# hypo, but anxiety.....????



## texgal418 (Jan 28, 2010)

Dear Experts,
Daughter with hashi's started on .50 synthroid, then upped to .75. She has been on this dose for 6 weeks, and will retest in two. Some of her symptoms of hypo (and she has them ALL!) have waxed and waned. Some days she is full of fluid, the next day, gone. Some days she has terrible dandruff; the next day, none. Some days she is freezing, but others, not so much. Comes and goes, goes and comes. The WORST thing that has happened, though, is that she gets terrible anxiety almost every day. It almost always comes on at night, but sometimes it begins in the afternoon. It is the most awful thing with no escape. There are no other symptoms of hyper such as diarrhea or shaky hands; just heart racing and a terrible feeling of anxiousness. Her temp is much higher during these times too. When just hypo, it runs at about 98, but when she feels this anxiety, it can be 98.5 or so. Any ideas or experience with this would be most welcome. Can anxiety be a symptom of hypo also? Can you have both hypo and hyper symptoms? What to do?
You guys and this board are awesome. Thanks!


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## chopper (Mar 4, 2007)

Hello and welcome. Your daughter sounds a lot like me. Get ready to have a strong backbone casue you'll get a lot of "your nuts" at the doctor offices. Trust me.

It sounds a lot like hyper hashi's with a touch of Graves. Was she tested for TSI?

Even without TSI, Hashi's alone can wax and wane exactly as you describe. It happens to me all the time even though (according to the docs) I am CLEARLY hypo.

The only problem with my "clearly hypo" diagnosis is that I do have high TSI which is known to cause Graves Disease.

Here's what's going on in a nutshell and why to this day I am personally still not fixed:

The hashi's antibodies attack her gland and as it does, some gland dies off and that hormone is released into the system, giving her a little too much. As the body uses all that hormone up her damaged thyroid can't make enough on its own so she floats on over to the other side, the hypo side and the cycle repeats...and repeats...and repeats. It's truly a major pain in the neck.

Eventually the thyroid should die off on its own and she'll become more and more hypo but that could take years.

Now consider this (also my personal dillemma), how do you take a single replacement dose when your thyroid is sometimes putting out too much juice and sometimes not enough? What happens to your hormone levels when you take that same dose each day but all of a sudden, your thyroid decides to kick back in and produce its own thyroid hormone? You get a little too much and that's when you get jittery and panic attacks.

Now the problem lies in the labs. You go up and you go down. When you draw blood at a given moment in time all you get is a general snapshot of that single moment which due to the ups and downs, usually equals "normal". Let's say, yesterday I was naturally +10 units of thyroid and today I am -10 units of thyroid, what will my labs look like tomorrow? ZERO (or normal). That's what makes titrating the dose so difficult with hashis. The darned thing is always changing around and many times the labs appear normal even though the intra-day swings are difficult to deal with.

Taking replacement hormone is supposed to help cut down on those attacks and it does take the bosy a while to get used to the meds but it sounds to me like your daughter is toggling over to the hyper side with the symptoms you discussed. I get the same way too and it's a bear to try to get doctors to believe your not crazy when they see "normal" labs.

Before adjusting meds it might be a good idea to ask for a TSI (Thyroid Stimulating Immunoglobulins) test. If she tests positive for TSI its usually indicative of Graves'. I have both Hashi's and Graves' although the Graves' portion is questionable as sometimes they do crossover. I do have high TSI and have been tested several times.

You can ask the doc to cut her back to .25 mcg Synthroid to see if the anxiety subsides. I personally tried starting Synthroid 3 different times and had the same reaction. I thought my heart was going to explode and I was really shaky and felt like I was on drugs or something. I vowed never to take it again but now I may need to as my thyroid is starting to finally die off - almost 8 years after being diagnosed. I should have just had a thyroidectomy and got it over with in retrospect.

I would also ask the doc about getting an RAI uptake test. Its a nuclear scan to see how well the thyroid takes in iodine (iodine is the required main ingredient to producing thyroid hormone). The RAI uptake scan can tell the doctors a lot of information about the overall health of the thyroid.

By the way my body temp fluctuates pretty wildly too - 97.1 - 99.8. When Im running hot, Im usually jittery and get heart palpitations. When Im running cold Im usually really tired and dizzy sort of feeling, like being hungover - sort of. It's not a very fun problem to have and is a real pain to deal with. Sometimes I think it's better to spare years of feeling like crud and just rip that sucker out. I wish I would have done that years ago. Keep in mind though some people do adjust well to meds and are fine once they get used to it and adjusted properly. I personally think your daughter needs more tests and I would be curious to know exactly what tests she had and the numbers to see how they came up with the diagnosis.

Good luck.


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## Lovlkn (Dec 20, 2009)

texgal14,

Post some lab's and ranges and we can shed some light on if it's the thyroid replacement she is on - otherwise it's impossible to tell.

How long total has she been on thyroid replacement? Do you have any of the labs that have been run on her so far?

She should go in immediately for labs, don;t wait the additional 2 weeks, especially if hese symptoms have come on since the dose change. If the doctor won't' run them then go to www.healthcheckUSA.com if in the US and see if they can be ordered in your state.

You need to have a FT4, FT-3 run which also comes with a TSH for around $85.00.

Any movement in thyroid hormone, whether up or down can cause the symptoms you describe.


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## chopper (Mar 4, 2007)

By the way, has she ever had anxiety trouble before starting Synthroid? Any history of panic attacks?


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## Lovlkn (Dec 20, 2009)

nasdaqphil said:


> By the way, has she ever had anxiety trouble before starting Synthroid? Any history of panic attacks?


Excellent point!


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## texgal418 (Jan 28, 2010)

She was only diagnosed 6 weeks ago, and the anxiety had somewhat started along with other hypo symptoms just before diagnosis. It has just gotten worse the last couple of weeks. That's why I'm kind of thinking this may just be one more of her hypo symptoms. She never had it before and it began just about the time she became exhausted, started gaining fluid and weight, dry hair and skin, foot pain, dandruff, low libido, constipation, and on and on. Her levels are below:

TSH 3.4
Free T-4 2.8 (3.5-4.0)
T-3 Uptake 29 (30-35)
T-4 Total 9.6 (10-12)

These tests were done by one doctor and she has since switched. Our new doc knows she needs Free T-3 tested, but started her on the meds immediately since she was obviously hypo. She was on .50 synthroid for a week, and has been on .75 for 6 weeks. I had read somewhere, but wasn't sure where, that anxiety could be a symptom of HYPO, and I think that is where we are. 
Since you asked some good questions and I rethought her case, I'm thinking if she had this before she started her meds, it may just be ONE more stinking thing!!! If she works up to a dose that totally suppresses her own thyroid, do you think that will help? Thanks so very much!!!!


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## daisy_ysiad2002 (Aug 17, 2009)

Sounds like what I'm going through right now between hashi's flare up and having to stop my meds completely. Have to retest my Tsh and such in 2 weeks off meds to see where I am at. Doc suspects possible hyper episode, still waiting on endo to see her for 8 months now. Was on Synthroid but got off of that in December as I was SO COLD but Tsh was good and they wouldn't do anything. Synthroid has lactose in it and some acacia *tree/grass pollen* fillers in it which I am allergic to the pollen and intolerant to the lactose. So I demanded to try natural Dessicated thryoid. Was doing well but it backfired and now I'm hyper....still hyper after stopping it last thursday but much better but not normal still. . They suspect I may have hyper/hashi flareup. Not sure.


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## Andros (Aug 26, 2009)

texgal418 said:


> She was only diagnosed 6 weeks ago, and the anxiety had somewhat started along with other hypo symptoms just before diagnosis. It has just gotten worse the last couple of weeks. That's why I'm kind of thinking this may just be one more of her hypo symptoms. She never had it before and it began just about the time she became exhausted, started gaining fluid and weight, dry hair and skin, foot pain, dandruff, low libido, constipation, and on and on. Her levels are below:
> 
> TSH 3.4
> Free T-4 2.8 (3.5-4.0)
> ...


All the numbers are very very low except for the TSH which is pretty much in range so I find that unusual. With the other lab results all below range, one would expect to see TSH sky-high.

This makes me wonder and I do suggest the following antibodies tests.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies),TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/understanding/conditions/thyroid.html

Is your daughter an adult or a child?


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