Hi. I have made several posts lately about what I thought were panic attacks. Now I'm not so sure .I've had several episodes now where I get uncontrollable shaking and almost shivers and have a horrible time sleeping over the last week. I just start to doze off and I startle awake or my muscles tense up. My Dr did blood work and my TSH came back at 8. Back in August I was at .3. I dont' know about t3 or t4, but she ordered another test because I insisted there must be some mixup. She also felt a goiter in my thyroid...I don't know what she's talking about, since I don't feel my thyroid often. I have an ultrasound today. I was diagnosed with Hashimotos about 10 years ago and my thyroid has been pretty stable since then. I don't understand what is going on..I feel like I have hyperthyroid symptoms with the anxiety and shaking, yet with my TSH being high that seems impossible.My periods have suddenly gotten irregular..one month 25 day cycle and the next was a 30 day cycle. I am concerned that maybe its a pituitary tumor or something. Does anyone have any ideas on what could be going on ? Is it possible for thyroid to suddenly fluctuate like that? Is it possible to have anxiety and by hypo? I feel like I'm dying here. I'm so scared, so tired, have no idea what I'm going to do. My Dr. wanted to just put me on antidepressants but I feel like I need to figure out what's wrong with me. Any thoughts?
Don't be scared, you are having thyroid symptoms, it is possible your thyroid hormones are causing all your issues, It does not happen all the time but in some cases you can be Hypo, have a nodule on your thyroid that secretes T4 in addition to the thyroid, this would possibly cause a back and forth Hyper Hypo situation, the shaking, shivers and restlesness are Hyper symptoms, and Anxiety, depression and indomnia could be from either Hyper or Hypo, Has your MD done the Free T3 and T4? if not I would demand he does, there is no way he can rely on TSH, since the pituitary is located in the brain, I doubt since they were looking at sinus, especcialy with xray rather than MRI. As far as panic attacks are concerned, You can have those in either case because you are stressed out about your present situation. I would not be too concerned about TSH at only 8, it is not a normal range, but is not extreme either. Ask if the Free T3 and Free T4 were done, if so get the results with the reference ranges and post for more Info. Best Regards FTB4
NO, I am so ticked off that she didn't do the t4 and t3. I am pretty sure she requested those in the retest I did yesterday. I'm just praying that the t4 comes back normal for hypo. Can stress somehow trigger my Hashimotos to flare up again and mess all this up? I had a rough 2 weeks prior to this with some reactions to some antibiotics where I spent every minute paranoid that I was gonna die. To think just a month a go I was happy and apparently healthy. Its funny how quickly things can change. Thank you for your thoughts. I will post my new results when I get them. Would I expect tsh to be much higher with a tumor?
I had a very similar ordeal two years ago -- insomnia, anxiety, muscle ticks, and what felt like a continuous, low-grade panic attack. I had been hypothyroid and taking the same dose for 10 years, no problems. One day after 4 months of this ordeal I decided to see what would happen if I skipped my thyroid med for a day, then cut the dosage to half.
I slept that night for the first time in months. My docs (several of them) disagreed that I had become hyper, but they let me cut down my dosage and it helped. I also started anti-depressants, but I think it was cutting my synthroid dosage that made the biggest difference.
Also, we later discovered that I had two big, cancerous nodes growing on my thyroid, and determined that I had Hashi's.
I had to really fight with the docs to get the help and attention I needed. There seems to be some huge prejudice against patients saying they have thyroid problems.
I had the worst episode of hysteria the other night, is the only way to describe it...like started laughing then couldn't stop but felt like I was crying at the same time. It went on for a long time, tears running down my face and felt out of control...
I have always had anxiety issues...and depression, low self-worth and trouble with emotions, either too much or not enough. I suppress then decompress...I am finding out so much about thyroid malfunction, hypo/hyper and the fluctuations that can happen, especially with Hashimoto's.
Anyway, just sharing, thanks. I too have had a major fight for many years for docs to take this serious. I'm going to Naturepath next week and see what light she can shed on it.
Yes Stress can aggrivate Hashimoto and Graves symptoms, Stress is a common trigger for almost all diseases and can magnify the symptoms and make them much worse. I have a low threshold for patience, and get aggrivated quickly, and I know from experience that it brings on my symptoms regardless of how well my labs are. I know it is hard, but you must try and relax, you will see a great difference in how you feel. Best Regards FTB4
I am so in your shoes. I was having the same symptoms as you. I also get itching in my feet, which is so annoying. I have yet to find a doc that knows what I'm going through or who even cares. If I were you I would not take antidepressants. I did for two months only to find out that it truly was my thyroid. The antidepressants were awful for me. Are you on any thyroid meds? If not when you start them, they will help stop the panic attacks. I know for a fact how you feel when you are about to fall asleep then you suddenly wake from a moment of fear. It is nice to hear someone else who knows what I'm going through. I am on 37.5mcg of levothyroxine and 20 of cytomel of which I am dosing myself( I don't advocate) I just can't seem to find anyone who cares. The cytomel has been a God send but I still don't know if I'm on enough meds or to much. Just know yes the panic attacks are from your thyroid an i do believe that stress is the major factor. Also make sure you are taking your supplements, like multivitamins, b12, calcium, mag, and zinc. I feel better than I use to but still very ill. Try not to be afraid. This is more of a stress issue, and it is not a death issue. Remember that!
Yes, I'm on thyroid meds, but god knows how much I need to be on or what's causing this crazy TSH. I was really hoping to have my new blood work back today but no luck. I felt like I nearly passed out driving for my ultrasound today and was shaking like a leaf for a long time. I finally took a xanax and was able to relax a bit but of course, not sleep. I constantly am aware of my heart pounding in my chest. I have a perfectly normal resting heart rate and blood pressure as of yesterday so I guess its just my mind messing with me even more. I wish I could get a good nights sleep. I think I am starting to suffer from exhaustion. FTB4...can you have graves and be hypo/have hashimotos? This is all way beyond my comprehension. I half considered going to the ER today just so someone would help me feel better. I will only go on the antidepressants as a last resort but I have to get this sorted out first. Obviously whatever is going on with my thyroid needs to be sorted out first. I am trying not to be afraid. Even when I am perfectly calm, sitting on the couch with my kids I start shaking. My heart rate doesn't rise, I dont' even feel panicky. I just start shaking. It makes no sense..SO.......FRUSTRATED!!!!
Hey one last word of encouragement. My sister went through the same thing with hashimotos and it took her two years to get better, but as of today she is doing just fine almost like she has no disease at all. Like I said, I'm in your shoes just waiting for the sun to shine. I have two little girls who have lost so much time with me but I will make it up soon. This too shall pass!
I have read posts about many members here experiencing the same Hypo/Hyper symptoms, I don't know the exact cause and maybe gimel can add something more than I, but I know you are not the first to have symptoms flipping back and forth. Thyroid nodules can cause some havoc with hormones. You have to keep in mind with Hashimoto's, just because you felt fine and your labs were perfect two months ago, does not mean they will be locked in at that dosage, The thyroid being attacked by your immune system does not stop progression just because you are taking replacement hormones, they just replace what the thyroid cannot produce, when the thyroids destruction becomes worse, you need to bump up the replacement hormone to compensate, if you don't, then symptoms recur. Take Care and try to relax, its just a bump in the road! FTB4
I didn't have a thyroid problem until after giving birth to my son. It started out with me getting overly hot, shaking, feeling dizzy, and anxiety really bad. I started noticing that I was losing hair. I was scared to drive because of the dizziness, it was making me miserable. I went and had a blood test and found out I had hyperthyroidism and multi nodules. They biopsied the nodules and they were not cancerous. Then killed my thyroid with radio active iodine, so now it's hypothyroidism. I think second doctor opinions are very important, because if I had another doc around when I was finding this all out, I feel things could have been different. Go see an endocrinologist. Don't be afraid, as long as you get to the root of the problem and get your health straight you will be fine :) I take synthroid as a thyroid replacement. Only thing that ***** for me personally is weight gain, still have hair loss, get overly cold now, and moody (but not everyone has all those issues). Good luck.
I finally have my second thryoid test results back, hoping someone can give me some thoughts.
My TSH was at 6.79
I only got to talk to the nurse and she didn't say if it was "free" t3 and t4 or not. I have no idea what any of this means! FTB4, do you have anything to add? The last 3 nights I have not slept much at all. I start to fall asleep, and jerk awake. I don't know what is wrong with me and I am really starting to lose it!
You have to verify if those are FREE T3 and FREE T4 or total T3 and total T4. They look like totals to me. Also, when you call back to verify that, ask for the reference range for each. Reference ranges vary lab to lab and have to come from your own lab report.
It's thyroid peroxidase antibodies (TPOab) that are 83. TPOab is one of the marker's for Hashi's. When TPOab is elevated (and yours is), Hashi's is indicated.
I am pretty sure they are totals. I just talked to the Dr and she was no help. I had been on 150mcg 4 days a wk and 187.5 for the other 3 because my former dr couldn't find a balance. For the last 4 days I have been on 175. They numbers are total t3 and t4 I think because the range for the t3 was 71-180 and the t4 was 4.5-12. The Dr just basically blew me off and said to go back on the 150 mcg and start Lexapro. I had 2 small nodules on my thryroid but there wasn't anything remarkable. I am so so so scared and confused. I've read a little about Hashimotos encephalitis or whatever its called and I am terrified i have it. Every night when I got to sleep I jerk awake a thousand times and can't sleep till I take a Xanax. I do NOT know what to do. I have no other place to go, it will take weeks or months to get in to see an endo. I think I'm gonna have a nervous breakdown
Where are you located?,only if you are outside the us in UK or Canada would it take so long to see an Endo, even though all Endo's are not the best at thyroid either, because the rely on TSH too much. If you are having symptoms that severe than find another MD that cares. Regards FTB4
I live in the Denver area and will be making calls first thing in the am. The nurse made out like my numbers were crazy and then the doc acted like no big deal. I am just so tired and not sure what to make of the numbers. It's hard being so unsure and getting mixed messages when the dr calls.
Your TT4 is at 44% of range. T4 should be around 50% of range, so it's a little on the low side. TT3 is VERY LOW...it's just about on the floor of the range. TSH is elevated. So, everything...FT3, FT4 and TSH...says you're hypo, not hyper. Also, T3 should be higher in its range (as a percentage of range) than T4 is in its. Yours is the other way round (FT4=44%, FT3=5%), and that indicates that you are not converting well. I don't think a decrease is going to make you feel any better. It looks like you might have to add some T3 to your meds.
Hashimoto's encephalitis is EXTREMELY rare... I can almost guarantee you don't have it. You are panicking, and that's why you're jerking awake, and the shaking is adrenalin talking.
So, why are you not converting well? Sometimes that just happens. Is there anything (ANYTHING, even if you think it's totally indignificant) you've done differently lately? Lifestyle change? New meds or supplements (even brand name changes)? Significant weight gain/loss? Stress? Other medical issues? Trauma?
Your labs perfectly explain how you feel. You're a little hypo. TSH, TT3 and TT4 are all consistent, which doesn't indicate a pituitary issue. You simply need a change of meds.
Omg. Thank you so much for your reply. It's so nice to feel like someone cares. In regards to your question about trauma... I moved here over the summer and I guess we are in the process of adjusting. As irrational as it is I started a huge stressful period right before thanksgiving when I had what I think was an allergic reaction to antibiotics. It really scared me. A week later I switched to another kind and was terrified of having it happen again. The night I had my first shaking episode was the night I started my second antibiotic. I hadn't eaten. Went to a party. Had 4 or 5 drinks with no food. I came home and went to bed late and it started in bed. I just assumed it was a panic attack for some reason. I had several more after that I've had a few days with nothing after the rare nights that I slept well. I know I have kind of worked myself into a frenzy over one thing or another over the past few weeks. . Can that actually mess with my thyroid ? The worrying about all this hasn't helped either. It's a ugly viscous cycle and I don't necessarily think that antidepressants are the answer right now. So you don't see anything that sounds horribly worrisome? Do you think it's the stress causing all of it? Maybe I can sleep tonite if I don't have to worry about my thyroid. You think I should stay on the 175 ? Thanks.
Goolarra. One add. I did recently start a calcium supplement and have basically cut out all alcohol , most sugar , pretty much everything that could aggravate anxiety. I usually have a drink every nights. I wonder if I am going thru some kind of withdrawal or something. The human body and mind are so complicated. I wish I understood it better. You must have some medical background to have the understanding that you do
There you go...a traumatic event. Coincidental that the night you had your first shaking episode was when you started the second antibiotic? I don't think so.
Yes, a frenzy can actually mess with thyroid. Stress is the one biggest precipitating factor in exacerbting Hashi's.
Antidepressants aren't necessarily the answer. In fact, they can make depression worse if the root cause is thyroid.
I don't see anything to panic over. Stress could be causing it all, and it might be self-correcting.
I think you could take two courses of action. 1) Continue with your current dose and see if this resolves spontaneously (especially if the stressor has resolved). 2) Ask your doctor about adding a little T3 (Cytomel) to your meds. Your T3 is very low, and T3 correlates best with symptoms. Be aware that many doctors don't like to prescribe T3, and if your doctor is one of those, you may have to find a new doctor or try to educate this one.
Relax and have a good night's sleep. You are not dying...we've all felt like we were when we were hypo.
Sorry, I didn't see your second comment until I'd already posted my response.
Maybe your drink wasn't such a bad thing??? Mild depressants (like alcohol) actually flood the brain with T3 making us less depressed. Yes, it's complicated, and we have to try to make it as simple as possible. Otherwise, we drive ourselves nuts.
I have absolutely NO medical background...just got put through the wringer with my own Hashi's, so it's become a bit of an obsession with me...we all have our little quirks!
Thanks for all your input goolarra. I'm at least convinced that I'm not gonna die today. :) I requested a referral to a endo today. I really hope that my Dr. will cooperate. She obviously has no idea what to do and will probably be glad to get rid of me. What does a Dr do to resolve the situation if they are unwilling to add in T3? Just let it go? Or do they continue boosting your Synthroid dose? So, adding additional Synthroid can't cause hyper symptoms right? My Doc said thats why I should go back to the 150 ...because I can't sleep, but if my body is low on T3, that seems unlikely. I know I have so many questions. I just really need to feel like I understand all of this. I wish I knew why I feel so jumpy and shaky...I mean if its just my thyroid situation causing all this, or just anxiety, or the MAJOR lack of sleep over the last week. Thank God for people like you that have been through all of this and are willing to take the time to explain it all to those of us that haven't and basically have no one to ask. I really regret not having an endo for the past 5 years or so. I didn't think I needed one anymore..LOL. Lesson learned.
If she knows she's out of her league, then all she can do is refer you.
"What does a Dr do to resolve the situation if they are unwilling to add in T3? Just let it go? Or do they continue boosting your Synthroid dose?" Too many of them either let it go or try boosting Synthroid indefinitely. People on T4 only meds with low FT3 are probably the group we hear from most often on this forum. Many have to find a doctor that will prescribe T3 in some form. (It's always best when choosing an endo to make some calls and find out who uses T3 and who doesn't. You can also ask your pharmacist who prescribes T3.)
Additional Synthroid can cause hyper symptoms. The balance of FT3 to FT4 is very important...one can't be ignored in favor of the other. The rule of thumb is that FT4 should be about midrange, and FT3 should be upper half to upper third of range at the same time. Do you have or can you get the results of any prior labs from when you felt well to see where your T4 usually runs? That comparison to where you are now would be invaluable.
T3 is the only form of the hormones that your cells can use, so it correlates best with symptoms. Your T3 is so low. Hypo can cause panic attacks, anxiety, sleep disturbances, etc.
You might need to reduce your T4 some...I'd definitely want to do that before adding T3. However, at the moment, if you just reduce T4 without adding T3, I really don't think that's going to make you feel any better. T4 looks pretty good (a little low for most people on meds), T3 is dismal, TSH is elevated...it all says you're hypo, not hyper. However, I don't think going back to 150 mcg will make you feel a lot worse, either. When you're not converting, your cells aren't getting the T3 they need, and no matter what your T4 level is, that's not going to change a lot.
It sounds like your doctor only tested TSH, so there probably isn't a lot of T3 and T4 labs history, but if you can get any, we could do some comparisons.
I just called my previous Dr and for some reason they didn't run T3 tests. In March my TSH was 4.18 and my FT4 was 1.19 I remember at that point I was on 150mcg and I was feeling tired and lousy so my Dr. bumped me up to 175. In July I retested and I think my TSH was .3 and my free T4 was 1.71. This was right before we moved and they said that my TSH was a little low and if I started to feel hyper that I could do the higher dose on a few days and the lower dose on a few and then follow up with a new Dr. here. I stayed on the 175 until sometime in August maybe and then I was starting to feel like maybe it was too much and switched myself to the alternating days. I am not great at keeping track of which days I did what so I think there were more days than there should have been where I took the lower dose of 150, but that was probably only for a few weeks ...basically when all this crazy stuff started happening. I know I never should have let all this go. There has just been so much other stuff to take care of and I've let a lot slide.
Last night was weird again. Jumping awake, feeling like I was shaking most of the night. I willed myself to not take a Xanax or tylenol PM and eventually got some sleep. I did have a cocktail last night but that didn't seem to help either.
I'm really torn on going back to the 150. If the extra T4 could be aggravating my anxiety maybe its worth it. Obviously, its not going to make any more T3 no matter how much T4 I am on. I have to go to my Doc's office and fill out an authorization to send my info to the endo. I suspect this is going to be a long process before I actually get to see someone. Maybe I should find another general practitioner in the meantime to get a second opinion. Is my T3 in any way dangerous to my health right now? Am i "severely" hypo?
This is so crazy. Its like a loop and I can't find where it started and how to break out of it.
Stress can also increase the rate of conversion of T4 into Revers T3 which is useless.
So the stress induced recently causing less T4 to be converted into the useful Free T3 and instead convert to worthless Reverse T3 could also have occurred.
If this was totally stress induced, then an anti depressant for a short term MAY help. I have to admit I'm not a fan at all of anti depressants. Just saying it has helped some people through a short term situation and helped alleviate some issues.
Reverse T3 is ONLY made during the conversion process. So increasing the amount of T4 IF a reverse T3 issue is occuring actually makes things worse and not better. Adding T3 is the better solution.
I agree with Goolarra on her points. I believe that some T3 is needed to be added.
Another option to consider is to switch from a T4 only medication to Natural Dissected Thyroid such as Armour. This has both at T4 and a T3 component in it. It has a significantly higher amount of T3 in it than the normal human thyroid produces.
flyingfool, your comments seem completely logical to me. I agree that my next step to find someone who will allow me to add the T3 or switch me to Armour. Do you or anyone else know about taking Selenium to help the conversion? I have been lazy in taking my multivitamin but after looking at it, I see that it has selenium, so I will be popping one of those babies with my lunch.
I finally feel like i have an understanding of all of this. All I really want to know at this point is whether or not I am in any "danger" in the time period between today and when I see someone to address my problem. I actually made an appt at a different family practice for monday, just to get a second opinion and hopefully some help. Trust me the antidepressants are very tempting right now. Its very much a chicken and egg scenario. Unfortunately, there is no way to know for sure which came first.
So, here's my plan...go back on the lower dose of T4 for the next few days. Take my vitamins, try to relax and find an endo, or at least hope that this other Dr will be able to help. Does that make sense? Its about all I can think of. Just reassure me that I'm not in danger. :) All I can really do is wait at this point.
Being Hypo is not life threatening. It is frustrating, debilitating and might drive you a little batty. But it is not generally life threatening. So you can relax. I think the stress is far more dangerous to you than being Hypo.
Selenium is said to help with conversion. I believe that is true. However I believe it is pretty minimal in the grand vision of things.
You can actually get too much Selenium and be toxic. Although I think it has to be pretty high dose. Most over the counter selenium supplements are I think 200 mcg and most places I've read seem to think that is fine to take.
Another source that is high in Selenium is Brazil nuts. Eating 1 or 2 nuts a day can add a lot as well I think even more than 200 mcg.
Selenium can come from food and is localized based upon the soil type. So certain areas of the country or world can have a lot of selenium in the plants or even from the meat from animals who eat the plants.
So you may not know if you live in an area of high or low selenium. You can have your Selenium level checked with a blood test. Just have to ask for it & get the Dr to agree to request the test.
All indications are that you are Hypo and you were feeling fine before the stressful situation. I'd be a little hesitant to lower thyroid meds when the indications are you are already hypo and then want to lower thyroid. But the worst that happens is that you go slightly more hypo.
As stated above many people have anxiety with being hypo.
You may be best served as stated I think above to start calling around. I think you will want a T3 medication so your best bet may be to start calling local pharmacy's and see if they will tell you what Dr's are prescribing T3 medications, either Cytomel which is a synthetic pure T3 or natural dissected thyroid such as Armour which has both T4 and T3.
If you are able to get some names of Dr's, then call their offices and ask them some questions. The important questions to ask are:
1) Does the Dr go by a patients symptoms or does he/she only go by blood lab results? If so what lab tests does he/she look at primarily?
2) Does the Dr normally test for BOTH Free T4 and Free T3 or does he/she only test for TSH?
3) Does the Dr prescribe T3 medications such as Cytomel or Armour or is he/she only prescribe T4 medications.
Before you go to the Dr you may want to request getting all new blood labs. And demand
1) Free T4
2) Free T3
3) Vitamin B-12
4) Vitamin D3
It is very common in America to be low in Vit D for ANY person but seems especially common for Hypo patients.
Both D3 & B-12 both if deficient cause fatigue/tiredness and both seem to have a pretty wide range and many people report they need to be WELL up into the range if not even toward the very top. So again being somewhere within the range is not good enough.
When the lab tests results come back. I think it was previously stated that many people have found they need BOTH of the following thyroid tests to be well up into the range. specifically
1) Free T4 to be in the MIDDLE of the range (50%) if not slightly higher
AND- that means in addition
2) Free T3 to be in the UPPER 1/3 of the range (66.7%)
Notice that these results are well up into the range. Do NOT accept being told that if you fall "somewhere" within the reference range that you are normal and fine and be told it is "in your head". when your results are at the bottom of the range.
Everyone is different and needs to be optimized the dosage for them. But after many, many people the target or 50% and 66% seem to be a MUCH better target to shoot for and make more people feel well when they approach these levels and are left symptomatic and feeling like crap by Dr's who refuse to increase dosage if they are within the range even if at rock bottom.
Do not be surprised if it takes a long time to find such a Dr. My wife is on Dr number 4 plus a referral to an endo which I had to educate before my wife FINALLY was able to get prescribed T3 medication. Many other people on this forum have been through 8 or more Dr's. So be prepared.
Doing your homework and making the calls to narrow the field will help. You are at least fortunate to live in a larger metropolitan area where there are a large number of Dr's. Some of us live in less population dense area with MUCH less opportunity.
I think if I were you, I'd go back to 150 mcg. As I said, I don't think it's going to make you feel a lot better, but I also don't think it's going to make you feel worse.
I'd also pre-interview endos and suggest to your doctor who you want to be referred to. You can ask to speak to a nurse. One good question to ask is which tests they regularly order for hypo patients. You want to hear FT3, FT4 and TSH. Another good question is if the doctor prescribes T3 meds. Just because a doctor is and endo doesn't make him a good thyroid doctor. If your doctor doesn't take much more interest in who she refers you to than she has in your treatment, you could be going from the frying pan into the fire. Also, try to get on a wait list with the endo.
No, I don't think your hypo is any immediate danger to your health. My FT3 on diagnosis was well below the lower end of the range. I felt like holy hell, but I was still basically functioning! Don't worry...you'll make it until Monday...probably with a little T3 to spare! In fact, you just might make it until Christmas...LOL
I thought of RT3 as well, but I really don't think it's something you need to consider at the moment. For a number of reasons, it can be VERY difficult to find someone who treats RT3. You need someone to treat the basics, and you don't need to be worrying about the esoterics at this point.
The enzyme that catalyzes the conversion of T4 to T3 is selenium-based, so it can't hurt to make sure your levels are good. Follow label directions on selenium, however, as it can be toxic in higher doses. Check on Brazil nuts before going that route...they are VERY high in selenium, and if you're going to use them to supplement, I think you might have to split them.
Wow, thanks for all that info guys! I really feel like I have a place to start and know what types of questions to ask. It makes a world of difference when you are not walking blindly into something. Saves a lot of time. You're right flyingfool, I am very fortunate to be living where I am now. My options would have been limited if this had happened a year ago.
Just out of pure curiosity, why are Drs so against Cytomel? What alternative is there?
I don't think I mentioned the nodules on my thyroid either. There are 2, pretty small...small enough that we are just going to "keep and eye on them". Does that sound about right? I got so worked up with these numbers that I forgot. Really trying not to think about that part if the equation.
These guys were taught in med school that all their patients needed was T4. And logically, that should be true. Conversion of T4 to T3 happens mostly in the liver, but also at lesser sites throughout the body. It's a separate process...metabolic, not thyroid. So, they were taught that you just adjust T4 and T3 takes care of itself. Enter reality...
T3 is more volatile than T4. You really have to take it more than once a day to avoid the peaks and valleys in levels that can occur because it's so much faster-acting. So, it's a little harder to control. Add to that that T3 is about four times more powerful than T4, so a little bit goes a long way.
Nodules are very common with Hashi's. I have a bunch of them, and we just keep an eye on them. Thyroids are naturally nodule-y (i can make up words if I want to). I read an article a while back by a doctor who said that he could pick five healthy people out of a grocery line, and three of them would have nodules.
Dr's know so little about thyroid that they don't venture far from the ranch. And the standard of care is T4 only medication to get TSH somewhere in the range. So they don't want to venture anywhere outside those bounds.
Frankly the body is so complex I don't have too big a problem with the average primary care physician not really understanding Thyroid. Probably 75% of the people if not more seem to get along fine with a simple T4 med and use of TSH only monitoring.
However for those remaining folks that don't fit into that circumstance, I do have a hard time not understanding the reluctance of a primary care Dr to refer you to another Dr who specializes in Thyroid. And I have absolutely no excuse or tolerance for an Endo who SHOULD know and understand Thyroid to do better. But many if not most don't seem to understand thyroid any better than the average general practitioner. That is unacceptable in my mind.
Many people here have a better understanding of thyroid than most Dr's and possibly most Endo's. How can this be in a day of technology for the Dr's to not understand this better. The research is out there. We can find it, why the heck can't they?
Just when I thought I might have an answer..,so I saw my new regular doc yesterday. He looked at my labs, agreed that there is an issue and said no problem to try cytomel. He said he didn't think I should reduce my synthroid and to stay at 175 mcg. You could tell he was not confident about that though. So, I pick up my rx today and see that he gave me 25 mcg daily. Uhhhhhh, that doesn't seem right. As it is i have tried a few days on 150 mcg of synthroid and actually slept at night. Then I decided I'd try the 175 and had a hard time sleeping. I know I should not be flip flopping probably. I have been feeling better anxiety wise tho. Not constantly shaking, no racing thoughts etc. Is it possible that now that I have calmed down that my body might readjust and start making t3 again or at least not making rt3? It seems like taking my b vitamins and stuff might be helping me feel better Not sure what to do now. I have an Endo appt on Jan 16. Maybe I should just try to stick it out on my synthroid until then. I just know from what I've read that the higher dose plus the cytomel is too much. Thoughts ?
Typically, when cytomel is added to a regimen, the T4 med is reduced by approximately 25 mcg for every 5 mcg cytome/T3 added, but I'm not sure you'd want to reduce quite that much, since your T4 is also low. 25 mcg of T3 med is a HUGE starting dose. If I were taking it, I'd try to get it in 5 mcg pills, then only start with 5 mcg/day and let your body get used to it. And if you do decide to take the full 25 mcg/day -- do NOT take it all at once. T3 is fast acting, so if you take 25 mcg all at once, you'll really have a "buzz" on, but it won't last long, then you'll crash.
You picked up the script - it is 25 mcg pills, or is it in 5 mcg pills? If they're 25 mcg pills, you can split them into 1/4's. Pain the rear, but much better than going overboard.
You weren't diagnosed with having RT3 dominance; it was only suggested in a previous post and it really doesn't appear that's much of an issue, at this point.
"I know I should not be flip flopping probably." No, you shouldn't, because you're going to end up not knowing where the heck you're at.
It takes between 4-6 weeks for a dosage change to take full effect, so if you were only on the 150 mcg for a few days, it would not have had much of an effect, that quickly; likewise, increasing back to the 175 mcg will not have an immediate effect.
I've been on the 150 longer than the 175 really. My cytomel is a 25 mcg tablet. If I were to split the tablet in 1/4 I would still be taking 6 plus mg a day, all in one dose. I'm not sure I could split that into halves. If I could would it make sense to go down to 150mcg of synthroid and take 6.25 mg of t3? I really want to get on stable dose of something when I see the Endo in a month she can make an accurate call based on my labs at that time.
It would be better if you could ask your doctor for 5 mcg tablets and split those. Keep in mind that T3 doesn't take as long to stabilize as T4, so it's the T4 component of your meds that you really want to keep stable. I agree that 25 mcg Cytomel is a HUGE starting dose...I wouldn't do it. Many doctors don't realize that T3 is dosed much more delicately than T4...they think it's the same.
If I remember correctly, your TT4 was 8.8 with a range of 4.5-12. That's 57% of range, and I would drop it 25 mcg (to 150 mcg) to accomodate the T3 (at 5 mcg split into two doses).
I also agree about the RT3...no reason to worry about that at this time. That was merely a suggeston and to make you aware of it as a possibility. Don't lose any sleep over it just yet! For most of us, it's never an issue.
I had similar anxiety when I was on Synthroid and had a low FT3. The anxiety and many other issues have now resolved since bringing it up. When I first added cytomel, I reduced synthroid from 150mcg to 137mcg, and added 2.5mcg cytomel (twice a day). After about three weeks, I increased to 5mcg(twice a day).
Slow and steady is the way with T3 meds. Too much T3 meds too fast can cause headaches or other bad symptoms.
25 mcg T3 is a huge starting dose as others have stated. A person may eventually get there. But they don't start there.
many people have shown that starting anything more than about 10 mcg of T3 can cause problems. Some people can tolerate it. But i"d say most can't or even more so it's not worth it to try.
I agree to see if you can get another prescription of a lower dose.
If you can't get the dosage changed split into quarters or simply not take any T3 and wait for your endo appt in Jan.
Also make sure to get in BEFORE your January Endo appointment and be absolutely sure to get tested for both Free T4 and Free T3.
Finally, if you do start T3, when you go get blood drawn, try to have the blood drawn BEFORE you take your T3 dose. As T3 becomes available very shortly in the blood. Then try to always follow the same routine and try to be tested at approximately the same time to keep everything consistent as possible in relation to eating, meds and blood draw. Otherwise you will be somewhat comparing apples and oranges.
T4 takes 6 weeks to stabilize. T3 only takes hours! As a result you want to split the dose of T3 up into at least 2 doses a day. Take at least half in the morning if not 2/3 and take the other half to 1/3 in the early afternoon. Waiting to past about 3PM for the 2nd dose of T3 may cause you to have difficulty getting to sleep.
I'm only going to make one more comment, then I'll back out of the conversation, because it might become confusing.
If you can get your doctor to change the prescription to 5 mcg tablets, rather than 25 mcg tablets, that would be best, then you can split those and start really low, which is best.
However, if you have to stay with the 25 mcg pills, you can split them into quarters, which would be 6 mcg/day. That's really a pretty small amount, too. You might think about taking the T3 (6 mcg) a little later in the day, than you take your T4 med. T3 does not have to be taken on an empty stomach, like T4 does.
For instance, I started out on 5 mcg/day and because I was working, it didn't work well for me to split it, so I'd take my T4 med when I got up in the morning at 3:30, but I didn't take the T3 med until several hours later, usually around 7:30. That worked well for me, for several years, then in Feb of this year, I was increased to 7.5 mcg, which I do split 5 mcg in the morning and 2.5 mcg at/near noon, but I'm retired now, so don't have to worry about carrying a tiny piece of pill around with me.
Another thing I'd like to point out is that T3 doesn't affect us all the same way. I never felt (still don't) the "rush" after taking my dose and I was on it for over a year before my FT3 actually came up noticeably. I've been on generic T3 since Jan 2009 and just this year, my levels have gotten to a point where I feel good, and I'm only on 7.5 mcg/day.
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