Nervousness, racing heart, sweating, shaky hands

[ilovethesea]

Your situation sounds very similar to mine. I've had a total thyroidectomy so completely dependent on thyroid medication.

I take NDT and T3. It's taken years to get the dose working ok.

I get very hypo taking smaller doses. My current regime is:

2 grains NDT on waking
25mcg T3 around lunch
1 grain NDT late afternoon
12mcg T3 30-40 mins before bed

This seems to work for me at the moment. I got some of the symptoms you described (particularly getting really stressed when rushed or just being challenged a bit - felt like adrenaline) when I wasn't taking enough T4. Three grains of NDT seems to do the trick.

As the others have said in this thread - and I can't stress this enough - more food/nutrients are required. I have needed lots more food to support my metabolism, and I take a couple teaspoons of salt each day (sometimes more - I find this essential). I also add sugar to my OJ, and do better if I have some starch - sourdough bread and potatoes work for me.

I've been experimenting with having OJ/salt/sugar or similar milk drink just before bed, and at my bedside to be drunk if I wake up for any reason. This has done wonders for reducing adrenaline in the morning, and has stopped my temps and pulse dropping after I have breakfast. Maybe that is something to look at?

I hope in the future, as I heal, that I only need NDT, as dosing with T3 is very tricky, but required at the moment. Also, I was taking a compounded NDT (in Australia) and it did not work half as well as they pimpom NDT Thiroyd (I think that is the correct spelling).

Interesting thank you - glad you know what I'm trying to describe here :) And how funny, your dosing schedule is the complete opposite of what the practitioner recommended to me - she said to do T3 in the day and T4 at night. Do you find the T4 at night keeps you awake and that's why you take it in the daytime? What happens if you don't also take the T3?

I agree just the one type of med would make things easier with dosing. T3 is a pain in the butt... but I noticed I feel the effects of it more than when I take some Cynoplus. On Cynoplus only I felt like I had plateaued and wasn't improving my hypo symptoms beyond a certain point. Hence the change in my dosing but now I'm so discombobulated I don't know where to adjust from here.

I noticed the same thing too with compounded thyroid by the way. It's so much more expensive than other NDT but is so weak that I don't know how they get away with selling it as the same dose. I ran out of Erfa once and had to take it and my temps just crashed. The whole compounded bioidentical hormone thing is such a scam.

I have been mainlining sugar so I think I get enough there... salt I have to increase for sure. I am pretty sure it was a trade off giving up starch for the sake of my allergies, because starch was my vehicle for salt, and now I'm suffering these stress symptoms without it. I'm not sure which is worse...

Someone else alerted me to your OJ drink :) I don't usually wake up in the night but I'll try that before bed. I've been getting about a litre of fresh OJ per day lately and it is amazing. I'm so glad I finally bit the bullet and started ordering oranges by the case.

 

[Mittir]

The reason I changed now is because I felt like I "plateaued" on the 2 Cynoplus per day regimen and wasn't getting less hypo (and yet my doctor was freaking out that I'm "hyper" on blood tests). I decided to try the 2 Cytomels throughout the day and 1/2 a Cynoplus at night, at the recommendation of a practitioner (who follows RP too). This was to keep my T3 at the same level.

I decided the last 2 days to try just 1 Cytomel per day with the same 1/2 Cynoplus at night. I noticed somewhat less of the nerves/adrenaline but maybe still some sweating, and I got a pimple and my feet and nose have been cold. So, I think I must need more thyroid - I just don't know how to adjust from here without getting those symptoms again.

Changing from 2 cytomel to 1 cytomel is like 50% reduction in T3 supply.
That is a drastic change in dose. Body needs time to get adjusted to
change in external supply of T3. It is best that changes happen slowly.
You probably know how prednisone doses are taper down.
Changing from 1/6 th of cytomel to 1/8th of cytomel is
a difference of 1 mcg, that is 25% of hourly T3 supply.
Are you tracking your pulse and temperature after introducing
lowered dose. Frequent changes in dosing can be confusing
to your body. I think asking RP if this kind of hourly dosing
is ok will be helpful to you and others who are adjusting their dose.

 

[juanitacarlos]

And how funny, your dosing schedule is the complete opposite of what the practitioner recommended to me - she said to do T3 in the day and T4 at night. Do you find the T4 at night keeps you awake and that's why you take it in the daytime? What happens if you don't also take the T3?

Just for me, taking the T3 before bed just seems to make me more relaxed and able to sleep, where for some reason the NDT taken at night stimulates me too much. I don't think one is better than the other at night, just at this point the T3 works better. I think it's ok taking Cynoplus or NDT at night - whichever works.

I agree just the one type of med would make things easier with dosing. T3 is a pain in the butt... but I noticed I feel the effects of it more than when I take some Cynoplus. On Cynoplus only I felt like I had plateaued and wasn't improving my hypo symptoms beyond a certain point. Hence the change in my dosing but now I'm so discombobulated I don't know where to adjust from here.

I so feel your pain! I posted this a while ago which might explain things for some people (like yourself and me). I think you might find it interesting.

I noticed the same thing too with compounded thyroid by the way. It's so much more expensive than other NDT but is so weak that I don't know how they get away with selling it as the same dose. I ran out of Erfa once and had to take it and my temps just crashed. The whole compounded bioidentical hormone thing is such a scam.

Agreed - no wonder people are hypo.

I have been mainlining sugar so I think I get enough there... salt I have to increase for sure. I am pretty sure it was a trade off giving up starch for the sake of my allergies, because starch was my vehicle for salt, and now I'm suffering these stress symptoms without it. I'm not sure which is worse...

That sucks. I take salt 1/2 tsp at time - just down the hatch. Is that something you can do?

Someone else alerted me to your OJ drink :) I don't usually wake up in the night but I'll try that before bed. I've been getting about a litre of fresh OJ per day lately and it is amazing. I'm so glad I finally bit the bullet and started ordering oranges by the case.

OJ is great. Last night I had the OJ drink with some Reggiano Romano and slept straight through. I think it's good also to have the OJ drink right there for when you immediately wake up to blunt the stress hormones. Most people don't eat straight away on waking - you know have a shower, or lie for there a while. For me, it helps.

 

[ilovethesea]

Changing from 2 cytomel to 1 cytomel is like 50% reduction in T3 supply.
That is a drastic change in dose. Body needs time to get adjusted to
change in external supply of T3. It is best that changes happen slowly.
You probably know how prednisone doses are taper down.
Changing from 1/6 th of cytomel to 1/8th of cytomel is
a difference of 1 mcg, that is 25% of hourly T3 supply.
Are you tracking your pulse and temperature after introducing
lowered dose. Frequent changes in dosing can be confusing
to your body. I think asking RP if this kind of hourly dosing
is ok will be helpful to you and others who are adjusting their dose.

Just an update, I think I've figured out that the stress symptoms are related to calories not excess thyroid pill.

I'm still doing the 2 Cytomel per day in 1/8 doses and then 1/2 a Cynoplus at night. I notice on days where I'm eating a lot, I feel absolutely fine.

On days when I am a bit stressed with work to do, eg. pressed for time and not taking the time to eat as much, I get the adrenaline symptoms. I assume this is from lack of calories and protein. The adrenaline happens on days when I'm drinking more liquids instead of having a satisfying heavier meal (eg. fruit, cheese, steak, fish, shrimp). I find the liquid diet of milk and orange juice, occasional greek yogurt, is ok but I really have to make an effort to remind myself to keep consuming something all day long.

(Note I struggle with the calories because I'm avoiding starch for endotoxin reasons - I get severe allergies.)

I talked to my practitioner again and she said women have a particular challenge with the thyroid dosing because our higher estrogen makes it much harder to convert the T4 to T3. That makes sense for why I thought I was plateauing on the NDT. I feel like my body is 'using' more of the hourly T3.

I will ask Ray about this at some point. The issue is how do I increase further than what I'm taking now, since the body can only handle a certain amount of T3 every hour... so how does that explain people like the 12 grain woman. Or the woman Dr. Derry mentioned who needed 20+ grains. Was that because their bodies could not convert the T4 though?? I am wondering...

 

[ilovethesea]

I so feel your pain! I posted this a while ago which might explain things for some people (like yourself and me). I think you might find it interesting.

Yes! I remember reading that when you posted it earlier. Makes sense. Sounds like the takeaway is to play with ratios lower than 4:1. I am doing 1:1 at the moment. I read a lot of the reverse T3 forum a few months ago and it seemed like not everyone was doing that well on T3 only, maybe their TSH still needs the T4 like Ray said.

I tried swallowing the salt but felt nauseous... I don't think it was more than 1/2 a tsp and I needed to lie down. For some reason I don't seem to tolerate that.

Good idea about having the OJ immediately upon waking.

 

[Mittir]

Thanks for the update. It seems like finally you have figured out the problem.
I have noticed in other people who thinks thyroid supplement alone will solve their
problem. I have to eat a huge amount of calories, including
a lot of sugar, at least 80 grams of protein, daily liver and all the vitamins and minerals
to feel good. Last month i experimented with relaxing my food intake.
I did not pay attention whether i was getting enough protein or nutrients.
At the end of the month TSH was way up and total T3 dropped by 30 points.
It is a lot work to maintain a high metabolism.
RP mentioned that if salt is causing gut irritation you can use sodium from baking soda.
But there is a possibility that baking soda can mess with pH. RP also mentioned that
other alkaline minerals can compensate for lack of any one of the minerals.
If salt is a problem for you then you can increase intake of other 3 minerals.
Since, hypothyroid people evaporate less water through skin and lungs, you
can experiment with a lower fluid intake. Just follow thirst and cravings.

 

[Peatit]

post 43249 I so feel your pain! I posted this a while ago which might explain things for some people (like yourself and me). I think you might find it interesting.

The relationship between TSH and the conversion rate of T4 to T3 made sense to me, but I found surprising that I have never read or heard something about this possibly important retro control loop from RP, so, I emailed him the two studies referenced in the article and here is his verbatim answer:

Since they used 100 times the physiological concentration of TSH, I don’t think it has any practical meaning.