# Panic Attacks



## Marathon Man

I just came across this article:

http://www.bellaonline.com/articles/art52285.asp

I did not know Hashi's causes panic attacks. My doctor didn't either. he suggested I see a psychiatrist. I thought I'd share with the group as this was news to me. I dailed my syntroid down from 200 to 125 two weeks ago and have been a basket case ever since. At least I'm releaved there is a medical reason.


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## cookfan56

Marathon Man said:


> I just came across this article:
> 
> http://www.bellaonline.com/articles/art52285.asp
> 
> I did not know Hashi's causes panic attacks. My doctor didn't either. he suggested I see a psychiatrist. I thought I'd share with the group as this was news to me. I dailed my syntroid down from 200 to 125 two weeks ago and have been a basket case ever since. At least I'm releaved there is a medical reason.


I am so glad you posted this article but when I thought about it everything made sense. I started having horrible panic attacks/social anxiety in early 2009. I was also diagnosed with hashi's at the same time. Now, before the hashis diagnosis a psychiatrist put me on klonapin. I'm still on it along with other A/D's. Klonapin is a very hard drug to get off of, a very slow wean. Anyway, at this point my thyroid treatment has just been changed to Armour

70 mgs/day, only two weeks ago, after being on 112 synthroid and 5 cytomel since 2009. My labs were all over the place during this whole time. Antibiodies high right now. TSH only at 2.0. But still, even now I am fatigued, depressed, lethargic, low mood, unable to find joy in anything, but I can say that my panic is mostly controlled. So the klonapin does its job. Unfortunately I have to wait a while to see if Armour will help me more than Synthroid did.


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## Octavia

cookfan56 said:


> Unfortunately I have to wait a while to see if Armour will help me more than Synthroid did.


I hope it does!


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## bigfoot

Thanks for sharing that article! Here is a link to another great article by Dr. Hall about anxiety (as well as other info) and how it relates to endocrine disease.

http://www.drrichardhall.com/anxiety.htm

I, too, have experienced anxiety and seemingly panic attacks. Been adjusting my thyroid medication quite a bit lately with the docs. Plenty of anxiety lately, too. Taking a low dose of Wellbutrin XL presently, but switching to Celexa since the Wellbutrin seems to be contributing somewhat to the anxiety.

Lots of angles to all of this stuff!


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## Alicia123

Thank you so much for this post. I have had anxiety, or panic attacks for a little over a year. This is the same time I was diagnosed with thyroiditis. The have NEVER put the two together. I have been wondering about this for quite some time. My tsh and frees are "normal" but I do have antibodies.

Thx for this post. I just took a very deep breath.


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## cookfan56

I know this probably has been asked/answered before, but honestly I'm so damn fatigued/brain dead right now that I don't remember. When my antibodies are high, I am very lethargic, depressed, no energy at all, weepy, etc. That is even with "acceptable" TSH, T3, T4, etc. I've only been switched to Armour for 2 weeks now, and I wait another three weeks to re bloodtest and then see the doc again.

With hashis, can I ever hope to be stable? Seems when my antibodies are high I just feel like crap. And I have lots of responsibilities and can't stand feeling this way anymore.


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## Negative101

If your free t3 and t4 are well within the range, you can generally rule out your thyroid as being the cause of your issues... This is whether your antibodies are high or not. When the active hormone is fine, there's little that can be done apart from looking at other possible factors. Granted, you could be a special case that requires a their free Ts in a small range otherwise you feel like crap.... But I wouldn't put money on that.

Get blood work when u feel like crap... It'll assist not only in finding out the cause, but also ruling out the possibilities. We, being hashi patients, almost always tend to blame our thyroid.... Were still humans, other things are possible.


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## McKenna

Movement of thyroid numbers can cause symptoms too. Lovlkn told me that a year ago and I find it true when my dose is changed.

Also, consider this article:

Hashimoto's Disease Can Affect Quality of Life Even When Thyroid Is Normal
http://thyroid.about.com/b/2011/03/0...yroid.htm?nl=1

New research published in the journal Thyroid has shown that Hashimoto's thyroiditis, an autoimmune disease and the most common cause of hypothyroidism -- an underactive thyroid -- in the U.S., has an effect on quality of life. Specifically, the study found that even when the thyroid levels are "normal," Hashimoto's thyroiditis can increase symptoms and reduce the quality of life.

In the study, researchers reported that among women with the same thyroid-stimulating hormone (TSH) levels, women who had higher levels of antithyroid antibodies had a substantially higher rate of symptoms.

The article concluded that hypothyroidism is only one factor that contributes to symptoms of Hashimoto's thyroiditis.

Charles H. Emerson, MD, Editor-in-Chief of the journal Thyroid, said: "This study raises important clinical issues. Although the authors did not study thyroid hormone treatment for Hashimoto's thyroiditis, it raises the possibility that optimal doses of thyroid hormone will not completely ameliorate all symptoms. Further studies are required to confirm the findings of Ott et al. and to determine if patients with hypothyroidism due to Hashimoto's thyroiditis still have residual symptoms despite achieving an ideal biochemical response to thyroid hormone replacement therapy."

Interestingly, it's been a full 10 years since the March 2001 issue of the same exact journal, Thyroid, published a German study that found that the use of levothyroxine treatment for cases of Hashimoto's autoimmune thyroiditis where TSH had not yet elevated ("euthyroid") beyond normal range could reduce the incidence and degree of autoimmune disease progression. Those researchers concluded that preventative treatment of normal TSH range patients with Hashimoto's disease reduced the various markers of autoimmune thyroiditis, and speculated that that such treatment might even be able to stop the progression of Hashimoto's disease, or perhaps even prevent development of the hypothyroidism.

The bottom line? At some point, we need the medical community to recognize that Hashimoto's -- even when the thyroid levels fall into the so-called "normal" range," can cause symptoms.

Sources:
Ott, Johannes et. Al. "Hashimoto's Thyroiditis Affects Symptom Load and Quality of Life Unrelated to Hypothyroidism: A Prospective Case-Control Study in Women Undergoing Thyroidectomy for Benign Goiter." Thyroid, 2011; 21 (2): 161 DOI: 10.1089/thy.2010.0191

Padberg S, et. al. ."One-year prophylactic treatment of euthyroid Hashimoto's thyroiditis patients with levothyroxine: is there a benefit?" Thyroid. 2001 Mar;11(3):249-55.


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## bigfoot

McKenna said:


> The bottom line? At some point, we need the medical community to recognize that Hashimoto's -- even when the thyroid levels fall into the so-called "normal" range," can cause symptoms.


Good find! That pretty much sums it up in a nutshell.


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## bbdailey

Im glad I came across this post. I definately had severe panic attacks and depression last year which was more than likely the beginning of my hashimotos. Every doctor said it was in my head but if they only could experience what I did for 5 min they would understand. This was not something I could control! My TSH was in range and antibodies werent tested until 7 months later(came up at 200TPO) Glad to see someone is making connections with the thyroid.


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## Gwen1

If Hashimoto's patients are taking thyroid medicine to keep TSH suppressed, and assuming we are "euthroid", would we still be getting symptoms from Hashimoto's? And what would those symptoms be?
The immune system should not be attacking the thyroid if it is suppressed, right?


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## Lovlkn

I speak from my experiences on anti thyroid and thyriod replacement medications and have had anxiety symptoms with the following circumstances.

Quick changes in thyroid hormone levels can cause severe anxiety and are frequent in initial thyroid hormone treatment whether hypo or hyper to begin. Many of us feel anxiety shortly after beginning our thyroid medications which should resolve once our bodies have re-calibrated.

If you are consistently over or under medicated anxiety can appear as well.

I have also found the addition of Cytomel to cause significant anxiety which resolves over time. Caution should be exercised when adding Cytomel to your hormone replacement and should be added in low doses gradually increasing to prescribed dose over a period of a week or 2.


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## bigfoot

Lovlkn said:


> Quick changes in thyroid hormone levels can cause severe anxiety and are frequent in initial thyroid hormone treatment whether hypo or hyper to begin. Many of us feel anxiety shortly after beginning our thyroid medications which should resolve once our bodies have re-calibrated.
> 
> If you are consistently over or under medicated anxiety can appear as well.


I agree with this 110%. Imagine my surprise recently when I was anxious due to being slightly over-medicated and technically "hyper", then dropped my dose down and was still pretty anxious six weeks later, despite leaning towards the "hypo" side of things; TSH went from 0.15 to 2.31 [0.34-4.82]. It's gotta be blamed partly on those pesky rapidly shifting hormone levels. Dr. Hall's research bears this out, too.


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## SimpleSonflower

I am also thankful you posted this because I am going through this right now. I was diagnoised with Hashi's/Hypothyroidism in the late summer and tried dessicated thyroid. I also take 75mg of Zoloft (have for years for panic/depression). Well, about a month into the thyroid meds, I started getting panic attacks, jittery, cold, stomach issues, etc. The doctor had me go off of it to calm down and the beginning of this November, I started with 1/2 grain of dessicated thyroid again. Sure enough, the symptoms are coming back. I had a panic attack this morning and now I'm just exhausted  Thankfully, I've experienced them before so the fear doesn't take too much of a hold. I go in the first week in December for blood work. Not quite sure what to do?????? I feel for all of you that experience this too because it is horrible! Just reading that others have similar experiences does help.


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## bigfoot

Beware that things like SSRI's can have an impact on thyroid levels (especially T4), too. One more thing to balance when adjusting medication.


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## SimpleSonflower

Thanks Bigfoot. Does that mean that my Zoloft could be causing the panic attacks because it increases the effectiveness of the Zoloft OR that the Zoloft could make my T4 elevated?


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## bigfoot

Actually, I think neither of the choices you mentioned. I believe that the SSRI's can interfere with the FT4 levels, lowering them somewhat by interfering with the absorption of thyroid hormone. So by lowering your FT4 you are making your body more hypo; anxiety can come from both hypo or hyper states. Also, the rapid movement of hormone levels can bring this on, too.

Since you are taking Zoloft already, and have been for a while, adding the external thyroid hormone is probably swinging your thyroid hormone levels down relatively quickly, resulting in the increased anxiety and whatnot. At least, that's my guesstimate. Or, perhaps, you don't need the additional T3 that is present in the Armour and would do better on a straight T4 medication (Synthroid, Levoxyl, etc.). It also could be that by properly dealing with your thyroid issue first, you reduce the need for things like Zoloft, et al.

Hard to say without knowing your labs. I tried adding synthetic T3 (Cytomel) to my T4 (Levoxyl) regimen and it didn't really work for me. But last I knew, my FT3 levels were already pretty good.

All I know is I took Celexa for a couple of years, including later when I first started thyroid medication. When I went off the Celexa with my doc's blessings earlier in the year, I suddenly had a lot more energy. When I went to restart it later in the year it all but knocked me out. Dizzy, nausea, anxiety, sick feeling, brain fog, totally spaced out and confused. Tried taking it again recently and same thing. What stumped me is I had taken it for a couple of years, so I expected restarting it to be a relatively smooth process. Instead I have been taking Wellbutrin XL (which, ironically, is also used off-label for inflammation).

There is definitely an interaction between SSRI's and thyroid. Just hard to say how each individual will react. I'm no doctor or pharmacist, and YMMV. However, my endo did acknowledge the SSRI <-> thyroid medication connection.


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## Jya1124

bbdailey said:


> Im glad I came across this post. I definately had severe panic attacks and depression last year which was more than likely the beginning of my hashimotos. Every doctor said it was in my head but if they only could experience what I did for 5 min they would understand. This was not something I could control! My TSH was in range and antibodies werent tested until 7 months later(came up at 200TPO) Glad to see someone is making connections with the thyroid.


When I first started having symptoms of hasitoxicosis it was back in 2008 5 months after I had my daughter. They always told me it was all in my head and that I was just an anxious person in general and the fact that we were military and just had a baby was to blame. At one point I was even hospitalized where they put me on Valium and 2 other meds. It was awful!!!!! One of the worst times of my life. I always knew deep down that something else was to blame. The medication only served as a bandaid and I continued having horrible anxiety for 2 more years until I got pregnant with my son in 2010. I got off of all of the medication, and felt normal. I was happy, not anxious, etc. I was only recently tested for hypothyroidism and hashis at 10 months post partum, and now it all makes sense. They said that when you are pregnant your body goes into protective mode over your baby and so your body stops attacking yourself. Also, pregnancy (post) brings out the thyroid issues and onset of symptoms because of that reason. It made sense that after my first daughter I started having the symptoms. By the time I was finally diagnose my tsh was a 27 normal being (.34-4.82) my tpo was a 309 (normal being below 60). It was only then that thy realized their own mistakes in not checking earlier, it was awful. I'm finally in the "normal" range, and on Klonopin, but still dont feel "normal." I read a couple of books recently that had a lot of information about anxiety and hashis but I was told not to post them here so I can send info if anyone wants the name just pm me. Thank you op for posting the article! Hang in there everyone, this disease is a walk not a race, we all just have to take it day by day.


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## Gwen1

Question!!! Concerning this Hashimoto's discussion: if you have Hashimoto's and you are on full replacement thyroid hormone, will you still experience symptoms of antibodies from Hashimoto's? - being that the thyroid is suppressed from thyroid medicine.
Does anybody know?


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## Jya1124

Gwen1 said:


> Question!!! Concerning this Hashimoto's discussion: if you have Hashimoto's and you are on full replacement thyroid hormone, will you still experience symptoms of antibodies from Hashimoto's? - being that the thyroid is suppressed from thyroid medicine.
> Does anybody know?


Good question! I wonder the same thing. My endo tells me that "it is not necessary to keep checking my tpo levels because my thyroid levels are now within the normal range." I was so angry, I don't understand why they don't think that the tpo levels are important.


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## Gwen1

So Jya, then evidently they have not put you on thyroid medication yet? Are you in the watching and waiting stage?


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## bigfoot

My newbie understanding is yes, you will have the antibodies for life. They don't "go away" and there is no "cure", as with any autoimmune diseases. But they can more-or-less go into remission and/or be controlled with proper treatment.

As far as re-checking thyroid antibodies, I think that's an individual doc's preference. Mine is of the train of thought that since I have them, there's no point in continually testing for them. I suppose in some ways it could be used to monitor how actively your body is attacking your thyroid at any given point in time.


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## shellebean

Hello guys, stepping in on the conversation...so, is it normal to NOT be medicated when you have Hashi's (firm diagnosis w/ FNA) but within normal TSH (2.87)? 
Just feel that there would be some type of med/treatment given for the Hashi/antibody symptoms even with thyroid still functioning.


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## AmyinTheHam

shellebean said:


> Hello guys, stepping in on the conversation...so, is it normal to NOT be medicated when you have Hashi's (firm diagnosis w/ FNA) but within normal TSH (2.87)?
> Just feel that there would be some type of med/treatment given for the Hashi/antibody symptoms even with thyroid still functioning.


I was diagnosed back in 2009 but told thyroid function was fine and to come back in a year. I just went back and while my tests came back in the normal range I had a big drop from 2009 so they put me on meds. I don't know if it is normal, but I was diagnosed and not treated.


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## Andros

shellebean said:


> Hello guys, stepping in on the conversation...so, is it normal to NOT be medicated when you have Hashi's (firm diagnosis w/ FNA) but within normal TSH (2.87)?
> Just feel that there would be some type of med/treatment given for the Hashi/antibody symptoms even with thyroid still functioning.


To be honest, and this is humble opinion only; it would be good to be on thyroxine replacement and keep the TSH suppressed which in turn would keep the antibodies quiet and reduce the risk of cancer.

Maybe a new doc is needed here?


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## shellebean

I have an appointment later today with ANOTHER doctor. We will see what he says. I hate to "doctor hop" but want another opinion. If this one says see ya in 6 months with no meds, I'll back off.


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## Gwen1

A second opinion is always a smart thing to do. I was with the same endo for 16 years and should have "doctor hopped" a long time ago. I am currently
in that process.
What I have heard is some doctors will start you on medication right away and
some like to watch and wait.


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## SimpleSonflower

Gwen1 -
That is a good question. I am going to the doc next week for my next lab and I will ask to get my Tpo done. I will let you know what I find out. My Tpo was 394 last time (normal being below 30) and I have been on the Armour thyroid for about a month now.


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## Gwen1

SimpleSonflower said:


> Gwen1 -
> That is a good question. I am going to the doc next week for my next lab and I will ask to get my Tpo done. I will let you know what I find out. My Tpo was 394 last time (normal being below 30) and I have been on the Armour thyroid for about a month now.


Thank you. I just have been reading posts and hearing alot about the antibodies messing things up. So I have been confused on the issue. I'm assuming they are talking about people who are not on medication yet or still have a partially functioning thyroid and are just supplementing.
So I've been wondering if antibodies could be causing me a problem too, even if though I am on full replacement- 16 years.

Hang in there with the thyroid med. It is a long slow process. And yes, it can cause anxiety as the body gets used to it, but it should be reported to the doctor.


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