From hypothyroid to hyperthyroid. Is it possible?

[Bari77]

Hi everyone,

I have been hypothyroid and on Levothyroxine for 18 years. I have been taking 100 mcg for quite a long time.

4 weeks ago I started having palpitations (my pulse went over 100 beats per minute), muscle twitches, I am losing weight and muscle mass, I have been anxious, not sleeping well, hair loss.

My NHS blood test on 15.7.2020 was:

TSH 0.29 (0.35-4.78), FT4 22.6 (10-20) No FT3 tested

I lowered my meds to 50 mcg, however my symptoms persisted

Last Tuesday 21.7., I had an episode, where my heart was racing, I was dizzy, shaky, blurred vision and nearly fainted. I felt so rough! I was taken to A&E. ECG was fine. My blood test from that day was:

TSH 0.05, FT4 20.5 No FT3

I was advised to lower meds to 25 mcg. I have not taken them for 3 days and feel much better. Heart calmed down, no palpitations, I feel stronger, less muscle fatigue, although still get muscle twitches here and there. I took 25 mcg this morning and so far feel fine, although noticed slight palpitations and more muscle twitching.

I have no idea what is going on at the moment and why is this happening.

Few other things to point out:

5 weeks ago I changed from 100 mcg North Star to Mercury Pharma but changed back to North Star after 2 weeks due to my symptoms developing.

I had negative test for Hashimoto's antibodies a month ago from Thriva, FT3 was 3.62 (3.1-6.8)

I am having a full thyroid NHS blood test next week including FT3 and antibodies TPOAb and TGAb. Apparently only endocrinologist can order TSAb and TBAb.

I am seeing an NHS endocrinologist on 21 August - anything I need to know and ask to be prepared for the appointment?

Any insight into this and advice would be much appreciated.

Thank you.

[SlowDragon Administrator]

Ask GP to test vitamin D, folate, ferritin and B12 now

Low vitamin levels are extremely common and can cause poor conversion of Ft4 to Ft3....leading to high Ft4 and low TSH

Plus thyroid ultrasound scan can be helpful

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[Bari77 in reply to SlowDragon]

Thank you for your response.

I had my vitamins tested via Thriva on 20 June.

D 88 (50-175)

B12 88.9 (>37.5)

Folate 25.60 (8.83 - 60.8)

[SlowDragon Administrator in reply to Bari77]

No ferritin result?

Folate slightly low, otherwise ok

[Bari77 in reply to SlowDragon]

Thanks!

Ferritin 139 (13-150)

[SlowDragon Administrator in reply to Bari77]

So that’s fine too

[greygoose]

Your FT3 is very low, you obviously don't convert very well. So, although you were slightly over-medicated on levo, you didn't have enough T3 to make you well - it's low T3 that causes symptoms. And, if you lower your levo, your FT3 is going to drop even further. It's probably below range by now.

[Bari77 in reply to greygoose]

Would heart palpitations, muscle aches and twitches and weightloss be due to low t3? These are more symptoms of hyperthyroid aren't they? I will find my ft3 level when I have blood test next week.

[greygoose in reply to Bari77]

Palpitations and muscle aches could certainly be due to low T3, yes. Twitches and weightloss possible. But, it's highly unlikely that your FT3 has suddenly gone from that very low level to a hyper-like level, unless you have Hashi's. And, in answer to your original question, no, it is impossible for an under-active thyroid to suddenly become over-active. The thyroid cannot regenerate - certainly not to that extent.

[Bari77 in reply to greygoose]

Thank you. I will post my blood test results once I have them. Hopefully they will answer some questions and point me to the direction on how to get better.

[greygoose in reply to Bari77]

You're welcome.

[Lynne_L]

Maybe an issue with cortisol?

But certainly that T3 is too low.

[Bari77 in reply to Lynne_L]

Cortisol and adrenals may well be the problem. I may do the cortisol test to find out.

[catrich]

It is rare - very rare, even - for a patient to swing between being hyper- and hypo- and back again. But it is not, according to the literature, impossible. Not suggesting that this is happening in your case - your endocrinologist will hopefully be able to shed some light on what may be going on - but in the meantime, this case study is very readable.

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

[Bari77 in reply to catrich]

Thank you for your message. I have seen this scientific paper and few others and that is why I started wondering. Like you say, it is not necessarily my case and the blood test, ultrasound and endocrinologist appointment will give me some answers but it is very interesting that it can happen. It just shows you that we are so unique and anything is possible even if it's not a common occurrence and belief. I am learning to rely on the signs and symptoms of my body more rather then be just guided by knowledge and experience of others. They are of course very useful but shouldn't solely determine the direction of your own health and healing journey.