TSH up at night cause for palpatations?

[gofigerr]

I have Hashimoto's but am not on meds, usually my tsh and other labs are normal. However I have the worst time with palpatations and heart racing at night. I just read an article that said TSH goes up at night between 9pm and 9am. A few times my heart has sent me to the ER once with AFIB, each time my TSH was up around 8. It would come back down by the time my regular doctor would check it. They did try me on synthroid but it made my nighttime symptoms much worse. My doc says that a Hashi's thryoid holds onto the thyroid hormone because it's sluggish and then can release it all at once, dumping it and causing hyper symptoms.

This is all making sense to me now, seems that I get the most hormone released at night, probably due to the elevated tsh.

Is there anyway to keep the tsh down at night without meds?

[stella5349]

You could also have a sign of adrenal fatigue and/or some magnesium issues.

A low magnesium level will spike this symptom especially at night time.

[gimel]

Was that Total T3 or free T3?  The total test is somewhat obsolete and not very useful.  You need to take charge of your testing and insist on being tested for FT3 and TT4, so that going forward you can tell if you are getting enough meds or not.  Also, just being anywhere within the range does not mean that everything is okay.  The ranges are far too broad for that.  If the doctor resists testing for FT3 and FT4, , then you should insist on it and not take no for an answer.  You are the customer, trying to feel better.

Your thyroid doesn't become sluggish and slower to release thyroid hormone, as your doctor suggests.  Your thyroid glands are gradually being destroyed by the antibodies from your autoimmune system.  With your thyroid glands being continually attacked by the antibodies, it is only a matter of time until you will need meds to relieve hypo symptoms and you will need FT3 and FT4 test results to best monitor your dosage.  

[gofigerr]

Thanks. I realize that the TSH doesn't cause the symptoms, I was thinking what you said, that it was causing the release of the elevation of the T3. What my doctor said is that from repeated attacks the thyroid becomes "sluggish" and slower to release hormone, and then during an attack or thyroiditis it releases too much. It just seems odd to me that it's always at night that I have the hyper symptoms. Thought maybe the tsh going up at night was causing the release of the storred up hormone.

My t3 is always right in the middle of normal. However unfortunately the ER docs never check my t3 just the TSH.

[gimel]

TSH is a pituitary hormone that does not, by itself, cause symptoms.  TSH has a Circadian rhythm that results in it being lowest in the morning around 9 am and the highest around 9 pm.  Studies have reported as much as a 70% increase from low to high.  

Along with that, FT3 also has a Circadian rhythm, but not nearly as large a change from morning to night.  The FT3 level seems to peak about 2-2 1/2 hours after the TSH.  For this reason, it may be that your high TSH is causing higher than desired levels of FT3 starting around 11 or 11:30 and getting you revved up over the next 3-4 hours.  I can not think of any reason that a Hashi's thyroid would hold onto thyroid hormone and release it all at once.  Doesn't sound right.  If there is a nodule causing leakage of hormone, this could happen anytime of the day or night, I think.

In my opinion the first thing you need to get done is testing for the actual, biologically active thyroid hormones, free T3 and free T4 (not total T3 and total T4).  FT3 is the most important because it largely regulates metabolism and many other body functions.  Studies have shown that FT3 correlates best with hypo symptoms, while FT4 and TSH did not correlate.  

With Hashi's you are going to see a gradual decline in natural thyroid hormone output by the thyroid glands, as they are being attacked and destroyed over some unpredictable time frame.  In my opinion the best way to treat a thyroid patient is to test and adjust FT3 and FT4 with whatever meds are required to relieve symptoms, without being constrained by resultant lower TSH levels.  If your doctor is unwilling to test and treat you clinically, as necessary to relieve symptoms, then you will need to find a good thyroid doctor that will do so.