# Am I losing my mind?



## Noreen63 (Mar 5, 2012)

HI,
Three weeks ago I was diagnosed with Hashi's. Last week I started SR T3 - 7.5 2x perday. (Doc says he wants to increase slowly.) I am also taking hydrocortisone and Vit. D3 and B12. I have moments when I feel normal, other moments when I feel hyper, and other times I am as exhausted as ever. Sometimes my eyes hurt, sometimes the front of my neck has this weird dull burning feeling. Its all subtle enough that I don't feel well, but I wonder if its all in my head. My mood is up and down and all over the place. Sometimes I have very clear thinking and other times I feel like I am in a fog. I wonder if Iam just too tuned into how my body is feeling because I am concerned about starting the T3. Is this all part of the Hashi's experience? You won't hurt my feelings if you tell me I'm nuts.:tongue0013: Will this level out or is this how its going to be?

Thanks for listening.


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## joplin1975 (Jul 21, 2011)

Just curious, was there any particular reason they started you on T3 medication as opposed to T4? I don't know much about the T3 options, but that sounds like a lot...


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## Andros (Aug 26, 2009)

Noreen63 said:


> HI,
> Three weeks ago I was diagnosed with Hashi's. Last week I started SR T3 - 7.5 2x perday. (Doc says he wants to increase slowly.) I am also taking hydrocortisone and Vit. D3 and B12. I have moments when I feel normal, other moments when I feel hyper, and other times I am as exhausted as ever. Sometimes my eyes hurt, sometimes the front of my neck has this weird dull burning feeling. Its all subtle enough that I don't feel well, but I wonder if its all in my head. My mood is up and down and all over the place. Sometimes I have very clear thinking and other times I feel like I am in a fog. I wonder if Iam just too tuned into how my body is feeling because I am concerned about starting the T3. Is this all part of the Hashi's experience? You won't hurt my feelings if you tell me I'm nuts.:tongue0013: Will this level out or is this how its going to be?
> 
> Thanks for listening.


The hydrocortisone can cause some of this. (anxiety, depression, insomnia etc..)
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682206.html#side-effects

And are you on T3 only; timed release? No T4?


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## Noreen63 (Mar 5, 2012)

Hi Andros,
As I understand it, the doctor started me on the hydrocortisone because my ACTH, and DHEA were low. He indicated that if my adrenal function wasn't optimal then the thyroid function wouldn't be optimal even with the SRt3. He chose SRt3 at 7.5 mcg 2x per day because he said my labs indicated there was
probably an issue with conversion from t4 to t3. So using t3 eliminates that issue.

TSH 3.5 (0.27 - 4.2)
Free t3 2.4 (2.0 - 4.0)
Free t4 .88 (.80 - 1.80)
Rt3 189 (90 -350)

My level of understanding is limited. I am learning as I go. I am also struggling because there is soooo much confllicting information.


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## Noreen63 (Mar 5, 2012)

Oh and yes the t3 is time released. No t4.


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## iroczinoz (Aug 15, 2011)

Noreen63 said:


> Hi Andros,
> As I understand it, the doctor started me on the hydrocortisone because my ACTH, and DHEA were low. He indicated that if my adrenal function wasn't optimal then the thyroid function wouldn't be optimal even with the SRt3. He chose SRt3 at 7.5 mcg 2x per day because he said my labs indicated there was
> probably an issue with conversion from t4 to t3. So using t3 eliminates that issue.
> 
> ...


Well your ft4 is definitely low and Ft3 not much better off. Your Ft3/rt3 ratio comes back at 12.5 and sources state it should be closer to 20 or above.

So maybe the T3 only will help but maybe dessicated thyroid could also be tried?

15mcg t3 daily is probably not that high considering your Ft3 levels are some what shot. Maybe an increase in dosage at a later date might benefit. Or you could try dessicated thyroid meds like armour as people state they are absorbed much better.

Maybe t3 only for now to cleae your rt3 and then maybe after a couple of months try Armour.


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## lainey (Aug 26, 2010)

> As I understand it, the doctor started me on the hydrocortisone because my ACTH, and DHEA were low.


And what is the dosage and strategy on this? Steroids are usually reserved for adrenal insufficiency, which is quite different from "adrenal fatigue".



> he said my labs indicated there was probably an issue probably an issue with conversion from t4 to t3. So using t3 eliminates that issue.
> 
> TSH 3.5 (0.27 - 4.2)
> Free t3 2.4 (2.0 - 4.0)
> ...


What kind of doctor is this? Not a traditional one.

No offense, but with free T4 so low in the range, you don't have enough of that available to convert to T3 in the first place--so the assessment that you have a conversion problem is quite premature. That conclusion is reached after you bring the T4 well up into the range (with is done by giving some kind of medication with T4 in it) and then seeing if the free T3 follows accordingly.

IMHO, this is a backwards dosing strategy.


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## Andros (Aug 26, 2009)

Noreen63 said:


> Hi Andros,
> As I understand it, the doctor started me on the hydrocortisone because my ACTH, and DHEA were low. He indicated that if my adrenal function wasn't optimal then the thyroid function wouldn't be optimal even with the SRt3. He chose SRt3 at 7.5 mcg 2x per day because he said my labs indicated there was
> probably an issue with conversion from t4 to t3. So using t3 eliminates that issue.
> 
> ...


According to the above labs, you were very undermedicated at that time. What were you taking when these labs were taken?

Your rT3 does not seem to be in excess so I question this protocul being employed as we all need some T4 for peripheral deiodination for all of the thyroid hormones.

http://thyroid-rt3.com/whatis.htm


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## Noreen63 (Mar 5, 2012)

I wasn't taking anything. I went to my original doctor because I thought the symptoms I was having were possibly related to perimenopause. During the exam she felt that my thyroid was a little enlarged, ordered an ultrasound that confirmed I had a goiter and then she looked at my labwork, said my TSH was fine and indicated she could refer me to a psychiatrist... That is when I started researching and I found my current doctor on a top docs web site for doctors who treat thyroid and hormone issues. He ordered more labs and spent over two hours with me discussing my concerns and asking questions. He indicated this might be a slow process. He said he wanted to move in stages in terms of treatment.


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## lainey (Aug 26, 2010)

T3 only therapy is generally not considered as a first choice, nor it is considered a long term solution.

I questioned the steroids, and you have not answered that. Once again, there is a huge difference between the treatment for adrenal insufficiency, which is a lifelong deficiency, and suspected "adrenal fatigue".

Top sites or not, his starting point is at the least unconventional. Most people would begin with a low dose of T4 medication while correcting existing vitamin deficiencies.

So, what exactly are the stages of treatment he has proposed?


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## Andros (Aug 26, 2009)

Noreen63 said:


> I wasn't taking anything. I went to my original doctor because I thought the symptoms I was having were possibly related to perimenopause. During the exam she felt that my thyroid was a little enlarged, ordered an ultrasound that confirmed I had a goiter and then she looked at my labwork, said my TSH was fine and indicated she could refer me to a psychiatrist... That is when I started researching and I found my current doctor on a top docs web site for doctors who treat thyroid and hormone issues. He ordered more labs and spent over two hours with me discussing my concerns and asking questions. He indicated this might be a slow process. He said he wanted to move in stages in terms of treatment.


We are a bunch of worry warts here. We don't want anything untoward to happen to you. Use your best judgement and hopefully you can glean some helpful information from us.

Aaaaaaaaaaaaaaaaaaaack; I can't believe you were referred to a psychiatrist. OMG! Don't blame you for doctor shopping. That is just too scary and by the way, the same has happened to many of us here.

That is why we are so nit picky. LOL!


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## Noreen63 (Mar 5, 2012)

Hi Lainey,
The Doctor used the term adrenaline insufficiency. He started me on 20 mgs of hyrtocortisone split into 3 doses. He started the HC first, then added the T3 about two weeks later. His plan is to increase t3. Wait for the Rt3 to clear and then use a t4 /t3 combo.


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## Noreen63 (Mar 5, 2012)

Thanks Andros, I appreciate all input. I want to be well informed.


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## Andros (Aug 26, 2009)

Noreen63 said:


> Thanks Andros, I appreciate all input. I want to be well informed.


Bless your heart! If only we had more credible resources as there is a lot of misinformation out there.

No matter what, we are in your corner! That's the bottom line.


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## lainey (Aug 26, 2010)

> The Doctor used the term adrenaline insufficiency. He started me on 20 mgs of hyrtocortisone split into 3 doses. He started the HC first, then added the T3 about two weeks later. His plan is to increase t3. Wait for the Rt3 to clear and then use a t4 /t3 combo.


Once again, your labs really are not showing signs of reverse T3 dominance. If that were the case, the RT3 would be high out of range. RT3 is a natural, inert byproduct of thyroid hormone synthesis that takes place in the body--yours was mid-range, which is to be expected.

"Adrenal insufficiency" is usually reserved for Addison's disease--which is a lack of production of adrenaline, and the steroid replacement is lifelong. Is this what he has diagnosed you with? If that is not the case, the steroid use should be short term and a plan in place to taper off. These are very powerful drugs, and carry their own set of complications.


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## Noreen63 (Mar 5, 2012)

Hi Lainey,
The Doctor used the term adrenaline insufficiency. He started me on 20 mgs of hyrtocortisone split into 3 doses. He started the HC first, then added the T3 about two weeks later. His plan is to increase t3. Wait for the Rt3 to clear and then use a t4 /t3 combo.


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## lainey (Aug 26, 2010)

Is that 20mgs/3x per day (60mg total) or 20mgs divided in thirds?

If you do have Addison's, a traditional doc would have picked that up. Also, if you do have Addison's T3 is contraindicated unless the condition is well managed first. Additionally, he has is not using something with an aldosterone in it in this case, as you say your DHEA was also low.

So, it makes a difference what you have, because if it is adrenal fatigue (which is low, but in range results and very different from INSUFFICIENCY which for is used to describe nearly non existent levels ), then the course of steroids would be temporary--and in fact, it is usually not treated with steroids.

You wanted to know why you don't feel well yet. It could be the steroids. It could be the T3. You have not chosen a conventional path of treatment, and aren't really providing full information about your diagnosis.


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