postpartum thyroiditis or synthroid forever?

[goldie153]

I recently went to my physician because the tip of my tongue was numb.  He ran some tests, and my TSH was at 30.52.  That was the only thyroid test he did.  He prescribed 75mcg Synthroid.  I went to a naturopath for more tests, and it was found that my TPO was >600, but everything else was normal.  I have very high B12 levels, nearly double the normal amount.  My vitamin D is in the normal range, but still low, despite the fact that I take 5000 units a day.

I wonder if I have postpartum thyroiditis (I never had a hyperthyroid phase, but I have read that this can and does happen), and if it at least MIGHT improve?  My doctor has indicated that I will have to take synthroid forever, but this seems contradictory to any postpartum thyroiditis information out there.  Is there hope?

[goolarra]

Long time ago, Breenymachiney.  Yes, I agree...PPT is considered a variant of Hashi's and antibodies are often elevated.

[Breenymachiney]

Please take a look at this link...antibodies are often present with postpartum thyroiditis! http://www.thyroid.org/wp-content/uploads/patients/brochures/Postpartum_Thyroiditis_brochure.pdf

[goolarra]

A number of our members have had ear ringing as a symptom of hypo...you're still not in the top ten, but you're getting closer!

Also, your son was born 9 months ago.  I'm wondering if you had hypo symptoms, but thought they were pregnancy symptoms.  They can be a lot the same.

When you get the FT3 and FT4 numbers, don't forget to get the reference ranges from your lab as well.

It's unfortunate that no FT3 and FT4 was done with your initial TSH before starting meds.  A look at those might have shed some light on why you so suddenly started feeling hypo just after starting meds.  Night and day symptoms are unusual, although they do sometimes sneak up on you in such a gradual way that you kind of get used to them.  

Going forward, I guess you have to decide whether to try d/cing meds to see if your thyroid function is returning or not.  Has anyone offered any guidance on when that might be worth a try?

Just a thought...have they tested your TGab?  That's the other antibody implicated in Hashi's.  Some of us are TPOab positive, some TGab positive and some both.  It might be interesting to have that done.  A negative won't disprove Hashi's, but a positive would be further confirmation...better than having to go hypo to prove it.

Is TGab (thyroglobulin antibodies) on your lab work sheet?  If so, you can check the box  or ask your doctor to add it before you go in for lab work this week.

[goldie153]

You know, it's funny you should mention because a part of me has always thought that my tongue numbness is not associated, as I also had a "crick" in my neck upon waking one morning - well before all of this started.  It was improving, but still not quite perfect.  The acupuncture has really worked wonders on it.  My chiropractor has indicated that my neck doesn't need adjustment, but I am going to see him again, and be a bit more insistent that he check it a bit more.

HOWEVER, I did go to the doctor a few months before because my ear was ringing (and I'm the type to go for a physical once a year, and that's all).  He told me to get my hearing checked.  Once I did go on Synthroid (starting hypo symptoms perhaps?), my ears started ringing again.  Keep in mind my iron levels are quite high, if anything.  I am starting to wonder if the ringing ear was part of hypothyroid months ago?

I do not have the FT3 and FT4 numbers, but I was planning on asking the NP for them at this next visit this week.  I have the sheet for lab work, and am going to get it done on Monday.  It has been 4 weeks and 1 day since starting Synthroid.  Yes, I understand that it takes several weeks for Synthroid to build in the body, but it was definitely quite strange at how quickly things went hypo as soon as I started!  Literally, night and day.

Thanks again goolarra.

[goolarra]

I'm sure tongue numbness is on a list of thyroid symptoms SOMEwhere...what isn't?  LOL  However, it's hardly in the top ten, and I usually associate mouth/facial/ear/head/neck pain/numbness with thyroid enlargement and or nodules, i.e. something is pressing on a nerve and causing discomfort, but you don't have swelling or nodules.

So, before Synthroid, no hypo symptoms.  After starting Synthroid, the whole list.  Now, after 4 weeks on it, you feel good again.  The tongue numbness hasn't gone away, so we might think it's not related.

Do you have your actual FT3 and FT4 results and the reference ranges (these are lab specific so have to come from your own lab report)?

One possible explanation for the onset of hypo symptoms after starting Synthroid:  labs often go off before symptoms appear and they often come back into range before symptoms are relieved.  So, even though it seems like the Synthroid is what caused your symptoms, they might have been inevitable anyway.  Synthroid takes several weeks to build in your body.  It doesn't reach its full effect for 4-6 weeks after you start taking it, although it's reached most of its potential after about 4 weeks.  

When are you scheduled for lab work again?  

[goldie153]

Thanks for the article!  I did find ...somewhere... a site that had an extensive list of thyroid symptoms, and indicated numbness/tingling in the tongue.  I have looked at so many things, that of course, I can no longer find it!  When I initially went to the doctor,  I felt GREAT other than I was concerned about the numbness of my tongue.

Yes, the "hyper" or "hypo" phase can be "optional" in postpartum thyroiditis.  As I definitely did not enter hyper phase.

I felt terrible after starting Synthroid.  I had virtually ALL of the other hypothyroid  symptoms upon taking it (and other hormone fluctuation problems: nightsweats, arm/leg hair stopped growing, excessively fatigued, terrible memory (Ivy League grad, this is really, very important to me!)!  Everything has since improved (4 weeks today), except my tongue is still numb on and off, although my lips are now frequently numb.

The NP ran the tests after I took Synthroid for 2 weeks.  Already my TSH was down from 30.52, to 3.42.  My FT3 and FT4 were normal.  I have no swelling or nodules, as I also had an ultrasound which indicated everything is "normal".  My iron, and B6 are also good.   I have abnormally high "good" cholesterol, and low "bad" cholesterol, as well as abnormally low triglycerides.  I eat very healthfully, with no prepared foods, and cook everything from scratch.  I exercise regularly, except until I started the Synthroid and I have since been quite physically exhausted.  It just is the TSH, and the TPOab at this point which are not normal.

Acupuncture actually seems to help the most with my energy levels, and overall feeling of well-being.

I think I sleep best from 6am - 9am.  Why I used to love to sleep-in, at least during those times.  Of course, with a baby who rises at 6am, and goes back to sleep at 9am, this isn't possible while nursing....

[goolarra]

Here's another interesting link:

http://familydoctor.org/online/famdocen/home/common/hormone/913.html

I noticed in the link you sent that the ATA article said that postpartum thyroiditis with antibodies is indistinguishable from Hashi's.  This makes me wonder if it isn't actually a Hashi's flareup precipitated by the stress of pregnancy and childbirth and/or the hormone imbalance that occurs after childbirth.  If that's the case, and the Hashi's was latent (asymptomatic) before the birth, then I suppose it could become asymptomatic again after female hormones get back to equilibrium.  I would think that would be a matter of how much damage the TPO antibodies do in the process.  

Both articles characterize postpartum thyroiditis as basically a hyper condition...the hyper phase is emphasized while the hypo phase seems "optional".  I'm sure there are exceptions as you state.  However, your lack of a hyper phase, combined with the timing (9 months postpartum is a little late, although, once again, I'm sure it happens) makes it appear a lot more like Hashi's.  

You said that you went to the doctor because your tongue was numb (not a typical thyroid symptom)...did you have hypo symptoms with a TSH of 30?  Did you feel better after starting Synthroid?  How long after starting Synthroid did your NP run his tests?  Did he order FT3 and FT4?  Do you know if you have nodules?

Lots of questions...sorry...but this is interesting.

I'm completely in favor of eliminating whichever meds can be eliminated.  You could try tapering off.  Do it slowly, and keep up with labs after each decrease.  If your thyroid has not recovered, you should start to see a dip in FT3 and FT4 levels as meds are decreased.  If you don;t see a dip, then you have to assume that your thyroid has taken over for the decrease in meds.  If you start to have hypo symptoms, you will know that you've decreased too much.  

[goldie153]

However, I am still a bit baffled.  The information presented by the American Thyroid Association seems to indicate that, regardless, the medication should be tapered to see if thyroid function returns to normal.  http://www.thyroid.org/patients/patient_brochures/postpartum.html

[goldie153]

Thanks so much for writing.

Don't worry, I realize that my doctor who only tested TSH... and several other comments, is not the most in touch with thyroid care or current research.  I will be seeking to find another doctor for the long term.  Hence, that is why I went to the naturopath for more tests.

[goolarra]

Most likely little hope...elevated TPOab indicates Hashi's.  Antibodies are not elevated in postpartum thyroiditiis. Hashi's is an autominnue disease in which your immune system attacks and destroys thyroid function.  Didn't the doctor who ordered TPOab tell you that you had Hashi's?  

A doctor who only tests TSH is not a good thyroid docor.  Free T3 and free T4 should be tested every time TSH is tested.

After starting Synthroid, you should have follow-up blood work in 4-5 weeks and re-evaluate symptoms.  Initial dose usually has to be adjusted to reach optimal levels and symptom relief.  

[goldie153]

My son was born 9 months ago.  I have lost any pregnancy weight...with ease.  Sorry ladies!