Is my thyroid medication doing me more harm than good?

[Elerylle]

Hi everyone,

In November 2014 my gynaecologist prescribed to me 75 mg of progesterone and Thyroxine (T4) 75 mcg/triiodothyronine (T3) 30 mcg.

(This is the clinic I go to if anyone knows the place: http://www.menopausecentre.com.au/. I have heard rumours of Dr. Aaron being a little dodgy, but you know what internet rumours are like)

This was due to low progesterone and hypothyroidism. I was originally prescribed estradiol too, but I had to come off this after only 1 month due to severe cystic acne, which I've never had before.

Over the past 12 months of being on this medication I have gone from 51 kg down to a frightening 44 kg despite steadily increasing my caloric intake to try and halt the weight loss. My exercise routine has been consistent for years, weightlifting 4 x per week. The rest of the time I'm pretty sedentary. I have lost most of the muscle I have worked so hard to build.

My last thyroid function tests came back with:
TSH = <0.02 L mIU/L
Free T4 = 16.7 pmol/L
Free T3 = 4.2 pmol/L

I feel that my health has declined slowly over the past 12 months.

I have developed severe food intolerances particularly to histamine and as a result I can no longer tolerate even small amounts of meats. If I eat even an ounce of liver I am violently ill the next day.

Googling I have found a few references to ‘Thyroxine-induced supersensitivity to histamine and norepinephrine activation of cardiac phosphorylasea’.

I now have severe CFS and fear that soon I will be disabled if I do not get to the bottom of this. This is devastating to me because I am only 25 and have had to pause my studies to concentrate on getting better.

I've explained repeatedly to my gynaecologist how terrible I feel but he either keeps upping the dose or telling me to take the medication at another time of the day.

I want to know if I should be on another type of thyroid medication, is the one I'm on contributing to my debilitating symptoms? I'm terrified right now and everybody keeps telling me different things. I have been following Ray Peat and Danny Roddy's work for several years and I know that they know their stuff when it comes to the thyroid. I appreciate any help that any of you can give. I'm so confused right now :)

 

[answersfound]

I would start from scratch. What you could do is get nutri-meds thyroid tissue and start with one tablet split up into 4 doses spread throughout the day. Or maybe you just need half a tablet. It would be a lot easier to evaluate progress this way than with two seperate medications like you are doing now. You may be giving your body thyroid hormone, but it doesn't know what to do with it because maybe your not eating enough calories, vitamin A, fructose for cholesterol, etc. pregnenolone could also be of help to you. Or maybe liver health could be an issue. I wish I had a more straight forward answer for you, but it's tough to say with so many variables. i would just start over from the beginning and focus on listening to your body.

 

[sweetpeat]

answersfound is right about there being a lot of variables, but on the surface of things it looks to me like you're being over-medicated on thyroid. And possibly progesterone as well. Have you tried lowering your dosages? Have you ever felt good at any point on the medications? How are your temps and pulse? Any more details that you can provide would be helpful. You're right that it doesn't make sense to keep doing something if it's making you worse.

 

[Blossom]

 

[dookie]

In some people, even a small amount of thyroid causes side-effects, and paradoxically raises estrogen levels. Do you feel more bloated and puffy on the thyroid than you did before?

 

[tara]

post 112895 answersfound is right about there being a lot of variables, but on the surface of things it looks to me like you're being over-medicated on thyroid. And possibly progesterone as well. Have you tried lowering your dosages? Have you ever felt good at any point on the medications? How are your temps and pulse? Any more details that you can provide would be helpful. You're right that it doesn't make sense to keep doing something if it's making you worse.

Elerylle
I'm not a doctor and not qualified or expert enough to give medical advice - just read bit here and elsewhere, so bear that in mind. But I have some thoughts.

I think you have good reason to be concerned about such rapid weightloss, especially when you are so small to begin with.
If you are wanting to give more information, maybe you could spell out what and how much you are eating? Some of us use cronometer either regularly or occasionally to get a rough idea of what nutrition we are eating. (It tends to undersestimate calorie needs, though, and overestimate PUFA needs from Peat's PoV.) The average weight-stable non-dieting adult woman eats around 2500 cals (not from Peat). If you are way above that and not overexercising, and still losing weight rapidly, there is probably something amiss. Too much thyroid is one possibility; others I can think of include something messing badly with digestion so you are not getting much out of your food, or a deficiency in some key nutrients, or parasites. Peat usually recommends getting at least 80-100g good quality protein/day. Sometimes low thyroid function can also make it difficult to gain weight - that's more likely to line up with low body temps and pulse.
Do you have an appetite for more food than you are eating? What foods are you managing to eat without severe histamine/intolerance issues?


It might be good to slow down the weights a bit for a while - it doesn't seem as though you have the resources to support it at the moment.

Do you have any idea why you were hypothyroid and low in progesterone to begin with? Not that all of us do, just that if you did it might help give more clues about what's going on now.

The following ideas are based on reading, not on my own experience. Wouldn't surprise me if you are getting too much thyroid supp, but as above, there are many factors, so hard to be sure. If your temperature and pulse are high, that would be consistent with too much. The very low TSH may line up with that too. (Low TSH isn't always a problem, just thinking it might be confiming an issue because of the other things you describe.) T4 has a long half-life - it can take 2-3 weeks for the level to stabilise when you change doses. T3 is much faster - a half-life of a few hours. I can't remember what the normal ranges are for blood T3 and T4. I think Peat says it's not just the free T3 and T4 that counts.
If you find your temps and pulse are high, and you want to do some cautious experimenting, you could reduce your T4 by a bit, and monitor of the next 2-3 weeks to see if there is an improvement. I wouldn't make a big change all at once, but maybe reduce by max 1/4 of your curent dose at a time.
How are you taking the T3? Peat usually recommends nibbling tiny bits of T3 (I think that means of the order of 1-2mcg) every hour or couple of hours as needed through the day. A healthy thyroid produces something like 3-4mcg/hour, so adding in 30mcg at once is a big amount, and as little as 1 - 2 mcg can give a significant boost. Because it is fast acting, you may be able to afford to play with this a bit - split your doses up into tiny, and take a little, and then more when you feel you need it - up to hourly. If you get too low, you have the option of returing to your previous dose, and the effects should be pretty quick.
Peat has written about people needing different ratios of T3 and T4 supps. He says for most people, the optimal lies somewhere between 1:2 and 1:4 T3:T4. Your prescription is in this range, but it may still not be quite what you need. To much T4 with not enough T3 can sometimes cause reduced thyroid function.
Have you had reverse T3 measured at all? rT3 gets made instead of T3 from T4 when the body thinks there is too much T3. This counteracts the thyroid supplement to some extent.

If your situation continues to deteriorate, I think it might be worth getting another medical opinion. You might get some useful clues you can use here, but since your situation seems serious, getting more local medical advice may be wise. Then you can take their ideas and figure out what you want to do - you may figure out more than they can anyway.

Take care.

 

[DesertRat]

I had pretty severe ME-CFS (not severe anymore) and for me, that would be a gargantuan starting dose. Many of us have low cortisol and taking all that progesterone can lead to a raise in cortisol if the adrenals convert it, which they do when people have been habitually low. High cortisol will lead to a breakdown of muscle tissue as it is a catabolic hormone.

When I started T3, I ground up a 25 mcg tablet and took about a week to get through it. Now finally after nearly 2 years I can take a full 25 mcg over the course of a day -- usually in 5 -6 small doses. If you've been low for awhile and with this mysterious illness, you could be pushing too quickly. I've found that every time I try something that's supposed to be good to speed up the system (e.g. methylene blue, or niacinamide, or taurine/glycine), it backfires because something in this illness is interfering with the energy production and we don't know where the block is.

So go slow and steady, divide up your doses and measure temp and pulse before and 30 min after.