# Endo described initial reaction to synthoid--does this sound right/familiar to you?



## Lauruffian (Jul 31, 2013)

When I saw the endocrinologist for my first appointment last week, she said my significant hand shaking and heart palpitations might be from starting the synthroid. I didn't understand, as I had only been on it 5 days when my symptoms of shaking and jitterness went nuts. I thought it takes longer than that to get into my system...yes?

Her reasoning was, sometimes when starting the medication, the body--which is so used to going without the hormone--doesn't know what to do with all of it at first, and those sorts of symptoms may appear.

It confused me, as again I thought it took longer for the synthroid to work, but then again, I'm not an endocrinologist.

Also, my TSH was cut in half--from 5.24 to 2.56--after just a week of synthroid. Does that make sense, too?

(Retesting it last week, around week 3 on synthroid, my TSH is more or less the same.)


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## joplin1975 (Jul 21, 2011)

Within hours of taking synthroid for the first time, I was shaky, jittery, sweating and a general mess. So, yes, it can happen.

Have you been tested for TSI?


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## Lauruffian (Jul 31, 2013)

Yes, I just got those numbers yesterday. Everything was normal except my TPOab and thyroglobulin antibody.

I was going to post asking about those numbers, but I can put them here too. 

TPOab: 409 (normal 0-34; I was a 404 last test)
Thyroglobulin antibody: 15.6 (normal 0.0-0.9; never tested before)
TSI: 37 % (target range 0-139%)
Total T4: 8.3 (range 4.5-12.0)
Free T4: 1.11 (range 0.82-1.77)
T3: 85 (range 71-180)
TSH: 2.55 (range 0.450-4.500)
TSH receptor antibody (tbii): <0.3u/l

From what I was able to Google, the thyroglobulin antibody is similar to the TPOab, yes? So it's another test confirming Hashimoto's in my case?

Considering how many symptoms I've been wrangling with, I'm rather disappointed my TSH, T3, and T4 were all normal range. :/


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## joplin1975 (Jul 21, 2011)

Well, despite being in the normal range, you aren't suppose to have any TSI. Having it will make it very difficult to tolerate synthroid.

You've had an ultrasound?


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## Lauruffian (Jul 31, 2013)

Yes--I have a single solid nodule on the left lobe. Even though it's not quite 1cm (0.8), she's doing a FNA on it tomorrow afternoon. Do I have to wait for biopsy results, or do they do it there, or does that vary?

I don't understand--if we're not supposed to have any TSI, why is there such a big normal range of 0-139?


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## hashimotocoaster (Mar 22, 2013)

"Normal" and the reference range aren't the same thing. I'm not a scientist, but I think reference ranges are AVERAGES, not what is ideal. So, if they tested a bunch of people and a few of them had TSI antibodies, then that'd explain that reference range, even though you're not really "supposed" to have any.

TPO is a blocking antibody and TSI is a stimulating antibody, which means the TPO is making you hypo but the TSI can cause you to be hyper.

I noticed a difference within a couple days of starting Synthroid, so even though it takes time to fully build up in your system, it is definitely possible to see changes a lot faster than a few weeks.


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## hashimotocoaster (Mar 22, 2013)

Also, having those TSI antibodies could be what's causing your TSH, FT3, & FT4 to be in range. If you're baseline hypo with bursts of hyper, the labs could average out to "normal."


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## Lauruffian (Jul 31, 2013)

Interesting. I'll be sure to ask the doc about all this.

I am feeling better, in that when I went through a fatigue swing it wasn't nearly as severe as a few weeks ago. The body aches, however, woke me up in the middle of the night last week, and were horrible for about 3 days.

Now, I'm actually feeling pretty okay, but jittery.


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## Andros (Aug 26, 2009)

Lauruffian said:


> Yes, I just got those numbers yesterday. Everything was normal except my TPOab and thyroglobulin antibody.
> 
> I was going to post asking about those numbers, but I can put them here too.
> 
> ...


It does not appear that you are hypo. It looks hyper to me.

The Thyroglobulin Ab suggests that cancer be ruled out. In your case, since you do have TSI, I suggest RAIU (radioactive uptake) instead of ultra-sound but...............................if the only thing you can swing is the ultra-sound; go for it.

Please read this stuff:

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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TBG (thyroxine binding globulin)
http://www.nlm.nih.gov/medlineplus/ency/article/003374.htm

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.[12][2]

TPO Ab is "suggestive" rather than definitive.

TPO Ab
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract
http://www.wikigenes.org/e/gene/e/7173.html

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Lastly, your doc should run a FREE T3 test!

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3


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## joplin1975 (Jul 21, 2011)

Lauruffian said:


> Yes--I have a single solid nodule on the left lobe. Even though it's not quite 1cm (0.8), she's doing a FNA on it tomorrow afternoon. Do I have to wait for biopsy results, or do they do it there, or does that vary?
> 
> I don't understand--if we're not supposed to have any TSI, why is there such a big normal range of 0-139?


Andros covered it...but regarding your biopsy, you'll have to wait for the results. They send of the slides to a pathologist. I'm glad they are willing to biopsy it.


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## Lauruffian (Jul 31, 2013)

Thanks everyone. Andros, I will say at least at time of diagnosis I was most definitely not hyperthyroid--I was (and have been for a while) hypo. That was my first diagnosis: hypothyroidism. My TSH has been around 5.2ish, which isn't too bad, but enough for the diagnosis. The second was the root cause of the hypo, Hashimoto's.

My endo was checking if I had hyperthyroidism as well--the stroke of luck that is getting both Hashi's AND Grave's disease--since I have symptoms of both. I've been swinging back and forth between bone-crushing body aches, impossible fatigue, weight gain, hoarse voice, etc. and heart palpitations/rapid heartrate and insomnia (the shaking hands is new).

My rheumatoid factor is also elevated (23.0, normal is 0-12.9), but that's beyond the scope of my endocrinologist's field and she's sending me to a rheumatologist.


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## Splash0306 (Aug 14, 2013)

I was diagnosed in April by my GP and put on Levvothyroxine 50 mcg. Had blood work, sonogram and biopsy. 4 months on 50 mugs and I still felt like garbage, but had none of the horrid side-effects I read about. I just didnt feel better. Finally! saw an endo in August (insurance hold-up) and he upped me to 100 mcg's. I was sure I was going to be misrable, especially since most talk about gradually upping the medication, however, the only thing I feel is better.


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