# Subclinical Hypothyroidism years after subacute thyroiditis



## Nova8 (Oct 30, 2014)

Hi everyone - it's been a while so my signature line may not be up to date.

After suffering subacute thyroiditis in 2014, with the extreme swings from hyper to hypo (that repeated itself several times over the years) I'm now experiencing swings between normal and subclinical hypo. Seems whenever my thyroid swings into a normal range, I'll feel hyper for a bit then okay, but it settles back into subclinical hypo again. I'm sick of this. I say 'subclinical' hypo because it's only my TSH that will go out of range into hypo levels.

It's worth it to note that I don't know why I even developed SAT in 2014. I was recovering from recurrent c. difficile infections and a fecal transplant for that. I was also bitten by a spider that year and had a major reaction to it. I didn't have a virus like most people get with SAT. Other than that, I was on synthroid in the late 1990s as a kid (I'm 30 y/o) because some naturopath thought I had somewhat low levels of T3. An MD took me off it a few years later in 2001 saying it was unnecessary. I was pretty sick for a few months after stopping the synthroid but things leveled out and I have had a goiter ever since.

My Tgab, TSI and TPOab are always negative.

Haven't had RAIU + scan since the subacute thyroiditis. Had 2 ultrasounds in the last few years which revealed normal thyroid, but slightly enlarged. Endo doesn't seem to think it's of concern.

Endo is hesitant to treat me because he says once you start synthroid, the thyroid shuts down and you're kind of stuck on the drug, and I don't want to b stuck on a drug.

What the hell is wrong with me?

My most recent labs:

9/14/2017

TSH/Thy.Stim.Horm

Ref: 0.36 - 3.74
Result: 4.160 uIU/mL

FREE T4
Ref: 0.76 - 1.46
Result: 0.86 ng/dL


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## joplin1975 (Jul 21, 2011)

Are your antibody tests really negative or just within normal range?


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## Nova8 (Oct 30, 2014)

Some are within normal range and the one is totally negative. I'll post them here for reference, the doctor ordered them a million times because my case is so confusing..

TSI ab:

Ref: <140

Unit: IU/ML

11/05/2014: 32

06/25/2015: 33

TPOab:

Ref: <9
Unit: IU/ML

10/28/2014: 2 
6/25/2015: 5
05/25/2016: 3
03/10/2017: 6

Tgab:

Ref: <OR=1
Unit: IU/ML

10/28/2014: <1
6/25/2015: <1
05/25/2016: <1
03/10/2017: <1


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## Nova8 (Oct 30, 2014)

sigh

no ideas at all?


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## joplin1975 (Jul 21, 2011)

I'm honestly not sure how to answer.

Just so we're all clear, you don't have any other health issues, do you?


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## Lovlkn (Dec 20, 2009)

> I was recovering from recurrent c. difficile infections and a fecal transplant for that.


Has this issue resolved? Meaning do you have normal digestive and elimination?

You are definitely hypo thyroid at this point based on your TSH and FT-4. If it were me, I would begin hormone replacement - no reason to suffer.

Does your doctor have an explanation for your "slightly enlarged" thyroid gland?


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## Nova8 (Oct 30, 2014)

Lovlkn said:


> Has this issue resolved? Meaning do you have normal digestive and elimination?
> 
> You are definitely hypo thyroid at this point based on your TSH and FT-4. If it were me, I would begin hormone replacement - no reason to suffer.
> 
> Does your doctor have an explanation for your "slightly enlarged" thyroid gland?


Thanks Lovlkin.

The c. difficile has resolved since the fecal transplant, yes. I have normal daily bowel movements when my TSH is within a normal range but I often will get constipation when TSH creeps up past 3.5 - 4.0

Will going on the synthroid stop the thyroid swings? My thyroid levels swing from hypo to normal, and when it swings to normal I feel quite hyper for a few weeks before it heads back down to low normal then to subclinical hypo, where I feel hypo.

I also wanted to ask you if metoprolol affects thyroid hormone. I know at high doses, atenolol does - but I'm on an incredibly low dose of atenolol - a quarter of the lowest dose available of the atenolol everyday for migraine prevention and also because when my thyroid goes into a normal range I get tachycardic for weeks.

There's ben a shortage of atenolol recently, so I'm going to have to switch over to an equivalent dose of metoprolol, and I'm wondering how metoprolol would affect thyroid hormone now. I really hope it doesn't, at least not at these very low doses.


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## jenny v (May 6, 2012)

I'm on Toprol XL and haven't noticed it affecting thyroid levels. I've been on it for a number of years now, slowly decreasing my dosage, and have had no noticeable affect on my thyroid meds. I've gone from 100mg down to 12.5mg (I'm splitting a 25mg pill) and hope to be off it completely in a few months.


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## Nova8 (Oct 30, 2014)

Thanks jenny v - I also wanted to ask if you noticed any weight gain from the metoprolol?

I gained about 13lbs after my thyroiditis but I believe that was from the hypothyroidism itself as it came off real fast when my thyroid stabilized. The atenolol makes me retain a pound or two of fluid but it's not significant.


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## jenny v (May 6, 2012)

I haven't noticed any weight differences with the Toprol. I was briefly on propranolol when my heart issues started but that really did not work out for me. I was like a zombie and it would cause me to randomly get faint and dizzy.


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## Nova8 (Oct 30, 2014)

It's ben a few days since I switched to metoprolol tartrate (twice a day) and I get rebound headache, heart pounding, tachycardia, and anxiety at night about an hour or so before I'm due to take my next dose. I can't deal with it. Atenolol didn't do this. It lasted me into the next day unless I was hyperthyroid and metabolizing it too quickly.... I'mnot ven hyperthyroid right now. what do I do?


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## jenny v (May 6, 2012)

It sounds like it's not working for you (I had to go through two beta blockers before I found one that worked). Have you ever tried an extended release like Toprol XL? It doesn't wear off as fast.


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## Nova8 (Oct 30, 2014)

Hi jenny, and Lovlkin,

I came back to kind of bring this issue up and ask how to approach my endo with it: I see my endo in December to talk about going on T4, but I'm not exactly sure if that will stop the subacute thyroiditis attacks from recurring.

Going on the T4 replacement would sound like the best idea if it would stop the subacute thyroiditis from recurring, but I don't know if it would. It's like I have to somehow shut off the gland.

What do people with Hashi's do when they go on T4 and they continue to experience hashitoxicosis?

I actually did some deep research and found a paper that confirms subacute thyroiditis can be recurrent for years, even after complete recovery and prolonged latency, in at least 2% of patients. Here's a link to the abstract if anyone's interested in reading about it: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jcem.81.2.8636251... it has a .PDF with the full paper linked to the abstract. And I'm going to show it to my endo, who is at this point very perplexed.

The paper also suggested that recurrences might not be as rare as once thought. The recurrences seem to be milder, and that's what is happening with me - every time I get an attack it doesn't seem to last as long and the symptoms aren't as bad as the previous one. What gets me is, what the crap can be done to stop this? Would going on T4 be the right thing to do or would it make more sense to have the thyroid removed?

Personally, I wouldn't mind going on T4 replacement if I thought that would stop the attacks. It's the attacks that I wish would stop. They happen about once a year - my levels will shoot up into high normal range, then will be okay for a few months, then they'll go totally hypo for months on end and the process repeats. I just want these attacks to stop.

How to approach my endo with this?

jenny, I ended up going back onto the atenolol after finding some in stock at a different pharmacy. I'm staying put with it there... what a disaster.


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## jenny v (May 6, 2012)

Honestly, the only thing that stopped my attacks was removing my thyroid. I tried for 10 years to control things with medication and it was a roller coaster of switching meds, feeling crappy, fighting with endos and finally having a very long surgery to remove it because it was just a mass of scar tissue by that time. When is the last time you had an ultrasound?


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