Hypo crash after going too fast with T3, saliva cortisol readings

[anakondratenko]

Hi, community.

So I’ve been on a bit of a wild run over the past 2.5 months trying to get my thyroid therapy back in good shape.

To give you a bit of the context, I am a 25 yo female, have been diagnosed with Hashimoto and subclinical hypothyroidism since 2018, started combo therapy (T4+T3) around 2020 and have been sticking to it ever since (felt very well!), checking my TSH, free T4, free T3 frequently, supplementing with selenium, vitamin D, methyl forms of B vitamins, betaine and all other goodness.

Early June this year I suffered a very intense 4-day insomnia episode with massive panic attacks/anxiety/heart palpitations (had some problems previously with panic attacks before getting diagnosed but sleep and heart - never, so that was new). Took me a while to understand that I actually was overmedicating myself by a mistake - I was taking T4 (75) + T3 (15) daily before but have mistakenly started taking 100 T4 + 20 T3 version and was taking it for half a month before above symptoms and episode has manifested.

Since then something changed in my body and I couldn’t even tolerate the previous dosage (75/15) like I used to - gave me heart palpitations, insomnia and anxiety 3-4 hours after taking the dose in the morning. In a desperate attempt I even went to see a “conventional” endocrinologist who put me on 100 T4, which I also couldn’t tolerate from the start, so I’ve cut the dose to 50 and decided to “hang on” on it for a bit and get stabilised before increasing further or adding back my usual T3.

I have 2 questions that I’d like help with:

1. I was trying to understand why I can’t tolerate t3 anymore and did a 4 point cortisol saliva test to rule out adrenal issues (ferritin/iron seems fine - I’ll put the latest lab results below as well). Not sure how to interpret these cortisol readings - some seem high some low:

Cortisol (07:15): 11.7 nmol/L Range 0.0-20.3

Cortisol (12:00) 5.66 nmol/L Range 1.6-5.6

Cortisol (16:00) 2.57 nmol/L Range: 0.0-6.94

Cortisol (21:00) <1.5 nmol/L Range: 0.0-7.56

ferritin 70 Range: 13-150

TIBC 54.8 Range:41-77

Iron 11.1 Range: 5.8-34.5

Transf saturation 20.3% Range:20-50

B12 562 Range:197-771

2. I’ve been taking my 50 T4 for around 3 weeks after a break in taking any thyroid medication of around 2 weeks (after overmedicating episode I described above). Heart palpitations have disappeared, my sleep has improved dramatically but I started getting air hunger/shortness of breath symptoms which I interpreted as my body wanting more hormone so I decided to act, apparently too fast.

I took 1/4 of Tiromel (25 T3/4=6,25 T3) before sleep, then on the next day my normal 50 of T4 plus 1/4 of tiromel and then I followed with another dose of 1/4 of tiromel at 15:00. Now it seems to me very illogical why I was going up so fast but I guess my logic was to put myself on 1/2 tab dosage daily by dividing T3 between morning and afternoon. Initially I felt amazing! No palpitations, very nice mood and energy, no air hunger. However at 21:00 I had a very sudden crash - my hands and feet went numb and cold like never before, extreme fatigue and I felt like I was going to pass out. I went to the ER as I was really loosing it - they checked my sugar levels, pulse, heart rate - all was normal. I’m still recovering after yesterday.. today I took my normal 50 T4 and wasn’t taking T3 at all. I’m not sure what happened but it was very intense. Could it be that because I upped the dose of T3 so fast it actually crashed into a very bad hypo episode? Is this even possible? How would you recommend for me to proceed further? I can also include here my latest TSH, T3/T4 results but they were taken after 2 weeks off any meds so not sure if any value. I plan to go do another thyroid blood work this week.

Thank you and sorry for a bit of a long read..

[Jazzw]

Do you have any thyroid blood test results at all? At the moment it feels a bit like you’re trying to amend your dosage based on guesswork—it may be that your palpitations/insomnia etc weren’t due to your thyroid medication. Do you know if you have Hashimoto’s (autoimmune thyroid disease)?

I think you need to know where you’re at right now and go from there. 50mcg levothyroxine is unlikely to be enough in the longer run but raising low and slow is always a better approach.

[anakondratenko in reply to Jazzw]

Hi!

Sure.

The latest bloodwork (21st of August before starting with 50 T4 and after 2 weeks of taking no meds):

TSH 12.10 Range: 0.27-4.2

FT4 12.4 Range: 12-22 4%

FT3 4.2 Range: 3.1-6.8 30%

TPO 497 Range: 0-34

Thyroglobulin antibodies 36.1 Range: 0-115

TSH receptor antib. <0.8 Range: 0-1.5

As an example, my bloodwork before overmedication episode, on 75T4/15T3 (Novothyral):

TSH 0.035 Range: 0-34

FT4 1.36 Range: 0.93-1.7 56%

FT3 3.55 Range: 2.0-4.4 65%

TPO 486 Range: 0-34

[humanbean]

Since then something changed in my body and I couldn’t even tolerate the previous dosage (75/15) like I used to - gave me heart palpitations, insomnia and anxiety 3-4 hours after taking the dose in the morning.

Whenever I over-medicated myself (which I did occasionally in the early days of treating my hypothyroidism) the best way of getting over it for me was always to stop taking thyroid hormones altogether for a little while, then when I felt slightly hypothyroid again I would begin to start taking my hormones again, starting at a low dose and working up. I would work up slightly quicker than before the over-medication started, but would still be cautious. It might only take a couple of days, but if your body has become completely over-saturated it might take a week or two or a month or longer.

[anakondratenko in reply to humanbean]

Thank you for sharing your experience.

I remember in the earlier days when I only was starting combitherapy I wasn’t so sensitive to upping the dosages.. I even remember sometimes when I’d run out of T4 tabs, taking T3 only - 20 mcg in one go and felt fine, never hyper nor hypo symptoms would manifest afterwards . This time it seems I have to go extra slow and gentle.

[humanbean]

For future reference this link gives optimal levels of cortisol in example 1 :

rt3-adrenals.org/cortisol_t...

.

And optimal levels of iron are given here :

rt3-adrenals.org/Iron_test_...

The above link is useful but doesn't give very precise info about ferritin, so I use this link for optimal ferritin :

thyroidpharmacist.com/artic...

where it says in one paragraph :

Normal ferritin levels for women are between 20 and 200 ng/mL. According to some experts, ferritin levels of at least 40 ng/ml are required to stop hair loss, while levels of at least 70 ng/ml are needed for hair regrowth. The optimal ferritin level for thyroid function is between 90-110 ng/ml.

[anakondratenko in reply to humanbean]

Thank you humanbean . So it does look I could do with some iron supplementation to get my ferritin and serum iron up to where it’s optimal.