Hyperthyroidism or Grave's Disease?

[leclontz]

I am a 23 year old female and I think I could have hyperthyroidism, but I haven't been diagnosed. About three years ago I went from being a relatively normal 5'1" 112lbs. to barely 100lbs. on a good day. My eating has only increased due to my trying to put the weight back on. I developed tachycardia that has seemed to persistently worsen as each year goes by. My resting heart rate is usually never less than 115bpm, and here lately it has been getting up in the 140s to 160s with minimal activity as simple as walking across a room, and it is pretty persistent throughout the day. I don't even think I would be able to tolerate exercise if I attempted it because of my HR. It got up to around 185 the other day and I was just standing up. I have been to the cardiologist in the past and they have done stress test, stress echo, EKG, holter monitor, renal doppler, and they say I just have sinus tachycardia and they don't know the cause. I had my family doctor check me for diabetes, anemia, and my thyroid function to see if we could figure out the cause of my tachycardia, but he just told me all my results were "normal." I don't have copies of any of those labs.
A few months back I was having sudden shortness of breath and tachycardia that wouldn't go away so I went to the ER and that's when I found out by chance I had a thyroid nodule. My BP was high and I was sweating and shaking and they just told me I was having a panic attack, which had never happened to me before. I am not to nervous and anxious usually so this was very surprising to me. A few days later when the shortness of breath hadn't gone away I asked my family Dr. to be referred to an endocrinologist because my list of symptoms is just so long that I barely feel functional anymore. Oh, and my grandmother had hyperthyroidism so that makes me even more suspicious that I might.

Symptoms:
-thyroid nodule, persistent tachycardia and palpitations, weight loss w/increased appetite, high diastolic blood pressure which they put me on Clonidine for, irritable/emotional, extreme mood swings that have become worse lately, fatigue/weakness/exhaustion with little or no activity, family Dr. recently diagnosed me with panic disorder, increasingly forgetful and have a hard time remembering things now, shortness of breath, seems like more hair is coming out than usual when i wash my hair, frequent sudden headaches that go away quickly, very oily skin, jittery.

Of all these symptoms the tachycardia is the worst. It has gotten so bad lately I don't even want to go to work. I also feel like my pulse is very strong and bounding, and I can literally count my pulse w/out palpating it because I can feel it so strongly in my chest at times. I work at the hospital so I keep a good check on my pulse there and hook myself up to the telemetry monitor on occasion. The other day my rhythm almost looked like it was trying to go into atrial fibrillation, which hasn't happened before. It never actually did, but like I said it definitely was close.  I have had the sensation of my heart trembling in my chest lately which is also new for me.  I don't smoke or drink caffeine ever so thats def. not it.  My symptoms seem to be worsening here lately to the point to where I just barely feel like getting out of bed most days.

Doctor put me on 0.1MG Clonidine twice daily to try and suppress my adrenal gland and lower my BP because my adrenal levels/catelcholamines were high on two separate occassions. It has lowered my BP but has not slowed my HR down a bit. W also did the urine test to rule out Pheochromocytoma which can mimic thyroid problems, and he said that my levels were not elevated enough to think I had an adrenal tumor. Plus since my BP is responding to the Clonidine it also makes us think its not a tumor since adrenal tumors aren't suppressed by Clonidine. So pretty much the cardiologist says that my heart is fine, but I have all these symptoms that aren't resolving and only getting worse, so I don't know what else could be wrong w/me besides my thyroid. I had more labs drawn yesterday to recheck my thyroid levels and my catelcholamines, so I will find out next week if anything has changed.

Just wondering what you make of all this and if I could be hyperthyroid or have Grave's disease?
Also, not sure I understand the TSI test results.  Should a normal person have any TSI percentage like I do, or are my results suggestive of Grave's?  And why are my adrenal levels so high if I don't have an adrenal tumor?  Thought maybe a hyperthyroid could be responsible for that.  I keep hearing conflicting answers on this.  Any advice you could give me would be greatly appreciated.  Thanks.

These are my labs from December:

Free T3 (range 2.45-3.61 pg/mL) RESULT: 4.26
Free T4 (range 0.61-1.12 ng/dL) RESULT: 0.96
TSH (range 0.35-5.5 uIU/mL) RESULT: 0.815
TSI (Negative 139) RESULT: 127%
Norepinephrine, Pl (range 0- 399 pg/mL) RESULT: 939
Normetanephrine, Pl (range 18-111 pg/mL) RESULT: 129
Metanephrine, Pl (range 12-60 pg/mL) RESULT: 75

[yankeeRN]

This sounds like how my hyperthyroid Grave's for me)  presented itself. The resting heart rate is what got my attention first--it was 106--I was expecting it to be much lower since I had upped my exercise (was at gym for 2 hrs with aerobics and weights) for a few months so when I got 106 pulse check for resting (I had been sitting watching tv for a bit)--in my opinion it should have 60's max. I was losing weight but I had been trying somewhat--I was starved all the time--I had to eat every 2 hours or I felt famished and got shakey. I was having intermittent palpitations at rest and a few what felt like major thuds (pvcs--I know you know what that is if you work medical on telem--me too by the way)--my pulse also bounded and many times I could count my heart rate from just sitting listening to it without a stethoscope. I developed a hand tremor which I blamed on my morning coffee (denial) so I gave that up. As my hand still trembled , especially with fine motor function in the morning which then  progressed to all day.  In the back of my mind I knew something bigger must be happening as I added up the symptoms. I looked back over time and I had also been sweating at times almost profusely if it was warm (but I though must be perimenopause--I had all the explanations--not). I brushed every symptom aside or had an explanation for it--not good because one day I woke up with a splitting headache --felt like my head would separate from my neck and blow off--but of course it was too late to call in to work and leave them to work sort --so I took some Tylenol and headed in to work at 7 am I made it to 12 noon not sure how because I had felt dizzy, shakey and my heart was ready to jump out of my chest it was pounding so hard--it was 170 per o2 sat----I told my boss I might have a virus and had to leave--I just wanted to go home to my sofa ---I went to ER--good thing--my bp was 197/97 ish heart rate  170--told md it might be my thyroid (which had been lurking in the back of my mind)---fortunate for me the ER md thought I might be right when he checked me out  because he also had Grave's--no more denying--they gave me iv fluids did tests (ekg, chest xray, labs, drug screen--I barely took tyenol--lol, etc) My heart rate and bp came down by themselves surprisingly---they wanted to send me home with a beta blockers--I declined---STUPIDEST thing I ever did in my life--was the worst weekend in my life--awful palpitations I couldn't do a thing except lay on sofa and pray for Monday am to call my md--I could have gone to ER but did not want to return--another stupid thing---that beta blocker was wonderful--it took away the panic attacks (I forgot to say I was having those too)--took away the tremors which had progressed to full body tremors--decreased the palpitations episodes---my memory and thinking still fuzzy--I still couldn't do much in line of activity--could barely walk across room too much activity (seriously I had been kicking butt at gym a few weeks before)  my muscles started to waste--going down stairs my legs would buckle---took 2 hands to lift a gallon of milk --so weak--I was a mess--could not work --took me 5 weeks to feel human again and finally back to work with the antithyroid med in my system and weaning the beta blocker.  For 4 years it was up and down adjustments though most of time I felt ok--I am happy to report it has been almost 5 months and by some miraculous way I have been in remission and not on any antithyroid meds since then...fingers and toes crossed.  So there is hope  for remission.....   I still think for you it sounds like hyperthyroid to me plus adrenals too????  Best wishes for improved health and for your md to get a handle on your diagnosis so he can treat it

[Barb135]

Your symptoms do not sound thyroid related, but to be sure, you should have thyroid tests done... The tests you need are Free T3, Free T4 and TSH...

[Ftffighter]

Hey, I made a post in the high blood pressure area of this site explaining my situation and I feel just like you and its getting worse every day! The shallow but hard breathing is the worst part but I have tachycardia as well. My BP has constantly been at 140/100 being in a "calm" state. One thing that triggers an episode like you had was the cold weather. http://www.medhelp.org/posts/High-Blood-Pressure---Hypertension/High-blood-pressure-and-Panic-attacks/show/2838318#post_13686918 here is my post if someone could please help me!

[JeannieLynn]

I was having the same type of symptoms and was hospitalized in October.  I was taking up to .5mg of clonidine a day.  I cut way back and feel much better.  I believe clonidine messes up tests for catecholamines and Pheochromocytoma so you can't be on it when having these tests done.  Recently, a friend told be her daughter had thyroid swings(up and down) for more than a year before it finally was diagnosed.  She had mood swings, panic attacks, etc.  If you really have a nodule on your thyroid, you must find out what that is right away. You may have bigger problems than hyperthyroid.  I believe a negative urine test doesn't really mean much.(My endocrinologists opinion)
Don't discount stress as a major factor.

[DLA]

Any time there is anything on the thyroid. . .nodule, goiter. . . it can give you all the symptoms of being hyper or hypo with your levels still in the normal range.  You need to have the nodule checked and see what is really going on with it and I mean soon.  If you work in the medical field then you already know the damage it is doing to your heart and your body.  I would run as fast as I can to the nearest thyroid specialist and MAKE them find out what is going on NOW!!

Good luck and keep us posted.

[stella5349]

All your comments on how you feel totally mock Hyper T - but your tests are good (T3 a little high) you seems very knowledgable and your doctor is looking at alot of issues. What do they say?