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Can hyperthyroidism come and go?
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Can hyperthyroidism come and go?

For 15 years I have had terrible symptoms of hyperthyroidism (heart arrhythmias, racing and pounding heart and palpitations, anxiety disorders, heat intolerance, weight loss despite increased appetite).  I have not seen an endocrinologist but once in the ER had my TSH checked and it was 1.5 which I know is normal so I didn't pursue it further.

The funny thing is that my symptoms sometimes come and go.  I've had stretches of time where I've felt ok and stretches of time where my symptoms return full force with no identifiable trigger.  Also, my symptoms seem to increase during PMS time.

My questions: Could I have hyperthyroidism despite having had a normal TSH level?  Should I see an endocrinologist?  Can hyperthyroid symptoms be episodic or increase with PMS?
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Avatar_n_tn
I was in the same position as you were. I had hyperthyroidism for 4 years and I tried to hold off until my pills made my liver enzymes go crazy. At this point my doctor has suggested 2 options? Surgery to remove the gland or RAI and stop the antibodies in the organ and thus making me hypo.

The endocrinologist recommended me to do RAI and after months of researching I felt it was the best option for me too. I had the same symptoms you had and I also had heat flashes. I couldn't take it anymore either.

Some days I felt great and some days I woke up sweating meaning I would have a horrible day of symptoms for hyperthyroidism.

I recommend you see the endocrinologist immediately.  Thyroid disease is an auto immune disease so if you think you have had it for 15 years, it wont go away anytime soon. The doctor will recommend you are put on pills  and if that doesn't work you have the 2 options I had.  

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393685_tn?1425816122
Yes - PMS will effect your thyroid and it's levels. All hormones work together -like a connected puzzle and if one is off (TSH) then others will spiral too.

What is your doctor saying? I think- if you can monitor when your PMS usually starts - try to plan a visit to your doctor during pre PMS - duing PMS - post PMS. If your doctor is willing do a TSH check during each stage.  You may notice that at one time a med may help you stabilize during that time. whether T4 or Armour or other hormone therapy.

This is truely a gamble - but it may be helpful - prior to getting on permanent meds - if you get a TSH level where YOU know WHEN you feel right. Then down the road if you find you need thyroid meds - you and your doctor will have a sure bet level (TSH) where you feel good at and can work to getting you there if you fall short later down the road.

Graves-Hashi and some others attack the thyroid and classify out as autoimmune disease. I think jumping into a permanent situation with RAI or TT is something that needs to be thought out - not jumped into and most endo's find that only to be the recourse of treatment. Remember - these treatments alters you permanently.

You say they come and go - and not constant. I think the approach of finding out during the course of the month (s) for you is your best option and if your doctor is willing - stay with him until a specialist is needed. If you find that he is not helping and your symptoms are not improving or become worse and are regular - you will have the need to see a specialist and your doctor will refer you if needed.  AND you will have a track record of blood tests to help determine where you feel at your best.

Not to be controversal with this poster above - just my thought. I believe I was also a hyperthyroid patient 10-15 years prior to my Dx of Graves. I jumped on RAI and think back - I wish I followed the above recourse prior to permantely changing my body.
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Avatar_f_tn
Thank you.  I haven't been diagnosed with a thyroid problem yet and haven't even had complete bloodwork done.  I just know that hormonally something isn't right and I am trying to figure out what it is.
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Avatar_n_tn
@stella

I tried everything to not have a permanent issue for the rest of my life. For the past 2 years I tried to watch for my hyper thyroidism. It got really bad for that last year and that was when my endo told me I had 2 options.

I have been on PTU for the past 2 years and my doctor warned me that if my condition got worse, I would have to stop all this and go forth to save my life.

I had frequent blood works for the past 6 months. The doctor said my thyroid levels were high and manageable but my liver enzymes went crazy high. My endo told me that I cannot carry forth with taking my PTU 3 times a day in safety of my liver.

I knew my options 2 years prior to the ATD's but that is how it happened.

To the OP, don't regret any decision you make. I have learned to live life without regret.
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393685_tn?1425816122
Once RAI is induced you have a permanent condition.  The poster does not even have a Dx of thyroid problems yet.  Has a normal TSH.

We have been Dx with situations in our past that a decision had to be made in order to save our lives.

I am not sure where you were going on your post to me.

Dear SIlly Heart -

It would be best to get the blood work as I said and document your levels.
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Avatar_n_tn
I have been diagnosed with Graves'...  
For the past 3 years, my symptoms came in like waves, and then went into remission.   I cannot stay on Tapezole daily, as it makes me pretty lethargic, increasingly moody, and causes weight gain.

Interestingly, at my last appointment, my T3 and T4 levels were normal (without any drug intervention), but my TSH was very low at .01.   This should not even be!  So, I think I don't have Graves' -  rather, I think it's Hashimoto.

I am currently researching natural remedies, and I agree that RAI or surgery should be a last resort.   The thyroid meds can cause liver damage and blood problems if taken in excess, but natural remedies can't hurt to try..

Good luck!!
BTW - anyone else have low TSH and normal T3 and T4 levels????
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Avatar_f_tn
Low TSH is a sign of HYperthyroidism.
You have been misinformed if you was told a low TSH is from Hypothyroidism.
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Avatar_f_tn
My posting was for sillyheart ;o)
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1299122_tn?1281044016
What you have shared sounds like Hashimotos auto-immune disease. I too had times in my life when I was HYPER....and then would go into periods of hypo. Sometimes blood tests are very deceiving! Hashimotos and Graves involve the thyroid, but they are auto-immune diseases, not truly a thyroid condition.The immune disorder begins somewhere else in the body, but attacks the thryoid - why is a not known. Unfortuntaely, the only treatment is the same as what is prescribed for hyper or hypo thyroid - T4 or T4/T3 drugs.
I am reading a book called "Why Do I Have Thyroid Symptoms When My Labs Tests Are Normal? by Datis Kharrazian. Its a real eye opener (for people with Hashis) and explains why thryoid med dosages often have to be increased and adjusted many times.
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Avatar_f_tn
Maybe its time to be tested for Graves (test is called TSI) and find out what you really have.
I still say its Graves as levels can fluctuate even with Graves Disease.
Its only when left untreated that the antibodies then fully attack the thyroid.
Either way...if it was me,,,I would want to know,
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Avatar_n_tn
This is an old thread so I hope my post gets scene. I have had the same question. I have had really fast metabolism my whole life. I can eat and eat but never really gain weight. If external reasons cause me to only eat once a day (stress/pain/medication) I drop weight fast. Before my spine surgery I was 97 pounds, I should be 115. Other symptoms I get off and on heart palpitations, shaky hands, muscle twitches all over body, low blood sugar symptoms (dizzy when standing, almost passing out and seeing stars), leg pains that come and go, vision problems, insomnia (tired all the time but can never sleep), hives and itchy spots under the skin, very enlarged glands (today I started choking when trying to take morning meds). I am recovering from cervical spine surgery still (7 months; arm went paralyzed for 3 days after surgery and have dealt with extreme nerve issues in hands and arms, numbness/buzzing, pain and dropping things), have frequent migraines and horrible allergies (started allergy shots). When I had the last MRI before spine surgery they noticed enlarged thyroid. I have had a bunch of blood work over the last 6 years but nothing has looked abnormal. I have been tested for everything they can think of and most recently MS but nothing fits. So all my symptoms have been excused away as the neck injury/nerve damage, migraines and allergies. I'm getting frustrated as these symptoms are still present and I have no answers. I have scheduled blood work for tomorrow to recheck again. Any suggestions?
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649848_tn?1424570775
Yes, hyperthyroidism can come and go... that's usually in the early stages of Hashimoto's, which ultimately ends up as hypothyroidism at some point.  With Hashimoto's, hyperthyroidism can alternate with periods of hypo or normal; they can last for weeks, months or years.  

Symptoms of hyper also mimic Type I diabetes so if you haven't been tested for that, you should be...

If you have recent thyroid hormone test results that you can post, please do so, so we can better assess your situation.  Please be sure to include reference ranges with any test results posted as ranges vary lab to lab and have to come from your own reports.  For thyroid testing you should be getting Free T3, Free T4 and TSH, at the least.  You should also have been tested for thyroid antibodies to test for, both Graves Disease, which is always associated with hyperthyroidism and Hashimoto's, both of which are autoimmune conditions.  

The antibodies to confirm Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb)... you need them both.  The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).

I don't know how long you've had these symptoms, but I'm appalled that you would have been tested for MS and not for, either, Hashimoto's or Graves Disease...
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I want to add something I just came across. Both my surgeon and my pain Dr don't think the nerve issues (Peripheral Neuropathy) I have is completely related to my injury/surgery on my neck. Some of my nerve issues are in the legs and feet. I just did a quick search and found a link to Graves and Peripheral Neuropathy. Now I'm really stunned about all the connections and even more frustrated my 4 Dr's (Ortho, Neuro, Pain and Primary) have not made the connection. Am I on the right tract?
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649848_tn?1424570775
There can be a link between thyroid conditions and peripheral neuropathy, but other things can also cause PN... for instance, have you ever had vitamin B-12 tested?  Long standing B-12 deficiency can also cause peripheral neuropathy... I'm proof of that.

Without thyroid hormone test results and reference range, there really isn't a whole lot I can tell you... Have you ever had your thyroid tested?
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Avatar_n_tn
My symptoms have gradually added over a span of years. The blood-sugar/dizzy/lightheadedness would be the first thing I remember and that started in my teen's. The rest of the symptoms really started picking up in my late 20's. I am 36 now, last 6 years is when I could no longer ignore them and starting pursuing answers. I have had a full blood panel done every year since 31. I have not asked for a copy of any since they have said it was all normal. I moved to a new state 1.5 years ago and got all new Dr's. I can get my pre-surgery bloodwork from the ortho and when I go in tomorrow I will get the one done in Oct. I just don't know if they did all the tests you mentioned as like I said they have never mentioned this disorder. I have also been tested for diabetes and they have checked for signs for cancers thru bloodwork. I have had 7 MRI's and 2 CT scans. Some were necessary for the neck injury but the rest was diagnostic. I will definitely make sure they do all the tests you mentioned. I am getting more and more mad the more I read about this.  It just makes so much sense. I take 5 daily meds and one as needed. They want to add another but I haven't started it yet. I am so anti meds and I just can't bring myself to add another.
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Avatar_n_tn
I have had the B-12 tested and it was good. I take B-12 and the hair, skin, nails supplements daily. My hair was falling out in clumps the last time my right thyroid was this swollen (May-Nov). The Dr said that would help the hair. She thought it was an infection so they gave me antibiotics. With it being so close to my surgery site she wanted to treat it as such. I was told they tested my thyroid the last test I had in Oct. I will get that result tomorrow and post it. Thanks everyone for helping me figure this out. I really appreciate it.
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Avatar_n_tn
One more piece of info. I notice an increase in the severity of symptoms before and during my menstrual cycle.
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649848_tn?1424570775
Once I see the test results the thyroid test results you have I'll be able tell whether they tested adequately (most likely not), and what those results might indicate...

Just because a B-12 test result was in the normal range, doesn't mean it was good... anything under 500 can cause symptoms of deficiency.  

If you're having trouble with hair, nails and skin, that can be a thyroid condition - often hypothyroidism or iron deficiency.

Vitamin D deficiency can also cause a lot of thyroid-like symptoms, as can magnesium deficiency.  

Most people (including doctors) don't even consider vitamin deficiencies when they have like these.  

Both, iron and vitamin D are necessary for adequate metabolism of thyroid hormones.  Deficiency of both, is often present in hypothyroidism/Hashimoto's... IF you have a thyroid condition, it sounds more likely that it's early (hyper) stages of Hashimoto's than Graves Disease, because it seems to come and go.  

You need "all" 3 of the antibody tests I mentioned above in order to confirm or rule out either/both of those conditions.  A few people have them both, with one or the other dominate at a given time.
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Avatar_n_tn
Like I said I had my Dr apt yesterday. They ordered my bloodwork and added some other things to the list you stated. She said it will help rule in or out possibilities. They also did a EKG in the office. The test showed irregular heart beats. So they want a stress test done too. Also ordered an ultrasound of my throat/neck. A few things she noted. It felt like both lymph nodes and thyroid are swollen. Like I mentioned I had cervical spine surgery last June. The incision site has also been randomly irritated the last few days, hasn't been like that since the incision healed. So she also is trying to rule out a random infection though I show no other signs of one.

I had a thought today about a possible allergy to titanium. I looked into after surgery as I have a titanium plate and this is about when my symptoms went from dismiss-able to concerning. In my early 20's. I got my belly button pierced with a titanium ring. My body basically rejected it and it got horribly infected. It was like my body was slowly pushing it out as it tried to heal. The two days leading up to the "flair-up" I'm having now. I started to use self tanning lotion. So I looked at the ingredients and what do you know it has titanium. So now I'm really left wonder if the titanium is somehow linked. I have stopped using it to see if my symptoms start to decrease. Maybe this is some type of autoimmune response to it. As soon as I get my tests back I will post.
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649848_tn?1424570775
Do you know which of the tests they are ordering and what possibilities they hope to "rule in/out"?  

Irregular heart beat can be caused by being hyper, but it's a good idea to have a good heart work up to make sure there aren't any issues there.  

The titanium wouldn't cause an "autoimmune" response, but it could certainly cause an allergic response, though titanium is used in a lot of things because allergy is quite rare...

I'll look forward to seeing your blood test results...
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Avatar_n_tn
They called with my results yesterday evening and said everything was normal except my potassium was really high. The nurse said not to take or eat anything with extra potassium and recheck in two week. Because I was really stumped and wanted to see everything they tested. I went to get my results this morning. I found that non of the T levels were actually check last Oct. They only tested TSH (1.030 uIU/ml) and T4, Free direct (1.41 ng/dL). As for the rest of the blood tests done, they look standard like the CBC and minerals. The only other thing that was off was Alkaline being low (35 IU/L). The potassium was (5.4 mmol/L). So I'm kind of discouraged as the potassium could explain the palpitations and maybe a little of the muscle/nerve issues but not much else.
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So the good news and bad news. My primary Dr and I have been able to narrow it down to the titanium plate. He said he thinks I have been going in and out of anaphylaxis since my surgery.  When paired with my high potassium level it looks like my kidneys are becoming affected in addition to muscles, nerves and nervous system. Now I just need the MELISA test to confirm. If it is the metal implant I already know it's going to be a fight with the Ortho who did the surgery. Thank you very much for the quick response you gave me. For those who read this at a later date I hope you can get your issues figured out fast.
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