Hello, question in the title…
I am subclinical hypo and find taking thyroid medication (levo,lio or combo) seem to completely tank my blood pressure and I get pretty severe symptoms of low BP at times.
My BP pre diagnosis was always fine so I’m really stumped by this as it seems being hypo causes high blood pressure?
anyone else struggle w low BP?
How did you resolve it?
Being hypo can cause both high and low blood pressure. I had high blood pressure most of my life until I was optimally treat on T3 mono-therapy. Doctors tend to think that hypo causes low BP and hyper cause high BP, but it's not as clear cut as that. A lot of symptoms cross over from one to the other. 
Thanks for your reply. It’s weird cos t3 tanks my blood pressure even more to the point I feel it’s dangerous…
Well, we're all different. But, I don't know enough about blood pressure to comment. Do you ever pass out or feel dizzy? I've not idea what to do about low BP. Perhaps your iron is low? Or you need more salt in your diet.
yes can pass out and do get dizzy too. I’ve been working on my iron and ferritin for 8+ weeks now and ferritin is nearly up to 80. I’d be surprised if it was iron causing these episodes.
I’ve been adding lots of extra salt to my diet for the last 4 weeks also but it doesn’t seem to prevent the low blood pressure and low blood sugar episodes, so feeling a bit stumped
What does your doctor say?
Doctor says no action required.
Despite the fact that when I feel well my BP is 112/79 blood sugar 5-6 compared to these episodes when bp is 92/52 and blood sugar 2.7 or below.(after eating and at end of day/evening)
Seems like a significant drop to me but told it’s no issue…
I was surprised given that it seems any blood sugar under 3.9 is a medical emergency…it would almost be funny if I wasn’t so unwell…
do you have a home bp test monitor and if so it might be giving you faulty readings if too old and apparently they need recalibrating every couple of years
mine is only a year old and bp is consistently 90s/50s… slightly higher in doctors office due to white coat syndrome!
I’d be surprised if it was faulty as my
Low bp coincides with v low blood sugar. I was seriously I’ll this evening after having dinner and my bp and blood sugar were v low (2.7m mol) (92/52)
I have noticed increased BP since being diagnosed hypo 3 years ago. Resting heart rate is lower though. Also increased white coat syndrome which doesn't help BP readings at the Drs. Haven't found a BP med that works for me.
I have been through endless tests for HBP. What is not odd/funny in hypothyroidism? It depends how my BP reacts at any given time. Mostly I have low resting HR, heart not responding to need to up-tic accordinding to situation required. However BP can go bonkers. Heart reacts like Atrial Fibrillation but it’s not that. When I get BP taken in the surgery, people call it White Coat Syndrome but for me it’s more ‘suppressed anger” at these idiots for not understanding the length and breadth of the effects of hypothyroidism. When I get the 24 hour test they can hardly hide their annoyance that it comes back pretty good.
I would say your medication is not quite right and I see you are SCH. I think also you may be quite young (can’t remember) so plenty of time to get this right. My SCH was ignored, even though I had massive symptoms. Just left to rot.
Just take your time and get it right - for you.
Thanks for your reply, it’s just so weird cos I’ve never suffered with high blood pressure…it’s always been normal to low. I’ve spent over a year now ‘fine tuning’ thyroid medications and doseages and they all make me feel worse and drop my blood pressure far too low and I have symptoms.
I am subclinical so wouldn’t have thought it would be this hard.
P.S. it’s all about the metabolism. Untreated your BP may go high or low or both. Slow HR is because you are hypothyroid. However even the BP has to be forced to become higher to allow you to do things. Otherwise your low HR will just let you fade away. Your body will try to help you ‘live’ and look after you/it, as long as it can without help from outside. In orthodox terms they just don’t know this because they don’t know nearly enough about hypothyroidism. If they picked up data from T3 testing they would soon see a connection but NO, this they are determined not to do.
There was a post just recently about doctors telling many of us about us being ‘very fit’ because of our low HR. Another case of ‘gaslighting’, I am afraid. They don’t know any better and they feel pushed to say something/anything other than display their ignorance.
Yes, I had a work medical about 8 years ago, and the assessor looked at me perplexedly and said that they usually see that sort of HR in elite athletes 
I was reasonably fit at the time and cycling 80 miles in a day at the weekend but elite athlete, er, no...
Quite FoggyThinker. Originally I was an athlete so I was pre-primed for this gaslighting. I thought I still must ‘have it’. Unfortunately not.
Honestly I think subclinical is likely to be harder because they avoid prescribing for it, in my experience. They don’t generally do it. I think they like TSH to run its course until it is to their liking - no matter the symptoms. Even although guidelines say they should be taken into consideration. They think they are saving money by avoiding diagnosis, without considering the knock on effects to their budgets of more prescriptions and other investigations. Stick with it. It’s terrible they need educating about thyroid issues at every turn. Shocking really.
This actually hasn’t been my experience my gp was happy to prescribe for subclinical levels but is completely stumped by my volatile reaction.
Weirdly my HR is actually fine.
I am not at all surprised by your volatile reaction. Your life force has not been sucked away by lackadaisical diagnosis BUT there is a further disparity in general lack and application of knowledge about treatment. Your up until now useful GP, is showing signs of being out of her depth. This is a common experience for a big number of people on the Forum. It’s not necessarily your GPs fault. There just is not the information available because of all the ‘stops’ being thrust on practitioners, good thyroid research being ignored and off course by politics with small and large ‘p’. Hopefully your GP will not lose interest before getting you ‘right’ or you find some useful info from Forumites.
Tbh I think gp has been out of her depth for some time. I absolutely believe that my SCH is due to another cause. Particularly as it seems transient…lasting for a few weeks and then improving on its own.
I also don’t think SCH can cause sudden crashes in blood pressure and blood sugar either but this continues to happen nearly every day.
Last night my blood sugar was 2.7 after eating and I felt so unwell I couldn’t stand or form sentences…but she brushed it off as nothing…
Honestly GreenTealSeal what you are mentioning here is the basis of hypothyroidism. I was just reading a research paper which explained the why this happens in hypothyroidism. I have suspected it all along but never seen it written so clearly. Quite a few people on the Forum have done the ZOE thing and discovered much to their surprise the foods which particularly cause them personal bother.
This piece of research describes The Metabolism of carbohydrates as a specific problem of Subclinical Hypothyroidism. Unfortunately it remains so with treatment until optimal meds.
“The Importance of HbA1c Control in Patients with Subclinical Hypothyroidism”. Edina Billic-Komarica etal.
Don’t tell helvella I still have not mastered his instructions on how to put up a reference. I will get around to it.
Mater Sociomed. 2012;24(4):212-9.
doi: 10.5455/msm.2012.24.212-219.
The Importance of HbA1c Control in Patients with Subclinical Hypothyroidism
Edina Billic-Komarica 1 , Amela Beciragic, Dzelaludin Junuzovic
PMID: 23678326 PMCID: PMC3633381 DOI: 10.5455/msm.2012.24.212-219
ncbi.nlm.nih.gov/pmc/articl...
Thank you helvella. I am determined to be a good student - eventually! Hopefully sooner rather than later.
Thank you for sharing arTistapple and helvella I’ve had a read through but struggling to make sense.
My blood sugar and blood pressure are typically much too low on thyroid medications.
My t4 shoots over range on 75mcg levo and adding t3 makes me seriously ill(I spent months trying) it makes me look grey puffy and makes me feel faint and seriously unwell.
My t3 levels have never been alarmingly low so I’m not sure optimal medication is the answer…if anything the higher the dose the worse I feel.
My appetite has been so poor for the last 6 months I’m not sure any diet changes would help at this stage.
I cut out gluten decades ago and dairy free for a year but felt no different.
I also find it notable that my prolactin is much too high when I’m on thyroid meds.
Testing. Testing. Wrote a huge long reply but system would not send. Could try again but need to know it will go through.
Unbelievable it seems to have gone through. Will try again with reply a bit later!
Oh how rubbish! I can see these messages but not the long one!
One likely reason that someone with hypothyroidism has high blood pressure is due to elevated cortisol levels. This was my case. I had systolic hypertension (140/70) along with severe insomnia (~3 hr sleep/night). Finding a competent doctor (non TSH'er) allowed me to get adequate T4 + T3 (100/20 now) which brought my BP down to 120/70 and normalized my sleep to around 7 hr/night.
Those who have lower-than-normal cortisol levels with hypothyroidism could be expected to have low blood pressure. Taking levothyroxine or especially liothyronine would tend to drop cortisol levels resulting in even lower BP readings.
You might want to research the symptoms associated with both high and low cortisol levels and see if you can spot the patterns in your symptoms. While cortisol is released twice per day (morning ~ 8-9am, afternoon ~5pm), it will be released anytime you perceive "distress", which can show wide variations in body temperature as well as blood pressure through the day.
There is a chart by Dr. Rind who has a method of evaluating whether ones symptoms are predominantly thyroid or adrenal related.
drrind.com/metabolic-scorecard
drrind.com/metabolic-temper...
So how would you dose thyroid medications for low cortisol?
My adrenal function is very up and down. I have spoken with several private doctors recommended on the thyroid uk site but they all just give me t3 and expect it to cure everything…which it doesn’t, it makes things significantly worse
My pattern is that my blood pressure and blood sugar tank every afternoon-evening, varying in severity.this occurs whether I take thyroid medication or not but on the thyroid medication it is significantly worse
"...this occurs whether I take thyroid medication or not but on the thyroid medication it is significantly worse."
Right. When you take thyroid medication, it will lower your cortisol levels even more.
There are some books written by Paul Robinson where he discusses timing thyroid meds (using liothyronine, not levothyroxine) so as to raise cortisol levels. This means taking T3 very early in the morning.
paulrobinsonthyroid.com/rec...
paulrobinsonthyroid.com/the...
paulrobinsonthyroid.com/the...
I have tried this with t3 and it still makes me ill.
Again really interesting reply, I was also wondering about a cortisol connection. Does split dosing help? I found NDT affected my cortisol levels especially after I was advised to raise my dose way too quickly by a private GP, and eventually my blood sugar control seemed to be affected too. Not sure about BP, historically it was low. Currently I'm trying T4 only. But split dissing my NDT send to help a bit, with one dose early morning as per Paul R...
Split dosing did not resolve anything for me. Thyroid medication makes me seriously ill even with split dosing.
I've nothing more helpful, just wanted to say I'm sorry you find yourself in such a difficult situation and hope you find something that works very soon.
Thank you, that’s kind of you to say
When you say you tried this with T3, how much T3? Everything regarding drugs is dose-related. What time did you take it? How long did you take it at that dose and that time? Thyroid hormone therapy is contraindicated in people who have very low cortisol levels. If you'd tried Paul Robinson's treatment strategy and it didn't work, then this leaves the option below:
Find out more about taking a corticosteroid, like hydrocortisone. The dose will be small, perhaps 5 to 10mg in divided doses, not more than 20mg/day. Doing this would also help you confirm or rule out that you have some degree of temporary insufficient cortisol output caused by low thyroid function. If you notice measurable improvement in your symptoms, then you can begin the process of finding the right dose of thyroid hormone.
I have tried it from last November to March this year. I slowly increased t3 doseage up to 20mcg but it made me violently ill…mono or combo.
I took my first dose at around 4am, but just meant I woke up feeling unwell.
I’m subclinical and my ft4 has always happily sat around 16-17 and my t3 around 4.7-5.5 so I’m wondering if cortisol issues are actually what is causing these spikes in TSH.
kiefer
My blood pressure is higher than I would like. And my cortisol is high too. I had wondered if the two things were related.
Hidden
You might find this link on the subject of BP of interest :
stopthethyroidmadness.com/b...
Thank you for sharing…
It’s odd because my bp is ok off of meds but thyroid medications completely tank both blood sugar and blood pressure…to dangerous levels on some occasions. Adding t3 medication seems to exacerbate this issue even further. Like I look permanently grey, puffy and really sick. T3 leaves me with nausea so severe I can’t turn over in bed or travel in the car without feeling sick/heaving or being sick.
Hi Hidden have you got anywhere going down the adrenal and NCCAH route with any of the private doctors you've seen? What were their thoughts on you not tolerating thyroid meds, could they explain why your BP and blood sugar tanks on them?
Hello! Sorry for the slow reply. I saw a great endo this week and they are going to do all the testing for me to get to the bottom of things.
The general thought is that I don’t need thyroid medication and there is something else going on that is sending my TSH high and then back down to normal (considering
My frees are always in range and never drop low) I completely agree tbh and have felt this way for a long time. But we’re gonna do a scan to definitively rule out hashimotos once and for all.
Oh that's so good the hear, I'm glad you've finally found one that seems to be a bit more empathic and willing to look at all of it on a deeper level 😊 Like you say, that scan will likely rule out a problem with the gland, then you can concentrate on other avenues knowing you've ticked that box. Wishing you the best of luck, do keep us updated with what happens regarding the rest of the tests and well done for persevering 🤗
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