# Heart Palpitation and Extreme anxiety after graves and total Thyroidectomy



## thyguy (Mar 31, 2016)

A little bit of a long post, just trying to figure things out more any insight would be Great!

Had a total TT 4/21/16

Blood tests at 6 weeks post TT6/1/16):

TSH - 3.03 (range 0.40-4.50)

FT3 - 2.6 (range 2.3-4.2)

FT4 - 1.3 (range 0.8-1.8

Reverse T3 - 31 (range 8-25)

taking 112mc Levoxyl at this time, took 24 hours prior to blood draw

I had to ask a GP for this reverse T3 test as endo would Not order it. Also pretty much begged for a free T3

On this first 112mg dose I felt VERY jittery anxious and horrible again after about 2 weeks after surgery. Was put on 125mg Levoxyl 6/10/16 1st week on 125 mg Levoxyl felt heart palps and anxiety flutter and did not feel good , but second week actually felt ok as far as my heart palps and racing. That week or so did not last long and now heart palp, extreme anxiety etc are back.

Just tested my labs again at 4 weeks on 125mc of Levoxyl and they are:

7/8/16

TSH - 1.46 (range 0.40-4.50)

FT3 - 2.5 (range 2.3-4.2)

FT4 - 1.7 (range 0.8-1.8

Reverse T3 - 35 (range 8-25)

this blood draw was done 12 hours after levoxyl dose

(taking 112mc Levoxyl at this time, took 12 hours prior to blood draw)

Could a lower end T3 be causing all this? Or something not related to my thyroid at all? The reason I think it has something to do with my thyroid is because all these heart palps, flutters, racing heart, extreme anxiety etc. started when I was diagnosed with graves APR 2015

I have seen several Endo's since my TT and don't really have a lot of faith in any of them. One said and I quote " reverse T3 doesn't mean ****" which has made question things lol. Endo also recommends I start an SSRI which I did this week. Met with the PA who works in the same office as a naturopath to discuss and still having racing heart, extreme anxiety and all that. He said to lower my dose of Levoxyl to 88mc and I agreed to do this and this alone for a week or until I feel increase of symptoms. He said this is what he would do personally and that my heart has been revved up to long??

the naturopath cautioned me that adding T3 might make my heart race more?

I asked the PA about adding T3 and he said that is ok. So I will try reducing this dose to 88mc for a week and see how I feel, but regardless I will add 5mc of T3 next week and increase the T3 if I need to.

Any thoughts? Also was wondering about dividing the T3 dose to twice a day taking the first half with my morning empty stomach dose, but unsure on when I should take the second half of the dose?

My theory is that my T3 has been off for quite a while and was suppressed on methimazole. I was put on methimazole APR 2015.

For fun I guess, here are all the labs that I had done after being DX Graves and then after my thyroidectomy on 4/21/16. I took my methimazole dose at night around 9pm and always had my blood drawn the next day usually late morning.

2/24/15 
FT4: 3.98 (range 0.82-1.77)
Thyroglobulin, Antibody: 1.2 (range 0.0-0.9)
Thyroid Peroxidase (Tpo) Ab: 10 (range 0-34)
Triiodothyronine,Free,Serum: 11.5 (range 2.0-4.4 )
(no thyroids meds at this time)

3/19/2015
Triiodothyronine,Free,Serum: 14.4 (range 2.0-4.4)
T4,Free(Direct): 5.61 (range 0.82-1.77)
Tsh: <0.006 (range0.450-4.500)
(no thyroids meds at this time)

APR 2015 started 50mc methimazole

5/16/2015
Triiodothyronine,Free,Serum: 5.7 (range2.0-4.4)
Tsh: 0.007 (range0.450-4.500)
T4,Free(Direct): 2.11 (range 0.82-1.77)
(started 50mc methimazole at this time)

6/18/2015
Triiodothyronine,Free,Serum: 3.3 (range2.0-4.4)
Tsh: <0.006 (range0.450-4.500)
T4,Free(Direct): 1.26 (range0.82-1.77)
(This Was the month when I felt the Best since DX with graves and pretty much the best I have felt since) 
( started 60mc methimazole at this time)

8/17/2015
T4,Free(Direct): 0.43 (range0.82-1.77)
Tsh: 38.120 (range0.450-4.500)
Triiodothyronine,Free,Serum: 2.0 (range2.0-4.4)
( I did start feeling a little tired this month)
( lowed dose to 15mc methimazole at this time)

8/24/2015
T4,Free(Direct): 0.64 (range 0.82-1.77)
Triiodothyronine (T3): 74 (range71-180)
Tsh: 20.830 (range0.450-4.500)
Thyroid Peroxidase (Tpo) Ab: 5 (range0-34)
Thyroid Stim Immunoglobulin: 72 (range0-139)
(15mc methimazole at this time)

8/31/2015
T4,Free(Direct): 1.02 (range0.82-1.77)
Triiodothyronine (T3): 93 (range71-180)
Tsh: 6.530 (range0.450-4.500)
Thyroid Stim Immunoglobulin: 163 (range0-139)
(15mc methimazole at this time)

9/17/2015
T4,Free(Direct): 1.49 (range0.82-1.77)
Triiodothyronine (T3): 110 (range71-180)
Tsh: 0.501 (range0.450-4.500)
(15mc methimazole at this time)

9/29/2015
T4,Free(Direct): 1.48 (range0.82-1.77)
Triiodothyronine (T3): 105 (range71-180)
Tsh: 0.949 (range 0.450-4.500)
(15mc methimazole at this time)

10/20/2015
T4,Free(Direct): 1.42 (range0.82-1.77)
Tsh: 1.090 (range0.450-4.500)
(15mc methimazole at this time)

12/4/2015
T4,Free(Direct): 1.42 (range0.82-1.77)
Triiodothyronine (T3): 101 (range71-180)
Thyroid Stim Immunoglobulin: 121 (range0-139)
(15mc methimazole at this time)

02/18/2016
TSI: 162 (Range High <140 % baseline)
T3, FREE: 2.8 (Range 2.3-4.2)
T4, FREE: 1.4 (Range 0.8-1.8)
Tsh: 0.949 (range 0.40-4.50)
(10mc methimazole at this time)

03/08/2016
T3, TOTAL: 88 (Range 76-181)
T4, FREE: 1.3 (Range 0.8-1.8)
Tsh: 4.11 (range 0.40-4.50)
(Horrible month one of my worst as far as symptoms)
(10mc methimazole at this time)

04/01/2016
TSH W/REFLEX TO FT4: 5.67 (Range 0.40-4.50
T3, FREE: 2.9 (Range 2.3-4.2)
T4, FREE: 1.3 (Range 0.8-1.8)
(10mc methimazole at this time)

04/12/2016
TSH W/REFLEX TO FT4: 5.18 (Range 0.40-4.50
T4, FREE: 1.3 (Range 0.8-1.8)
(10mc methimazole at this time and stopped taking methimazole 4/20/16, had total TT 4/21/16 then put on 112mc starting 3 days after surgery)

6/1/16 
TSH - 3.03 (range 0.40-4.50)
FT3 - 2.6 (range 2.3-4.2)
FT4 - 1.3 (range 0.8-1.8
Reverse T3 - 31 (range 8-25) 
( this was 6 weeks post thyroidectomy and steel felt hyper anxiety etc and horrible) 
(112mc Levoxyl at this time, took 24 hours prior to blood draw )

6/14/16
DHEA SULFATE : 391 (range 106-464 mcg/dL)

24 hour adrenaline urine test 
METANEPHRINE : 124 (range 36-190 mcg/24 h) 
NORMETANEPHRINE : 139 (range 35-482 mcg/24 h)
METANEPHRINES, TOTAL: 263 (range 115-695 mcg/24 h)
DOPAMINE, 24 HR URINE : 229 (range 52-480 mcg/24 h)
CREATININE, 24 HOUR URINE : 2.16 (range 0.63-2.50 g/24 h)
NOREPINEPHRINE, 24 HR UR : 34 (range 15-100 mcg/24 h)
CALCULATED TOTAL (E+NE) : 40 (range 26-121 mcg/24 h)
EPINEPHRINE, 24 HR URINE : 6 (range 2-24 mcg/24 h)
(112mc Levoxyl at this time)

7/8/16
TSH - 1.46 (range 0.40-4.50)
FT3 - 2.5 (range 2.3-4.2)
FT4 - 1.7 (range 0.8-1.8
Reverse T3 - 35 (range 8-25)

(125mc Levoxyl at this time, took 12 hours prior to blood draw)

I felt horrible in Feb and March before being DX with graves disease in APR 2015. Around Nov/Dec 2015 is where I started feeling strong heart palps, extreme anxiety, panic attacks, jittery etc. In this time some months that were better than others, but in all my symptoms have progressively gotten worse.

June 2015 was the best month as far as how I felt that I remember. Here are all my results for the last year+

f you need me to provide you with any further info or if you have any thoughts on this let me know,

Thanks


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## Lovlkn (Dec 20, 2009)

Can I ask you to edit your post and list the medication and dosage you were taking prior to the lab draw.


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## thyguy (Mar 31, 2016)

I do not remember exactly but it will be close. Did the edit, I took my methimazole dose at night around 9pm and always had my blood drawn the next day usually late morning.


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## Lovlkn (Dec 20, 2009)

> 6/18/2015
> 
> Triiodothyronine,Free,Serum: 3.3 (range2.0-4.4)
> Tsh: <0.006 (range0.450-4.500)
> ...


This is where your doctor messes up. Your FT-4 and FT-3 were in range. They were focusing on your TSH. Most doctors make this error.



> 8/17/2015
> 
> T4,Free(Direct): 0.43 (range0.82-1.77)
> Tsh: 38.120 (range0.450-4.500)
> ...


BAM! See how you went completely hypo. ALl this thyroid movement makes one thing they are going crazy. Anxiety can be debilitating.



> 6/1/16
> 
> TSH - 3.03 (range 0.40-4.50)
> FT3 - 2.6 (range 2.3-4.2)
> ...


You are feeling the reverse T3, probably left over from when you went incredibly hypo.



> 7/8/16
> 
> TSH - 1.46 (range 0.40-4.50)
> FT3 - 2.5 (range 2.3-4.2)
> ...


Make a note to do this every lab draw. Consistency on lab draw post TT is so important to dial in your post op replacement medications.

Your reverse T-3 continues to rise as does your FT-4. The high RT3 and high FT-4 are the likely cause of your heart palp's and anxiety. I had this exact thing happen to me post TT. I tried adding Cytomel and could not handle it - eventually gave up. 12 months later I was able to add the Cytomel without issue. At the time, I did not have a RT3 done but my FT-4 was high range so I likely had some. I tried a short trial of 200mg Selenium daily which did appear to raise my FT-3 slightly. I then got a prescription for Cytomel and quit the Selenium.

JennyV is the high RT3 expert. I'm sure she will chime in.


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## jenny v (May 6, 2012)

Your reverse T3 is sky high, which means the T3 is not getting into your cells and is building up instead of being used. When mine was high, I had a weird mix of hypo and hyper symptoms, including anxiety, heart palps and exhaustion. Common causes of high rT3 include iron issues and cortisol issues. You're going to need to find a doc who really knows hormones and knows what tests to run and what other thyroid meds to use. If you're on Facebook, there's a really good good called FTPO - Without a Thyroid that can help you get started.


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## thyguy (Mar 31, 2016)

Thanks for getting back Lovlkn and the info. Yeah seeing my labs on 6/2015 and seeing how they only really looked at TSH has made me see even more clearly how looking at only TSH is wrong that is a picture perfect example. I no longer see that doc and sure if my current endo seen these labs she would want me to stay on 125mc or increase the dose and do T4 synthetic only.

Yes after my TT I am trying to be more detailed with my notes about my lab draws.

This most recent lab I have I have ate like 6-12 brazil nuts per day. Not sure how much selenium they have, but it did not help raise or convert to T3 so far.

Also you mentioned I my be feeling the left over RT3 when I went hypo, but that was over a year ago? Just wanted to make sure?

Thanks for getting back.


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## thyguy (Mar 31, 2016)

jenny v said:


> Your reverse T3 is sky high, which means the T3 is not getting into your cells and is building up instead of being used. When mine was high, I had a weird mix of hypo and hyper symptoms, including anxiety, heart palps and exhaustion. Common causes of high rT3 include iron issues and cortisol issues. You're going to need to find a doc who really knows hormones and knows what tests to run and what other thyroid meds to use. If you're on Facebook, there's a really good good called FTPO - Without a Thyroid that can help you get started.


Thank you for the info. Yeah my RT3 is high, so what can be done about it? and would that alone cause these symptoms?

My naturopath seems pretty good on hormones, and his partner knows hormones as well, so I will see how good they are at it. I will also be checking out this FB group

Is there a specific type of doctor that would know hormones?

Will adding T3 help lower the RT3?

Its crazy cuz I seen one endo who said RT3 and I quote "doesnt mean shit" and all other endos said it does not mean anything either. Clearly there is a huge divide


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## jenny v (May 6, 2012)

Definitely high rT3 could be causing your symptoms--your body isn't processing the T3 available to it, so things are all messed up. My doc is a former gynecologist who also has thyroid problems herself, so she knows hormones. A good doc will know how to treat the high rT3 with either T3 only or a combo of NDT and T3 (which is what I'm doing).

But you also have to find the root cause of the high rT3 and treat that, as well, For me, it's adrenal issues (discovered by doing a 4 point cortisol saliva test). 10 years of Hashi's and Graves disease messed my system up and my adrenal glands tried to overcompensate for things and now I have high cortisol at night when it should be low.

It's not a quick or easy fix, but it can be fixed.


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## thyguy (Mar 31, 2016)

jenny v said:


> Definitely high rT3 could be causing your symptoms--your body isn't processing the T3 available to it, so things are all messed up. My doc is a former gynecologist who also has thyroid problems herself, so she knows hormones. A good doc will know how to treat the high rT3 with either T3 only or a combo of NDT and T3 (which is what I'm doing).
> 
> But you also have to find the root cause of the high rT3 and treat that, as well, For me, it's adrenal issues (discovered by doing a 4 point cortisol saliva test). 10 years of Hashi's and Graves disease messed my system up and my adrenal glands tried to overcompensate for things and now I have high cortisol at night when it should be low.
> 
> It's not a quick or easy fix, but it can be fixed.


Alright well I have been type one diabetic for 18 years, so that may be a cause of high RT3, but that is just a shot in the dark. So should I be looking for a gynecologist as a guy? I don't care I will lol

I did do a 24 hour urine adrenal test and all those came back normal. Wondering if a 24 hour adrenal saliva would show anything that did not? I can ask for it tho I guess.

I have done the AM cortisol blood test and that is always a little high. Did you test cortisol at night to find that out?

So if it is an adrenal issue, it still sounds like yours was solved with your thyroid replacement meds? Or did you take meds or something for your adrenals?

Could you do a Synthetic T4 and Synthetic T3 combo?

And yes thank you for these responses and the info, things certainly do feel all messed up lol.


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## jenny v (May 6, 2012)

I would look for an integrative doc, if you're thinking of switching. Someone who does whole body health.

The four point cortisol saliva test can be ordered online--it is more accurate because it measures cortisol levels throughout the day, instead of just one point in time. I am still working on my adrenals, it's a slow process. Some people with low cortisol need prescription meds, some can do over the counter, same with high cortisol issues. I am taking zinc and holy basil to address my high points.

And you can add a T3 med to T4 med; the most common T3 med is Cytomel, even though there are generic versions, too. Definitely something to discuss with your doc.


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## thyguy (Mar 31, 2016)

Yes I have started seeing a naturopath and have had my most recent appointment with a PA that works in his office to go over my most recent labs. The PA however does not practice everything the naturopath does, so I think I will see the naturopath again. Yes my adrenal urine test was over 24 hours, but I will still be asking him about an adrenal saliva and a four point cortisol saliva test. Sounds like a good idea.

Also the plan with the PA was to lower my Levoxyl from 125mc to 88mc which I started doing now and to do that for a week and then to add T3 5mc and see how that goes. Hoping it helps.

Thank you for the info  trying hard to understand why I am feeling this way and what I can do about it.


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## gravesguy (Feb 18, 2016)

Hi I wanted to follow up on this. Or maybe I will make a new post.

Here is my recent labs for the past two months:

7/8/16

TSH - 1.46 (range 0.40-4.50)

FT3 - 2.5 (range 2.3-4.2)

FT4 - 1.7 (range 0.8-1.8

Reverse T3 - 35 (range 8-25)

(125mc Levoxyl at this time, took 12 hours prior to blood draw)

7/18/16

Iron

IRON, TOTAL - 121 (Range 50-180 mcg/dL)

% SATURATION - 42 (Range 15-60 % (calc)

IRON BINDING CAPACITY - 296 (Range 250-425 mcg/dL (calc)

FERRITIN - 122 (Range 20-345 ng/mL)

VITAMIN B12 - 869 (Range 200-1100 pg/mL

7/19/16

saliva cortisol test(from quest)

Reference Range:

8-10 AM: 0.04-0.56

4-6 PM: < OR = 0.15

10-11 PM: < OR = 0.09

8AM - 0.09

12:00PM - 0.20

4:00 PM - 0.94

11:00 PM - 0.07

8-5-16

Was on 88mc Levoxyl and 5mc T3 twice daily since like 7/18/16

took t4 and t3 morning dose at 6:50am, blood draw at- 3:45pm

TSH - 1.17 (range 0.40-4.50)

FT3 - 2.8 (range 2.3-4.2)

FT4 - 1.3 (range 0.8-1.8

Reverse T3 - 30 (range 8-25)

TSI - <89 (range <140 % baseline)

THYROID PEROXIDASE ANTIBODIES - 1 (range <9 IU/mL)

FREE TESTOSTERONE - 59.8 (range 35.0-155.0 pg/mL)

TESTOSTERONE, TOTAL, LC/MS/MS - 558 (range 250-1100 ng/dL)

VIt D - 54 (range 30-100)

CORTISOL, TOTAL - 15.9

Iron

IRON, TOTAL - 70 (Range 50-180 mcg/dL)

% SATURATION - 25 (Range 15-60 % (calc)

IRON BINDING CAPACITY - 280 (Range 250-425 mcg/dL (calc)

FERRITIN - 149 (Range 20-345 ng/mL)

As far as my symptoms I still have this internal shaking weakness and heart still pounds from time to time, but it is improving slightly. I am not sure if it the Prozac I started taking on 7/12/16 or from my thyroid levels improving. But my levels have only improved slightly. And my RT3 is still high.

So I am on 88mg of Levoxyl and 5mg T3 twice daily (started these doses like 7/18/16)

Do you think I should increase my T3 and by how much? Do you think I should lower my T4 and by how much? I really want to get this optimized and I do not think I am going to do a T3 only treatment, sounds to scary,

Would love to hear your thoughts thanks


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## Tocra (Mar 25, 2011)

Your TSH is bouncing all over the place. Not good! You want this stable to be sane. And Sheesh! Prozac? I think once they put me on a beta blocker that was it for me! If you saw a shrink for the anxiety this is a common prescription along with a mild sedative (usually). Yes, been there!!! In my opinion, the Prozac the shrink would give me would not work at all. I stopped taking it because it did nothing but interfere with my healing. The mild Benzo helped a lot though. So I do recommend a mild Benzo if you can obtain them. But this is a temporary crutch to use sparingly in case a panic attack happens. But yeah, this post sounds like me before and after my TT. It was worse before though. I had the food allergies, gluten intolerance problems, blood sugar crazy problems. The list goes on, and on. But yes, I haven't posted in a while but I read this and thought I'd see if I could help you. I had a similar problem after my TT for Palp cancer. Extremely long story short, I had to leave several endo's because I just could not tolerate the levothyroxine crazy pill. I could barely hold it together throughout the day. Very long spouts of anxiety and heart palps etc. etc. With me, it felt like I was a broken engine but the mechanic wanted to fuel me with 500 octane drag car fuel. That may work if my engine wasn't broke, chassis was in order, and transmission wasn't completely fried... Anywho, I had enough. I finally found one who prescribed me Armour Thyroid non-generic which was completely alien to me. It comes in various dosages and works amazingly well. Try several small doses throughout the day and start there. I ended up starting ridiculously small and gradually built up to normal with fully suppressed TSH's and normal labs. I see these posts too often and I wonder why doctors don't try this method of treatment. It's not the best solution and can be a bit demanding in the beginning but it is something to try if all else fails. PM me if you want more info. I totally get what you are going through.


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## Jolanta (Aug 21, 2016)

It might be that you are taking slightly too much Levothyroxine. 10mcg of T3 is a good dose but it is also about how an individual feels.


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## gravesguy (Feb 18, 2016)

Tocra said:


> Your TSH is bouncing all over the place. Not good! You want this stable to be sane. And Sheesh! Prozac? I think once they put me on a beta blocker that was it for me! If you saw a shrink for the anxiety this is a common prescription along with a mild sedative (usually). Yes, been there!!! In my opinion, the Prozac the shrink would give me would not work at all. I stopped taking it because it did nothing but interfere with my healing. The mild Benzo helped a lot though. So I do recommend a mild Benzo if you can obtain them. But this is a temporary crutch to use sparingly in case a panic attack happens. But yeah, this post sounds like me before and after my TT. It was worse before though. I had the food allergies, gluten intolerance problems, blood sugar crazy problems. The list goes on, and on. But yes, I haven't posted in a while but I read this and thought I'd see if I could help you. I had a similar problem after my TT for Palp cancer. Extremely long story short, I had to leave several endo's because I just could not tolerate the levothyroxine crazy pill. I could barely hold it together throughout the day. Very long spouts of anxiety and heart palps etc. etc. With me, it felt like I was a broken engine but the mechanic wanted to fuel me with 500 octane drag car fuel. That may work if my engine wasn't broke, chassis was in order, and transmission wasn't completely fried... Anywho, I had enough. I finally found one who prescribed me Armour Thyroid non-generic which was completely alien to me. It comes in various dosages and works amazingly well. Try several small doses throughout the day and start there. I ended up starting ridiculously small and gradually built up to normal with fully suppressed TSH's and normal labs. I see these posts too often and I wonder why doctors don't try this method of treatment. It's not the best solution and can be a bit demanding in the beginning but it is something to try if all else fails. PM me if you want more info. I totally get what you are going through.


Thanks for your response. Well I think TSH going from 1.46 to 1.17 is hardly bouncing around. as mine in that past has gone from like 0.08 all the way to 40.00! Also as someone without a thyroid I don't really think TSH is as important. Prozac I actually take for chronic dizziness as my nuro said helps to re balance things in the brain that contribute to dizziness. It seems to be helping with my dizziness VERY slightly, But I guess helps a little with the panic attacks and stuff too, I have not noticed any crazy usual side effects yet either. Yes it sounds like you felt similar,

How did you find out you had food allergies? I don't eat gluten either.

So I have dropped my Levoxyl from 88mc to 62mc (half 125mc pill) and increased my T3 to 7.5mc twice daily. I will see how this does. My naturopath doc said I should stick to the synthetics first to try and get my levels optimized before trying to switch to Amour and stuff.


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## gravesguy (Feb 18, 2016)

Jolanta said:


> It might be that you are taking slightly too much Levothyroxine. 10mcg of T3 is a good dose but it is also about how an individual feels.


Yeah I am adjusting down. It has been every month for over a year I have adjusted meds, whether it be Methimazole or now replacement meds. I just wish I could get there and know what I need so I don't have to adjust every month. I hope I don't have to adjust meds like this the rest of my life lol.


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