synthroid rush

[caryh30]

Anyone get a serious fast rush of energy from synthroid or other t4 meds.  I have an interesting issue.  Im 17 years thyroid patient with dx of graves post RAI treatment at time of dx.  with few changes in dose at the beginning I have been on 200 mcg synthroid for the first 15 years...felt great.  I have been rididng the TSH line for all that time and have been asymptomatic.  Almost two years ago I had a new internist see my low levels and decide to change my dose to 175 mcg.  Now I knew from experience that I would get dizzy if I missed a dose for just a few days, but hoped that would not happen with a decrease.  It happened , but then a few months into the dizziness despite having normal tsh/t4 levels I experienced an instant onset case of severe dizziness and severe impairment to short term memory/brain fog.  These  symptoms have been with me consistently since onset.  At one point I had a melt down thinking I was gonna die so I stopped my synthroid for a week and then started again at a dose of 100 mcg.  I had to go to the hospital at this time with palpitations and other issues.  My tsh was at 14 on first visit and before the second week even while on the 100 mcg  dose it went to 34.  that is fast for tsh change in two weeks.  I'm currently back on the 175 mcg dose for many months with same symptoms minus the one episode of palpitation my symptoms have gotten a bit lighter over time but are still unlivable, however,  I have made some observations.  First, when I wake in the mornings I feel a bit better with some residual symptoms.  Second, within one hour of taking my full dose of synthroid  my dizziness and headache return full force as well as the added symptoms of full body muscular tension and cramping, increase in diastolic pressures by 10 points, and some other minor symptoms.  I'm a very compliant patient so I hardly ever miss a dose, but I did miss some recently as I realized that I felt better in the mornings and wanted to see if symptoms improved if I didn't take a dose.  They did improve, and before you all go off on how I shouldn't feel a difference from day to day on t4 I say hold your comments until the end...I am going somewhere with this.  I am also aware that TSH readings are absolutely worthless for anything other then treating the doctor rather than the patient.  So going forward with this new knowledge I figured I must be having a reaction to something in this new dose, of course the only thing that changed was the color as the fillers and binders are the same across all synthroid doses.  I asked my doctor to prescribe me my dose in 50 mcg pills because they are dye free.  I began taking these and still had the same issues with the overwhelming surge of energy and all the symptoms that go with it.  So I skipped another day here and there with the same effect of diminishing my symptoms.  One day I decided to skip two days.  I was dead tired halfway through the second day...my chest felt heavy and breathing seemed to take extra effort.  It was about 4pm, but I decided to take just a small portion of my synthroid at 50mcg.  At this point I still believed that a daily dose of t4 would have little effect, but I wanted to try.  Within 45 minutes of taking it I was given a powerful surge of energy, breathing was easy, it was amazing.  I have taken cytomel before and it felt just like this.  now I had more information to work with and my symptoms of now 19 months came into a new light.  Now I submit for your discussion the following:

Is it possible that someone in a hypo state can become an overly efficient converter of t4 to t3 as the body tries to meet its need for metabolism.  I pretty much proved this was true by splitting my t4 dose.  In the morning for the last several days I have taken a loading dose of my synthroid at 50mcg to allow my body to convert what it needs immediately.   Before, recall that I was dumping all 175 mcg  and I believe that an overly large portion was being converted and causing my anxiety like symptoms as well as tension headaches and strain to the ocular muscles resulting in unfocused vision and dizziness/headache.  Now with a smaller loading dose it was manageable.  Within an hour and a half of this dose I would take the larger portion of my synthroid  to complete my dose with no added side effects or symptoms and the surge would diminish within several hours usually 3-4.  Now all the symptoms I had before subsided except for the one that are indicative of an under treated thyroid issue which for me are fatigue, dry skin etc...I will also add that my heart rate never goes above 70-80 when this happens....just feels like it is beating harder than usual and my body can sometimes feel pulsatile which no doubt contributes to the headache and brain fog.

My argument is this.  When faced with an under treated thyroid the body over time can become a super converter of t3, and for those taking t4 meds this can cause the symptoms of anxiety and brain fog.  Simply splitting your t4 med and taking a loading dose can possibly prove this for you, also in the face of hypothyroidism those with what is deemed to be poor t3 converters would do just as well with an increased dose of t4 meds that possibly suppresses TSh in favor of allowing the body more free t4 to convert t3, or a combined t4/t3 med that will increase available t3 in favor of less t4 and inevitably a TSh level that your doctor can live with.  I personally chose one pill and would take a higher dose of t4.  

I will say one last thing.  If you think any of what I have typed here  applies to your situation please do not make changes to your prescribed dose/treatment plan without first talking to your doctor.  I am not a physician, I am just a fellow thyroid sufferer that has had a scenario play out that has allowed me a few insights I wanted to share with you all.

[Lynniebird16]

Thank you for posting this. I am experiencing the same reactions only on a much lower dose. Now I can share this with my doc and explain it intelligently. I am taking magnesium for the anxiety. Works great!

[gimel]

Please post your thyroid related test results and reference ranges shown on the lab report.  Also what is your daily dose of T4?  What other symptoms do you have, if any?  If tested for Vitamin D and ferritin, please post those as well.

[goolarra]

I would think for your theory to hold water a couple things would have to be true:

1) Your FT4 level would have to be extremely low.  If it weren't, your body would be converting T4 to T3 throughout the day and night, so why would there a lack to make up for?  Your FT4 level is the residual build up of the meds you've taken for the past 4-6 weeks.

2) T4 is not indiscriminately converted to T3.  If it were, our FT4 levels would all be zero all the time.  Conversion is catalyzed by the deiodinase enzymes, and their build up and let down is what regulates conversion.  So, deiodinases don't just build up and up and up until they find some T4 to convert.

If you have recent labs and ranges to post, I'd be interested in seeing your levels.

If this works for you, I see absolutely no problem with taking your meds the way you do, unless you get hungry if you don't eat until half to one hour after the second dose.  

[caryh30]

I want to add that I get this rush from my smaller dose each morning.  I feel that if I were on an adequate dose of t4 meds it would build enough of a residual in my system that my body could more selectively  convert rather than the rapid conversion it does now to make up for the lack.