Why the sudden change?

[TennLady]

I had a right side lobectomy 8 months ago. It has been pretty miserable but I thought I was making some progress when all the sudden I began to have heart palpitations around the clock. My doctor has ordered a heart monitor and lowered my Armour Thyroid dosage twice in the past week thinking I am over medicated. Still I have no change in the palpitations and am seeing a return of previous symptoms. He does test for both T3 and T4 levels but still tends to focus on TSH results. Does it ever get better? Why do so many people not have problems and I am having so many? I feel like my life as far as feeling well ended 8 months ago, I wish I had never allowed them to remove any part of my thyroid.

[esther1971]

Thank you both. Yes Brucergoldberg, I do have Hashi's, and yes, Goolarra is kindly speaking with me on a separate thread... I couldn't work this system out, but i have now, and realise people WERE responding - so ive narrowed it all down & am trying to clear up the loose ends. thanks so much for the responses.

[Brucergoldberg]

I am curious to see if you have hash's.   This could be very important.   I know Goolarra is taking good care of you, but if you have half of thyroid with hashimotos, that may also cause factors for having problems getting balanced.   The wonderful world of thyroid.

[goolarra]

I am, thank you, but I have a couple more questions.

"...had been told to stop nt during menses".  How long had you stopped for, and was this just before your Christmas crash?  Did you do this every month, and if so, how had you reacted previously?

One of the first things in your post that impresses me is that someone has been jerking your meds up and down way too quickly.   You started 100 mcg the beginning of February, then three days later increased that to 150.  Then, they lowered that to 112.5 (why not 137.5 or 125?).  Were you having hyper symptoms before you went to 112.5, when your FT4 was 27?  You said you felt good...

I'm with you...I'd worry about 20 mcg of T3, too.  Certainly, you'd want to have your cardio sign off on that before starting it.  If you do decide to add some synthetic T3 in, I'd certainly want to start much lower than 20 mcg and increase as needed and as tolerated.

Adrenal problems could be making you feel worse.  

[esther1971]

i hope goolara is doing well... this thread was really interesting... sorry, but ive got some questions too?

I was on t4 only till 2010, and was converting ok, but started getting terrible numbness/pinns&needles/weight gain, etc.

eventually i was put on naturthroid in spring/summer 2011, but was initially overdosed till my t3 was 13 in a (3-6 range). i developed heart issues (wearing a 7 day holter again now!). when it was corrected i got much better, then xmas 2011 had a crash - infection saw me in hospital showing my tsh was 55 (had been told to stop nt during menses, dont know if really low tsh by beginning of sept. 2011 at 0.006 meant thyroid was also suppressed so stopped making any too resulting in the crash?

either way, had big probs, as was put straight back on 2grains daily, and 2 days later had a crazy REALLY high bp sweating tachichardia night. my veins were really high and have still not settled now.  was told to go back to levo.

started 1st feb on 100, then 150 3 days later... test showed
t3 3.5 (3-6)
t4 20 (12-22)
tsh 17 (0.4-5.5)

over feb my tsh lowered and t3 & t4 raised... by beginning of march was:
t3 5.2
t4 27
tsh 0.4

(yes my body works too fast!!!)... but i felt GOOD! YAY!

but due to t4 being high, they lowered me to 112.5 levo. daily, so:
t3 3.8
t4 19
tsh 1.8

I feel SO BAD... i cant get up. feel so hypo.

now my endo has offered my synthetic t3 at 20mcg daily... im worried this is to high - especially considering my cardio possibilities?... and separate doctor has said if my body isn't making t3, it needs to rest after this rollercoster, and if i take t3 ill crash worse!

i cant afford that!... im so confused. feel really really hypo, heart is slowly thudding & had to go to a&e last week with low pulse & temp... id rather have nt added to my t4 (& starting at 1/4 grain & slowly building), but im also wondering, due to my excessive thinness & anx. issues, if adrenal problems could be compounding the issues... although my cortisol is always a little high out of range, but saliva tests suggest up & down.

any ideas?

im wondering... if i stay at this level... will the t3 build again?...

and to the other lady... yes i get the pressure in my ears too... & in my viens!

[goolarra]

Sometimes people who have Hashi's become a lot more stable if the thyroid is removed or "dies" completely.  As it's dying, it tends to work in fits and starts, and that can cause swings from hypo to hyper.  However, unless there are extenuating circumstances, surgery is rarely recommended for Hashi's...it's not considered worth the risk.  

If you don't have a thyroid disease, but a normally functioning lobe, it can only help you to keep it.  Once again, we all react differently, and sometimes people are not all that specific about what was going on with them.  I wonder if the person you cite had Hashi's, if you do, etc.  I'm pretty certain that Hashi's is one of the things they look for in pathology.

Sorry to hear you weren't feeling so good last night.  I hope today brings better...

[TennLady]

One of the individuals had half removed and struggled for a year and then the rest removed. She said she has not had problems since. This was many years ago.

I had an ultrasound in January and do have a very small nodule on the other side.

I will ask my Doc about Hashimoto's. If they tested they did not tell me.

I am glad you stuck around, it is helpful to chat with you. Like tonight, I am feeling pretty lousy..thanks for being out there.

[goolarra]

Unless there's a good reason to remove the rest of your thyroid, I think you're better off with it than without it.  Did these two people have justification for making that statement?  Have you ever had antibody testing to see if you have Hashimoto's thyroiditis...pathology report on the lobe removed should have been able to determine that?  I assume you have periodic ultrasounds on the other lobe to check for nodules???

I'm not in the medical field.  I just struggled with my thyroid problems long enough to acquire some knowledge in one little, tiny area of medicine.  When I was first on the forum, some great people helped me with my problems.  I learned a lot from them, and I was hooked!  So, I've stuck around...  It's a very interesting subject, actually...

[TennLady]

I have spoken to at least two people now that say removal of the rest of the thyroid is the answer. Is this remotely possible or just wishing it so? I certainly wouldn't want to go through that and it not help at all.

You seem so knowledgeable and are so well versed in the terminology, are you in the medical field? I find myself struggling to understand much of it.

[goolarra]

It's best to see the cardio and be sure...it's not something you want to have to worry about.  Peace of mind is worth a whole lot.

Let me know how it goes...

[TennLady]

You have made more sense than just about anyone I have talked to..thank you.

I was on T4 meds for a short time but you may be right, it will be something I discuss with my doctor soon. I am not totally off meds, they just decreased the dose to 30 mg which I can tell is not enough (at least not enough T4) because I am having a return of symptoms that were under control.

I see the cardio on Thursday the 8th. I have never had any heart problems and am pretty confident that this is all due to the thyroid.  But I am happy to go to be sure.

Thanks again for taking the time to help me and I hope you can enjoy good health and "happy hormones"

[goolarra]

There will be better days...it takes some time and lots of patience.  Everything to do with thyroid is so individual, from the levels we each feel comfortable at to the meds that get us to those levels.  You just have to experiment until you get it right, but you will.  

Have you ever tried T4-meds (Synthroid, Levoxyl, etc.)?  I'm wondering if you might not feel better if your FT3 were a little lower and your FT4 a little higher.  Unfortunately, because the T3 and T4 content in desiccated is fixed, that can be hard to achieve.  Perhaps consider replacing some of your Armour with a T4-only med.  If you'd been fairly stable on the 60 mg Armour until the palps started, you're going to have to get back on thyroid meds soon, or you'll be very hypo.

Meds with T3 in them may not be the best choice if heart issues are involved.  I have WPW syndrome, which is a congenital heart defect that causes episodes of tachycardia.  Until I was on thyroid meds, that was controlled without heart meds.  The thyroid meds exacerbated my condition.  I went from a few episodes a year to 20-30 per day.  Since I finally got on a stable dose of meds, my heart has behaved better than it has since I was about 8 years old.  So, what I'm saying is that both too much and too little thyroid hormone can cause heart issues.

Do you see the cardio soon?    

[TennLady]

My lobe was removed because of a large nodule that doctors said the biopsy did not provide enough evidence to rule out cancer. It was benign. (thank you Barb for clearing up what PT is for me)

Yes, I felt fairly stable on the 60 mg until the palps started.

My doctor sent me for an EKG yeterday, called shortly after to say it was abnormal and to report to ER which I did and was there for a few hours being monitored and finally the ER doctor said everything looked ok. They have made an appointment with a cardio doctor to be safe.

My doctor did increase beta blocker dose yesterday as well which seems to help some but palps are still happening.

Hypo symptoms are increasing now with the lower dose of Armour.

I am so confused and VERY weepy and emotional thinking there will never be better days.

Thanks for advise.

[goolarra]

Sorry about the PT...yes, Barb's right, that is what I meant.  Why was your lobe removed?

So, you'd taken your meds prior to the draw, which would inflate your FT3.  As a rule of thumb, any meds with T3 in them shouldn't be taken before the draw.  However, even though your FT3 probably would not have been above range had you not taken your meds, it still may be running a little high for YOU personally.

Sorry to ask so many questions, but I'm brainstorming here.  Have you been fairly stable on the 60 mg until just recently?  Where have your FT3 and FT4 been running prior to the current labs?  Had you increased to 60 mg only a short time prior to getting palps?

The last time I was overmedicated (I'm not convinced yet that you're overmedicated), my endo advised me to discontinue all thyroid meds for three days and then resume at a lower dose.  You might ask your doctor what he'd think of that approach.  I found it helped relieve the worst of the symptoms pretty fast.

A beta blocker could also help with the palps.  However, you doctor would probably want you to do the heart monitor before prescribing those.  

[Barb135]

PT - I believe she's referring to Partial Thyroidectomy (why was your right lobe removed?).  

[TennLady]

I am sorry, this is all fairly new to me, what is PT?
I had taken my meds prior to the blood draw.
Yes, I am still having near constant palps even on the 15 mg.

[goolarra]

Your FT3 was over range when your blood was drawn.  Had you taken your Armour before the blood draw?  High FT3 levels can cause palps.  At the same time, your FT4 is a little on the low side.

There's a lot of T3 in Armour compared to what our thyroids would make if they were healthy.  While you do look overmedicated as far as T3 is concerned, you look a little undermedicated as far as T4 is concerned.

So, even after lowering to 15 mg, you're still having palps?

Why did you have the PT?

[TennLady]

Ranges are:
T3, free (2.3-4.2)
Thyroxine Free (0.65-1.52
Thyroid Stimulating (.55-4.78)

These were results at the 60mg. I am down to 15mg for a couple of days and my chest is rocking hard with palpitations...scary

[goolarra]

Please also post the ranges on your FT3 and FT4.  Ranges vary lab to lab, so they have to come from your own lab report.  

Guessing at the ranges, it looks to me like your FT3 is pretty high and your FT4 is low.

[TennLady]

Sorry I failed to answer your question on how long I have been on meds. They did not start me on them immediately after surgery, it was some weeks later when symptoms began.
You also asked about other symptoms. They are pressure in my ears, back and shoulder pain, numbness in a couple of fingertips and I am very emotional.

[TennLady]

Thank you for responding.
My last labs showed T3, free @ 4.3 and Thyroxine free @ .87 and Thyroid Stimulating @ .383
I was on Armour 60mg. which was reduced to 45mg. and days later to 30mg. which is where I am now with no improvement of symptoms.

[flyingfool]

Are you sure you are being tested for FREE T3 & FREE T4 and not "total".

If not clearly identified as FREE then you are most likely being tested for "total" which is an outdated test of little value.

Please post your blood labs AND their reference ranges as they appear on the lab report.

Also what medication are you taking?  How much, And for how long have you been taking it (I assume for about 8 months???)

Heart palps can be a sign of Either Hypo or Hyper.  The palps are often different in each case. Usually Hyper is racing heartbeat and associated with the upper chamber of the heart (Atrium) and is usually called a-fib as short for atrial fibrillation.  Hypo is more common to affect the lower chamber of the heart called the ventricle.  This is usually a pre or early contraction of the ventricle and are called PVC's standing for Pre-Ventricular-Contractions.

Since a-fib is more serious, the safe thing to do was to assume you were over-medicated and Hyper and thus reduced your medication.

Are you having other Hyper symptoms?  Or could you tell us what symptoms other than the heart palps you are having.