It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Thyroid Disorders Message Board
Post New Thread   Reply Reply
LinkBack Thread Tools
Old 11-18-2012, 07:51 PM   #1
Newbie
(female)
 
Join Date: Nov 2012
Location: Tampa, FL
Posts: 4
anxious23 HB User
Trying to figure out hypo plus anxiety... Need advice.

Hello,
I'm new to the board. My basic question is regarding anxiety with hypothyroidism. My detailed history with blood tests is below, but in short, I have been on Synthroid for about 10-11 weeks, and I am having continued anxiety, brain fog, racing pulse at times, some shakiness, clumsiness, and so forth. My levels are "in normal range", but I know that TSH should really be much lower. However, because of the anxiety, my endocrinologist is not willing to increase the dose at this time, because it will make it worse. Looking for opinions on this. Here is my history:

I had half of my thyroid removed about 7 years ago. I ended up settling down with a dose of 100mcg Levothyroxine for the next 5 years. Then, in Jan 2011, for various reasons, I stepped down and then discontinued the meds, and stayed off of them until 2 and a half months ago. I started having serious anxiety attacks in July that weren't directly related to any real events, just irrational panic about me driving, my husband driving, serious hypochondraic thoughts, and so on. I had blood work done in July, and found this:
TSH, 3G: 5.48 mIU/L ( 0.4 - 4.50 )
T4 Free: 1.0 ng/dL ( 0.8 - 1.8 )
Clearly hypothyroidism. A week later, I had a full thyroid panel done:
T3 free: 2.7 pg/mL (2.3 - 4.2)
T3, Total: 78 ng/dL (76-181)
T4, Free: 1.2 ng/dL (0.8-1.8)
T3 uptake: 29% (22-35)
T4, Total: 6.4 mcg/dL (4.5-12)
Free T4 Index: 1.9 (1.4-3.8)
TSH, 3G: 3.81mIU/L ((0.4 - 4.5)

Still not good. So, after visiting an endocrinologist, I started on 50mcg of Synthroid around Labor day. On 10/26, they drew a new blood test, for some reason only TSH and T4 Free:
TSH: 2.53 mIU/L (0.4-4.50)
T4, Free: 1.1 ng/dL (0.8-1.8)
Also, Cortisol, Total was high at 25.2mcg/dL (4.6-20.6)

So. The TSH went down a little 7 weeks after synthroid start. The general opinion is that people feel better when it is lower, though. However, he doctor says that increased dosing will make the anxiety worse. Doctor dismissed the Cortisol level as possibly due to being in pain from the needle stick (?!). Or is it adrenal related?

So what to do? Until July, I didn't have anxiety like this. It's not the synthroid that brought it on, since I didn't start the meds until September. But will bumping up the dose make the anxiety worse? Anyone had a similar situation? Should I look for a new doctor to get a different view on it? Or should I wait it out another 6 months and see if things settle down?

Thanks in advance for any guidance!

J

PS. I have blood levels from 2005-2009 if helpful.

 
Reply With Quote
The following user gives a hug of support to anxious23:
nisreen1811 (11-24-2012)
Sponsors Lightbulb
   
Old 11-20-2012, 09:35 AM   #2
Senior Veteran
(female)
 
Join Date: Jan 2003
Location: Missouri, USA
Posts: 12,274
midwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB Usermidwest1 HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Since you had anxiety before starting Synthroid, it's likely it was from T4/3 levels too low. Increasing the dose could - theoretically - increase anxiety, but only for a time. You need to get those hormone levels up if you hope it to get permanently better.

Your MD's notion is mistaken. If you feel you can tolerate becoming a little worse in an attempt to get better long-term, insist on trying an increase to see what happens.
__________________
"We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses." Abraham Lincoln
~~~~~~~~~~~~~~~~~~~~~~~~

 
Reply With Quote
The Following 2 Users Say Thank You to midwest1 For This Useful Post:
anxious23 (11-21-2012), nisreen1811 (11-24-2012)
Old 11-20-2012, 09:36 PM   #3
Inactive
(male)
 
Join Date: Sep 2012
Location: Canada
Posts: 157
telus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Dear Ms. Anxiety

Man-oh-man-oh-man-oh-man. I know what you're going thru. I'm glad I tuned-in here tonight. Yup, you need a new doctor.

First of all - you are not suffering from anxiety attacks. It is NOT in your head! You are probably suffering from supraventricular tachycardia (SVT) or atrial fibrillation or something similar. If your doc had sent you for an ECG or to a cardiologist - you would have found out. I'm sorry if this news sets it off again - but you do not have to worry, a lot of people live a long time with this. And the good news is that it will go away when you get the thyroid right.

Second - the SVT is being caused by you being hypothyroid. Your endo believes that SVT is due to being hyperthyroid. He is wrong - you can get it being either hypo or hyper. So all you have to do is get up from being hypo into "normal". (Another problem is that your endo does not have a clue what is 'normal'; the reference range is not normal.)

OK your last lab the FT4 was 1.1. That is at the median or average or 'normal' level for females. The problem is that when you only take synthroid or other T4, you have to take more T4 to push your FT4 above average in order to get your FT3 up to average. And it is the FT3 in your body that does all/most of the work that thyroid hormones are supposed to do. So you are still short in the FT3 department. The still high TSH is indicating that. Average or normal TSH would be around 1.1 - 1.2.

It is far better to take some T4 plus T3 to get to the happy state of both of them being around average, or a little above if you need it. Because another major problem you can get into is if you take too much T4, your body will get rid of it by converting excess to Reverse T3, which works against your FT3 - you do not want to go there.

Third - you were hypo for a very long time. Your cortisol is probably way out of whack too, because your adrenal glands would have been trying to compensate for your hypothyroid condition. So you are not going to be back to normal until you get both your thyroid and "adrenals" back to normal. You must look up 'adrenal fatigue'...

Fourth - where I would start. Look thru your old labs. Tabulate T4 dose, TSH, FT4, FT3.
Where did you have FT3 around 3.1 to 3.3? I hope you have FT3 readings. Anyway, you say you were on 100 T4 for a long time.; you didn't have racing heart then. 100 T4 is not a very high dose. You could make the decision to go there right now - just take 2 of your 50 pills. Maybe just tell the doc that's what you are doing. Get labs in 4 weeks after change. Keep good record of symptoms daily.

Fifth - new doc. Look for a doc who prescribes T4 and T3. An easy way to find one is to go to a compounding pharmacy in your area and ask the druggist for the names of some doctors who prescribe T3 or "slow release T3". These are the docs who are going to know a lot more about thyroid issues. The druggist probably talks to these doctors; ask him which one he would go to. Then go see them.

Sixth - do not expect instant results, you are probably well aware by now that you have to be patient on this thyroid stuff. If you go back to the 100 T4 you have to have faith that you are doing the right thing because that SVT (or whatever it is) occurs so randomly that it will test your resolve and give you doubts. But don't give up.

Seventh- if your SVT (or whatever it is) is causing you too much consternation, get your doc to refer you to a cardiologist. If you have some other underlying heart condition, then SVT could be a problem. He may do heart tests. He may prescribe a beta-blocker to help control it. Metoprolol is a beta blocker that does not mess with thyroid levels; some of the other beta-blockers do mess with thyroid levels, and of course you do not want that.

Eighth - follow the rules (if you already are not) to get proper absorption of your T4 meds. If you take your T4 in the morning, make sure you take it and leave at least an hour before eating or drinking (except water). Or take the pill at night before going to bed - a couple of hours after you last ate anything.

Ninth - there is a ton of info above. Read it several times. Keep it for reference.

Tenth - Good Luck! and fire back with more questions.

 
Reply With Quote
The Following 2 Users Say Thank You to telus For This Useful Post:
anxious23 (11-21-2012), nisreen1811 (11-24-2012)
Old 11-21-2012, 04:30 AM   #4
Newbie
(female)
 
Join Date: Nov 2012
Location: Tampa, FL
Posts: 4
anxious23 HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Thanks for are the great info! I really appreciate it. I pulled out my adrenal fatigue book yesterday, which I had shelved years ago, and it's all sounding very familiar again.

Quote:
Originally Posted by telus View Post
Fourth - where I would start. Look thru your old labs. Tabulate T4 dose, TSH, FT4, FT3.
Where did you have FT3 around 3.1 to 3.3? I hope you have FT3 readings. Anyway, you say you were on 100 T4 for a long time.; you didn't have racing heart then. 100 T4 is not a very high dose. You could make the decision to go there right now - just take 2 of your 50 pills. Maybe just tell the doc that's what you are doing. Get labs in 4 weeks after change. Keep good record of symptoms daily.
I have labs from 2006 and 2007 with free T3 when things were pretty good.
2006:
T3 free: 3.33 pg/mL (1.8 - 5.4)
T4, Free: 1.8 ng/dL (0.8 - 2.1)
TSH, 3G: 0.57 mIU/L ((0.45 - 4.5)

2007:
T3 free: 3.0 pg/mL (2.4 - 4.2)
T4, Free: 1.5 ng/dL (0.8 - 1.7)
TSH, 3G: 0.90 mIU/L ((0.45 - 4.5)

Seems like after that when i was feeling even better in 2008-10, they only took TSH, and once they did total T4 and T3. TSH was always below 1 in that time, so at least by that measure, 2.5 is not my good level.

Quote:
Originally Posted by telus View Post

Fifth - new doc. Look for a doc who prescribes T4 and T3. An easy way to find one is to go to a compounding pharmacy in your area and ask the druggist for the names of some doctors who prescribe T3 or "slow release T3". These are the docs who are going to know a lot more about thyroid issues. The druggist probably talks to these doctors; ask him which one he would go to. Then go see them.
This is a great idea, because it's been really hard to find anyone based on online searches.

I wanted to mention that a couple of times, I've had anxiety attacks that were accompanied by shaking. The shaking felt like really intense shivering, even though I wasn't feeling cold. is that common to SVT?

Finally, is there any difference between Synthroid and Levothyroxine? The current doc seemed to say that Synthroid was better/purer/etc. than Levo and seemed to be part of his reason for starting at a lower dose, as if it worked better.

I'm sure I'll have more questions soon.

Thanks again.

J

 
Reply With Quote
Old 11-21-2012, 07:46 AM   #5
Inactive
(male)
 
Join Date: Sep 2012
Location: Canada
Posts: 157
telus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Hello again Ms. Anxiety

one. I think you should refer to the racing heart as palpitations, (at least until you find out for sure what it is). It's not anxiety or panic attacks. And I think you may find that a doctor reacts quite differently to you. The doc should have sent you for an ECG (electrocardiogram) immediately. But it won't pick up anything unless you are actually have an "attack" at the time of the reading. He also could have ordered a Holter Monitor test.

two. Shaking? The only time I had shaking/shivering was when I really was cold. Being hypothyroid makes you a lot more sensitive to cold and it happened just a few times to me at night. I do not know what it could be otherwise - best that you take it up with the doc.

three. Great. Your labs from 2006-2007 look good and you say things were pretty good, so that's ideal - that's where you want to go. So I'm not the doc - but assuming you were on 100 T4, I would say it would be safe to go back to 100 T4 immediately. It's still not a huge dose; lots of people take 125-150 or more.

three. Levothyroxine is the generic name of the active drug that is in Synthroid which is made by a certain manufacturer. There are a number of companies that make the pills and give them different names, and there are also generic versions. Some people say that the fillers or binders in the pills can be different, and can cause problems in some people. I think what the endo may be referring to is that the generic versions may not be as accurate in the dose - if they say it is a 100 pill, it may actually be 90 to 110. But the Synthroid 100 pill might be 97 to 103. (I'm just making up these numbers to make the point). I use Synthroid. If you were on 100 something else before, then use 100 Synthroid.

four. Like I said before, it takes a while to get the effect of a dose change. The half-life of Synthroid (T4) is 7 days. Using a formula you can calculate how much has accumulated in your body. For example at 7 days it is only at 50% buildup. At 14 days 75%, 21 days 88%, 28 days 94%, 35 days 97% and 42 days 98%. That's why you need to give it at least 4 weeks before doing lab tests. So considering it takes six weeks to get to 98% and then allow some time for your body to adjust to the full dose - you can see that you may have to give it quite a while to see if your symptoms go away. And remember - the adrenal stuff has to get right as well.

five. Try to get TSH, FT4, FT3, ReverseT3 labs next time. Then for all future TSH, FT4, FT3.

six. Some more thyroid rules: (1) Do get your blood tests done at the same time of day (say 8-9 am), for consistency of results. Thyroid levels do rise and fall thru the day.
(2). Do not take your thyroid meds in the morning prior to your blood test (also for consistency of results). The meds make your levels go up for 3 or 4 hours.

Here's hoping that you will soon change your name!

 
Reply With Quote
The Following User Says Thank You to telus For This Useful Post:
nisreen1811 (11-24-2012)
Old 11-21-2012, 09:14 PM   #6
Newbie
(female)
 
Join Date: Nov 2012
Location: Tampa, FL
Posts: 4
anxious23 HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Spoke with the current doctor's office about upping the medications. His nurse said another blood test would be necessary. When I asked about checking free T3 and reverse T3, they said that they don't do those tests, only TSH and Free T4 because that's enough. i think I'm done with them. Now I need to find someone else quickly. The compounding pharmacy gave me a few names but none look promising, the reviews are mixed with claims of having to join some sort of wellness program that my insurance won't cover, and a focus on homepathic supplements and product sales.

The last two days have been tough, almost no palpitations, but deep fatigue and difficult emotions today, and general depression. A friend suggested looking into psychopharmacologists if the endocrinologists are a strike out. I've been scouring the web for someone worth going to, but so far nothing has seemed right. Frustration...

Thanks
J

 
Reply With Quote
Old 11-21-2012, 09:16 PM   #7
Newbie
(female)
 
Join Date: Nov 2012
Location: Tampa, FL
Posts: 4
anxious23 HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

double post.

Last edited by anxious23; 11-21-2012 at 09:19 PM. Reason: double post

 
Reply With Quote
Old 11-21-2012, 11:34 PM   #8
Member
(female)
 
Join Date: Nov 2012
Location: USA
Posts: 50
mayfliesmayfly HB Usermayfliesmayfly HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

I don't have any advice for you, just that I sympathize.

I had a panic attack for the first time the other day, WHILE at the doctor, and they assumed it was an appendicitis (which of course it wasn't). I've also been dry heaving nearly every day without actually vomiting, which I think is due to the stress.

If I figure out any answers, I'll be sure to let you know. Good luck!

 
Reply With Quote
Old 11-22-2012, 12:40 AM   #9
Newbie
(female)
 
Join Date: Nov 2012
Location: United States
Posts: 5
Askalice HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Could never take levothroid or synthroid. Additives in them made me way too anxious. Armour worked better but always had a bit of an anxiety or hyper issue. Recently my tsh was elevated, maybe a bad batch of pills or allergy to additive in armour. Went from 2- 60mg to 1- 120mg and starting to feel much better. Thinking about compounding. Went through major stress 2 months ago, could be that? Taking xanax for a week also helped me out of the panic.

Last edited by Askalice; 11-22-2012 at 12:45 AM.

 
Reply With Quote
Old 11-23-2012, 11:27 AM   #10
Newbie
(female)
 
Join Date: Nov 2012
Location: Pennsylvania USA
Posts: 2
letty65 HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Quote:
Originally Posted by anxious23 View Post
Hello,
I'm new to the board. My basic question is regarding anxiety with hypothyroidism. My detailed history with blood tests is below, but in short, I have been on Synthroid for about 10-11 weeks, and I am having continued anxiety, brain fog, racing pulse at times, some shakiness, clumsiness, and so forth. My levels are "in normal range", but I know that TSH should really be much lower. However, because of the anxiety, my endocrinologist is not willing to increase the dose at this time, because it will make it worse. Looking for opinions on this. Here is my history:

I had half of my thyroid removed about 7 years ago. I ended up settling down with a dose of 100mcg Levothyroxine for the next 5 years. Then, in Jan 2011, for various reasons, I stepped down and then discontinued the meds, and stayed off of them until 2 and a half months ago. I started having serious anxiety attacks in July that weren't directly related to any real events, just irrational panic about me driving, my husband driving, serious hypochondraic thoughts, and so on. I had blood work done in July, and found this:
TSH, 3G: 5.48 mIU/L ( 0.4 - 4.50 )
T4 Free: 1.0 ng/dL ( 0.8 - 1.8 )
Clearly hypothyroidism. A week later, I had a full thyroid panel done:
T3 free: 2.7 pg/mL (2.3 - 4.2)
T3, Total: 78 ng/dL (76-181)
T4, Free: 1.2 ng/dL (0.8-1.8)
T3 uptake: 29% (22-35)
T4, Total: 6.4 mcg/dL (4.5-12)
Free T4 Index: 1.9 (1.4-3.8)
TSH, 3G: 3.81mIU/L ((0.4 - 4.5)

Still not good. So, after visiting an endocrinologist, I started on 50mcg of Synthroid around Labor day. On 10/26, they drew a new blood test, for some reason only TSH and T4 Free:
TSH: 2.53 mIU/L (0.4-4.50)
T4, Free: 1.1 ng/dL (0.8-1.8)
Also, Cortisol, Total was high at 25.2mcg/dL (4.6-20.6)

So. The TSH went down a little 7 weeks after synthroid start. The general opinion is that people feel better when it is lower, though. However, he doctor says that increased dosing will make the anxiety worse. Doctor dismissed the Cortisol level as possibly due to being in pain from the needle stick (?!). Or is it adrenal related?

So what to do? Until July, I didn't have anxiety like this. It's not the synthroid that brought it on, since I didn't start the meds until September. But will bumping up the dose make the anxiety worse? Anyone had a similar situation? Should I look for a new doctor to get a different view on it? Or should I wait it out another 6 months and see if things settle down?

Thanks in advance for any guidance!

J

PS. I have blood levels from 2005-2009 if helpful.

 
Reply With Quote
Old 11-23-2012, 11:39 AM   #11
Newbie
(female)
 
Join Date: Nov 2012
Location: Pennsylvania USA
Posts: 2
letty65 HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

I am sorry to hear about your anxiety. I was diagnosed with Hypothyroidism in April, 2007. In May of 2010, I felt great and stopped taking my medication (levothyroxine, 75mcg.) By the Fall of 2010 I was so anxious, could not sleep, lost 10 pounds without dieting and lost lots of hair which is growing back. I was put back on the meds because I developed a goiter and my TSH levels were high. Unfortunately, the anxiety is still with me and no doctor has a clue. My dhea-s is high and that is not the norm for a post menopausal woman. Endo is checking for PCOS. Anyway, I,m wondering if there is some link to the medication withdrawl that contributed to your anxiety such as was my case.

 
Reply With Quote
Old 11-23-2012, 01:34 PM   #12
Newbie
(female)
 
Join Date: Nov 2012
Location: United States
Posts: 5
Askalice HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Did you get anxious after starting synthroid? Is it ever after eating sugar or salt? As I stated, synthroid made me panicky that is why I went to armour. Doctors, especially endocrinologists, don't seem to know much besides levels and most don't like to give armour. You might be nervous over the whole mess and have gone into a panic.

 
Reply With Quote
Old 11-24-2012, 07:32 AM   #13
Newbie
(female)
 
Join Date: Nov 2012
Location: United States
Posts: 1
Hashimotopatti HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

I've found that eating/drinking caffeine {soda, chocolate} will cause me to have panic attacks, racing heart, agitation, anger, etc.

And my endo has found that my labs don't need to be in the range that they have listed as normal for everyone. {1.9-2.0 for me, dr goes off just one test and I can't remember which but I think its the T4 free}

I take levoxyl because the others made me jittery and affected my divitiulitus. I take 112 mcg. or 100 mcg When my ob had me on 175 mcg because he was keeping me in the range thats listed on the labs as normal, I was very ill. {back when I first found out I had hypothyroid}

 
Reply With Quote
Old 11-24-2012, 09:41 AM   #14
Inactive
(male)
 
Join Date: Sep 2012
Location: Canada
Posts: 157
telus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB Usertelus HB User
Re: Trying to figure out hypo plus anxiety... Need advice.

Ladies,

Most likely those are NOT anxiety attacks or panic attacks that you are having.
They are most likely palpitations being caused by you being hypothyroid.
If you are having palpitations, it means that you are more than a little hypothyroid.
Being hypothyroid is not good for a lot of parts of your body.
Palpitations will stop if you get your thyroid hormones to the proper level by taking the proper dose of T4 and T3.
For many reasons most doctors do NOT know how to get you to the proper doses.
So you have to find the right doctor, or learn a lot about thyroid on your own.
A doctor who only looks at one or two tests is not the right one.

It is not normal to get palpitations. They can turn into serious problems in people with underlying heart conditions.

 
Reply With Quote
Reply Reply




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Armour
Cytomel
Levothroid
Levoxyl
Potassium
  Synthroid
Tapazole
Unithroid
Xanax
Zoloft




TOP THANKED CONTRIBUTORS



sammy64 (666), midwest1 (627), FinnMaid (308), Reece (224), lisa789 (196), Tree Frog (80), mkgbrook (72), cd37 (56), ladybud (45), Bran'sNana (44)

Site Wide Totals

teteri66 (1164), MSJayhawk (997), Apollo123 (898), Titchou (832), janewhite1 (823), Gabriel (758), ladybud (745), sammy64 (666), midwest1 (665), BlueSkies14 (610)



All times are GMT -7. The time now is 07:32 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!