• Simply: I lived with Graves disease since the age of 21. I eventually needed a thyroidectomy due to becoming severely neutropenic from a reaction to anti thyroid drugs. My life took a serious downturn after I had RAI (Radioactive Iodine - complete ablation of the thyroid gland)
• I genuinely believed that the subsequent depression, social withdrawal, anhedonia, mood swings, and unpredictable lethargy (which often left me house bound) was a result of me selling the company and having "finished life" with nothing else left for me to do. It was only when I began intense training again - experiencing horrible exercise intolerance, becoming sofa ridden inexplicably - that I realised how intensely ill I was underneath it all. The heavy legs - my most hated symptom (other than the depression) - was no longer a tenable symptom. Life is barely worth living when you cannot predict if you will be able to walk reliably or not on any given day.
• Every single "holiday" I have attempted since RAI has resulted in me flying home in tears (literally), from crippling insomnia and depression, leaving everyone else behind.
• I have been living with supraphysiological T4 but impaired T3 levels for years. All of my endocrinologists told me it was fine as it was in range. Ask a graves disease patient who has had a thyroidectomy or RAI and many will tell you the opposite. In range is NOT fine for many - for me it was a living horror movie.
• After RAI or thyroidectomy, the margin for error is close to zero. When I was previously simply hypothyroid, partial replacement was trivial - because the thyroid itself and the hormonal negative feedback loop simply picked up the slack if I was slightly out.
• Mental stability is my no.1 goal. I also wish to be able to walk reliably, but sleep reliably too. I want to be able to agree to social events then actually turn up. This sounds like I'm a charity case. It sounds melodramatic. But this disease has me by the balls. I accept my refusal to give up training exasperates my symptoms, but I am a type A personality all-or-nothing, go-big-or-go-home, black or white personality, and I don't want to change that. Success would be entirely absent from my life without persistent dedication. Even in the absence of disease and symptoms, I would still refuse to be Mr. Average in any aspect of my life and I would genuinely prefer to die trying than give up.
• NB. During the process I intentionally made myself hypo / hyper to concretely ascertain symptoms. This was reckless, and a health risk, but I am past caring. I need to learn to manage this disease and empower myself to deal with it for life.

This is basically how I felt the past 7 years of my life:

https://healthunlocked.com/thyroiduk/posts/148727306/to-my-gp-my-endocrinologist-my-next-employer-anyone-who-dares-try-to-normalise-my-experience-of-hashis-on-a-bad-day

• Whilst in range: Complete remission of anhedonia, depression; regained lust for life after years of depression
• I am finally concrete in my opinion that I am not mentally ill (despite multiple historical diagnoses from psychiatrists: Bipolar disorder, ADHD, Major Depressive Disorder, Generalised Anxiety Disorder). It was just the thyroid hormones. Everything has been thyroid hormones. It was fine before RAI, all hell broke loose after. Even withdrawal from recreational drugs cannot reproduce the suffering of being extremely hyper/hypo. Remember: This shit ONLY started after RAI. I was not a mental nutcase before RAI.
• I have validated with a high level of confidence that my symptoms are not related to my other health conditions / medications
• I have become SIGNIFICANTLY more aware of my current hypo/hyper state. I have this disability for life. Thyroid dosage will never remain static, particularly with my bulk/cut fitness style of life. This will certainly benefit me long term.

Insomnia / Elevated Cortisol / Nocturia

• Derailed by crippling insomnia - very hard to discern symptoms / state whilst sleep deprived
• I thought I had it working, but I was sedating myself through elevated morning cortisol with sleeping meds
• Hypercortisolism - morning cortisol would not resolve (2 - 3 x upper range) irrespective of T3 dosage. I believe it probably needed to continue to go UP now to resolve it. Almost as soon as my background T4 became undetectable in serum, I developed a rough case of hypercortisolism with levels 2 to 3x upper limit upon waking. This coincided with torturing blanket insomnia - I was lucky to sleep 3 hours even with sedation most nights. Awoken by a feeling of panic and distress, with a feeling that I had been awoken by someone pouring a bucket of water over my head. This was followed most mornings by crying episodes and/or rage. This made me so frustrated I became reckless. My only respite during this period was wiping away tears whilst reading /r/insomnia and reading others talking about suicide and self harm and just knowing others are also at their wits end.
• Nocturia - the growth of visceral fat (Cortisol belly) became so severe that I was not only developing insulin resistance and destroying my physique (which is devestating for someone who prides themselves on their obsession with fitness and dietetics), but also finding it hard to urinate - I had to sit down and push down on my bladder to piss. That was living hell at night, especially whilst having to get up 3 - 10x per night from uncontrolled elevated blood sugar from the hypercortisolism. Even a strict ketogenic diet could not mitigate the hyperglycaemia and visceral fat growth whilst my levels were out.

Mistakes

• Fear of T3; fear of the "come up" manifesting as either euphoria or panic after each dosage change. Huge placebo effect of T3 makes pragmatic analysis challenging.
• General dislike for the sawtoothing peaks/valleys of T3 in serum. Fear of long term compliance issues. Fear of T3 long term availability issues ("WTF happens if I become incapacitated?")
• A refusal to stop training negated ability to use metrics such as heart rate etc as KPIs. It also intensified fatigue symptoms during periods of extreme exercise intolerance: "I can't get up the stairs without screaming my head off, it is so hard; I feel like I'm carrying an elephant. Is it a state of overtraining induced by training through illness, or just transient due to thyroid levels?"

Dislike of short acting T3 itself

• The suffering when T3 levels are too high or too low became untenable. Fear of being traumatised for life. Fear of destroying social relationships
• Sudden, overambitious cessation of sleeping tablets and SSRI caused mayhem - psychological symptoms / mood swings difficult to discern from T3 overdose/underdose

Dosage notes

• 50mcg = HYPO for certain - cracking nails, depression, hair loss, water retention, inability to control blood glucose, and a need to "summon" energy. Blood sugar a total mess, body composition slowly degrading with a "thyroid belly" and visceral fat storage.
• 75mcg = probably about right, maybe even too little. Far better mental outlook, explosive energy, no depression but sometimes anxious, and perhaps a bit manic. 75 returned good blood results with the lowest cortisol numbers (T3 top end of range 12 hours post dose, TSH < 1, FT4 undetectable)
• >75mcg - I did not sustain any dosage higher than 75 for any decent period. I was frightened of the transient side effects. If I was not derailed by crippling sleep deprivation I would have persisted increasing the dosage to see if that reduced morning cortisol. I was convinced more T3 = more insomnia (based on the loose theory that T3 is stimulating, and the times in the past I have been in thyrotoxicosis I have completely lost the ability to sleep)