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Hyperthyroidism and Sleepless Nights

I have been diagonalized with Hyperthyroidism since the 24th of May.  I am a 51 year old female.  I have been on Methimazole for three weeks (5MG for first week, 10MG, the second week, and 15MG for another week).  My blood work result is as followed:  TSH <0.005, T4 2.15, Glucose 137, Bilirubin 1.9, and Thyroid Stim Immunoglobulin 3.42.

I suspected that this started in late 2020 when I start losing weight.  I lost a total of 25lb, and I am currently weighing at 125lb and I am 5’5.  Things got bad when my 19 years relationship ended in  March.  Before the diagnosed, I thought I was just going to breakup with weight lost, sleepless, anxiety, nights, and rapid heartbeat.

Once I was diagnosed, I was relief, but my anxiety and sleeplessness didn’t go away.  I was on 10MG Propranolol as needed basis.  However, to make the anxiety go away, I must take it three times a day.  About 18 days into the Methimazole, I started to take only one or two 10MG Propranolol.  I think I may not need to take it today or even just one.  I have heard that Propranolol, beta blocker, can also create insomnia.

However, I still can’t sleep.  I am rotating between Benadryl, motion sickness med with Meclizine, and Zzzquil to avoid tolerance for high dosage of the meds.  I was able to sleep like 2-5 hours when I took them separately.  I took Ambien once, but I will reserve that for special occasion like my 20th anniversary last week.  5MG Ambien is wacky since when I took it, I was telling myself, hmmm, it’s not working, but I woke up the next day after having 5 hours of uninterrupted sleep.

I guess I want to know if this has happened to you with the sleepless nights and when Methimazole will start kick in and I can sleep again.  I used to be able to sleep like a baby and I never have any issue sleeping.  Please HELP.
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Avatar universal
Hi, sorry to read of sleep difficulty.  A few years ago, I was experiencing hyper symptoms, sleep seemed impossible, 3-5 hrs nightly.  I tried Melatonin, and other sleep aids, that put me to sleep, but didn't keep me asleep.    

I was prescribed Hydroxyzine 10mg, for sleep.  Hydroxyzine put me to sleep and kept me asleep up to 10 hrs solid.  Only con was, waking up a little tired, but tiredness wears off after an hour or two, was active rest of day.        

Hydroxyzine is also used to treat anxiety, but at higher doses.

Wish you well.....        
Would you able to sleep when the hyperthyroid was treated?  I have not been able to sleep for so long that I am so anxious about never able to get a good sleep.

Sleep returned to normal, after med were adjusted.  Give Hydroxyzine a try, till your hormones balance.  
I was taking 10MG doxepin for a month and is not working any more.  I asked my PCP to provide Hydroxyzine 25MG.  I will be pick it up today and try it tonight.  Hopefully, I can have some restful sleep.  The doxepin works sometime but my sleep had always been interruptive as much as 10 times a night.  Thanks AJWS6!
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Avatar universal
The half life of Methimazole is only 3-5 hours, which means that your serum levels should reflect your dose in the same day.   However, T4 has a half life of about a week.  This means that if all T4 production by your thyroid gland was stopped, It would take 4-5 weeks to be fully reflected in serum levels.  Because of that, this is info I found.  "The decreasing rate of free T4 level per one tablet of methimazole during 1 month, was 4.33 pmol/L, which means that, if a patient takes one tablet of methimazole (5 mg), during 1 month, his free T4 level will decrease by 4.33 pmol/L  (.3364 ng/dl). " Since you need to get your FT4 down from 2.15 to about 1.30 (mid-range), It seems that you have the right dose, but unfortunately it may be up to several weeks  yet before the symptoms go away.   Wish I had better news.  Hang in there and please let us now how it goes.  
Helpful - 2
Per this calculation, I should already fall within range 1.63 in three weeks.  First week, I had 5 MG: .3364 divided by 4 and multiply by 3 equals to 0.25.  Second week, I had 10MG: .3364 divided by 4 and multiply by 3 equals to o.17.  Third week, 15MG: .3364 divided by 4 equals to 0.09.  The sum of them would be 0.52.  My blood work says I have 2.15, and 2.15 - .52 = 1.63 which is less than 1.77.

649848 tn?1534633700
Your glucose level was also too high - if it was fasting glucose, it was in the diabetic category.  Has that been addressed?   Diabetes/glucose issues can also cause weight loss, anxiety and insomnia.

That said - even if your FT4 is down to 1.63 (per your calculations), it would be higher than necessary and could still cause symptoms.  FT4 should be approximately mid range.  You need a Free T3 test, also, to determine exactly what's happening since FT3 is the hormone actually used by individual cells.
Helpful - 0
Thanks for your response.  It not fasting glucose.  My next test is this Thursday and it will ask for Free T3 test.  I notice my symptoms still didn't go away as I will need to take Propranolol to control my symptoms.  I have been taking Methimazole for 2 solid months and I wonder how long it will get adjusted.
Avatar universal
Was that T4 test for Total T4, or Free T4?  Also what reference range was on the lab report?
Helpful - 0
The T4 is Free and Direct.  The reference range is .81-1.77.


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