Hashitoxicosis and mental health

[felix1234]

Just wondering if anyone had any experience of hashitoxicosis? What symptoms did you experience and how long did it last? I have Hashimotos and am seeing a psychiatrist soon about various mental health issues, a diagnosis of bipolar has been mentioned but am worried it could acutally be hashitoxicosis that is making me feel "up" for periods of time? Thank you for your help and thoughts.

[greygoose]

Bipolar is more likely to be a symptom of hypothyroidism. Are you optimally medicated? Is your FT3 in a good place?

[felix1234 in reply to greygoose]

Hello greygoose, thank you for your reply, my last results were TSH 2.32, T4 146, FT4 25.6, FT3 4.12 so I would expect to be a bit hypothyroid at that? I take 115 of levothyroxine daily. I have experienced rising and falling in mood for a long time so could be a psychiatric issue as well as my hashimotos but began to wonder about hashitoxicosis recently.

[SlowDragon Administrator in reply to felix1234]

Can you add the ranges on these results. The figures in brackets after each result

Also very important to regularly test vitamin D, folate, ferritin and B12

Add results and ranges if you have them

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

[greygoose in reply to felix1234]

I'm afraid we really need the anges for those results, because ranges vary from lab to lab. But, I can say that your TSH is too high - should be 1 or under. Your FT4 does look rather high, so my guess is that you're not converting well at all. And, it's low T3 that is responsible for symptoms like mood change. The addition of T3 to your levo would probably make all the difference.

Those results do not suggest hashitoxicosis.

[liekki]

I have gone through a couple bouts of overt hashitoxicosis. Last one in October.

There were typically one day with a shakey feeling and mild anxiety, a wired feeling If you will. It would start some time before noon, probably when my ft4 peaked after morning meds, and dissipated before evening. This overt phase was preceded and followed by a couple of nights of bad sleep and perhaps some minor anxiety.

For about two weeks afterwards I would feel good, normal, compared to my hypothyroid self. First days would be best as my energy slowly waned during this period.

I would get these good periods occasionally without the shakes, though.

These were typically the only times I felt good for a while when I was on T4 only, these and after dose hikes, up until 125 mcg, after which they did nothing for me.

I also considered some mild bipolar issue for these short bursts of normality between months of apathy, but I didn't feel my energetic phase was nowhere near mania, not even hypomania.

[Lora7again]

I think your TSH should be 1 or lower and you are undermedicated. Don't let your Doctor push you down the mental health route when it is because you need more Levothyroxine. My Endocrinologist offered me counseling when I had a TSH of 9 and felt very ill. I then walked out of his clinic never to return. My GP has actually also done the same and actually booked me an appointment with a counselor which I cancelled. Just imagine what we would have talked about ... my hair is falling out by the hundreds, my nails are lifting off their nail beds, I have blurred vision, my skin is very dry and I cannot be bothered to get out of bed or shower or get dressed. Yes Mr Counselor I am depressed because I feel so ill. I have also had delusional written on my medical records because I had untreated Graves' disease for over 2 years. I have heard the same story time and time again on various support forums in the US and here. Thyroid patients are not being treated properly or taken seriously by a lot of Doctors unfortunately. I now don't see my GP about my Graves' disease because I won't get any help. Last year I was admitted to hospital with a thyroid storm and was advised to see my GP afterwards. What a waste of time that was instead of a full thyroid function blood test all I got was TSH and N/A (No Action) was written by the side of it. I know my thyroid is under attack because my antibodies are 4000 and I have a multi-nodular goitre but the NHS do not think that is important. Sorry if I have rambled on but I still feel angry about it 12 years after I first started to feel ill. You can read my story on my profile page. Unfortunately I am not the only one who has been let down by doctors and the NHS and this is why this site exists.

[SlowDragon Administrator]

Links about Mental issues including Bi-polar and Hashimoto's

drknews.com/when-hashimotos...

holtorfmed.com/mental-illne...

thyroidpharmacist.com/artic...

drknews.com/when-hashimotos...

hypothyroidmom.com/miss-dia...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

[Hidden]

Hi there, I had anxiety, agitation and confusion when I was first unwell with thyrotoxicosis and get similar symptoms of on too much T3 or over medicated on Levothyroxine. Psychiatry was actually a big help. The psychiatrist I was referred to was very knowledgeable about thyroid problems (they use t3 to test severe depression). He insisted that endocrinology took charge after they had declined an initial referral. He was my best advocate for getting specialist thyroid help. He didn’t push for me to take long term mental health meds. So you might be lucky and get good support from psychiatry if you explain you think your symptoms are related to your thyroid problems.

Good luck and hope your symptoms improve soon.

Michael

[Hillwoman]

Oh, the symptoms are miserable. For many, many years, I didn't really know what was behind my own behaviour. I was anxious, nervous, shaky, had palps and arrhythmias, plus verbal diarrhoea - very off-putting! That's just a summary.

The times when I became hypo, I went to the opposite extreme, though really I was profoundly fatigued all the time. In both active Hashi phases and the hypo ones I was 'tired and wired': either too much thyroid hormone, or too much adrenalin to keep me going when hypo.

I've since discovered that people I knew back then thought I was bipolar, because to them I often seemed "elated". So please make sure the psych you see knows, or is prepared to learn about, the mental effects of Hashi hyper and hypo phases.

I lost a lot of friends, and then-new acquaintances have avoided me ever since. I've realised that perhaps such people are no great loss.

One thing to think about is whether any past traumas may be contributing to your current mental health issues. I was dealing with a lot of trauma when I became ill, and it took me a long time, and a lot of reading, to understand that persistent theories of somatisation are not, and have never been, proven fact. Once I understood this, I found it easier to tease out the various influences on my mental and physical health.

[Babette]

I had anxiety, agitation, and a pounding heart, but also had the awareness that it wasn't the usual me. A slight increase in work stress had me sitting in tears. A couple of weeks on a reduced level of T3 (from 40 mcg to 20 mcg) and I was fine again.

[felix1234]

Hello everyone, thank you very much for answering my question. I'm just back from the psychiatrist and have been diagnosed with bipolar 2, still a bit unsure as to whether it could be my thyroid or if i have both so going to some more reading before I decide what to do.

[Lora7again in reply to felix1234]

What type of symptoms do you have for that diagnosis? The reason I ask is because when I had untreated graves I became paranoid and actually felt like my family were plotting against me. I also thought I was being stalked on the internet but that is another story that actually was true. My family became increasing worried about my mental health not knowing I had a suppressed TSH and very high T4 and T3. Once I was treated these symptoms disappeared but I do have "delusional" written on my medical notes because of the way I was acting. I personally would do further investigations because your thyroid can affect your brain and thinking.