# update on anxiety



## KarinStanley (Aug 26, 2012)

I wanted to give an update. The last six weeks have been very difficult. I have hashiomotos and taking 75 synthroid. My labs as of five weeks ago:
Got my lab results. TSH 2.17
T4 total 1.8 range 8.9 range 4.5 to12.0
T4 free 1.8 range .8 to 1.8
T3 total 79 range 76-181

Thyroglobulin antibodies 53 range less than 20
Thyroid per oxidase antibodies 424 range less than 35

TSI 89

Ultrasound nodule.

Have been having a lot of anxiety, heart pap, weight loss, some hair loss, digestive issues, some difficulty swallowing and insomnia. The insomnia has worsened to the point that I am sleeping very little. 
Started to get anxiety due to not sleeping on top of the already there anxiety. However I will have a day that is better than the next and will get to sleep one night and then go five nights in a row with one hour a night of sleep. I have been to the ER twice thinking something was wrong but just anxiety I was told. I started seeing a psychologist to work on the anxiety/ sleep issues and she has told me that I am presenting like a patient with a thyroid issue due to how responding to therapy and my symptoms. My last two endocrinologists were not any help and said my labs were perfect. I am getting a second opinion tomorrow by an endocrinologist who has been recommended by several others. I am going out of network and private paying the visit. What are some good questions to address and ask tomorrow? I am also going to see a psychiatrist tomorrow due to the degree of insomnia and anxiety at night I am experiencing. I never had any anxiety issues until this August which is around the time I was diagnosed with the hashiomoto.I am praying for some answers and some relief tomorrow.


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## jenny v (May 6, 2012)

I would definitely ask about a beta blocker to help with the heart palps and anxiety. Have you had an ultrasound of your thyroid? I would ask for that, too, since your TPO is way too high and you've got TSI presenting.


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## KarinStanley (Aug 26, 2012)

Yes I had an ultrasound and have one nodule and goiter. Does the beta blocker help with heart racing and help you relax? The heart racing occurs mostly at night and then I am awake with insomnia. It starts a bad cycle because now I also have anxiety about the insomnia.


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## Octavia (Aug 1, 2011)

Here's a good "plain English" explanation of beta blockers...

http://www.mayoclinic.com/health/beta-blockers/HI00059


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## CA-Lynn (Apr 29, 2010)

Excellent link to beta blockers above.

But I don't think it's wise just to toss some beta-blockers at people for heart palpitations without understanding clearly the reason for the cardiac palpitations and doing sufficient testing first.


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## sjmjuly (Mar 23, 2012)

CA-Lynn said:


> Excellent link to beta blockers above.
> 
> But I don't think it's wise just to toss some beta-blockers at people for heart palpitations without understanding clearly the reason for the cardiac palpitations and doing sufficient testing first.


I agree completely. Alot of people have heart issues with thyroid/hashi's, but you should have your cardiac issues tested to see if there is any other outlining issues before taking beta blockers.


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## joplin1975 (Jul 21, 2011)

And just remember that TSI is likely playing a big role in all of this. I was only on synthroid for a week (while I still had my thyroid, I mean), had high levels of TSI, and I damn near lost my mind.


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## Lovlkn (Dec 20, 2009)

T4 free 1.8 range .8 to 1.8

Your FT-4 is top range, that is what you are feeling.

Start requesting they run your FT-4 and FT-3 every lab draw.

Having both TSI and TPO antibodies can be a challenge.

Ask for some Lorazapam.

I don't think I would add a beta blocker with such a low T-3


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## CA-Lynn (Apr 29, 2010)

I will say it again: no one but a psychiatrist or neurologist should prescribe anti-depressants or anti-anxiety medication.

Regarding Lorazapam:

http://www.rxlist.com/ativan-drug.htm

What are the possible side effects of lorazepam (Ativan)?

Get emergency medical help if you have any of these signs of an allergic reaction:

hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

confusion, depressed mood, thoughts of suicide or hurting yourself;
hyperactivity, agitation, hostility;
hallucinations; or
feeling light-headed, fainting.

Less serious side effects may include:

drowsiness, dizziness, tiredness;
blurred vision;
sleep problems...

SIDE EFFECTS:
Drowsiness, dizziness, loss of coordination, headache, nausea, blurred vision, change in sexual interest/ability, constipation, heartburn, or change in appetite may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. 
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any unlikely but serious side effects, including: mental/mood changes (such as hallucinations, depression, thoughts of suicide), slurred speech or difficulty talking, vision changes, unusual weakness, trouble walking, memory problems, signs of infection (such as fever, persistent sore throat), trouble breathing (especially during sleep).

Get medical help right away if you have any rare but very serious side effects, including: yellowing eyes or skin, seizures.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Ativan (lorazepam) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS:
Before taking lorazepam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as alprazolam, clonazepam, diazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, glaucoma, lung/breathing problems (such as sleep apnea), mental/mood disorders (such as depression, psychosis), drug/alcohol abuse.

This drug may make you dizzy or drowsy or cause blurred vision. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Avoid alcoholic beverages.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially loss of coordination and drowsiness. Also, the elderly may not experience relief of anxiety with lorazepam. It may have the opposite effect on the elderly, causing symptoms including mental/mood changes, sleeping problems, increase in sexual interest, or hallucinations.

Children may not experience relief of anxiety with lorazepam. It may have the opposite effect on children, causing symptoms including agitation, shaking, or hallucinations.

This medication is not recommended for use during pregnancy. It may harm an unborn baby. Tell the doctor right away if you notice symptoms in your newborn baby such as slowed breathing, feeding problems, or constant crying. Consult your doctor for more details.

This drug passes into breast milk. Consult your doctor before breast-feeding.


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## surge (Aug 15, 2012)

Karin-- I'm really sorry you feel so bad still. I know it's been hard for you. Even if it wasn't anxiety before, it's an element now, just waiting to see if it's going to be a *good* night or a bad one.

I can't believe you've been such a trooper and really tried counseling to see if there is anything you can do.

I don't think it's anxiety or anything but your thyroid and in particular, all the antibodies, being very reactive right now.

When I wore the holter monitor a few weeks ago, it did show that my heart rate was elevated overnight. It went up to 128 at midnight, when I took an ambien, then it calmed down until 4am, when it started creeping up again. It was at 154 b/w 5-6am. When I'm supposed to be sleeping, I have the same max heart rate as when I used to go jogging. It's ridiculous. So your sense that it's speeding up at night is probably true-- though there may be other runs during the day when it's high, too, though you'll notice them less.

I just met with a 2nd surgeon and got a surgery date to remove my thyroid, though the surgeon was pretty explicit that it might not help. She recommended trying to increase synthroid steadily. I guess you could ask the new endo about this for you. In the hashitoxicosis forum nasdaqphil says he did know one woman who's endo really systematically stepped up her synthroid in very small increments until the hashitoxicosis was tamed, but with your T4's already being at the upper range, that doesn't seem like the right path for you, either.


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## KarinStanley (Aug 26, 2012)

The anxiety especially at night has worsened. This week I saw a psychiatrist who wants me to start taking paxil and xanax at night short term due to being unable to sleep. I went to a new endo and had a lot of lab work done including free t3 and 4, cortisol and adrenal. He also wants s biopsy of nodule done. I hate taking xanax even if short term but I go nights with no sleep at all snd I have 5 children to care for. My question do I start the paxil or wait till all labs are back? This has been going on for over 8 weeks and the anxiety and insomnia is running my life.


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## CA-Lynn (Apr 29, 2010)

Take the drugs.


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## karenhj (Oct 21, 2012)

I hear you on the anxiety. Was in the hospital last week for 2 days. Felt dizzy, felt faint and had tightness in chest. They observed me for 24 hours on the monitor. It was all over the place. Sometimes BP and HR would be high, sometimes when I was sleeping, it would go low and they would come in and check on me. Of course, that freaked me out and added more anxiety. When I came home, I was scared to go to sleep, so got about 2 hours a night for 2 nights until I borrowed lorazepam from a friend until I get back to the doctor. I only took a half tablet which was .25 mg. I have no problem taking anxiety meds. You start to go crazy if you can't sleep. I usually take xanax, but I actually liked the lorazepam better. It didn't make me drowsy like the xanax can sometime. It lasts longer too. You can see my post "newbie hashimotos post" in this section if you want lab details. I hear you. I wish you luck in your quest.


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## CA-Lynn (Apr 29, 2010)

I would be negligent if I didn't say this:

NEVER BORROW MEDS OF ANY KIND FROM A FRIEND NOR LOAN THEM.

You don't understand the possible ramifications of taking borrowed drugs. It could be deadly.


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## karenhj (Oct 21, 2012)

CA-Lynn - while I appreciate your concern, I am not into drug pushing nor would I advise anyone to do anything out of their realm of comfort. Just relating my experience. Everyone does what works best for them. Not that I need to explain myself, but Lord knows I have done plenty of reliable research on the benzodiazepines. Not saying I'm an expert, just sayin. I would certainly hope/expect that one would seek a prescription from a reliable doctor and not get them "on the street."
If it makes you comfortable to advise against it, then so be it. You did, so it's done.


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