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Adrenaline surges, nausea, diarrhea (hypothyroid/levothyroxine)
Hi everyone! Please excuse the detailed post, but wanted to give as much info as I can.
In the summer of 2014, I was 34 years old & healthy. Despite no change to diet and exercise, I began putting on some weight. Then in January of 2015, I began having some troubling adrenaline surges, which would happen seemingly at any time, and for no reason. I met with my PCP, who wasn’t sure why this was happening, but decided to do some basic blood work to see if anything was “off.” Everything came back “normal” at that time, except for a slightly-elevated TSH:
1/13/15 TSH (.27 – 4.2 normal range) 5.8
Due to the elevated TSH, my PCP stated that my symptoms were likely thyroid-related, and decided to prescribe me 25 mcg Levothyroxine. A few months after starting the levo, those strange adrenaline surges eventually dissipated and I felt better. However, I have steadily gained weight (about 10 lbs/year) since then, and nothing seems to help that.
Over the course of the next 3 years, my PCP steadily increased the levo dosage and re-checked the TSH levels, and by the fall of 2017, I was taking 75 mcg/daily, and received the following test results:
12/1/17 TSH (.27 – 4.2 normal range) 1.6
Free T4 (.9 – 1.8 normal range) 1.4
T4 (4.6 – 12 normal range) 9.0
In December 2017, I began working an incredible number of hours at work, and was very stressed by the acquisition of my company by a larger company, which resulted in my receiving a promotion with the company that had acquired us. I began working 80+ hours per week (up from ~50 hours per week before this). Also at this time, I began having occasional heart palpitations, which my PCP had told me to watch out for on the levo. This was mid-December, and my PCP was in the process of switching practices, and thus unavailable until mid-January. So, just before Christmas, I decided to drop my dosage to 50 mcg to stop the palpitations (a dosage that I had previously done well on), and to follow-up with the PCP in January. I took 50 mcg daily for several weeks (although, to be honest, I may have missed some doses entirely, due to all the working and stress).
Two weeks ago, I was out at a work dinner, and had a terrible “episode” (which is what I’ve been calling them now), where I had a huge unexplained adrenaline surge, quickly followed by nausea, vomiting, and diarrhea. We were at a seafood restaurant and had eaten some raw seafood, so I assumed it was food poisoning. I felt really bad for several more days, kept having episodes, etc… I just kept thinking I was getting over food poisoning.
One week ago, I decided I had to see my PCP at her new practice, as I wasn’t getting better. At my appointment, I had high blood pressure (149 over something, which is weird for me, I am always under 120). I told my PCP what had happened with dropping my levo dose, and she advised me to start taking the 75 mcg dose again. She also prescribed .5 mg Lorazepam to help with the adrenaline surges. She asked me to start checking my BP at home regularly, and to call the office if it goes above 150. That day we did some additional blood work, which came back as follows:
1/17/18 TSH (.27 – 4.2 normal range) 1.85
Free T4 (.9 – 1.8 normal range) 1.6
Vitamin B12 (211 – 911 normal range) 806
Fast forward to that same night, when I had the worst episode to date. Even though I did take that first dose of Lorazepam before bed, I was up all night with terrible adrenaline surges, vomiting, and diarrhea. The next morning, I was so weak and dehydrated, my PCP advised that I should go to the ER. I spent the whole day in the ER, where they gave me Saline for dehydration, Zofran for nausea, and Torodol for headache. I also had a CT Scan of my abdomen to rule out adrenal tumors, which came back normal. Standard blood work all came back normal. The ER doctor also ordered a plasma metanephrine test, but stated that those results would take several days, and I have not received them yet.
Since being discharged from the ER, my BP has remained elevated at times, and I continue having similar “episodes.” I have absolutely no appetite, can barely eat anything, and continue to have periodic diarrhea. I feel hot sometimes, and cold at other times. Symptoms seem worse in the morning as soon as I wake up, and in the evening around dinner time. I have been able to sleep, but wake frequently after 4/5 hours of sleep. I have been taking the 75 mcg levo dose since my PCP recommended last week, but I will not take the Lorazepam again, as I don’t like the way it makes me feel, and have been sober for over 5 years.
I have an appointment with an Endocrinologist tomorrow morning to discuss all of this. Any suggestions or tips for that appointment? Has anyone else experienced these adrenaline surges, which seem to get better with levo, and recur when switching to a lower dose? I’m so confused and scared at this point – I can’t eat, I can’t work, etc… Please help!
In the summer of 2014, I was 34 years old & healthy. Despite no change to diet and exercise, I began putting on some weight. Then in January of 2015, I began having some troubling adrenaline surges, which would happen seemingly at any time, and for no reason. I met with my PCP, who wasn’t sure why this was happening, but decided to do some basic blood work to see if anything was “off.” Everything came back “normal” at that time, except for a slightly-elevated TSH:
1/13/15 TSH (.27 – 4.2 normal range) 5.8
Due to the elevated TSH, my PCP stated that my symptoms were likely thyroid-related, and decided to prescribe me 25 mcg Levothyroxine. A few months after starting the levo, those strange adrenaline surges eventually dissipated and I felt better. However, I have steadily gained weight (about 10 lbs/year) since then, and nothing seems to help that.
Over the course of the next 3 years, my PCP steadily increased the levo dosage and re-checked the TSH levels, and by the fall of 2017, I was taking 75 mcg/daily, and received the following test results:
12/1/17 TSH (.27 – 4.2 normal range) 1.6
Free T4 (.9 – 1.8 normal range) 1.4
T4 (4.6 – 12 normal range) 9.0
In December 2017, I began working an incredible number of hours at work, and was very stressed by the acquisition of my company by a larger company, which resulted in my receiving a promotion with the company that had acquired us. I began working 80+ hours per week (up from ~50 hours per week before this). Also at this time, I began having occasional heart palpitations, which my PCP had told me to watch out for on the levo. This was mid-December, and my PCP was in the process of switching practices, and thus unavailable until mid-January. So, just before Christmas, I decided to drop my dosage to 50 mcg to stop the palpitations (a dosage that I had previously done well on), and to follow-up with the PCP in January. I took 50 mcg daily for several weeks (although, to be honest, I may have missed some doses entirely, due to all the working and stress).
Two weeks ago, I was out at a work dinner, and had a terrible “episode” (which is what I’ve been calling them now), where I had a huge unexplained adrenaline surge, quickly followed by nausea, vomiting, and diarrhea. We were at a seafood restaurant and had eaten some raw seafood, so I assumed it was food poisoning. I felt really bad for several more days, kept having episodes, etc… I just kept thinking I was getting over food poisoning.
One week ago, I decided I had to see my PCP at her new practice, as I wasn’t getting better. At my appointment, I had high blood pressure (149 over something, which is weird for me, I am always under 120). I told my PCP what had happened with dropping my levo dose, and she advised me to start taking the 75 mcg dose again. She also prescribed .5 mg Lorazepam to help with the adrenaline surges. She asked me to start checking my BP at home regularly, and to call the office if it goes above 150. That day we did some additional blood work, which came back as follows:
1/17/18 TSH (.27 – 4.2 normal range) 1.85
Free T4 (.9 – 1.8 normal range) 1.6
Vitamin B12 (211 – 911 normal range) 806
Fast forward to that same night, when I had the worst episode to date. Even though I did take that first dose of Lorazepam before bed, I was up all night with terrible adrenaline surges, vomiting, and diarrhea. The next morning, I was so weak and dehydrated, my PCP advised that I should go to the ER. I spent the whole day in the ER, where they gave me Saline for dehydration, Zofran for nausea, and Torodol for headache. I also had a CT Scan of my abdomen to rule out adrenal tumors, which came back normal. Standard blood work all came back normal. The ER doctor also ordered a plasma metanephrine test, but stated that those results would take several days, and I have not received them yet.
Since being discharged from the ER, my BP has remained elevated at times, and I continue having similar “episodes.” I have absolutely no appetite, can barely eat anything, and continue to have periodic diarrhea. I feel hot sometimes, and cold at other times. Symptoms seem worse in the morning as soon as I wake up, and in the evening around dinner time. I have been able to sleep, but wake frequently after 4/5 hours of sleep. I have been taking the 75 mcg levo dose since my PCP recommended last week, but I will not take the Lorazepam again, as I don’t like the way it makes me feel, and have been sober for over 5 years.
I have an appointment with an Endocrinologist tomorrow morning to discuss all of this. Any suggestions or tips for that appointment? Has anyone else experienced these adrenaline surges, which seem to get better with levo, and recur when switching to a lower dose? I’m so confused and scared at this point – I can’t eat, I can’t work, etc… Please help!
Also, curious as to your results for the home adrenal tests. I posted info on an old answer of mine.
https://www.medhelp.org/posts/Adrenal-Insufficiency/ACTH-Stimulation-Test/show/1742344
https://www.medhelp.org/posts/Adrenal-Insufficiency/ACTH-Stimulation-Test/show/1742344
Good morning everyone,
Wanted to circle back and give an update on how I am doing after going to see an Integrative Medicine doctor yesterday. Wow, what a difference!! This practice could not have been more different from Tuesday's traditional endocrinologist visit. This doctor spent a full 90 minutes with me, and let me tell my whole story in a narrative form, rather than talking over me before I could finish sentences.
Red_Star - you were right! She said everything I've described fits exactly into the symptoms of Adrenal Fatigue Syndrome, Stage 3 (where all of the hormones in the body are in disequilibrium and out of whack). This explains the adrenaline rushes (she stated that my body is running out of cortisol, so it's releasing adrenaline instead), the heart palpitations, the reactive hypoglycemia symptoms (which are related to the whacky insulin levels), the irregular blood pressure, and irregular menstrual cycles. Of course, my hypothyroidism is connected to this as well - it's all endocrine related.
Traditional endocrinology does not recognize AFS as a real condition - basically, if you don't have Addison's Disease (no cortisol) or Cushing's Syndrome (way too much cortisol), it's all in your head so go see a shrink (they don't recognize any adrenal disfunction in between those two extremes). Which is exactly what I experienced at Tuesday's appointment. She said she sees someone similar to me at least once a week, who has been to multiple traditional doctors, but gotten no answers and no help.
I actually sobbed in her office with relief to have someone actually listen to me, to tell me I'm not crazy, to tell me that she has seen this before, and knows how to help. I've lost 15 pounds in 2 weeks, and was starting to think no one could help.
Here is the plan she is putting me on:
First, she is doing a lot of lab work, including:
Full Thyroid Panel
Cortisol Saliva Test w/DHEA
Food sensitivity testing
Heavy metals testing
Vitamin D
Ferratin
Second, she is putting me on a strict diet plan called the "Elimination Diet", to get my blood sugar levels under control and stop the reactive hypoglycemia symptoms, and to reduce the chronic inflammation I have (due to lower back pain, carpal tunnel, etc). This diet is Gluten free, Dairy free, Low carb, Low sugar. She gave me a comprehensive guide that includes recipes, so my husband will have no problem making meals that I can eat. I am to follow this diet for 6 weeks, then we will re-assess how I feel.
Third, she gave me a few supplements to start to try to help with the adrenaline rushes and heart palpitations.
Lastly, she recommended that I absolutely cannot work more than 40 hours per week, no strenuous exercise (walking, swimming, yoga is OK), and in general I just need to rest and take it very easy for a few months.
Once she gets the Full Thyroid Panel back next week, we will review that and make changes to my levoxyl script as necessary. She is willing to switch me to a NDT, like Armour. She may have other recommendations after all of the other testing comes back as well.
I'm very hopeful that this doctor is going to help me and get me back on track. I am fully committed to following her suggestions, and making the lifestyle changes that I need to. I plan to call my boss on Monday and give him an ultimatum - when I am feeling better, he can have me back at work taking it easy, or he can have me not at all, and I'll have to go out on Short Term Disability.
I'll keep y'all updated on my progress - hopefully I will start feeling better soon!
Wanted to circle back and give an update on how I am doing after going to see an Integrative Medicine doctor yesterday. Wow, what a difference!! This practice could not have been more different from Tuesday's traditional endocrinologist visit. This doctor spent a full 90 minutes with me, and let me tell my whole story in a narrative form, rather than talking over me before I could finish sentences.
Red_Star - you were right! She said everything I've described fits exactly into the symptoms of Adrenal Fatigue Syndrome, Stage 3 (where all of the hormones in the body are in disequilibrium and out of whack). This explains the adrenaline rushes (she stated that my body is running out of cortisol, so it's releasing adrenaline instead), the heart palpitations, the reactive hypoglycemia symptoms (which are related to the whacky insulin levels), the irregular blood pressure, and irregular menstrual cycles. Of course, my hypothyroidism is connected to this as well - it's all endocrine related.
Traditional endocrinology does not recognize AFS as a real condition - basically, if you don't have Addison's Disease (no cortisol) or Cushing's Syndrome (way too much cortisol), it's all in your head so go see a shrink (they don't recognize any adrenal disfunction in between those two extremes). Which is exactly what I experienced at Tuesday's appointment. She said she sees someone similar to me at least once a week, who has been to multiple traditional doctors, but gotten no answers and no help.
I actually sobbed in her office with relief to have someone actually listen to me, to tell me I'm not crazy, to tell me that she has seen this before, and knows how to help. I've lost 15 pounds in 2 weeks, and was starting to think no one could help.
Here is the plan she is putting me on:
First, she is doing a lot of lab work, including:
Full Thyroid Panel
Cortisol Saliva Test w/DHEA
Food sensitivity testing
Heavy metals testing
Vitamin D
Ferratin
Second, she is putting me on a strict diet plan called the "Elimination Diet", to get my blood sugar levels under control and stop the reactive hypoglycemia symptoms, and to reduce the chronic inflammation I have (due to lower back pain, carpal tunnel, etc). This diet is Gluten free, Dairy free, Low carb, Low sugar. She gave me a comprehensive guide that includes recipes, so my husband will have no problem making meals that I can eat. I am to follow this diet for 6 weeks, then we will re-assess how I feel.
Third, she gave me a few supplements to start to try to help with the adrenaline rushes and heart palpitations.
Lastly, she recommended that I absolutely cannot work more than 40 hours per week, no strenuous exercise (walking, swimming, yoga is OK), and in general I just need to rest and take it very easy for a few months.
Once she gets the Full Thyroid Panel back next week, we will review that and make changes to my levoxyl script as necessary. She is willing to switch me to a NDT, like Armour. She may have other recommendations after all of the other testing comes back as well.
I'm very hopeful that this doctor is going to help me and get me back on track. I am fully committed to following her suggestions, and making the lifestyle changes that I need to. I plan to call my boss on Monday and give him an ultimatum - when I am feeling better, he can have me back at work taking it easy, or he can have me not at all, and I'll have to go out on Short Term Disability.
I'll keep y'all updated on my progress - hopefully I will start feeling better soon!
I just sent you a PM with info. To access, just click on your name and then from your personal page click on messages.
1 Comments
Thank you!!! That's very helpful.
Can' say that I am surprised. That is the typical lousy
standard of care we hear about so often. And of course we wouldn't want to be confused with additional test data. Unbelievable.
I think that in order to obtain a license all Endocrinologists should have to be hypothyroid (either naturally, or forced TT) and have to rely only on themselves for diagnosis and treatment, in full accord with their usual standard of care. Nothing beyond that. How long do you think it would take for their standard of care to change?
It is hard to find a good thyroid doctor. If you will tell us your location, perhaps we know of a doctor in your area that has been recommended by other thyroid patients.
standard of care we hear about so often. And of course we wouldn't want to be confused with additional test data. Unbelievable.
I think that in order to obtain a license all Endocrinologists should have to be hypothyroid (either naturally, or forced TT) and have to rely only on themselves for diagnosis and treatment, in full accord with their usual standard of care. Nothing beyond that. How long do you think it would take for their standard of care to change?
It is hard to find a good thyroid doctor. If you will tell us your location, perhaps we know of a doctor in your area that has been recommended by other thyroid patients.
1 Comments
Thanks, gimel. I am in Massachusetts (Framingham, to be exact). Willing to travel within reason, if anyone knows a good doc who is willing to run labs and listen to specific history/symptoms.
UPDATE -
Just back from the endocrinology appointment, and it went just as I feared. Despite presenting him with all of the information above, he does not think that what I am experiencing is an endocrine issue. He suggested that I see a gastroenterologist for the nausea and diarrhea, and a psychiatrist for the adrenaline surges (which he says are panic attacks, despite my assertion that I don't have any panic/anxiety/depression issues).
He also refused to run any additional tests, and stated that TSH and Free T4 are the only "useful" labs to look at it, and mine are within normal ranges. He said running a full thyroid panel will only confuse us more.
I guess I need to see someone else. I know there is something wrong with me, and that it's not panic attacks.
Just back from the endocrinology appointment, and it went just as I feared. Despite presenting him with all of the information above, he does not think that what I am experiencing is an endocrine issue. He suggested that I see a gastroenterologist for the nausea and diarrhea, and a psychiatrist for the adrenaline surges (which he says are panic attacks, despite my assertion that I don't have any panic/anxiety/depression issues).
He also refused to run any additional tests, and stated that TSH and Free T4 are the only "useful" labs to look at it, and mine are within normal ranges. He said running a full thyroid panel will only confuse us more.
I guess I need to see someone else. I know there is something wrong with me, and that it's not panic attacks.
Your symptoms are all listed under adrenal exhaustion (stage 3 of 4 stages of adrenal fatigue). Check out the article by Dr Lam "Adrenal Exhaustion and Other Adrenal Fatigue Symptoms" to read in full. And you may find when sorting out your stress issues you can get off thyroid medication.
Here is a short excerpt ...
"...As the body tries to repair itself with the limited tools it has, there are wild, exaggerated and paradoxical autonomic-driven reactions. These are characterized by adrenaline rushes, labile blood pressure, and hypoglycemic episodes after meals and anxiety attacks. A state of near adrenal failure (Phase D) eventually occurs as the body’s pool of hormones reaches a level too low to prime the adrenals. Without sufficient levels of hormones, the body goes into a full-blown shut down mode to stop as much of the non-essential functions as possible to conserve energy in order to survive. During this stage of Adrenal Fatigue, the libido is suppressed, digestion slows down and metabolic rate declines to conserve body weight."
Here is a short excerpt ...
"...As the body tries to repair itself with the limited tools it has, there are wild, exaggerated and paradoxical autonomic-driven reactions. These are characterized by adrenaline rushes, labile blood pressure, and hypoglycemic episodes after meals and anxiety attacks. A state of near adrenal failure (Phase D) eventually occurs as the body’s pool of hormones reaches a level too low to prime the adrenals. Without sufficient levels of hormones, the body goes into a full-blown shut down mode to stop as much of the non-essential functions as possible to conserve energy in order to survive. During this stage of Adrenal Fatigue, the libido is suppressed, digestion slows down and metabolic rate declines to conserve body weight."
1 Comments
Wow, a very eye-opening article! The symptoms described in Stage 3C are eerily similar to what I've been going through these last 2 weeks.
Thank you for sharing, looks like I have a lot more reading to do!
Thank you for sharing, looks like I have a lot more reading to do!
I also meant to mention to make sure you get a cortisol test done. Stress like you have had is not good for you and it can affect cortisol levels.
Sorry I caught this post so late that I have little time to respond. However, I can tell you that taking a dose of T4 like you have done will result in lower TSH, which then reduces the stimulation of the thyroid gland and thus lower levels of thyroid hormone. Most hypo patients find that to relieve hypo symptoms, the med dosage needs to be raised enough to get FT4 to at least mid-range, and FT3 into the upper third of the range, and then adjusted from there as needed to relieve symptoms. This dosage of thyroid med usually suppresses TSH and doctors misunderstand that as hyperthyroidism. In reality it is hyperthyroidism only if you have hyper symptoms due to excessive levels of FT4 and FT3.
It may be that there are other things at play as well. so I highly recommend reading at least the first two pages of the following link, and more if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
When you see the Endo, what you are looking for is doctor that will treat clinically by testing and adjusting FT4 and FT3 s needed to relieve symptoms, without being influenced by resultant TSH levels. You also need to get some additional tests done. The tests needed are listed in Sugg. 4 on page 2 of the link. You should try and get all of those as well as an ultrasound of the thyroid gland. If the doctor resists, you should try to persuade him to do the tests.
Please let us know how the appointment turns out for you.
It may be that there are other things at play as well. so I highly recommend reading at least the first two pages of the following link, and more if you want to get into the discussion and scientific evidence for all that is recommended.
http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf
When you see the Endo, what you are looking for is doctor that will treat clinically by testing and adjusting FT4 and FT3 s needed to relieve symptoms, without being influenced by resultant TSH levels. You also need to get some additional tests done. The tests needed are listed in Sugg. 4 on page 2 of the link. You should try and get all of those as well as an ultrasound of the thyroid gland. If the doctor resists, you should try to persuade him to do the tests.
Please let us know how the appointment turns out for you.
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