (9.01 - 19.05) . T3 5.3 (2.63 - 5.7). This and usually all my blood tests are early morning before taking either T4 or T3 and my previous T3 dose would mostly be about 15 hrs before.)

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hobbycat
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TiggerMe profile image
TiggerMe

For 1.5 hours after dosing that isn't bad, it's a big dose of T3 to take in one hit, have you tried splitting it?

You can't really compare it to this one...

(For info, my starting point in June/July23 on 118.75 T4 and 17.5 T3 was TSH 0.01. T4 13.60 (9.01 - 19.05) . T3 5.3 (2.63 - 5.7). This and usually all my blood tests are early morning before taking either T4 or T3 and my previous T3 dose would mostly be about 15 hrs before.)

with such a long gap after the last T3 (8-12hours is how we generally roll)

Dizziness can mean a drop in glucose which can be bought on by the sudden surge of T3, do you feel better after a snack? Or low iron? Can't remember where you are on that score? Your folate was on the low side wasn't it... and where did we get with cortisol just the 2018 results and these showing still low, a big dose of T3 gives the adrenals a shock which makes you feel flaky... there is a knock on effect to all your other system when you adjust your dose or even timings

Would be worth getting a finger prick test an getting a proper reading before changing again

hobbycat profile image
hobbycat in reply to TiggerMe

Eeyore100, thank you. I made a typo - I take 10 T3 at 7am and 8.75 at 2pm. Interesting the dizziness as a glucose drop with surge of T3 - could this be momentary, it's not more than a second or two I would say. Other times I have had it out running for longer and my heart does funny things then.

TiggerMe profile image
TiggerMe in reply to hobbycat

Sounds more adrenal than low glucose me thinks, do you take Vit C and have a decent amount of salt in your diet (adrenal food)? I'd suggest having an adrenal cocktail an hour or so after your T3 doses and see if that helps

For me a glucose crash would mean shaky, lightheaded, cold sweat, nauseous and take half an hour to come right after a snack or might even need a nap.

Have you tried splitting into three doses, taking one before bed?

Looks like you felt your best on the 24rd Nov dosing so why did you up it then? I would suggest you knock your T3 back to 17.5mcg and stick with that

hobbycat profile image
hobbycat in reply to TiggerMe

Can you say more about it sounding like an adrenal thing? And what is an adrenal cocktail?

If I’m splitting may dose is that not considered a dose change in itself? I am tempted to try it.

TiggerMe profile image
TiggerMe in reply to hobbycat

I did add a bit to my last answer... (Looks like you felt your best on the 24rd Nov dosing so why did you up it then? I would suggest you knock your T3 back to 17.5mcg and stick with that)

No splitting doses isn't changing the dose just adjusting timings to see what works best for you.... dosing is based over 24 hours, getting the timings right is as important as dose size

Any kind of stress affects the adrenals and your cortisol is low suggesting your adrenals are fatigued and struggling to keep up... there are various cocktail recipes... what have you got in the cupboard?

healthyhuemans.com/5-simple...

Blu-cat11 profile image
Blu-cat11 in reply to TiggerMe

Hi, I’m now trying a couple of crumbs of armour every other day. I still have a racing heart so I’m thinking of trying the adrenal support cocktails. My cortisol test did state that my cortisol was depleted. The salt may address my constant thirst too. The easiest seems to be the vitamin c- orange juice. I’m not sure I can get organic oranges would a vitamin c and zinc tablet do the trick?

TiggerMe profile image
TiggerMe in reply to Blu-cat11

Anything which contains T3 should be taken daily at the same time and dose ideally so as not to add more stress to the system... yes any form of Vit C will do the trick, do you have any cream of tartar hidden in the back of the cupboard as this is the potassium element or a banana?

Blu-cat11 profile image
Blu-cat11 in reply to TiggerMe

Hi interesting to dose daily. The racing heart is unpleasant at best and long term I worry that it could be damaging. Yes I do have cream of tartar. Time to make a cocktail! Thank you for your advice and quick response.

TiggerMe profile image
TiggerMe in reply to Blu-cat11

T3 is quick to uptake and drop off compared to T4, how does your heart react for the first few hours after a dose?

NDT I think has a slightly slower uptake due to being bound... I don't really know much about NDT 🙃

Blu-cat11 profile image
Blu-cat11 in reply to Blu-cat11

It seems to be 7 hours after the dose that my heart rate increases.

TiggerMe profile image
TiggerMe in reply to Blu-cat11

Does it increase rapidly or just to a higher than normal resting rate and feel stronger in your chest? How long does the increase last?

Hypothyroid = weak and slippery pulse... Chinese medicine description

When we have been hypo for a while we tend to have a very low resting heart rate so when you add back in the missing hormone it can feel strange but it is just bringing you back up to a functioning level and should raise your temperature and generally get your sluggish system back up to speed

Blu-cat11 profile image
Blu-cat11 in reply to TiggerMe

Sorry for my slow response I’ve been monitoring my heart rate. You have helped me analyse this in a different way. My pulse has always been weak, neither my husband or I can find it easily so I tend to go by my heart beat. It is always around 60 beats per min and stays that way. What I am noticing is that it feels more pronounced not faster and increases my anxiety for hours after my dose has kicked in. So if I take the dose at 7 am my heart rate and anxiety are more pronounced 7 hours later and stay with me until I go to bed around 11 am. I have felt a bit flushed at bedtime too and I’m always cold. I also recall an acupuncturist saying my pulse was weak years ago. Perhaps this all adds up to my body responding to the armour and it just needs time to adjust.

I’ll keep the cocktail going.

Really appreciate your thoughts, You have been very insightful. Thank you ☺️

TiggerMe profile image
TiggerMe in reply to Blu-cat11

I'm so glad 🤗

I remember the sensation of my pulse strengthening and an unusual awareness of my heart when I first started T3, fear not it is a good thing and a sign your heart is finally getting what it needs to work effectively... also that rare lovely feeling of warmth which I would only get when lying in a very hot bath, we get so used to being cold blooded creature don't we 🙃

Try to relax and enjoy it and like you say give it time, this is the new you emerging 😉

Blu-cat11 profile image
Blu-cat11 in reply to TiggerMe

Thank you so much for your reassurance 😁

FancyPants54 profile image
FancyPants54 in reply to Blu-cat11

You could look at this the other way around. Your T3 dose has dropped right down again by 8 hours after taking it. So this increased pulse and anxious feeling could simply be your body unhappy at its loss. You can do a very simple experiment to prove this. Cut a tablet into 8ths as best you can and take one of the pieces as soon as your heart speeds up. If you are like me, 20 minutes later you will feel fine. Works every time for me. If this works for you then you perhaps need to split your T3 dose into more frequent, smaller amounts to keep levels steadier.

I first discovered this January this year. I had just switched to NDT and then I had a really awful cold. During the long drawn out cold I started to wake in the middle of the night. Scared of the dark and terribly anxious. My heart racing and generally feeling like the sky was falling in. I could not stay in bed in the dark. I had to have lights on. It was horrible.

I don’t know why, but one night I was so tired and anxious I just thought what if it’s too little hormone. And I refused to obsess over it, I quickly swallowed a small piece of T3. 20 minutes later I was calmly getting into bed in the dark and snuggling down to sleep. I am so glad I did that. It taught me that thyroid is never obvious and can be the opposite of what we think it is.

hobbycat profile image
hobbycat in reply to TiggerMe

My starting point in June was 118.75 and 17.5. On 23Nov I was on 125 and 17.5. But what I've not showed here was the 3 months before when I was upping my T4 and not having any positive effects. It was not until I went to 18.75 that my brain came online and my energy picked up. My translation being I need that extra T3.

The adrenal cocktails look mad especially as I steer clear of salt ! Thank you for the link.

TiggerMe profile image
TiggerMe in reply to hobbycat

I know crazy isn't it we were bought up thinking too much salt is bad!! Not if your adrenals are starved from it! Give it a go, they are surprisingly nice and uplifting 😋

FancyPants54 profile image
FancyPants54 in reply to hobbycat

Salt is vital for us. Don’t fear it. Try the cocktail. It’s nice and can help.

Incoguto profile image
Incoguto

My results after 2 hours were way higher. Are you feeling overdosed after taking them or all day?

Cortisol is low...

I'm having similar issues, nothing I take makes me feel ok (I'm either over or undermedicated even by a crumb of 1.25 t3..not normal I think!), I'm thinking it could be my adrenals. I forgot if you're splitting your dose. I'm not splitting mine...but years ago when splitting I had same issues, perhaps, it's cortisol or that we need to be t3 only 🤗

hobbycat profile image
hobbycat in reply to Incoguto

Incognito, I've been feeling over medicated for two days now and it's pretty much all the time. I really resonate with your experience of being affected by tiny changes, and I am wondering the same, about whether I have an adrenal issue in parallel and where to start with it.

Incoguto profile image
Incoguto in reply to hobbycat

Yes, I don't think it's normal that we feel such fluctuations by such small changes. I will be trialling hydrocortisone for adrenals, I'll keep you updated.

hobbycat profile image
hobbycat in reply to Incoguto

That would be great, yes please.

janeroar profile image
janeroar

Hi hobbycat it sounds very stressy what happens when you’re feeling ‘overmedicated’. Once you’ve decided to settle on your dose it’s worth trying to calm your nervous system down. Low cortisol suggests as been advised here adrenal issues. Have you thought about introducing a breathing routine? Just five minutes a day would help. Yoga is perfect too. These things have a big impact on nervous system and adrenals

MariaZetta profile image
MariaZetta

Hello. I am not an expert but i was in a similar situation as you. My doctor recommended to take 88 levothiroxine per day plus 5mg of t3 3 times a day. When i checked my blood results few month later my Tsh was extremely low.I was feeling constantly on edge. I was irritated about everything. I thought my heart would explode. Horrible feeling. I immediately reduced one dose of T3 and i felt normal again. Now i continue with levothiroxine and 2 doses of t3 and i feel great. Listen to your body....

FallingInReverse profile image
FallingInReverse

hobbycat

Going to read this thread now but before I do … nice data management!!! I knew I loved your spreadsheet… but these charts/graphs are impressive! So good : )

FallingInReverse profile image
FallingInReverse

my opinion:

I’m very glad the only-one-change-every-6-8 weeks message got through.

and yet….

- “feeling horribly overmedicated”

You can’t “feel” overmedicated. It’s symptoms + blood tests together.

- “T4 - 18.90 (9.01 - 19.05) . T3 - 7.00 (2.63 - 5.7) To note this blood test was unexpected and was taken 1.5 hrs after my 118.75 T4 and 10 T3.“

So it almost looks like you had the symptoms + bloods BUT… thyroid bloods after your T doses… that is not comparable to previous blood tests. Further, as someone pointed out - after those 2 doses… I’m surprised your levels aren’t even higher.

- “DO I stay in this overmedicated place for another 6 weeks ?? It seems crazy to do so.”

Speaking from experience, our minds will do anything to justify impatient decisions when we are in the long process of titration. The above has a logical flaw - where “overmedicated “ is just a guess. If your proper bloods showed overmedicated, then yes! You would make a decrease your next move. Which of your blood tests were done consistently properly?

(For info, my starting point in June/July23 on 118.75 T4 and 17.5 T3 was TSH 0.01. T4 13.60 (9.01 - 19.05) . T3 5.3 (2.63 - 5.7). This and usually all my blood tests are early morning before taking either T4 or T3 and my previous T3 dose would mostly be about 15 hrs before.)

I can’t keep up with all those dosing zig zags. I think someone else - maybe even one of our admins - made an actual dose change recco. I can’t remember but I think it was a slight reduction to T4? Go back and find that advice!

Until you are on a steady dose for a solid 6 weeks, then bloods will be misleading and as earlier responses said, you are stabbing blindly in the dark, and all that good data tracking is going to waste.

Regards your heart racing, here’s 2 experiences:

1) heart palpitations are an expected side effect of T3, and of too much/too quickly doses. Hold the line!

2) of course there are people who have heart concerns, and of course Lio has that warning. I don’t know anything about that - but obv other people have weighed in, and you should of course tend to that.

But- if you don’t stop the T4/T3 changes (at whatever level you figure out) for six weeks (6-8 weeks even), then all your time and bloods will be wasted time and you won’t draw good conclusions. That’s where you are right now.

Further, addressing adrenals and cortisol while also mixing up your T doses, robs you of a valid A/B test. Sounds like you need more than optimal T levels. But again, no way to know until you stop mixing up all these changes.

hobbycat profile image
hobbycat in reply to FallingInReverse

Thank you FIR, for your thoughts. I am going to try and stick with this new change. I’m interested in what you say about there being a difference between feeling and being overmedicated, that makes sense splitting those out. The more uncomfortable symptoms of a few days ago have subsided a little now which makes it easier to stay with current dose.

FallingInReverse profile image
FallingInReverse

Glad to hear it!!! Well done!

Indeed - same, steady dose gives a range of symptoms over the days while it settles. Keep those notes and when you get to 6-8 weeks you can scan them and get the general trend over that time. Then when you get bloods, you will have the info you need to see what titration you need.

And now that you’ve made it through the last few days - one day at a time, keep it up for the 6-8 weeks.

I am right now 3 weeks into a dose change and to be honest I am struggling. But I if I changed now I’d reset the clock and have to start all over again. So I am sticking it out for 3 more long weeks.

(note what I said about tending to your heart : ) I am not high risk so know nothing about it. But myself and tons of others have these palpitations and they are just something to wait out. But yes, we all worry when we feel them, so never hesitate to post here with your concerns)

hobbycat profile image
hobbycat in reply to FallingInReverse

Thank you. I’m two weeks in and it’s good to read your encouraging words. Sticking it out for another 4 weeks for me seems such a big ask. My heart rate is up which is always accompanied by anxiety.

FallingInReverse profile image
FallingInReverse

It is definitely a big ask. I am almost at 4 weeks and so impatient, and I feel pretty lousy. On the upside - getting to 6 weeks is like Christmas morning, when you finally get to get a blood test and have some numbers you can make a dose change based on.

Palpitations and anxiety- two things that we know will get better as we optimize our meds.

Good luck - “see ya” in a month! Post again if you are getting impatient again if you need support!

FallingInReverse profile image
FallingInReverse

I’m at 4 weeks today!!!! Feel so limited. The next 2 weeks will be an eternity. Writing here to give myself a little encouragement to stick with it and I hope you are sticking with it too!

hobbycat profile image
hobbycat in reply to FallingInReverse

Hiya. In what way are you feeling limited? Perhaps the Christmas distractions will carry you through the next couple of weeks. Keep going !

FallingInReverse profile image
FallingInReverse

Hi! When I first started on 50 mcg Levo almost all of my multitude of symptoms largely cleared up.

But I was left with the debilitating/limiting fatigue and brain fog. And still being freezing cold all the time (but I nothing 4-5 sweaters won’t fix lol. ) Over the past few months I’ve had a few good days, and then I dip back. Although I am in average “better” the past few weeks have been just like old times. Like, on Sunday I couldn’t get my head off the pillow and ended up napping or staring into space for about 5 hours in the middle of the day. In the big picture, over the past year, I often choose to avoid social situations because it takes so much effort and stress to mentally prepare. And so that’s starting to get to me - maybe that’s why I used the word limiting. Feels so isolating, like I’m trapped, and also I am losing hope a little.

Plus, some old symptoms are popping up (joint and muscle pain, rosacea, face flushing, and some other new ones.) Oddly enough in the past week, I’ve started getting hot flashes/sweating randomly. Greeeeeat.

That being said , I filled my 2 week pill pack on Sunday and know that I can see the finish line.

I can’t freaking wait to figure out my next dose change and get on with it.

Thanks for asking, thanks for listening.

hobbycat profile image
hobbycat in reply to FallingInReverse

You have only mentioned T4 - are you on T3 too?

FallingInReverse profile image
FallingInReverse in reply to hobbycat

Hi, just seeing this. Yes, on T3. My well intentioned but uninformed doctor added t3 as the very first step after I said 50 mcgs of Levo weren’t working. I wish wish wish he’d just given me 75 mcgs. But yes, here I am on T4/T3 together.

hobbycat profile image
hobbycat

By way of an update, after a convo with my GP we decided that with the overmedicated blood tests and symptoms that I drop my T4 a little as I was on route to even more T4 settling in. So as 14 Dec I started 112.5mcg T4 and 18.7mcg T3. So pleased with this move as 10 days on and I feel the best I’ve felt in ages. My body, brain and heart are feeling very in sync. Note - the massive difference has come from just adding 1.25mcg T3.

TiggerMe profile image
TiggerMe in reply to hobbycat

Yay, sounds good! I does take a fortnight for fT4 levels to drop after a lowering of dose 🤗

FallingInReverse profile image
FallingInReverse in reply to hobbycat

So glad you are feeling good!

Was this based on your Dec 2 bloods or did you get another blood test between then and Dec 14?

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