Anxiety 2 hours after taking Synthroid and cytomel

[Bern3]

I have been on 75 mcg of Synthoid and 2x 5mcg cytomel for a while now.  I have been feeling great.  Suddenly I have experienced anxiety/panic attacks 2 hours after taking dosage, almost a disconnect if that makes sense.  My levels seem to be ok.  I have them checked about every 4 months.  I feel completely normal when I wake up, and feel completely normal at night.  I'm thinking it's the cytomel since it is short term absorption. I am just unsure why suddenly I'm reacting this way.  Also, recently I had not smoked in 2 weeks, and also experienced being Hypo...dry itchy skin, swollen eyelids, and now noticing dry skin patches on my face.  I have heard when you quit smoking you need adjustments to your medications.  But 2 weeks??  
A little history...I had radioactive iodine to kill my thyroid about 9 years ago.  

[Bern3]

P.S.  What the interaction does is the cortisone increase your cytomel dosage.

[Bern3]

I'm posting this to help someone else who is having these problems taking synthoid and CYTOMEL...
I found out there was a drug interaction with Cortisone and Cytomel.  It gave me extreme anxiety, heart palpitations, panic attacks within a couple hours after taking meds..  So if you are on any Cortisone like products do not take with Cytomel.  I had to be taken off cytomel and am just on a higher dose of synthroid to correct this, and have been off cortisone product for 2 weeks now.  I cannot believe how much better I feel.  I can't believe Doctors are not aware of this interaction.
Here's the link for more info...interactions w meds...SIDE EFFECTS

Hope this helps someone...you're not crazy!!

http://www.ehealthme.com/drug-interactions-side-effects/Cortisone-Motrin-Cytomel-Synthroid-Growth-Hormone-6019113

[ahmee]

The solution to low ferritin is iron supplementation. From what I understand, even if your iron levels are high-normal, it is okay to supplement with ferritin-- it's only a problem if your iron and ferritin are both high/above range. Think of it as building up your iron reserves: you can have a lot of active iron, but low stores. Best to discuss with your doctor and do a little research on it, but low ferritin can cause problems like fatigue, cold intolerance, and hair problems.

[Bern3]

BTW..I'm a "she!" lol  That might make a difference...hormones and all.

[Bern3]

I was looking at another blood test I had last year where I was having symptoms.  I went in because I was having some anxiety.  This was stress caused because I remember what was going on at the time.  And I WAS smoking then.
Here's the reading...T4 1.33..TSH  0.048..T3 3.0...all with same ranges.  She said my TSH was too high and that was why I was having anxiety, so she dropped my dosage 50 daily.  I gradually went back to 75.  I just know that when the TSH changes like this I do get anxiety.  Or is it the stress itself that is just masking these levels?

So your saying the TSH doesn't matter...It seems that is the only thing that changes when I'm having symptoms.  How is it possible to increase dosage a little to raise the T4 and T3 and NOT the TSH?

And also, with this reading, how does my T4 and T3 look?  Is it where I should be??  Is it still Hypo??

And does weight have a lot to do with dosage changes?  Say I lose a little or gain a little?  Does that affect whether I start to have symptoms or not??
I know thyroid levels fluctuate.

[Barb135]

If your doctor is freaking out over the TSH, you need to try to educate her.  We can provide links to studies that show that low or suppressed TSH doesn't necessarily mean hyper, if you think she would bother to look at them; some doctors will, some get upset/angry when they find out you've researched or gone to a forum.

[Barb135]

You can't use slightly higher values, because lab ranges aren't interchangeable.  We have to go by what his lab uses.

We're both making the same point.

[telus2]

Yes. Sorry. You are quite right, I used Bern's TSH reference range by mistake. Using Bern's reference range of 2.0 - 4.4 for FT3 and your rule, his FT3 target would be 3.2 - 3.6. ( I personally would use slightly higher).

Overall I'm trying to make the point that Bern is hypo, and give him some ammo to allow him to work with his doctor to increase his dose.

[Bern3]

Thanks for the info...I agree
I think my Dr looks at the TSH and freaks out!  That is why she's keeping me low.  I'll be chatting with her in a couple of weeks
I so appreciate the thyroid lesson.  It has been helpful.

[Barb135]

Yes,  in March your hormone levels were too low in the ranges.  Your FT4 was only at 48%, which is "close" to the rule of thumb, which is 50%; yours was at 48%.  Your FT3, however, was far from optimal.  Rule of thumb is for FT3 to be in the upper half to upper third of its range.  Yours was only 41%.  FT3 should be higher in its range than FT4 is in its range.

You're still hypo and you're suffering anxiety from trying to stop smoking.  

Maybe you should pick one and work on one issue at a time?  For instance get your thyroid hormones up to a therapeutic level, then look at quitting smoking.. If smoking and drinking go hand in hand for you, you may have come up with a plan B... If you have to drink when you smoke, or smoke when you drink, maybe the drinking is the culprit, rather than smoking?

Give your body a break and try to tackle one issue at a time.  Get your thyroid levels stable, then move on to other issues.  I know people who have hypothyroidism and still smoke and drink...  

[Bern3]

I just thought of something, when I have stopped smoking that means I stopped drinking alcohol too. Since the 2 go together for me, so maybe I just have anxiety period!  I hope not, not another thing.....ugh!

[Bern3]

To start, I have always taken ALL my meds, synthroid and cytomel together for the last 9 years.  Whether feeling good or feeling bad, always all at once.

March
T4 Free         1.28        (0.82 - 1.77)                                      
TSH              0.117      (0.45-4.50
T3 Free          3.0         (2.0  4.4)

Symptoms?       NONE
Med dosage/change?  75 mcg and cytomel 5mcg 2x daily
Smoking?   YES

You missed one..;)
JULY
T4 1.20
  TSH  0.097
  T3   3.0

Symptoms??   This is when I started having symptoms with  extreme anxiety, panic attacks in middle of night, anxiety 2 hours after taking meds etc..... .  I did have some stress going on.
Meds  ??  75 mcg cytomel 5mcg 2x daily
Smoking?? YES AND NO...meaning I cut down because I tried hormone replacement for 2 weeks, but then stopped that and then continued to smoke again

AFTER THIS APPT I WAS DROPPED IN DOSAGES

August
T4 Free        1.04           (0.82 - 1.77)
TSH             1.410         (0.450 - 4.500)
T3 Free         2.4            (2.0 - 4.4)

Symptoms?   BETTER, NOT AS OFTEN WITH ANXIETY 2 HOURS AFTER TAKING MEDS
Med dosage/change?     50mcg 1 day...75 mcg 6 days...same cytomel 2x daily      
Smoking?YES

Sept
TSH    0.155   (0.45-4.50)
FT4    1.20     (0.82 - 1.77)
T3 Free 2.7     (2.0 - 4.4)
Symptoms?  Not as often with anxiety and especially NOT 2 hours after taking meds
Med dosage/change?  same dosage...50 mcg 1 day 75 mcg 6 days cytomel 2x day
Smoking? YES

The last 2 weeks.....
symptoms???        Reappeared but not as extreme in July
Meds  ???     75 mcg and cytomel 2x day
Smoking??  quit (2 weeks)

Last 2 days
Symptoms?   Much better
Meds ?   Same as above
Smoking?  YES


So are you saying even in March my readings are too low (Hypo).  I can say I had a change in Drs because the other one left and ever since I've had this one I have felt more towards Hypo.  I have seen this Dr for about 2 years now.  I have told her I need to be higher, I do better.
Do you see any big differences in level readings between March and July??  I can tell you I felt very extreme with my symptoms in July.  Something I haven't felt in years.  I don't see a big difference.
And where do you think I need to be as far as the result levels, approximately.

[Barb135]

Actually, I went ahead and did it, so I don't have to keep searching for the individual sampling events.  Please correct me if I got anything wrong.

March
T4 Free         1.28        (0.82 - 1.77)                                      
TSH              0.117      (0.45-4.50
T3 Free          3.0         (2.0  4.4)

Symptoms?
Med dosage/change?
Smoking?

August
T4 Free        1.04           (0.82 - 1.77)
TSH             1.410         (0.450 - 4.500)
T3 Free         2.4            (2.0 - 4.4)

Symptoms?
Med dosage/change?            
Smoking?

Sept
TSH    0.155   (0.45-4.50)
FT4    1.20     (0.82 - 1.77)
T3 Free 2.7     (2.0 - 4.4)
Symptoms?
Med dosage/change?
Smoking?

I know the information is all up there, but let's condense it.  You can just answer the questions... lol

Now that I have the labs all together, I have to say that there's absolutely nothing in any of them that would indicate hyper and/or a need to decrease dosage.

TSH is very volatile and is affected by so many variables that have nothing to do with actual thyroid hormone levels. It should never be used as the basis for diagnosing or treating a thyroid condition.  It's very common for TSH to be suppressed when one in on a replacement hormone med, particularly one containing T3, such as cytomel.  My TSH has been at
< 0.01 for the past 5 years and I've never been hyper.

Another thing that just dawned on me:  Are you taking the cytomel at the same time as you take your Synthroid?  Or close to it?  If so, it could be the cytomel that's causing you to have the anxiety, because you've been taking it all at once, so you're getting that "jolt" when it starts kicking in, within a couple hours of taking it.

You don't become hypo overnight, whether you're smoking or not; nor does your metabolism slow down that much, that quickly.  It all happens over time.

As far as missing cigarettes - I've been smoke free (totally) since Aug 2007 and I still miss it; sometimes, I even crave a smoke, but all I have to do is remember why I quit, then wait 5 minutes and the craving is gone.  The thing with quitting is that you have to want to, and if you don't really want to, it's not going to happen, as is obvious with you, since you keep going back to it.  My husband quit once for 6 months, but he only did it because I'd quit and he thought he had to, too, but he didn't want to.  He went back to smoking and I know he won't quit unless/until something happens that forces it, and maybe not even then.

It sounds to me like your anxiety, panicky, depression has everything to do with trying to quit smoking and almost nothing to do with your thyroid, except maybe taking the cytomel all at once and getting that jolt.  Your symptoms are typical for someone who's trying to quit smoking.   I had them when I first quit, too, then my doctor prescribed me Chantix, which attaches to the same "feel good" receptors in the brain, so you no longer crave a cigarette.  It also works for drinking alcohol.

[Bern3]

I'm not sure which time you are referring to, but in July a physical symptom along with all the other symptoms was my hair was a frizzy cotton ball mess. That I've never had. Irritability was another. This happened initially when it started.  I have these blood tests on a previous post, you can see my TSH is off, compared to March...Is it strange that it was just my TSH that was off and not either T4 or T3????  If you would like I can repost all my levels together if it's easier.

My Doctor does adjustments only when I'm having severe symptoms, otherwise she leaves everything alone.  She did bring that up the last time, that we cannot change these doses this often....not good.

One thought I had was this....when I have stopped smoking, I can honestly say after a week I still feel great.  I feel free actually, good feeling.  By week 2, I'm not craving a cigarette, but yes I miss it.  But suddenly, almost overnight It all starts to happen, anxiety, panicky, sort of depressed.  So my thought was maybe I slowly become Hypo, not necessarily because of the smoking itself but because  my metabolism starts to slow down.  Maybe I'm eating more, maybe a slight weight change.  In turn means I'll need a little more meds, and that is why I become Hypo and have all these symptoms happening.
I think I'll need to come up with a plan when I do this for good.  I can say right now all I want is to get back to normal.  I do feel better today than I did yesterday, didn't have any anxiety today.  I didn't have it as bad yesterday either.  I did split the cytomel today...and it could the continual 75 dose is starting to help too...or lighting up that last 2 days.  

[Barb135]

The pounding heart beat is a common symptom of anxiety; I had it horribly bad when I was really hypo.  It can be a symptom of hyper too, though.  

What other symptoms were you having when you thought you were hyper?  Did you do any blood tests during that time you thought you were hyper?  I'm sorry to say that your doctor is keeping you on a roller coaster, by constantly lowering and increasing your med like that.

I don't really think it has as much to do with the smoking as you think it does.  I don't know the exact link between smoking and thyroid function, though I've read that there is one and many of us who smoke or did smoke seem to end up with some type of thyroid condition; it may affect actual thyroid function, but once the thyroid is no longer producing hormones, I don't believe smoking has much to do with how well we absorb the med.

It sounds like you might be a candidate for a low of dose of anti-anxiety med for a while, but you can't just take it, then stop at will.  It has to build in your system, then you have to wean off when you no longer need it.  When I had symptoms like yours, I went on a low dose of Buspirone; I was on it for about 2 years, but have been off it now, for almost a year.

[Bern3]

If that is off, what would they do to correct it??

[Bern3]

Initially when things began, it happens this way(this would be what happened in July)......
In the middle of night I'll get a panic attack.  I can literally feel my heart beating.  Not a fast heartbeat, a hard heartbeat.  This is when I know my meds are too high, and then from that point on it's down hill from there until I'm adjusted.  The anxious feeling feels isolating, panicky, almost like I'm drugged, disconnected. This all happens 2 hours after I take meds and then subsides by nighttime.  When they start to decrease my meds, the middle of the night panic attacks go away but the rest remains.  My Doctor will then start to increase me back and then the anxiety starts to subside.  By then I'm smoking again.  And then I feel completely normal!
It all seems to start with any change, trying to stop smoking, or some other stress in my life.  Otherwise I feel pretty normal.  I have read smoking changes how your thyroid functions and absorbs meds.  
My blood pressure has always been good, even when I've gone in to get checked at the time this is all happening...it's normal.
I have taken anti-anxiety meds when it gets too bad.  I'm wondering if I should just start taking them at the very start when I start having these symptoms.  But then I'm worried that in itself will throw me off even more.  I'm so sensitive to any little change.  Maybe it would help so it doesn't get out of control.  It's almost as if the whole reaction I go through stresses me out even more...maybe that 's why it takes so long to get back to normal.  It's really amazing how your thoughts can affect your body, physically.  It's all so frustrating, but If I can understand better of why it happens I can deal better...Hopefully
I remember before I was even diagnosed having these symptoms, but they went away on their own.  I had no idea what was happening to me.  Again, it seemed stress was the culprit and I was a regular smoker then too.  Back then before I was diagnosed, within 2 years I went from having normal levels to being extremely Hyperthyroid. So finally found I wasn't crazy!
So now when I get symptoms, I keep thinking I'm hyperthyroid because I get the same panicky, anxiety symptoms of when before they diagnosed me.  But after being on this website it seems to be the opposite at the moment.  Maybe not initially when it starts, but after.

[Barb135]

As I noted before, anxiety is a symptom of being hypo, so when the anxiety hits, it seems that's a sign you should get your levels checked.  

It's also not unusual for symptoms to worsen, or for new ones to appear when a med dose is increased/decreased, until your body gets used to the different med/dosage.  

You can try a small dose of anti-anxiety med, just until you stop smoking and get used to not smoking.

"That would be crazy to think smoking makes me feel better.........".  No, it's not crazy.  You know how you get when you're in a situation where you can't smoke?  You get antsy, jumpy, out of sorts, etc, then when you get that first drag off the cigarette, you're instantly calm, because the nicotine attaches to the "feel good" receptors in your brain.  That's the habit and as long as you continue to smoke, you'll have the same issues.  Best to just stop smoking, get through the anxiety and get used to not turning to a cigarette to calm you down; that's why they're addictive.  

[ahmee]

Ferritin is not part of a CBC, so you would probably have to request it. It is your storage iron level. It is possible to have low ferritin and normal-high iron levels. Anyways, a good idea to have it checked along with the B12 and D.

[bedheadblonde]

Smoking is relaxing to some people, even though it's a stimulant. When I used to smoke, I'd lit up after being particularly upset and it would calm me down. So it could be possible it's the smoking, but also perhaps the the meds?

Now when you say you feel anxious, do you get rapid heartbeats? Do you know if your blood pressure goes up?? Have you asked about possibly going on a low dose beta-blocker or even a very low dose Xanax to help you while this rides out? I was on both (though not at the same time, and I still find myself needing at least one pill of xanax a day still) just until my thyroid evens out. I needed them when I wasn't on any medication for Graves, but was able to wean off when I was finally on antithyroid pills and my thyroid calmed down, however I needed them again when my first RAI didn't work and I became hyper again, and when I also went very hypo after the second RAI took.

[Bern3]

Also, I agree with you, it's not just one stress going on at the same time.  With this happening recently I'm thinking smoking is the MAIN cause, along with stress.  Needless to say the last 2 days I have lit up, and I'm feeling a little less anxious.  Is it the smoking or are my levels starting to improve with a tiny increase in meds??  That would be crazy to think smoking makes me feel better.........

[Bern3]

Yes, to the dosages at that time and yes I was cytomel the whole time.

I'm trying to jog my memory for that time in July, since it seems since then it's been out of whack(off and on).  Meaning with the adjusting, getting better, adjusting some more, etc.  I would say around end of June, I tried to go on hormone replacement and at the same time i tried to quit smoking( or I cut down).  Within a week and a half I started having symptoms, whether it was hormone replacement or the not smoking, (I have read you have to make adjustments when you are taking this), so I don't know.  Needless to say, I went off the hormone replacement after this happened and then finding out I will need to monitor my levels even closer!  I said forget it, not worth it, and then I went back to smoking too, which when I say this means smoking occasionally.  I mostly smoke when I have a drink and I know it doesn't matter, still not good for you.

I almost feel I should just take something else when I suddenly have symptoms like this just to calm the anxiety for a few days instead of dropping my dosage....probably not a good idea.  I would say from March to July I felt really good, NORMAL.
Is it normal for just the TSH to change under stress??  It seems the other levels don't change much...It will be interesting when I go back next month with being on the 75 w cytomel how it will change.  I think it will be 6 weeks by then, to get an accurate reading...

[Barb135]

Are the Sept blood tests the ones when you were on 50 mcg 1 day and 75 mcg 6 days? Then after those blood tests, you went up to 75 mcg every day?  And where you on the cytomel that whole time?

Stress does play a big part in how things work.  If you had a working thyroid and you got into a stressful situation, your thyroid would put out hormones as needed.  This is otherwise known as "on demand".  Since, like most of us, you don't have a working thyroid, your levels have to be kept high enough to cover all situations.  If hormone levels aren't high enough, you'll have symptoms quite quickly.

Because quitting smoking is a stressful situation for most of us (I quit in 2007, so I know how stressful it can be), that could have been enough to trigger your symptoms.  Unfortunately, most us don't just have one stressor at a time, either.  And on top of the stress, there might be something else going on in your body causing a need for extra hormones.

Because those of us with thyroid conditions often have other conditions that develop in our bodies, you can't really rule out anything, but don't start looking at other things, until you get your thyroid levels to an adequate point and stable; then if your symptoms don't go away, start looking for other issues that can cause the same or similar symptoms.  

Remember that it takes 4-6 weeks for a dosage increase to take full effect.

[Bern3]

Thanks for your information, it's been helpful.  
I looked over my blood work, and I realized I missed the most recent(Sept).  I went in a month later,(That tells you a lot about my concentration.) September's....
T4 Free..1.20  Range .82 - 1.77...TSH .155 Range .450 - 4.500...T3 Free 2.7..Range 2.0 - 4.4
So you see it improved in a month..AT THAT TIME I was on 50mcg 1 day and 75 mcg 6day......and most recent, because I started feeling that anxiety, I started taking 75mcg because I felt I was not having enough.  This has been 2 weeks now.  With those levels in March which are in my previous posts I had been on 75mcg...(these were all with the cytomel,2x)
What happened between March(where I felt good) and July(where I started having symptoms of Hyper) I don't know.  The only thing I can blame it on was stress...here's my July results, and notice it doesn't seem like it's drastic.  But then again from what you are explaining maybe it was enough to cause symptoms...T4 Free..1.20...TSH 0.097..T3 Free 3.0  All with same ranges.
Stress seems to play a part..or could it be something else that is not working in my body???
I hope this makes sense....