Aa
So scared
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?
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.
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.
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
5) Selenium
6) Iron
7) Ferritin
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.
Happy hunting!
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
5) Selenium
6) Iron
7) Ferritin
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.
Happy hunting!
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.
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.
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.
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.
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.
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.
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.
Did you sleep any better last night?
"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.
Did you sleep any better last night?
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