Hyperthyroid and diarrhea

[WildMtn]

So I've had bowel issues for a little over a year, and I'm trying to determine how/if being hyperthyroid is related.

I don't know how long I've been hyper, for sure.  I was tested in October of 2013 and my results seem to point to being hypo at that time.  In Dec of 2013 I first became ill, and the diarrhea has been constant since Jan 2014.  I only felt my neck to be tender and swollen last month, and was tested hyper then.

The diarrhea pattern has waxed and waned over the last year+.  Right now, it's pretty severe, to the point of waking me from sleep again, which had stopped for several months.  

I see an Endo next week, and I just had a colonoscopy last week (my 2nd).  Everything looks good in the colon.  I follow up with GI in May.  I'm just wondering if anyone here has any ideas.

TIA

[Barb135]

I know we're all different, but just take myself for instance -- my TSH level was at 55.6 when I was diagnosed and my FT4 was 0.6... my doctor started me at 25 mcg for one week, then bumped up to 50 mcg, then 75 and on up to 100, which was too much, so I had to drop back to 75 and stay there for a while.  I eventually went up to 88 mcg and was there for several years, until this past August, when I finally bumped up to 100 mcg...

There are also other factors to be considered along the way, as well.  For instance, we discovered that I don't, adequately, convert FT4, which is a storage hormone and isn't used directly, to the active FT3, which is used by every cell in the body, so we had to add a T3 med.  

If I were you, I'd get the script, so I could started, but I'd split the pills for today and tomorrow - of course, by the time you pick up the script, it will probably be too late to take one for today, since you will have eaten and everything - levo is supposed to be taken first thing in the morning on an empty stomach with a full cup of water, then wait 30-60 minutes before having anything else to eat/drink besides water (most of us go ahead and have coffee... lol).  So you'll have the script to take for tomorrow and Thurs, then you'll be seeing your doctor on Thurs and you can talk to her about lowering the dose.  Since that would really be a waste of money, you can talk to your pharmacist when you pick up the script and he can call the doctor and "suggest" a lower starting dose...

[WildMtn]

Thanks.  It seems high to me, I don't know anything about it!  I'll talk with the pharmacist, too, when I pick it up.

[Barb135]

OMG - she's "starting" you on 112 mcg?  Granted your levels are very low, but that's an enormous starting dose and is almost unheard of.  There could easily be a dosage between 25 mcg, which is the lowest and 112 mcg that would work well for you.

A typical starting dose is 25-50 mcg, then rechecking after 5-6 weeks and adjusting as necessary... You might want to consider splitting those 112 mcg pills in 1/2 for a week or so to make sure you're going to tolerate them okay...

When you get your recheck labs in 6 weeks, insist that she order Free T3 (not Total T3), along with Free T4 and TSH.

[WildMtn]

Thanks!

It is for levothyroxine, 112mcg, hopefully they will be able to fill it this evening now that things are getting straightened out.  I also have an appointment to follow up with her Thursday, and then we'll re-check labs in 6 weeks.

[Barb135]

If you haven't heard anything, yet, you should call the doctor back and just say that you got her message, but your pharmacy doesn't have any script for you and you want to make sure she called the right pharmacy.  While you're at it, you might also ask what she's calling in a script for, as well as the dosage.  

With your levels as low as they are, it's certainly an annoyance and if you don't start on med soon, things will simply get worse.  You should not continue the way you are.

[WildMtn]

So my Endo got back to me on Friday, and I missed her call.  She said she wanted to put an Rx in to my pharmacy, but something must have gone wrong because that never happened...so no meds yet, one week after those results.  

Is that a "very" bad thing, or just an annoyance?

[Barb135]

Hmmm --- your TPOab is still below range, but since it's climbing, and you're thyroid hormone levels are in the basement, I'm going for Hashimoto's and your antibodies just haven't ramped yet.  

It's not the least unusual for symptoms to show up long before labs indicate issues and Hashimoto's is notorious for presenting hyper periods before/alternating with hypo.  

Knowing what I know now, I believe I alternated between hyper and hypo for about 20 yrs before finally settling into permanent hypo.

Right now, you need to be on replacement thyroid hormones, but that doesn't mean permanently - yet... When I was going through my swings, I wasn't being tested for thyroid hormones and it was only after the fact that I figured out what I'd gone through.  During all those years, I was also deficient in Vitamin B-12, so that was really throwing a curve ball into the whole thing and none of my doctors were testing that either... It wasn't until 2007 that I was, finally, diagnosed with Pernicious Anemia (autoimmune inability to absorb vitamin B-12) and once started on B-12 injections, that was supposed to solve all my problems, but when it didn't, my doctor started getting irate and actually labeled me a hypochondriac.  He "offered" a diagnosis of Fibromyalgia, which is, basically, nothing and I refused.  I insisted that we keep looking for what was wrong.

A few months later I started putting on weight like there was no tomorrow and insisted that they test my thyroid.... My TSH was 55+ and my FT4 was 0.6 (range 0.8-1.8) - no wonder I felt like crap...

We all have to start somewhere and it looks like you've started down the path a lot of us have taken.  We've been there, done that, so we know the territory; we'll walk along with you.

[WildMtn]

So it seems the outstanding result was for thyroid antibodies.  My thyroglobulin antibody is still <1, but TPO antibodies have gone from <28 (on 3/19/15), to 45 today (range is <60).  

[WildMtn]

I'm not sure why she's testing the way she is.   I think there might be one more test pending, though. If so, I'll post when I get it.  

I guess I'll call the office tomorrow and make sure they read these results, and not sit on them for a few days (not they mean to, they just get busy).

[Barb135]

You've flipped completely to hypo... Your TSH is too high and your FT4 is actually below range.

Why isn't your doctor ordering Free T3 instead of Total T3?  Total T3 is pretty useless and obsolete, so is Total T4.  Even so, both TT4 and TT3 are at the very bottom of their ranges.  You need to be on thyroid replacement med.  Sub-acute thyroiditis often becomes permanently hypo.  

[WildMtn]

Been a week and a half, and we ran tests again today.  Symptoms are mostly exhaustion, brain fog (getting so bad the kids are teasing me as I drift off mid-sentence, forgetting where I was going), and gained 2 more pounds (ugh).  

TSH: 6.16 (0.34-5.6)
T4: 4 (4-11)
Total T3: 60 (60-181)
Free T4: 0.58 (0.89-1.76)

[WildMtn]

Latest test results, I am more and more positive it's subacute thyroiditis, and that my thyroid has just dumped all the T4/T3 and now there's very little left.  I have gained 2 lbs this week.

TSH:  0.03 (0.34 - 5.6)
T4:  7  (4 - 11)
Total T3:  92  (60 - 181)
Free T4:  0.95  (0.89-1.76)

Has anyone had any experience w/subacute?  I've heard that it's one of the more "rare" causes (leave that to me!).  Did your thyroid ever get back to full functioning?  If you were hypothyroid, how long did that last (I've read varying studies)

[Barb135]

I posted a comment this morning, now it's gone and I don't know what happened to it.  I know MH has a glitch where some posts disappear and show back up; I wonder if this is going to be one of those instances.

I don't know much about Nutrisystem, but most prepared foods have WAY more salt in their foods, to make it more palatable than it otherwise would be. This is not a weight loss system I would recommend for anyone with Hashimoto's, if they won't tell you whether they're using iodized salt, since iodine is contra indicated for those of us with Hashimoto's.  

I'll wait and see if my post from this morning shows back up and if not, I'll try to remember what was all in it and repost it later.

[WildMtn]

Ok, me again again!!

Endo just called -- appears that much iodine in my urine sample is WAY too high, and I can't get the thyroid scan :(

Now, I did have a CT with contrast back in December, but nothing since, and I thought that was out of your system in days?

I also started eating Nutrisystem foods in mid-February.  I noticed the lump in my neck in early-ish March.  Could there be ANY relation there?  I asked on the NS forum, and the official response was fairly generic: "Since the FDA does not require manufacturers to report if they are using iodized salt, we are unable to provide you an exact percentage. If you are concerned about the amount of exposure, we would recommend looking at incorporating some lower sodium menu items in your meal plan."  So I have no clue how much iodine I'm getting from their foods.  Of course I am getting a huge delivery TODAY :(

For now, my endo is holding off on any meds.  She is hoping the tiny rise in TSH, and the slightly elevated sed rate point towards thyroiditis.  She wants me in mid-week next week for another blood draw for more tests, to see where things are headed.  

I was soooo hoping for answers by then!!  i want to know WHY I'm ill, darn it all!!

However, my neck is feeling less swollen internally - it's easier to swallow lately.  And the atenolol is helping the pulse a LOT.  So I'm feeling some better between those two.

[WildMtn]

Guess that isn't it - results are in:
Random urine iodine  497  range: 26-705

[WildMtn]

One more thought:  I had iodine contrast in December for a PE study (all clear!) so they are also checking a random urine sample for iodine - could that really have effects this much later?  I should have those results soonish.

[WildMtn]

thyroiditis looking more and more likely!

TSI 97% (range <122%)

[Barb135]

Stay with us here so we don't have to ask for info somewhere else..

[WildMtn]

Just updating more results.

Trab is <0.9 (range <1.75)
Sed rate 23 (range 12-20)

Keeping fingers crossed it is thyroiditis and I'm on the downhill side.

[WildMtn]

Back from the Endo - decided to keep things mostly in this one thread, since my earlier results are up there!

She ordered quite a few tests, but so far all that's come back (I check online) is the TSH, and that one has come up to 0.15 (Range of 0.34-5.6).  Can that mean anything at all?  I'm kinda hoping it means this is "just" thyroiditis and I'm getting better, but my other tests have been taken at different times of the day, and I don't know how much that matters, etc.

She did say this could be thyroiditis, because my AB's were negative, but then again, until today no one had checked for the Grave's specific AB.  

She also ran a sed rate, to look for inflammation.  

I should get a call here in a next day or so to schedule the RAI uptake scan.

[Barb135]

Sounds like what you're eating and when you're eating it might be part of your trouble...I hope the protein in that shake wasn't soy.  

Make sure you're getting some healthy fat with that protein at every meal; fat satisfies just as much as the protein. The fat can be a little bit of butter seasoning your veggies, coconut oil in your oatmeal, peanut butter on your whole grain toast or apple, etc.  Or try a bulletproof coffee... yummy!!

MedHelp has a diabetes tracker that you can use to track your blood sugar levels.  I don't see anything wrong with monitoring your BG levels, but don't get carried away.  The monitor might have been relatively inexpensive, but the replacement strips can get pretty spendy for some of those, so I'd suggest that you use wisely.  I think mine came with 25 strips, but a package of replacements are about $30, so they aren't something I waste.

Each meal throughout the day should include protein, a complex carb and some fat.  I use full fat dairy, which qualifies as both protein and fat.

[WildMtn]

Thank you sooo much!!  You really are a wealth of information!

Yes, my tummy was grumbly after the protein shake.  I ended up laying down until dinner, which I just ate, and now that I have had a "proper" meal, with complex carbs, and protein, etc, I feel MUCH better.

I think I may go ahead and I get some sort of log book or tracker app (there's an app for everything) so I make some use of the monitor and not go overboard - just enough to see a trend, not so much that I get my head all wound up in it, does that sound right?

I may also just start eating small "meals" - since I've been so hungry, it may keep me on a more even keel.

Thanks again!

[Barb135]

This isn't really the right forum, but yes, you could be having some hypoglycemia or possibly even some insulin resistance, where your body isn't using insulin properly.

Since you have the meter now, try taking fasting BG (before you eat anything in the morning) and see what your levels are over a period of time.  Also try taking it before you eat lunch or dinner, when you get that weak, shaky, hungry feeling and see what your level is, but keep in mind, you can't go by single readings; you have to establish a trend... you can also track post prandial readings, which are those 1-2 hrs after eating (I'd wait 2 hrs vs 1).  

There are 2 ways you could be dealing with hypoglycemia - 1) is simply that your BG is never rising high enough and 2) you're eating things that are spiking your BG, like sugary food and since they wear off quickly, your BG drops very quickly, putting you right back into hypoglycemia again.

Your BG of 95 an hour after eating the protein shake was probably okay - first because protein doesn't increase your BG and secondly an hour might not have been long enough and you don't say what carbs were in it, since there are, both, simple and complex carbs... simple break down quickly and spike your blood sugar (but not necessarily within an hour), complex take a longer time to break down and don't spike your blood sugar.   When you felt hungry and shaky and your tummy was grumbly, was that after you ate the protein shake?  If so, take a look at your protein powder.

My doctor tried getting me to add 2 protein shakes/day because my protein levels were low and he thought it would help me lose weight and I felt horrible, plus, I never felt full or satisfied and I often went through bouts of hypoglycemia, in spite of having insulin resistance/metabolic syndrome. There is such a thing as too much protein.  

What often happens with hypoglycemia is that your blood sugar drops, you eat something really sweet, and instead of just a little bit of something sweet along with something else that will take the blood sugar up more slowly, most people eat way too much, which causes insulin to spike in an effort to bring down the blood sugar level... This can cause blood sugar to crash again, so you're right back to hypoglycemia and you do the same thing all over again.  It ends up being a vicious cycle.  Just a couple ounces of OJ or something will get the blood sugar rising, then a glass of milk will take it the rest of the way up, without pushing it so high, so fast that it spikes insulin too... that's just one example - you could do a couple ounces of OJ and a slice of whole grain toast, etc.

I used to have bouts of hypoglycemia quite often and I found myself in the vicious cycle of having to eat the sugary food - it was always so hard to break the cycle.  I finally figured out that it was easier not go get it started in the first place.  If I eat the right foods on a decent schedule I don't get it started, then I don't have to deal with it.  I do sort of blame that for today's insulin resistance, because when you're making the pancreas work like that it eventually gives out.

Both your pancreas and thyroid are part of the endocrine system and everything has to work together, so they could be related.  Establish a trend with the BG thing, but don't take it to extremes or let it drive you nuts.  

Make sure you're eating plenty of complex carbs and fat on a regular basis.  If you're having hypoglycemia, you should be eating smaller amounts every 3-4 hrs to keep your BG levels stable.  If you eat smaller amounts more often, that should also be easier on your tummy.

[WildMtn]

OK, me again, with yet another question that this may not be the right forum for, but here goes!

Throughout my life I've experienced episodes that I've thought were possibly "low blood sugar" but I've never had the tool to test it, so I just ate something reasonable if possible -- other times I have gotten to the point of passing out. It used to happen more often w/exercise, so at one point a dr suggested it *might* be exercise induced hypoglycemia, and had me just drink the sugary type of gatorade or such while exercising, and low and behold, no more passing out!  

Now, I've been getting similar symptoms again, but I've been eating a LOT lately, too.  However, due to vomiting, the dr wanted me to eat less, drink more, and take it easy on my stomach today.  That's great in theory, but I feel AWFUL!  

Anyway, I don't know when you're "supposed" to take blood sugar measurements, other than the 1-2 hours after meals thing.  So when I mostly recently felt bad I had a fairly high carb protein shake, waited an hour, and my BG was only up to 95.  Is that ok?  I still feel awful - shaky, hungry, etc, but my tummy is also grumbly and not quite sure what to do with what I just put in it :(

Could this BG thing be related at all to the thyroid being out of whack?

Any and all advice welcome, TIA!!