Hypo/Hyper Swings

[thyroidhack]

Hello Dr. Lupo,
I have Hashimoto's thyroiditis which was successfully treated with a T3/T4 combo for about 3 years, then I began experiencing hyper swings. I get hyper symptoms in the afternoons but overall I'm hypo. These swings have made the hypo impossible to treat.

I have a nodule and goiter, which I plan to have biopsied, I also am going to ask my doctor to test for TSI and TSAb to see if I have Graves in addition to Hashi's.

My question is...do you see people get their thyroid removed due to Hashimoto's with hyper swings? My blood tests do not show hyper because the hyper/hypo seem to cancel each other out, but I have definite AWFUL symptoms of hyper and it is making my life hell. This has gone on for almost 3 years and I cannot get balanced. If my thyroid were removed I'd at least only be dealing with hypo rather than this push/pull.

Thank you,
Leila

[Mark Lupo, M.D.]

only if there is documented lab evidence of swinging from high to low, etc.  Otherwise there may be "thyroid-like" symptoms that are not really do to thyroid, so would not want to commit anyone to surgery that may not be solving the problem.  OR, make sure it is clear to the patient (you in this case) that surgery may not solve the problem, but you elect to have surgery given this history.

[thyroidhack]

Yes they are rare, unfortunately not rare enough in my case. I stopped the T3/T4 over two years ago, I am currently on Low Dose Naltrexone since I cannot handle anything else (nor T4 alone). The question remains...have you seen removal of the thyroid in unmanagable cases of such swings?

[Mark Lupo, M.D.]

It is rare to have swings, but possible.
Would consider stopping the T3 and see if once daily T4 alone smooths things out.