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Avatar universal

Thyroid Erfa causes drowsiness?

I have increased my Erfa dose a little, from 2 to 2.25 G. This causes drowsiness in the evening and morning. In the morning it is difficult to wake fully. When I take 2 G, there is no such problem.

What other causes may be for drowsiness?
10 Responses
649848 tn?1534637300
COMMUNITY LEADER
I don't think it's the ERFA causing your drowsiness; it's most likely that your FT3 levels are either too high, or too low.

Please post your current thyroid hormone levels.  Since you're taking a med with T3 in it, you should be getting TSH, FT3 and FT4 tested on a regular basis. Be sure to include reference ranges, which vary lab to lab and have to come from your own report.  

Have you had vitamin B12 tested?
Avatar universal
When masured, in 2013, my FT3 has been 5.5-6.7 at ERfa Thyroid 2.25G.
At 2.0G it has been 5.5-5.7. Ref.: 3.1-6.8.
TSH is 0.02-0.03 (ref. 0.3-4.2).
FT4, when sometimes measured, 14-15 (ref 12-22).

In previous years my FT3 has been lower in relation to the reference range, although my dose has been higher, 2.5G.  (My medication started at the end of 2006).

My B12 (and active B12) test results have been normal.

During spring-summer, this year, I have been losing much hair. But what is very weird, I have lost muscle strength. I have found it when carrying water buckets and also in hand grip strength tests.

My thyroid gland has shrunken to very small and the cysts it has carried have also shrunk to below one cm.

I have primary hyperparathyroidism. Could this be involved in losing muscle strength?
649848 tn?1534637300
COMMUNITY LEADER
What was the result of your latest FT3 and FT4 tests, and what dosage were you taking?

FT3 at 6.7, with a range of 3.1-6.8, is too high.

The parathyroids control how calcium is used in your body, so it would affect your bones, but I'm not sure how it would affect muscle mass.

Have you checked out the following web site on parathyroid?  

http://www.parathyroid.com/


Avatar universal
FT3 was (sorry, reference ranges are slightly differet at different times):

after being at 2.0G Thyroid for 16 days before March 6, 5.7 (3.5-6.5)
after being at 2.25G Thyroid from March 6 to March 28, 5.5 (3.1-6.8),
after being at 2.25G Thyroid from March 6 to April 30,  6.7 (3.1-6.8),
after being at 2.0G Thyroid for one week before July 18, 5.5 (3.5-6.5).

In 2013 I have tried to decrease my dose from 2.5 through 2.25 to 2.0G but have not yet succeeded to be at 2.0 for longer times. The March 28 value was lower that April 30 due to shorter time on 2.25G.

At the beginning of 2013 I got atrial fibrillation after increasing my vitamin D intake from 50 to 100 mcg (but dropped it immediately to 50). Before that I was at 2.5 G Thyroid, then dropped Thyroid for a short time but returned to 2.5.

My thyroid dose had been 2.5G from spring 2010 to early 2013, although I have sometimes tried to change it a little.

FT3 at 2.5G Thyroid:

June 16 2010: 6.4 (2.8-7.1)
August 3 2010. 5.8 (2.8-7.1)
October 26 2010: 5.9 (3.5-6.5)
January 28 2011: 5.1 (2.8-7.1)
April 26 2011: 5.2 (3.5-6.5)
August 10 2011: 5.3 (2.6-5.7)
January 12 2012 after being at 2.75 for some time: 5.5 (2.6-5.7)
    ( for Aug 2011 I was first given a wrong reference (2.8-7.1), therefore the temporary dose increase)
May 10 2012: 4.7 (2.6-5.7)
July 9 2012: 5.8 (3.5-6.5)
--------
In early 2010, after changing from Armour to Thyroid in late 2009, I had reached the dose of 3G or little over. First I fealt that Thyroid does not work as Armour. I, for instance, fealt ill and had sore joints. Therefore I went to overdosing (at the chage of years 2009-2010 FT3 6.9, ref. 3.5-6.5). In the first months of 2010 I was in my best condition, my cognitive function was better than before thyroid medication. I was glad. Then in April I got atrial fibrillation, which was cured with cardioversion in November. Immediately at the onset of the AF in April, the Thyroid dose was dropped to 2.5G.

During thyroid medication I have had many other diseases, eg. in 2010 many infections, antibiotic diarrhea, cholelithiasis and cholecystectomia, respiratory difficulties due to AF, and at the end of the year I got muscular dystonia, which was not diagnosed until after one year. And my hypercalcemia was found and followed.

I still have chronic and other infections and many different symptoms. I have read the parathyroid pages. Doctors here do not believe that my weird symptoms could be due to my primary hyperparathyroidism. Many symptoms fit well to it. I wanted to have a sestamibi technetium scan, and it rervealed possible hyperplasia of the righht lower parathyroid.

My ionized Ca was 1.37 ( 1.16-1.3) on April 30 2013.

Different reference ranges of thyroid labs at different times make compararison slightly difficult. I myself have ordered many masurements of FT3 (it is very expensive!) . Doctors have also given prescriptions, but they often give only TSH or TSH and FT4.

Because of continuous or intermittent syptoms it is difficult to decide, which symptoms could result from hypothyroidism or its medication.
Avatar universal
My S-B12-TC2 has been 123 (ref. over 35) on May 25, 2012. B12 has previously been above 400, this may be good. I take some B12 or vitamin B combination every day.

My basal body temperature is fairly low, about 36.3C in the morning and the maximal temperature is slightly over 37 for a short time in the afternoon. I hardly have extra sweating. During years, I often have had freesing, and sometimes episodes of flushing or hot feeling.

My heart rate is often under 60 when I am sitting in front of the computer. I Note that I have betablocker in use, Tenoblock 25 + 20 mg per day to prevent rhythm disorders (from the eighties). It was also for blood pressure, but I have not high blood pressure now. It varies, however much.

Now when I am again at 2G Thyroid, I don't sleep well, but I think that at 2.25 I sleep better but have extra sleepiness in the evening and morning. I am worried about my hair loss and muscle and bladder weakness. I have sitting difficulties. Sometimes I cannot keep my head up and I have tremor (muscular dystonia!).

In this year I have had a four-month period of intermittent bad feeling behind eyes or other eye symptoms. I let my eye muscles scanned with mri - nothing abnormal was found. I have never had thyroid antibodies in my blood. I have had chronic infection in my paranasal sinuses and tonsils for years. The sinuses were also cheked in spring, OK. I have slight immune deficiency.

In spring I had an area of slight intermittent pain from a lymph node in my neck through ear area to the upper temple. Nothing was found in my ear or elsewhere. Vertigo, attacks of dizziness, hair loss, and supraventricular tachycardia (new symptom) have been even on 2G Thyroid.  I have had sore joints and loose ligaments.

Possible causes for all this:
hypothyroidsm
overmedication (upper abdominal pain sometimes during walking, polyuria, dehydration)
hypercalcemia (primary hyperparathyroidism diagnosed, hypercalcemia, high PTH, polyuria)
partial central diabetes insipidus (could not be excluded, polyuria, dehydration, nocturia)
muscular dystonia (diagnosed)
coronary artery disease (suspection, ST segment depression in ECG during recovery)
chronic disease anemia (have microcytosis, high erythrocyte count)
hemoglobinopathy (a heamotolgist suggested, was not found)
infections (immune deficiency found, intermittent lymph node symptoms)
sarcoidosis and other diseases have been suspected ( a tumors in lung, not sarcoidosis, don't grow with time, slightly high ACE and lysozyme)
HLA-B27 positivity (joint problems, arthrosis)
faeochromocytoma (not found, different attacks, no panic, hyperventilation excluded)
hyperaldosteronism (not found, sometimes hypernatremia)
adrenal insufficiency (ok S-corsol, no hyperkalemia, no hyponatremia)
CFS (diagnosed in 2007, from the eighties, have had much exhaustion during working years)
and other diseases, which may not be causes
maybe I don't even remember all possibilities for causes
------
Great variability in my condition, even within one day, has been mysterious.
Avatar universal
It is to be noted that the body temperature values above are from sublingual measurements, which give higher values than from the armpit. The values are the same as those in my fertile age (could not have a child).
649848 tn?1534637300
COMMUNITY LEADER
You're right that you have so many different conditions, it's hard to pinpoint any specific one, as many of them can present similar symptoms.

The only way you can compare FT3 levels when there are different ranges, is calculate the percentage of the range, that your result was.  I calculated them all from what you posted above.  They are as follows:

June 16 2010: 6.4 (2.8-7.1)                   83%
August 3 2010. 5.8 (2.8-7.1)                 70%
October 26 2010: 5.9 (3.5-6.5)              80%
January 28 2011: 5.1 (2.8-7.1)              53%
April 26 2011: 5.2 (3.5-6.5)                   57%
August 10 2011: 5.3 (2.6-5.7)               87%
January 12 2012 after being at 2.75 for some time: 5.5 (2.6-5.7)       93%
    ( for Aug 2011 I was first given a wrong reference (2.8-7.1), therefore the temporary dose increase)
May 10 2012: 4.7 (2.6-5.7)                  68%
July 9 2012: 5.8 (3.5-6.5)                    77%

after being at 2.0G Thyroid for 16 days before March 6, 5.7 (3.5-6.5)   73%
after being at 2.25G Thyroid from March 6 to March 28, 5.5 (3.1-6.8),  64%
after being at 2.25G Thyroid from March 6 to April 30,  6.7 (3.1-6.8),   97%
after being at 2.0G Thyroid for one week before July 18, 5.5 (3.5-6.5).  67%

Rule of thumb is to have FT3 in the upper half to upper third of its range; however, there's little doubt that when you were at  97%, 93%, 87% and possibly even 83%, you were probably a bit hyper.

Why do they not remove the offending parathyroid and rule that out, as being a cause for symptoms, particularly, since you say you have most of the symptoms of hyperparathyroisim?

B12 at 400 is actually quite low.  Japan's reference range doesn't even start until 500 for the lower limit. I have to keep my B12 levels at/near the top of the range (200-1100) in order to feel well.  You might think about increasing your intake of B12.

Have you considered trying a different thyroid medication?  It's possible that you don't need as much T3, as what's in the ERFA.  Do you take your thyroid med apart from other meds?  
Avatar universal
Thank you for your great work of calculating the percentages!

I take my morning Thyroid at 6 o'clock, then after about 15-30 min I have my breakfast (no milk products) and take betablocker and children's aspirin. Then I take vitamins etc. during lunch slightly before noon. I take my afternoon Thyroid pill at about 4-5 o'clock (after one hour without food). At about 8 o'clokc I take again betablocker. Before the bedtime I take magnesium (usually with vitamin B). I take vitamin D with food (usually with lunch).

I must not take extra calcium. I only eat sour milk products 4 dL and take much cheese, sometimes fish, eggs. I take often zinc, try to take it fairly distant from Thyroid. According to a hematologist, I do not need iron alhough I have microcytosis. I use mild estrogen patches and have 14-day periods of progesterone pills in every second month.

How much do you take B12? I increased my B12 dose from 1 to 2 mg today.

I have tested a combination of thyroxin and Armour. It was not good, it dumped down good effects of Armour.

I have been wondering why I have been gaining weight (5kg) during the last halfyear. Before that, when my dose was higher, 2.5G, my weight remained very stable for 2.5 years. I think that I cannot be hyper now.

Because my calcium has not increased enough and I do not have renal stones or osteoporosis, they do not want to do parathyroidectomy. Also my age 65 may be some limiter. My parathyroidectomy would be very difficult. It would begin from the sick parathyroid, and all the others should also be revealed and possibly taken off leaving only a half gland put in the arm. The side effects could be worse than when there were only a single adenoma.
Avatar universal
It is very difficult to fine-adjust the optimal dose of the thyroid medication when the laboratory results are within the reference range. I have tryed to adjust it based on ocurring symptoms, but it is not easy. Now I have flicked through my notes of thyroid medication and symptoms for svereral years. It is not easy to see clear connection between the dose of medication and symptoms, other diseases also complicate the situation. I have, however, become to the following conclusion:

If the dose is slightly too high, the symptoms may be
- weight gaining or difficulty to drop weight
- fluid retention
- excess drowsiness in the morning and evening
- good sleeping
- polyuria
- hair loss
- joint and muscle pain
- pain in the backside of neck
- muscle weakness or tightness
- constriction in upper abdomen during walking
- sometimes low heart rate

On a slightly lower dose:
- sleeping not good
- hunger
- polyuria
- dehydration
- weight dropping

On much higher dose:
- broken sleep
- hotness (not sweating) and heart pounding in early hours
- blood pressure varying from low to high
- variable blood sugar
- atrial fibrillation
- hair loss

When I was hypothyroid, my cognitive function was poor and I was tired and lacked initiative. No extra hair loss since the seventhies. I had no constipation, preferly had often diarrhea. I had many infections and other diseases.

Some symptoms may occur at all Thyroid doses:
- sore joints
- infections
- occasional serious freesing
- thyroid medication has no effect on the body temperature

This is not a general rule, the situation may be quite different for another person. You see, that my situation is somewhat controversial when compared with the symptoms which are often listed to belong to hypo- and which to hyperthyroidism/medication.

Avatar universal
New labs after being on 2G Thyroid more that 2 weeks:

TSH 0.031 (ref. 0.4-4.5)
Free T4 11.8 (9-21)
Free T3 5.6 (3.5-6.5).
FS-folat 26 (>6)
S-B12-TC2 not yet ready
S-D-25 70nmol/l (>40)

Free T4 seems to be fairly low. S-D-25 should be >80 nmol/l for good health of bones. Maybe I could increase my vitamin D intake form 50 to 75 mcg now, when my Thyroid dose is smaller. (At the end of 2012 I increased vitamin D intake to 100 mcg, and I got trial fibrillation).

It seems that I am again losing one of the extra kilos left. At the end of August I tested 2.25G Thyroid for a few days, and found again that I began to gain weight! Then I returned to 2.0G. I have found that increasing of protein in the diet helps in weight losing.
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649848 tn?1534637300
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