# Help me understand- Hyper to hypo



## stellablue (Jun 2, 2012)

I just got my most recent labs back, and it looks like I am becoming quite hypothyroid, although I still have mostly symptoms of hyperthyroid. I am quite confused. I will post my symptoms, history, and test results.

In April 2012, my labs showed a TSH of .02. In May, I ended up in the ER with a fever, high heart rate, and uncontrollable shaking. I was told I was in thyrotoxic crisis and put on 45 mg of tapazole daily and beta blockers.

By July, I was off of the beta blockers and taking 35 mg of tapazole daily. My labs came back as following:

Free T3 2.8 [2.0-4.4]
Free T4 1.43 [.70-1.70]
TSH 1.86 [.32-5.50]
TSI <1.0, <=1.3

The doctor told me he was very happy with the results. He told me that he only wanted to lower me 5 mg, and that if I still felt, I should lower 5 mg every 2 weeks. So by August, I was down to 20 mg daily.

I started back to work mid August (I'm a teacher), and immediately started with shaking hands, a faster heart rate, was hungry all of the time, and was exhausted. I called the doctor with my symptoms, and he ordered me to go back up 5 mg daily (so 25 mg tapazole daily), and to repeat bloodwork in 2 weeks.

So now I am taking 25 mg of tapazole daily (10 in the morning, 5 in the afternoon, 10 at night), and my most recent bloodwork came back as follows:
(Bear with me, I am translating results from Spanish and may have some errors in the words)

TSH: 34.48 (.35-4.94) !!!!!
t3 (it doesn't specify free or not): 0.7 (.58-1.59)
t4 (also not specified if free or not): 3.7 (5.53-11.0)
Free thyroxine (is this free T4 maybe?): 0.7 (.71-1.47)
t3 uptake: 29.8% (23.5-40.5)
Index of free thyroxine: 1.10 (1.4-3.1)
Iodine protein: 2.41 (2.9-8.1)

I don't really know how to read these the right way, but the lab results say hypothyroid. I have an appointment on Thursday to talk to the doctor about it, but I would like to have an idea of what all of this means.

My current symptoms include:
-If I forget to take my medicine or take it a bit late, my heart rate shoots up to nearly 100. 
-high heart rate, shaky hands, and out of breath ONLY when I do anything that is "exercise"
-extreme fatigue, especially in arms and legs
-anxiety
-fast metabolism (running to the bathroom quickly after eating)
-extremely tired, but waking up all through the night

While taking my medication (tapazole), my hands rarely shake. I am tired most of the time, but I get "adrenaline rushes" throughout the day. My resting heart rate is now down to about 80-85 (before it was in the 100s), but I still find that quite high for me, as I have always been athletic and had a low heart rate. To me, my symptoms still seem to indicate hyperthyroid, but maybe I am mistaken? Could my symptoms take awhile to "catch up" to what the bloodwork says? I would appreciate any insight! Thanks!


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## Lovlkn (Dec 20, 2009)

Your starting doses were very high. When you are on doses that high you need to be tested every 4-6 weeks minimum.

The 2 most important tests you need to be concerned with are FT-4 and FT-3.

The 2nd group of tests you had run were not the proper tests.

Going forward insist that your doctor tests your FT-4 and FT-3. Right now it sounds like he is dosing you on TSH only.



> By July, I was off of the beta blockers and taking 35 mg of tapazole daily. My labs came back as following:
> 
> Free T3 2.8 [2.0-4.4]
> Free T4 1.43 [.70-1.70]
> ...


If you still felt what?

A better plan would have been to test in 4 weeks after reducing your dose before reducing again.

Sounds like you went hypo, most of your labs are low range.

Call your doctors office to clarify what tests were run.


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## stellablue (Jun 2, 2012)

*If I still felt okay* that was supposed to say.

I agree, I probably should have had more bloodwork done. My doctor insisted that it wasn't necessary to do so much bloodwork and that we could do bloodwork once every few months and dose based on symptoms and office evaluations.... Stilll, my last two tests are about 8 weeks apart.

At the laboratory here, there is only one choice to get the thyroid tested- something called a "thyroid profile." Unfortunately, I don't have a choice to get anything different than these tests unless I travel to a different city or back to the US. I will clarify exactly what all of the tests are when I go in.

My big question is why I don't feel like my lab results match how I feel? Over the past few weeks, I have been worried that I was becoming more HYPERthyroid, and it turns out that I am becoming more hypothyroid. Maybe I have just not felt well in so long that I don't even know how I feel in comparison to "normal" at this point. :/


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## stellablue (Jun 2, 2012)

I went to the doctor today, and now I am even more confused and am not sure whether or not I need to start looking for another doctor. My options are slim here.

He seems to look at only TSH. He told me that the only Total T3 was taken, and both Total and Free T4, and that Free T3 is unnecessary as it is only the result of the converted T4. This doesn't seem to be consistent with what I have read.

Now with TSH at 34, but he still wants me on 20 mg of tapazole every day. It is 5 mg lower than I was taking, but it still seems like so much to me! I was thinking that he would lower it to 5 mg. He says that even though my labs now show HYPOthyroid, my diagnosis is still HYPERthyroid and the medicine is just "tricking" the body for now. He seemed very pleased that I am now hypothyroid. He said that where I am right now is "safe" and he doesn't want to risk lowering the medicine much. He said that I am still 100% banned from doing exercise or any thing that could stimulate my heart and thyroid back into a hyper state.

I asked him when I would get more bloodwork, and he said that it would be awhile, and that office visits are more important than bloodwork. He scheduled me to go back in to his office 4 weeks so he can evaluate. From what I understand, when trying to get medicine right, bloodwork needs to be frequent and monitored closely..?

He told me that his best guess is that I have Hashimoto's which is causing me chronic bouts of hyperthyroidism; however that was just a guess. (But...I thought that Hashimotos generally caused hypothyroidism, which I have never had and only have right now as a result of the tapazole). I asked him how we could be sure of what was causing my problems, and he said that it was "unnecessary" to find out, because with hyperthyroid, the treatment options are the same.

The one positive thing I heard from him was that "The results of the bloodwork are only a guideline. A lot depends upon how you feel and what works best for you personally."

Ughh... I am frustrated, and I'm not sure what to do. I don't want to stay on such a high dose of tapazole because I am afraid to become even more hypothyroid. I am not convinced that this doctor knows what he is talking about....


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## stellablue (Jun 2, 2012)

I think I posted incorrectly about Hashimoto's. I believe the doctor was saying he thinks I have Hashitoxicosis (My office visits are all in a second language for me, which sometimes makes things even harder to understand). I guess that would explain why HYPERthyroid, but I haven't had any tests that reveal this to be true. I'm not sure how one could "guess" Hashitoxicosis.


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## Andros (Aug 26, 2009)

stellablue said:


> I just got my most recent labs back, and it looks like I am becoming quite hypothyroid, although I still have mostly symptoms of hyperthyroid. I am quite confused. I will post my symptoms, history, and test results.
> 
> In April 2012, my labs showed a TSH of .02. In May, I ended up in the ER with a fever, high heart rate, and uncontrollable shaking. I was told I was in thyrotoxic crisis and put on 45 mg of tapazole daily and beta blockers.
> 
> ...


It is my opinion that antibodies are attacking the receptor sites and your basic thyroid panel labs are somewhat skewed.

Most of us find that at a certain point, anti-thyroid meds no longer work well and we opt for either RAI or ablation (surgical removal.)

Your symptoms indeed are hyper. Bet your TSI is really high right now.

Here is a bit about the TSI.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

I am sorry you are going through this; it "is" rough.


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## stellablue (Jun 2, 2012)

Andros said:


> It is my opinion that antibodies are attacking the receptor sites and your basic thyroid panel labs are somewhat skewed.
> 
> Most of us find that at a certain point, anti-thyroid meds no longer work well and we opt for either RAI or ablation (surgical removal.)
> 
> ...


Thanks for the response, Andros.

In some aspects, I do feel like I have hypothyroid symptoms too. At times I feel really heavy, as if my arms and legs were filled with rocks, and I am SOOOOOO tired; however, my heart rate still keeps shooting up and I run fevers frequently.

What makes you think the TSI is high? In July my TSI came back low. It said <1.0. I guess that means I must have had some, but not much.

I didn't get TSI tested this time because TSI is not even available at the laboratories in the city I am living right now. I am thinking about traveling 4 hours to a bigger city and getting new labs and a second opinion with another doctor. I'm concerned that I am not getting appropriate treatment. I would like to try to put this hyper into remission with medicine instead of taking it out/radiation, but I want someone who is really careful with monitoring me. I feel like the doctor I am seeing doesn't know what he is doing.


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## Andros (Aug 26, 2009)

stellablue said:


> Thanks for the response, Andros.
> 
> In some aspects, I do feel like I have hypothyroid symptoms too. At times I feel really heavy, as if my arms and legs were filled with rocks, and I am SOOOOOO tired; however, my heart rate still keeps shooting up and I run fevers frequently.
> 
> ...


I think it is high because you are hyper and the reason you feel exhausted is because your metabolism is in high gear, even when you are resting.

Just to be on the safe side, I am enclosing the Thyroid Storm warnings and signs. Don't like that you have a fever too!

Thyroid Storm Symptoms
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001437


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