Hypothyroidism, Hypoglycemia - Unsure How To Proceed

[outdamnspot]

I have a decade-long history of depression, anxiety etc. that has been exacerbated by some very stressful living circumstances. Im historically sensitive to meds and never found much relief. I had been doing a bit better last year, but 6 months ago suddenly developed fatigue alongside reactive hypoglycemia. I tried to push through it initially, but the symptoms got worse and I crashed hard with vertigo, tinnitus, poor stress response etc. Some tests were done and my TSH was a 2.2, which was deemed normal. Meanwhile, I was barely surviving and having to eat every 2 hours to stave off panic attacks.

I switched to a keto diet, which helped. My blood work was done again (before keto) and my tsh had jumped to 4.0 in 8 weeks. Again I was told this was normal. However, due to other symptoms -- constipation, feeling cold, vertigo, sore throat, physical heaviness and leaden limbs, hunger, 20kg weight gain -- I now suspect I'm hypothyroid.

I found a very good integrative endocrinologist via a Facebook group who I've seen once. He ordered a lot of tests but said he is willing to try treatment because of the severity of my symptoms, so I'm going back in 10 days.

Here's what I've noticed so far:
Anything that lowers cortisol -- melatonin, magnesium etc -- drastically worsens my symptoms.

Caffeine, with no tolerance, fixes my symptoms for a week before tolerance develops.

Stimulants -- nicotine etc -- crash me, instead of stimulating me.

I know adrenal fatigue is nonsense and I've read here that boosting thyroid can restore normal cortisol levels. However, given how badly I react to stimulants, I was worried about not being able to tolerate thyroid replacement. I thought that caffeine fixing my symptoms temporarily might mean it was boosting cortisol.

I will go over all of this with my endo, but just curious, based on my reactions, what it would be best to address first -- thyroid or adrenals?

 

[Richiebogie]

What is a typical day's diet like for you (including calorie breakdown)?

 

[outdamnspot]

I don't know my caloric breakdown. Because of the reactive hypoglycemia, I just eat to stay on top of symptoms. Because I'm doing keto, it's usually some variation of eggs, bacon, chicken, avocado, nuts, yogurt, sour cream, spinach, kale.

 

[Emstar1892]

hey, your experience sounds exactly the same as what I've been through. the struggle remains. i hope things work out for you! godo luck :)

 

[outdamnspot]

hey, your experience sounds exactly the same as what I've been through. the struggle remains. i hope things work out for you! godo luck :)

Have you tried treatment?

 

[BastiFuntasty]

Have you tried pregnenolone? It converts in so many hormones, even in cortisol.

 

[outdamnspot]

Have you tried pregnenolone? It converts in so many hormones, even in cortisol.

No I haven't. I'll ask my endo about it. I've read it can help some people tolerate thyroid replacement better. My hope was I could deal with the problem in the simplest manner possible, i.e. just treat the thyroid.

 

[BastiFuntasty]

No I haven't. I'll ask my endo about it. I've read it can help some people tolerate thyroid replacement better. My hope was I could deal with the problem in the simplest manner possible, i.e. just treat the thyroid.

It helps many people with better thyroid function, so shouldn't be wrong to try.
Don't get wrong or so, but I would stop with keto if you feel so bad.
Of course ketones have their benefits, thyroid health isn't one of it.
Have you tried peating before? It helped so many to regain good thyroid. You can even possibly benefit from ketones if you add enourmus amounts of coconut oil every two hours or so, despite normal carb intake.

 

[Drareg]

Ketones are working for you because they correct the stress response, they may act like a hdac inhibitor,electrical cellular corrector of sorts,Its natures last shot at getting you coherent with the environment so you can adapt it seems. This works temporarily but you will crash on this diet eventually, plenty of discussion on it by Danny Roddy videos,covers it well IMO.

How do you know cortisol is low or high ?You may need more comprehensive labs,searching the forum here and reading Ray Peats articles will give you a clear idea of what's required.
The main thing now it seems for you is to stop the panic, increasing co2 seems a good thing to try ,context of your situation is everything. Healthy metabolism corrects co2 balance.

In saying that you seem to need something quick before you can really study ,increasing calories while taking aspirin even 500mg can stop the panic, you could break up the aspirin between meals, vitamin b1 with meals will also help up to 100mg per meal. Careful of blood thinning effect of aspirin ,many people take vitamin k2 to counter this,k2 will also push metabolism in the correct way.

 

[Emstar1892]

Have you tried treatment?

Hey, I don't have the money unfortunately. You?

 

[tara]

Welcome outdamnspot.

I'm not an expert, just been reading around.

If everything that lowers cortisol knocks your energy, I would guess that means you are running on chronic stress hormones, and insufficient thyroid. Your lab results seem consistent with that - I agreed TSH 4 looks hypothyroid, and TSH 2.2 may have been too. Do you have any other thyroid test results - eg total T3 and T4?
Before just supplementing thyroid, I think it's worth considering how that came about. You may not be able to figure that out, but sometimes there are clear contributors, eg chronic undereating and/or overexercising, living in a dark cold cave for too long (ie missing necessary sunlight and warmth), severe life stress, etc. Or it may be (epigenetically or otherwise) inhereted, or there may be some actual damage/malfunction in the thyroid gland. Ideally, it seems good to set up conditions so that you don't need to call on high levels of stress hormones all the time for basic living, but can keep them in reserve for occasional/intermittent/emergency situations.

My hope was I could deal with the problem in the simplest manner possible, i.e. just treat the thyroid.

It would be nice to have a simple solution. I'd like one too. Maybe you will be lucky. More likely, if you want long-term good effects, it will be helpful to attend to nutrition too, and maybe also cautiously begin supplementing thyroid. I don't think it makes sense to just treat the thyroid without getting good nutrition. Adding thyroid supplements to that might set up more stress and catabolism.

I don't know my caloric breakdown. Because of the reactive hypoglycemia, I just eat to stay on top of symptoms. Because I'm doing keto, it's usually some variation of eggs, bacon, chicken, avocado, nuts, yogurt, sour cream, spinach, kale.

What were you eating before you went keto? And how much?
Around here, a lot of us have learned to eat more carbs. Low carb seems to negatively affect thyroid metabolism and blood sugar for a number of people after a while - there are several people here attempting to recover from that. Even though keto can reportedly sometimes feel better for a while.

Have you read around here a bit? And some of Peat's articles or interviews?
He tends to be pretty clear about PUFAs being antimetabolic, so eating a lot of nuts may not serve you so well. Many of us here make an effort to get PUFA consumption down as low as practical.
Some of us use cronometer to get an idea of roughly what we are getting from our food.

If you haven't yet, I'd start reading up on his articles on sugar, fats, thyroid, and then continue with the ones that interest you (and some of us have to reread to get the gist, but it improves).
raypeat.com/articles

If you do decide eventually to try thyroid supps, Peat has talked about the difficulties some people have with the common T4 only formulations, and the value of small (tiny - 1-2mcg) doses of the active T3 through the day. And allowing 2 weeks at least between increments of T4, because it has a longish half-life.

I'm guessing you've got a good shot at getting significant improvements, but may not all be solved overnight with a silver bullet.
Good luck.

 

[outdamnspot]

I've been having hypothyroid symptoms for approx. 10 months now, following a few years of severe stress. My initial symptoms were increased fatigue and hypoglycemia, though I pushed through and crashed badly after 5 months -- developing tinnitus, vertigo/balance problems, severe anxiety, low waking temperatures (35.2-36.1 degrees Celcius), dry peeling skin, constipation, heat and cold intolerance, memory problems, weight gain (20kg) etc.

My TSH was tested during all of this and it had risen from 1.9 to 3.31 over 2 months (coinciding with the symptoms becoming debilitating). An endo ran a full panel 2 weeks ago and my TSH was 2.9, my
FT3 was 5.5 (3.3-6.4) FT4 was 17.9 (11.0-22.0) RT3 was 434 (140-540)

My cortisol was high: 558 (142-497)
Testosterone was low .. I don't have the numbers on me, but they're in the bottom quarter of the range.

I've done a 24-hour Saliva Cortisol test too, but am waiting to get the results this week.

Now, my endo agreed that all my symptoms look like hypothyroidism but did not want to treat me at this stage. He prescribed me Low-Dose Naltrexone for the fatigue, which I plan to start tonight.

Here are some other things I've noticed:

1. Lowering cortisol (via Melatonin, Holy Basil, Magnesium etc.) is anxiolytic, but makes my hypoglycemia and dizziness a lot worse.
2. I am pretty intolerant of stimulants and find that they will generally 'crash' me and also make the hunger etc. worse.
3. The anxiety is crippling -- I can feel my body pumping out norepinephrine all day long, which I've read is a biological coping mechanism in hypothyroidism, and it's making me feel awful. I suspect the high morning cortisol reading was from my reactive hypoglycemia and fasting for the blood test.

I am becoming extremely desperate because living with these symptoms for so long now -- and losing my part-time job, social life etc. and being practically housebound -- is taking its toll; what's more, I am living in an extremely high stress environment, which makes finding a solution all the more urgent.

I've read some conflicting things on RT3: some sites say that it *does* compete with T3 and can induce symptoms of hypothyroidism, whereas other sites say there is no evidence for that. I've also read that the *cause* of the RT3 needs to be treated, but if that is stress in my case, I don't know what I can do about that, especially because my body is in such a weakened state and getting on top of things and building proper habits seems impossible now.

I've made an appointment with an integrative GP who is supposed to be very good and prescribes bioidentical hormones, and supposedly treats subclinical hypothyroidism.

So, the thing I am unsure about is whether I should be looking at this as a 'stress-induced' hypothyroidism and whether I should be doing something to help my adrenals, such as an SSRI (though I really loathe anti-depressants, to be honest, and would like to avoid them unless I have no other choice), or is it possible that thyroid treatment (pending I could even tolerate it) could help bring things back into balance?

FWIW, I am doing a Ketogenic diet, which has helped the hypoglycemia to an extent, though I still struggle with feeling hungry frequently. Sugar and carbs make the issue a lot worse.

 

[PakPik]

Hello there!
Ketogenic diet is probably one of the factors contributing to your high stress hormones/hypothyroidism issue.

"“Ketones are very protective as a fuel, but the problem is that they are produced as a result of metabolic stress. If the liver is extremely good, it can store enough glycogen for a day, but chronic, frequent, stress usually damages the liver’s ability to store glycogen.” (RP)

The liver has a central importance for thyroid function; having a good glycogen storage capacity in the liver is paramount to process hormones and toxins (for example, glucose perform the conversion of T4 to T3) , and someone with poor glycogen stores or someone with wastage of glycogen stores (this wastage occurs frequently when thyroid is inadequate or when liver is flooded with endotoxin) will have hypoglycemia issues.
Ketosis is harming all those aspects, and I think taking a thyroid supplement while restricting carbs is dangerous. RT3 blocks T3 function within the cell, and Rt3 usually comes from high cortisol or adrenaline. But then again, not having enough sugar will increase the cortisol. The more carb restriction, the more difficulty the person will have to metabolize them when eaten again

1. Lowering cortisol (via Melatonin, Holy Basil, Magnesium etc.) is anxiolytic, but makes my hypoglycemia and dizziness a lot worse.

High cortisol, as i understand it, is helping you meet the demands for sugar: it catabolizes muscle into sugar, so it makes sense that if you try to lower it you get into a hypoglycemic state. If one wants to lower cortisol safely and soundly, one has to provide the body with enough sugar to meet its needs. Otherwise it backfires. Cortisol also blocks thyroid function by breaking muscle apart and liberating tryptophan and cystein from them, then the thyroid gland goes into startvation mode, so it slows down its function so you don't break your body down too fast, trying to save your organs from cortisol.

 

[tara]

+1 to everything PikPak said.

FWIW, I am doing a Ketogenic diet, which has helped the hypoglycemia to an extent, though I still struggle with feeling hungry frequently. Sugar and carbs make the issue a lot worse.

What kind of carbs/sugar, and in what way worse?

I struggled through sugar withdrawal in my twenties to try to deal with what I think was hypoglycemia (with some of the symptoms you describe). In retrospect, since I've read Peat, I now figureit was exactly the wrong thing to do. I'd have been better off treating the sugar deficiency with more sugar.
The body experiences low sugar levels as stress, and attempts to address this by raising adrenaline and cortisol.

So, the thing I am unsure about is whether I should be looking at this as a 'stress-induced' hypothyroidism and whether I should be doing something to help my adrenals, such as an SSRI (though I really loathe anti-depressants, to be honest, and would like to avoid them unless I have no other choice), or is it possible that thyroid treatment (pending I could even tolerate it) could help bring things back into balance?

If you haven't yet read Peat on serotonin, I'd recommend it before considering SSRIs.
If your thyroid and fuel supply is able to provide you with more energy, there will be less demand on adrenals, and that may give them a break and a chance to recover.

Have you read Peat's articles on sugar?

 

[outdamnspot]

I experienced a terrible crash 6 months ago with hypoglycemia, tinnitus, weight gain etc. (basically, all the hypothyroid symptoms).

I spent a long time trying to find a doctor who would be willing to try treating my mildly elevated TSH (3.31). Other values looked okay: FT3 was 5.5 (3.3-6.4) FT4 was 17.9 (11.0-22.0), but RT3 was high-ish 434 (140-540).

My Vit D was low, so was B12, but supplementing with either seems to exacerbate my hunger/hypoglycemia issues -- hence, my wanting to work on the underlying hormonal issues first.

For adrenals, he prescribed me DHEA in the form of a trouche that I dissolve in my cheek; he said this would bypass conversion into Estrogen etc. He also prescribed NDT and said to begin on 1/4 grain, and then move up 1/4 each week.

I began this morning by taking the NDT on an empty stomach. Immediately, I began to feel worse, with air hunger and palpitations. I've read these can be signs of low adrenals, so took my morning DHEA dose. At that point, I felt even worse -- weak, depressed, hungry, lethargic etc. I continued for a few hours, then took my second DHEA dose and was hit by the same symptoms.

I honestly feel like thyroid is a major culprit in my current symptoms and would like to continue along this route, but I'm tremendously frustrated that I feel even worse as I have heard of people getting an initial boost from NDT/T3.

What I'm wondering is whether the DHEA is somehow *lowering* cortisol? I've read it can lower cortisol, but wasn't sure if it simply modulated it when it was high, rather than lowering already depressed levels. I had my doctor check my iron levels today to make sure that wasn't a factor in my reaction, and I'll have the results next week.

I know it is still very early stages and that I shouldn't be impatient, but I've been dealing with this cr*p -- bedridden, lost my job etc. -- for 6 months. I was a tiny bit more functional before, i.e. could watch TV or read a little, but the DHEA and NDT have laid me on my *ss all day.

From everything I've read, Pregnenolone seems like a better option for tolerating thyroid replacement, and I have ordered some drops, but they'll take 1-2 weeks to arrive.

In the meantime, should I stick with the DHEA and NDT, or possibly just try the NDT on its own and see how I go and whether the air hunger etc. passes?

This integrative GP is really expensive and I was hoping I wouldn't have to see him for another month or so, but I might have to go back next week to discuss all of this.

Oh, and I know people place a lot of emphasis on diet here. FWIW, I follow a ketogenic diet to try and control my hypoglycemia, which it helps significantly with. Since experiencing my crash, I cannot tolerate carbs or sugar -- they were spiking my blood sugar, and causing horrific reactive hypoglycemia.

 

[Giraffe]

@outdamnspot , I merged your different threads, so people who try to help you don't need to ask questions that have been asked before.
...........

I began this morning by taking the NDT on an empty stomach. Immediately, I began to feel worse, with air hunger and palpitations. I've read these can be signs of low adrenals, so took my morning DHEA dose. At that point, I felt even worse -- weak, depressed, hungry, lethargic etc. I continued for a few hours, then took my second DHEA dose and was hit by the same symptoms.

Eating?

Has your cholesterol been checked?
Check Starting thyroid supplementation

My Vit D was low, so was B12, but supplementing with either seems to exacerbate my hunger/hypoglycemia issues -- hence, my wanting to work on the underlying hormonal issues first.

Oh, and I know people place a lot of emphasis on diet here. FWIW, I follow a ketogenic diet to try and control my hypoglycemia, which it helps significantly with. Since experiencing my crash, I cannot tolerate carbs or sugar -- they were spiking my blood sugar, and causing horrific reactive hypoglycemia.

The question is how to make you process carbs again. Just throwing out a few ideas.... Have you tried restricting PUFA? Have you tried having carbs together proteins and fats? Tried coconut oil? Gelatin?

 

[outdamnspot]

@outdamnspot , I merged your different threads, so people who try to help you don't need to ask questions that have been asked before.
...........


Eating?

Has your cholesterol been checked?
Check Starting thyroid supplementation




The question is how to make you process carbs again. Just throwing out a few ideas.... Have you tried restricting PUFA? Have you tried having carbs together proteins and fats? Tried coconut oil? Gelatin?

No problem, Giraffe. I was worried my thread had been deleted. My cholesterol hasn't been checked; I'd read that iron levels could influence thyroid hormone tolerance, so I had a panel done yesterday.

I believe that I will people able to process carbs again when I can get the underlying hormonal issue (thyroid, adrenal?) under control and my hypoglycemia improves. I do supplement with coconut oil and find it beneficial.

Since I started the NDT and DHEA together, it's a bit hard to parse what is doing what.

 

[Giraffe]

How do you know you get blood sugar spikes and reactive hypoglycemia from carbs? What symptoms do you have?

 

[tara]

My Vit D was low, so was B12, but supplementing with either seems to exacerbate my hunger/hypoglycemia issues -- hence, my wanting to work on the underlying hormonal issues first.

If you do anything to improve metabolism (ie improve bodies ability to turn food into energy), it is normal to feel the need for more fuel. BeiFeeling hungry is often a good sign.
Hypoglycemia is a shortage of blood sugar. This can often be addressed by eating sufficient carbs.

He also prescribed NDT and said to begin on 1/4 grain, and then move up 1/4 each week.

That seems reasonable, though you could take the increases at fortnightly intervals instead of weekly, and I would add that it would be wise to monitor before each increment. Measure waking body temps and resting heart-rate. Dosing needs can vary from person to person and change over time. If you can stop when you get to a suitable dose for you, you may avoid the troubles of taking too much.

I began this morning by taking the NDT on an empty stomach.

Try taking it after breakfast instread. Or even better, split it in half and take half after breakfast and half after dinner. Or split into 3-4 doses.

For adrenals, he prescribed me DHEA in the form of a trouche that I dissolve in my cheek;

How much? I think Haidut recommends not more than 5mg at a time.

From everything I've read, Pregnenolone seems like a better option for tolerating thyroid replacement, and I have ordered some drops, but they'll take 1-2 weeks to arrive.

Seems really helpful for some, but not for everyone. Start with small dose ad see how it treats you. Long half-life, so may not be necessary to take every day.

In the meantime, should I stick with the DHEA and NDT, or possibly just try the NDT on its own and see how I go and whether the air hunger etc. passes?

My (non-expert) hunch is gradually reintroduce carbohydrates - eg fruit for starters, maybe potatoes or other roots you like, maybe milk if it agrees with you - so you have something for that thyroid to burn, and keep using the small NDT. I'll leave the DHEA question to others.

Oh, and I know people place a lot of emphasis on diet here. FWIW, I follow a ketogenic diet to try and control my hypoglycemia, which it helps significantly with. Since experiencing my crash, I cannot tolerate carbs or sugar -- they were spiking my blood sugar, and causing horrific reactive hypoglycemia.

I'd say this is key. I think it is likely to be very difficult to get to a robust metabolism on a ketogenic diet.
Since you have been avoiding carbs, you may be less adapted to use them now than before.
Some people have been able to turn this around.
What are you actually eating?

You know Peat recommends keeping PUFA intake as low as practically possible, because PUFA counteracts metabolism in various ways?
Are you aware of the Randle 'cycle' (seesaw) that suggests that while you are eating very high fat, it is hard to burn carbs?

I strongly recommend you read Peat's articles on sugar and diabetes if you have not yet.

I believe that I will people able to process carbs again when I can get the underlying hormonal issue (thyroid, adrenal?) under control and my hypoglycemia improves. I do supplement with coconut oil and find it beneficial.

I don't think it is so simple as the hormones being the underlying issue. If you block cellular respiration in other ways and withhold appropriate fuel, you can't necessarily fix all the resulting problems with thyroid supplement.

How do you know you get blood sugar spikes and reactive hypoglycemia from carbs? What symptoms do you have?

+1

 

[outdamnspot]

How do you know you get blood sugar spikes and reactive hypoglycemia from carbs? What symptoms do you have?

I was monitoring my blood sugar; it would spike after meals, then rapidly drop. I experience intense cravings for food/sugar, panic, shakiness, impending doom etc. I would feel full for about an hour, then need to eat again. On Keto, my sugar does not spike and these symptoms are much improved.