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Old 08-18-2002, 08:05 AM   #1
Join Date: Apr 2002
Location: OK
Posts: 5
OKMom HB User
Thyroid flare-ups

Can anyone explain to me what exactly a thyroid flare-up is? I am trying to find out what is going on with me and am wondering if it could be a flare-up although I am having other symptoms such as a pain in my neck when swallowing. I've also heard the term "thyroid storm" and am not sure what that means either. I have Hashi's but seem to be having symptoms of hyper thyroid right now. My doctor says my TSH is normal at 1.8 and my T4 is 9.7 which he says is normal. He also says that he doesn't feel any nodules. Any advice would be greatly appreciated.

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Old 08-18-2002, 08:34 AM   #2
Join Date: Apr 2002
Location: fremont,mi
Posts: 91
marsv63 HB User
Re: Thyroid flare-ups

Flare Up:
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.

Thyroid Storm:

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).]

Old 08-18-2002, 10:45 AM   #3
Join Date: Aug 2002
Location: Martin, TN USA
Posts: 6
TracyD HB User
Re: Thyroid flare-ups

I'm not much on useful insight or facts hon cause I'm new to this myself, but just know that you're not alone...I'm just coming down today from a flare up and I know how ya feel...I am SO thrilled to see some improvement today knowing that I'm finally headed out of that tunnel back into a fairly decent life...I really hate these flare ups...I'm sure I didn't have a clue what I was doing, but I just rested, ate the foods suggested to me to not make my goiter any worse and tried to keep my emotions in check until I got through it...

One thing I can say is that the other members of this board have greatly helped me and I'm sure they are a huge help to you too...Take care and don't lose faith...

Knowledge is power.


Old 08-18-2002, 11:24 AM   #4
Senior Member
Join Date: Jan 2001
Location: Brooklyn, NY
Posts: 190
ArtfulD HB UserArtfulD HB User
Re: Thyroid flare-ups

Great post, Marcia. Would you add it (or the links to this info) to the Information Archive?

Old 08-18-2002, 04:52 PM   #5
Join Date: Apr 2002
Location: OK
Posts: 5
OKMom HB User
Re: Thyroid flare-ups

Hi Marsv63,
Thank you so much for your wonderful discriptions of thyroid flare-ups and thyroid storms. I really appreciate you taking the time to try and help me. I am just trying to figure out what's going on with me as I have Hashi's but am showing signs of hyper thyroid right now even though my blood tests came out normal. I am also having trouble with my neck in that I have a very sore lumpy feeling when I swallow and it feels like someone has their hands on my throat although the lump can't seem to be felt with hands. I've also had episodes of diarrhea, headaches and nausea. Right now I am waiting to go back to my Internist the end of this coming week. Thanks again for your help and info.

Old 08-18-2002, 04:55 PM   #6
Join Date: Apr 2002
Location: OK
Posts: 5
OKMom HB User
Re: Thyroid flare-ups

Hi TracyD,
Thank you for you input too. I would love to know what you just went though with your flare up and did your blood tests remain within the normal range when you are going through a flare up? Do you have trouble with your neck and voice? My voice is almost a whisper and I have a feeling that someone has their hands on my throat along with a sore feeling when I swallow. I feel sick all over and feel very hyper right now. I look forward to hearing from you. Thanks again.

Old 08-18-2002, 08:52 PM   #7
Join Date: Aug 2002
Location: Martin, TN USA
Posts: 6
TracyD HB User
Re: Thyroid flare-ups

Hey OKMom,

Glad to help in any way I can...First of all, due to being laid off right now from my job, I've temporarily lost my health insurance so I didn't go get my levels tested during my flare up...

When I started feeling symptoms of a flare up, I got a nasty headache that wouldn't go away, my depression got alot worse and I got more and more tired with every step I took...After about 2 days of that, I started having trouble swallowing...First it was like something was caught in my throat...Then it got difficult to breathe and even harder to swallow...Next day I could easily feel a nodule or goiter on the frontal right portion of my neck which was tender and caused me pain when I tried to turn to the left...I became exhausted and more depressed and spent 2 days without even walking out my front door...I slept alot and didn't have the energy to do anything...Finally, I've started getting over it because I now have some desperately needed energy and the nodule is beginning to disappear...I'm still having trouble swallowing and I'm not ready for a marathon yet, but it is going away...

Emotionally, these flare ups are so hard...Its very difficult to deal with and I'm not even working right now...Its even worse when you're working...

I am just now learning about all of the ways to make life with Hashimoto's and hypothyroidism better, so I have a long way to go...I'm only taking 100 mcg right now of Synthroid and nothing else...After some more learning here, I intend on going to visit my doctor for some changes.....

Good luck and take care...


Old 08-19-2002, 06:11 AM   #8
Join Date: Jul 2002
Location: Virginia Beach, VA, USA
Posts: 3
jestes HB User
Re: Thyroid flare-ups

marsv63, that was the best information that I have read describing a flare up. This board is amazing. Over the years I have kept these symptoms to myself and just quietly learned to cope. I feel like an idiot! Kowledge is definitely power. I am pretty reserved and have never posted to a board before, but this forum is vital for anyone with thyroid issues. Thanks again.

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