Join Date: Apr 2002
Re: Thyroid flare-ups
You're Having a Thyroiditis Flare
Some patients who have the autoimmune condition known as Hashimoto's thyroiditis are diagnosed during a period when they are hypothyroid. But in a thyroid that is failing due to autoimmune disease, the thyroid can frequently sputter into overdrive, then back into underactivity, and into overdrive again, as it "burns itself out" over time. You can, therefore, experience periods of overactivity - hyperthyroidism - even while your thyroid is underactive over time and generally on its way to burning itself out. So, you can experience hypothyroidism symptoms, but periodically have hyperthyroidism symptoms that also appear. And remember...hyperthyroidism symptoms don't "cancel out" your hypothyroidism symptoms...they more often are added to them.
At the same time, Hashimoto's can also mean that periodically, the thyroid experiences a flare-up, or "attack" of thyroiditis, which is frequently accompanied by symptoms such as palpitations. Noted thyroid expert Stephen Langer, M.D., who coauthored the popular thyroid book Solved: The Riddle of Illness with James Scheer, refers to thyroiditis as like an "arthritis of the thyroid." He explains that just as arthritis attacks the joints with pain and inflammation, thyroiditis can mean pain and inflammation in the thyroid for some sufferers. And in particular, during a thyroiditis attack, common symptoms you might experience are anxiety, panic attacks, heart palpitations and problems sleeping. - all common hyperthyroidism symptoms - as well as swelling in the thyroid area, and problems swallowing.
What Can You Do?
Generally, whatever the cause, some patients find relief from palpitations and rapid heartrate with beta blockers. Antianxiety drugs may also be a help in panic attacks and anxiety. Some patients find that they require treatment for particularly troublesome hyperthyroidism symptoms. For example, during periods when palpitations or high pulse become bothersome, drugs such as beta blockers - which lower heart rate and blood pressure and can slow or stop palpitations -- can be prescribed to help control symptoms. Sometimes, anti-anxiety drugs can be a help, and in some people, temporary use of sleeping pills may also be of assistance. On the natural end, some patients find that yoga, biofeedback, or breathing exercises can help with palpitations or rapid pulse.
One of the best treatments for dysautonomia symptoms is regular physical exercise, which calms down and regulates the autonomic nervous system. Palpitations are also responsive to acupuncture treatments. From a more nutritional medicine perspective, Dr. Langer suggests that patients experiencing thyroiditis and having trouble sleeping take calcium/magnesium, which are nutrients that have a sedative effect, along with a pain reliever to relieve inflammation -- buffered aspirin or ibuprofen -- before you go to bed, this might help. He's found that this helps about two-thirds of his patients suffering from nighttime thyroiditis symptoms.
Reducing swelling is another key aspect of dealing with thyroiditis attacks, according to Dr. Langer. Says Langer: "Just as with arthritis, an anti-inflammatory pain reliever doesn't cure the problem, but it temporarily ameliorates the symptoms."
When it comes to palpitations, Dr. Langer feels that they can be misunderstood.
What happens with Hashimoto's patients having thyroiditis attacks is that many wind up in the emergency room seeing cardiologists. It happens a few times and then they're written off as psychiatric cranks. They end up with large doses of anti-anxiety medications or antidepressants.
Frequently, when not misdiagnosed as a heart problem, anxiety, or depression palpitations may be misinterpreted as a sign that a patient is getting too much thyroid hormone. But when medical evaluation rules out hyperthyroidism due to too much thyroid medication, mitral valve problems, or other cardiac abnormalities, Dr. Langer has found that nutritional deficiencies may be to blame -- in particular, deficiencies of calcium, magnesium or Vitamin D. Says Dr. Langer:
There's compelling evidence coming to the surface that Vitamin D is not only a vitamin but a hormone...The recommended daily allowance for Vitamin D is 400 IU, but scientists doing studies actually believe that people who do not get regular exposure to sunshine should be getting 2000-4000 Vitamin D. The Vitamin D also has profound effects on absorption of calcium and magnesium.
Here's a thyroid storm. From a medical textbook, The 4th edition of Emergency Medicine (eds. Tinhiralli, J., Buiz, E. and Krome, R.L. Some parts are quotes, some speedy summations.
"Thyroid storm is a RARE complication of hyperthyroidism in which manifestations of thyrotoxicosis are exaggerated to life-threatening proportions. Thyroid storm is most often seen in a patient with moderate to severe antecedent Grave's' disease and is usually precipitated by a stressful event. "
Precipitating Factors listed as primarily as infection, especially pulmonary infection, ketoacidosis in diabetics, hyperosmolar coma . . . Events possibly to initiate storm in vulnerable person: RAI, premature withdrawal of ATDs, use of an iodinated constrast medium during x-ray, thyroid hormone overdose, vigorous palpation of the thyroid gland . . . can also be vascular accidents, pulmonary emboli, toxemia of pregnancy and emotional stress.
Signs and Symptoms:
"The earliest signs are fever, tachycardia, diaphoresis, increased CNS activity, and emotional lability If condition is untreated, a hyperkinetic toxic state ensures in which symptoms are intensified. Progression to congestive heart failure, refractory pulmonary edema, circulatory collapse, coma and death may occur within 72 hours.
Fever ranges from 100.4-105.5. The pulse rate may range between 120 and 200 beats per minute but has been reported as high as 300 . . . sweating so profuse as to lead to dehydration from insensible fluid loss . . .
Central nervous systems . . . vary from restlessness, anxiety, emotional lability, manic behavior, agitations and psychosis, to mental confusion, obtundation and coma . . . cardiovascular abnormalities . . . increased stroke volume, cardiac output, etc . . .
<p>[This message has been edited by marsv63 (edited 08-18-2002).]