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How long does a "hyper" episode take to resolve?
Hi,
I'm new to this forum so the answer to this may be somewhere here. If so, please let me know.
I've been taking Synthroid for about 30 years, at gradually decreasing dosages, for Hashimotos, but recently found myself between dosages -- the .112 that I'm on is too high, but .100, that I tried a few months ago, was too low.
So just last week we tried alternating dosages, one dose one day, another the next, and after 1 week my body went completely nuts. I ended up going to the ER over the weekend because of stomach cramping, heart racing, palpitations, dizzy, trembling, waves of cold sweats, paranoia and obessive thoughts. So I went back to my .112 just to try to stabilize before making any more changes.
Now I'm wondering how long it might take for me to get back to where I was before I started this -- weeks? Or can something like this cause a permanent change?
After 3 days I'm still doing pretty badly (yesterday was better, today is worse) and at night is terrible -- last night I was up every hour and drenched in sweat.
Thanks!
I'm new to this forum so the answer to this may be somewhere here. If so, please let me know.
I've been taking Synthroid for about 30 years, at gradually decreasing dosages, for Hashimotos, but recently found myself between dosages -- the .112 that I'm on is too high, but .100, that I tried a few months ago, was too low.
So just last week we tried alternating dosages, one dose one day, another the next, and after 1 week my body went completely nuts. I ended up going to the ER over the weekend because of stomach cramping, heart racing, palpitations, dizzy, trembling, waves of cold sweats, paranoia and obessive thoughts. So I went back to my .112 just to try to stabilize before making any more changes.
Now I'm wondering how long it might take for me to get back to where I was before I started this -- weeks? Or can something like this cause a permanent change?
After 3 days I'm still doing pretty badly (yesterday was better, today is worse) and at night is terrible -- last night I was up every hour and drenched in sweat.
Thanks!
Your RT3 is high, especially in light of the fact that your FT3 is low. What's important is the ratio of FT3 to RT3, not the raw numbers. So, if your FT3 is high, it's okay for your RT3 to be high, too, etc. The formula is FT3 / RT3 * 100 (2.3 / 329 * 100 = 0.7). This number should be between 1 and 2 (roughly), but preferably closer to 2. So, your numbers indicate RT3 dominance.
Check out this link, which gives a really good explanation:
http://www.custommedicine.com.au/blog/2007/04/17/reverse-t3-dominance/
Our bodies convert T4 to both T3 and RT3. T3 is active, but RT3 is a mirror image of T3. It's inactive, but can dock at T3 receptors in cells (upside down) and block T3 from getting in. Oddly enough, somethimes this can become a vicious cycle as the more RT3 builds up in the cells, the more RT3 is converted from T4.
This is a controversial subject as many doctors "don't believe in" FT3 dominance. The treatment is T3-only meds for a short period of time (6-8 weeks approximately). This, in effect, "shuts down" conversion. Since RT3 only comes from conversion, the RT3 in the cells is cleared out, restoring the balance of FT3/RT3. T4 meds are then reintroduced, either alone or with T3.
It sounds like you're feeling much better, so I'd be reluctant, as I'm sure you are, to rock the boat. I think repeating the tests is an excellent idea.
Check out this link, which gives a really good explanation:
http://www.custommedicine.com.au/blog/2007/04/17/reverse-t3-dominance/
Our bodies convert T4 to both T3 and RT3. T3 is active, but RT3 is a mirror image of T3. It's inactive, but can dock at T3 receptors in cells (upside down) and block T3 from getting in. Oddly enough, somethimes this can become a vicious cycle as the more RT3 builds up in the cells, the more RT3 is converted from T4.
This is a controversial subject as many doctors "don't believe in" FT3 dominance. The treatment is T3-only meds for a short period of time (6-8 weeks approximately). This, in effect, "shuts down" conversion. Since RT3 only comes from conversion, the RT3 in the cells is cleared out, restoring the balance of FT3/RT3. T4 meds are then reintroduced, either alone or with T3.
It sounds like you're feeling much better, so I'd be reluctant, as I'm sure you are, to rock the boat. I think repeating the tests is an excellent idea.
Well I got some test results back and one of them was that reverse T3 was apparently high --
Triiodothyronine, Reverse 329 (90-350 pg/mL)
That test was done a few days before the other thyroid tests above.
Other tests showed that I was very mildly deficient in Oleic Acid, Lipoic Acid, Vit A, Zinc and Magnesium. And a urine test looking at neurotransmitters showed I was low in Serotonin but elevated in GABA and Dopamine. Estradiol was low, but not extremely.
So I'm going to start on 5-HTP or L-Tryptophan first. He wrote me a prescription for Cytomel that I can use if I decide to.
Recently, just in the past few weeks, I've had a huge improvement in my muscles not being stiff or weak or cramping or any of the many problems I've had -- feeling almost completely normal for the first time in a year! At the same time, starting to sleep through the night. But why? The only thing I did was raise the Synthroid dosage a tiny tiny bit, and raised the methyl B12 a tiny tiny bit. Could the rT3 have gone down? Why is it so high in the first place? I had also experimented with removing dairy and wheat from my diet, but without wheat I got hyper after just 2 days, so went back to it.
It's all a mystery.
Any thoughts on rT3 would be helpful. I'm going to do the same thyroid tests in a few weeks again to see where these levels are moving.
Triiodothyronine, Reverse 329 (90-350 pg/mL)
That test was done a few days before the other thyroid tests above.
Other tests showed that I was very mildly deficient in Oleic Acid, Lipoic Acid, Vit A, Zinc and Magnesium. And a urine test looking at neurotransmitters showed I was low in Serotonin but elevated in GABA and Dopamine. Estradiol was low, but not extremely.
So I'm going to start on 5-HTP or L-Tryptophan first. He wrote me a prescription for Cytomel that I can use if I decide to.
Recently, just in the past few weeks, I've had a huge improvement in my muscles not being stiff or weak or cramping or any of the many problems I've had -- feeling almost completely normal for the first time in a year! At the same time, starting to sleep through the night. But why? The only thing I did was raise the Synthroid dosage a tiny tiny bit, and raised the methyl B12 a tiny tiny bit. Could the rT3 have gone down? Why is it so high in the first place? I had also experimented with removing dairy and wheat from my diet, but without wheat I got hyper after just 2 days, so went back to it.
It's all a mystery.
Any thoughts on rT3 would be helpful. I'm going to do the same thyroid tests in a few weeks again to see where these levels are moving.
Thanks!
I'm heading out to my next appt with the new doctor now.
I've actually been doing a LOT better lately in terms of many of my more dire symptoms going away (muscle pains, cramps, and burning, headaches, hyper feelings, waking up at night, etc) and the only thing I've changed is going from 94 mcg Synthroid to approximately 96 mcg, which seems crazy. I feel much more myself, but still hypo -- really lose energy half way through the day, need 2 coffees now instead of 1, etc.
I do already get a lot of energy out of my morning Synthroid dose when I take it but that wears off, so maybe it would make sense to take T3 once in the afternoon?
In any case, I would like to do the 98% T4 and 2% T3 ratio suggested by Dr. Ken Blanchard. I guess I'll need to do the numbers . . .
Thanks for the specifics and the support!
I'm heading out to my next appt with the new doctor now.
I've actually been doing a LOT better lately in terms of many of my more dire symptoms going away (muscle pains, cramps, and burning, headaches, hyper feelings, waking up at night, etc) and the only thing I've changed is going from 94 mcg Synthroid to approximately 96 mcg, which seems crazy. I feel much more myself, but still hypo -- really lose energy half way through the day, need 2 coffees now instead of 1, etc.
I do already get a lot of energy out of my morning Synthroid dose when I take it but that wears off, so maybe it would make sense to take T3 once in the afternoon?
In any case, I would like to do the 98% T4 and 2% T3 ratio suggested by Dr. Ken Blanchard. I guess I'll need to do the numbers . . .
Thanks for the specifics and the support!
To me, your FT4 looks like it's a bit high (upper quarter of range where midrange is recommended), which is probably why you start feeling hyper the minute you increase your Synthroid even very slightly.
On the other had, your FT3 is very low (way down into the bottom quarter of the range where upper half to upper third is recommended). This is most likely why you feel hypo the minute you decrease your Synthroid. You are a slow converter.
I think your new doctor has hit the nail on the head. You need some T3. Of course, you will have to decrease Synthroid to compensate for the addition of T3. T3 is the active form of the thyroid hormones. Your body cannot use T4 at all...it has to convert it to T3 before your cells can use it. It's always nerve-wracking to add a new element, but keep in mind that T3 is very fast-acting (it's out of your bloodstream in a few hours if not used promptly), so if it affects you negatively, you can always d/c it, and it's effects will be gone in a short time, unlike T4 meds. I think getting your FT3/FT4 balance in line will make you feel much better and get you off the hypo/hyper rollercoaster you've been on.
When adding the T3, you will want to decrease T4 simultaneously. Since it takes a while for FT4 levels to adjust after adjusting Synthroid, you will want to add the T3 in slowly so that your FT4 levels go down as your FT3 levels come up. It's often best to split T3 dose in half and take half with Synthroid in the morning and the other half later in the day when the first half has "worn off" so that it stays more level throughout the day.
I'd follow your doctor's advice and give it a try...if it doesn't go well, you can always stop taking it, but my bet is that it will make a world of positive difference for you.
On the other had, your FT3 is very low (way down into the bottom quarter of the range where upper half to upper third is recommended). This is most likely why you feel hypo the minute you decrease your Synthroid. You are a slow converter.
I think your new doctor has hit the nail on the head. You need some T3. Of course, you will have to decrease Synthroid to compensate for the addition of T3. T3 is the active form of the thyroid hormones. Your body cannot use T4 at all...it has to convert it to T3 before your cells can use it. It's always nerve-wracking to add a new element, but keep in mind that T3 is very fast-acting (it's out of your bloodstream in a few hours if not used promptly), so if it affects you negatively, you can always d/c it, and it's effects will be gone in a short time, unlike T4 meds. I think getting your FT3/FT4 balance in line will make you feel much better and get you off the hypo/hyper rollercoaster you've been on.
When adding the T3, you will want to decrease T4 simultaneously. Since it takes a while for FT4 levels to adjust after adjusting Synthroid, you will want to add the T3 in slowly so that your FT4 levels go down as your FT3 levels come up. It's often best to split T3 dose in half and take half with Synthroid in the morning and the other half later in the day when the first half has "worn off" so that it stays more level throughout the day.
I'd follow your doctor's advice and give it a try...if it doesn't go well, you can always stop taking it, but my bet is that it will make a world of positive difference for you.
Sorry to be delayed in posting the reference ranges:
TSH -- 4.73 (.450-4.5 uIU/mL)
T4 -- 8.6 ug/dL (4.5-12 ug/dL)
T3, free, serum -- 2.3 pg/mL (2.0-4.4 pg/mL)
T4, free (Direct) -- 1.56 ng/dL (.82-1.77 ng/dL)
TSH -- 4.73 (.450-4.5 uIU/mL)
T4 -- 8.6 ug/dL (4.5-12 ug/dL)
T3, free, serum -- 2.3 pg/mL (2.0-4.4 pg/mL)
T4, free (Direct) -- 1.56 ng/dL (.82-1.77 ng/dL)
What are the ranges on your FT3 and FT4? Reference ranges for these are lab specific and have to come from your own lab report. Will comment further after seeing those.
I'm still in this situation, and still messing around with things, new symptoms, etc., but am more consistent then before.
I finally had to go get my own labs done because my endo refuses to consider T3. And I started paying out of pocket to see a doctor at a clinic who focuses on hormones and whole body. I've only had one visit so we've mostly just ordered a bunch of tests.
I was obviously hypo on 88mcg of Synthroid, then managed to move up to 94mcg by cutting an 88 and a 100 and putting each half together for my dose. But after awhile I was hypo on that -- continuous muscle problems escalating into painful spasms, headaches, waking up at 5 am every morning with panic, etc.
So I tried to move up to 100 mcg but got hyper, couldn't do it.
Now we've figured out how to shave the pill very carefully to get a ridiculously specific dose (96 mcg) to keep me out of the extreme hypo symptoms while not going hyper all the time, however, the hyper is creeping in again. I'm trying to just deal with it.
So this TSH is only about 2 weeks into moving from 100mcg to 96mcg, so probably is still just in flux.
TSH -- 4.73
T4 -- 8.6 ug/dL
T3, free, serum -- 2.3 pg/mL
T4, free (Direct) -- 1.56 ng/dL
Looking at this it seems like T3 is on the low end, but I don't know much about T3. My new doctor had suggested adding Cytomel (T3) (before seeing these results), and although I want to, I'm also nervous about it. I never gain weight (about 114 lbs, 46 yrs, female) and already have a high metabolism in that I need to eat often, get shakey if I don't, need a lot of protein, etc. And my understanding of Cytomel is that it is used to boost metabolism and (wrongly) to lose weight.
So I am worried about it. I've gone through so much it's hard to make any change, and still having bouts of hyper, I get very fearful of taking anything stimulatory at all.
We're doing a bunch of other tests and he thinks I may be estrogen deficient.
Anyway, that's my latest.
I am still having occasional episodes of hyper.
I finally had to go get my own labs done because my endo refuses to consider T3. And I started paying out of pocket to see a doctor at a clinic who focuses on hormones and whole body. I've only had one visit so we've mostly just ordered a bunch of tests.
I was obviously hypo on 88mcg of Synthroid, then managed to move up to 94mcg by cutting an 88 and a 100 and putting each half together for my dose. But after awhile I was hypo on that -- continuous muscle problems escalating into painful spasms, headaches, waking up at 5 am every morning with panic, etc.
So I tried to move up to 100 mcg but got hyper, couldn't do it.
Now we've figured out how to shave the pill very carefully to get a ridiculously specific dose (96 mcg) to keep me out of the extreme hypo symptoms while not going hyper all the time, however, the hyper is creeping in again. I'm trying to just deal with it.
So this TSH is only about 2 weeks into moving from 100mcg to 96mcg, so probably is still just in flux.
TSH -- 4.73
T4 -- 8.6 ug/dL
T3, free, serum -- 2.3 pg/mL
T4, free (Direct) -- 1.56 ng/dL
Looking at this it seems like T3 is on the low end, but I don't know much about T3. My new doctor had suggested adding Cytomel (T3) (before seeing these results), and although I want to, I'm also nervous about it. I never gain weight (about 114 lbs, 46 yrs, female) and already have a high metabolism in that I need to eat often, get shakey if I don't, need a lot of protein, etc. And my understanding of Cytomel is that it is used to boost metabolism and (wrongly) to lose weight.
So I am worried about it. I've gone through so much it's hard to make any change, and still having bouts of hyper, I get very fearful of taking anything stimulatory at all.
We're doing a bunch of other tests and he thinks I may be estrogen deficient.
Anyway, that's my latest.
I am still having occasional episodes of hyper.
It sounds to me - you should look into getting the Free T3 test - along with the TSH and FT4.
You may find your Free T3 is too low and that can cause many issues.
Your TSH is just hovering the borderline of still being hypothyroid. I could never function with that being so high.
You may find your Free T3 is too low and that can cause many issues.
Your TSH is just hovering the borderline of still being hypothyroid. I could never function with that being so high.
Ferritin levels can change very quickly. Even over a few days. Mine drop horrendously when I forget or run out of my supplement. I can even faint after two days! Ferritin is important for many bodily functions.
If you have a lump and trouble swallowing then yes, it is time to ditch the old and get to the new. Thyroids are not a trivial game to play with, and your last endo is being irresponsible.
Good luck!
If you have a lump and trouble swallowing then yes, it is time to ditch the old and get to the new. Thyroids are not a trivial game to play with, and your last endo is being irresponsible.
Good luck!
Now I'm having trouble swallowing and I think I can feel a lump on the left side of the front of my neck. I've called the endocrinology dept and will try to get in asap. I'm dumping my last endo who claimed that none of this sounded like thyroid.
Also just found out my ferritin is lower than it was in Dec . . .
It was 29 ng/mL in Dec and now is 21 ng/mL
I did change my diet in Dec to have much less red meat because my cholesterol was high. That did normalize cholesterol, but now .. . maybe made ferritin worse. Still, that's a huge relative drop. Anyone know how much ferritin can change over time? I've read that it's important for thyroid function.
Thanks.
It was 29 ng/mL in Dec and now is 21 ng/mL
I did change my diet in Dec to have much less red meat because my cholesterol was high. That did normalize cholesterol, but now .. . maybe made ferritin worse. Still, that's a huge relative drop. Anyone know how much ferritin can change over time? I've read that it's important for thyroid function.
Thanks.
Thanks so much for stopping by with your update. I have the Vit D thing going on, too, and it can really make you feel miserable when the levels are very low.
C~
C~
Hi,
Well, it's two months later and now I am on short term disability, having used up all my sick time and being unable to work for several weeks now. Things worsened a lot before I discovered I had a D deficiency, and I already knew I had a B-12 deficiency which had stabilized before I started the dosage change of the Synthroid.
I got to the point where I couldn't even walk. It was awful.
Now I can walk but I get a lot of muscle weakness and pains. Since starting on Vitamin D it *seems* like I have fewer palpitations, but that's not consistent.
I still have a lot of hyper symptoms -- high heart rate, palpitations, sweating, anxiety, tremor -- mostly at night and in the mornings, but sometimes most of the day. I've had a couple of HYPO episodes, where I suddenly slow down a LOT and get depressed and it's like being "frozen" in a way. Those typically have only lasted a few hours or a day, but not ongoing.
I wake up at night about every 2 hours. My endo wanted me to do the ACTH stimulation test but it was hard to imagine getting injected to "see how much my adrenals could put out" while being so hyper, so I've put it off so far. Instead, I did a morning cortisol test, which came back just at the borderline between unclear and confirming that I do NOT have adrenal insufficiency (19.6 ug/dL, with a range of 3.1-22.4). So I may get the stim test . . .
My endocrinologist insisted he doesn't think this is thyroid, so I've been doing tests for everything else and they've come up negative. So now I'm going to try a new endo at the suggestion of my primary doctor.
My levels, at about 1 month after lowering my dosage from .112 to .100 are:
TSH (range .1 - 5.5) = 3.06 IU/mL
Free T4 (analog) (range .8-17) = 1.6 ng/dL
But the last time I lowered my dosage to .100, within two months my TSH was too high (over 6) and my T4 was 1.6ng/dL, so we increased it again to .112. During that time I missed some dosages because of dealing with the start-up symptoms of B-12, so that may explain the high TSH, we don't know.
Now it's been about 1 more month since that reading and I will get my levels checked again early next week, although this endo only ordered TSH, not Free T4.
Anyway, I've found the writings of Jim Lowe to be helpful, over on Bella Online (http://www.bellaonline.com/articles/art54966.asp).
I don't know if it's Hashitoxicosis or something else though, so I'm headed toward finding a new endo soon.
Thanks, any thoughts or experience are helpful.
Well, it's two months later and now I am on short term disability, having used up all my sick time and being unable to work for several weeks now. Things worsened a lot before I discovered I had a D deficiency, and I already knew I had a B-12 deficiency which had stabilized before I started the dosage change of the Synthroid.
I got to the point where I couldn't even walk. It was awful.
Now I can walk but I get a lot of muscle weakness and pains. Since starting on Vitamin D it *seems* like I have fewer palpitations, but that's not consistent.
I still have a lot of hyper symptoms -- high heart rate, palpitations, sweating, anxiety, tremor -- mostly at night and in the mornings, but sometimes most of the day. I've had a couple of HYPO episodes, where I suddenly slow down a LOT and get depressed and it's like being "frozen" in a way. Those typically have only lasted a few hours or a day, but not ongoing.
I wake up at night about every 2 hours. My endo wanted me to do the ACTH stimulation test but it was hard to imagine getting injected to "see how much my adrenals could put out" while being so hyper, so I've put it off so far. Instead, I did a morning cortisol test, which came back just at the borderline between unclear and confirming that I do NOT have adrenal insufficiency (19.6 ug/dL, with a range of 3.1-22.4). So I may get the stim test . . .
My endocrinologist insisted he doesn't think this is thyroid, so I've been doing tests for everything else and they've come up negative. So now I'm going to try a new endo at the suggestion of my primary doctor.
My levels, at about 1 month after lowering my dosage from .112 to .100 are:
TSH (range .1 - 5.5) = 3.06 IU/mL
Free T4 (analog) (range .8-17) = 1.6 ng/dL
But the last time I lowered my dosage to .100, within two months my TSH was too high (over 6) and my T4 was 1.6ng/dL, so we increased it again to .112. During that time I missed some dosages because of dealing with the start-up symptoms of B-12, so that may explain the high TSH, we don't know.
Now it's been about 1 more month since that reading and I will get my levels checked again early next week, although this endo only ordered TSH, not Free T4.
Anyway, I've found the writings of Jim Lowe to be helpful, over on Bella Online (http://www.bellaonline.com/articles/art54966.asp).
I don't know if it's Hashitoxicosis or something else though, so I'm headed toward finding a new endo soon.
Thanks, any thoughts or experience are helpful.
Its been 8 months since I had RAI and 5 months since keyhole Thyroidectomy.
My levels are 99% normal (where I would like them) but it has been hard work...I wont lie.
Hormones change in your body over the years, age cxhanges a lot of things too but most of all...as we get older we suffer with vitamin deficiencies we never dreamed of.
I was like you ...hyper to hyper to hypo.
Then I had a vitmain deficiency test done.
It was found I was dificient in Calcium, Vit. D, and B12.
I now take these daily....and since then my levels are normalising.
They are suddenly becoming stable and have been stable for a few months now.
I have also started taking 1 cranberry Capsule per day as I always suffered with urinary tract infections.
I havent had ONE since being on the cranberry capsules.
I find I dont eat as much as I used too amd stick to all healthy stuff like fruit, vegies, meat etc (yes I have the accasional binge) but I am doing great now.
Get your vitamin levels checked.
So many blame the thyroid for everything when it is in fact a deficiency of something else.
All the best
My levels are 99% normal (where I would like them) but it has been hard work...I wont lie.
Hormones change in your body over the years, age cxhanges a lot of things too but most of all...as we get older we suffer with vitamin deficiencies we never dreamed of.
I was like you ...hyper to hyper to hypo.
Then I had a vitmain deficiency test done.
It was found I was dificient in Calcium, Vit. D, and B12.
I now take these daily....and since then my levels are normalising.
They are suddenly becoming stable and have been stable for a few months now.
I have also started taking 1 cranberry Capsule per day as I always suffered with urinary tract infections.
I havent had ONE since being on the cranberry capsules.
I find I dont eat as much as I used too amd stick to all healthy stuff like fruit, vegies, meat etc (yes I have the accasional binge) but I am doing great now.
Get your vitamin levels checked.
So many blame the thyroid for everything when it is in fact a deficiency of something else.
All the best
Having experienced thyroiditis/ hyperthyroid and then later being artificially hyper because of meds, I can certainly identify with what you're feeling...do you know what your TSH and Frees are right now? Also, you may consider talking to your Dr about low dose Inderal for a month or two (I was on 10 mg twice a day which was enough to slow the heart rate and keep the blood pressure down while the hyper settled...-Within 3 days I felt SO MUCH BETTER!) If you do take it, you will need to taper it off when it is time for you to get off of it...Good luck..~MM
Your Synthroid is slow at converting to T3 - so depending on how you convert everything that is how long it will take you to go back.
Normal time frame on new dosages and testing is usually 6 to 8 weeks ( if not stable on meds) So I may assume you could have a bit of an episode for a few weeks?
Normal time frame on new dosages and testing is usually 6 to 8 weeks ( if not stable on meds) So I may assume you could have a bit of an episode for a few weeks?
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