I’m a 46 year old female, very over weight and on Amlodipine 10mg and Thyroxine 75mg for hypertension / hashimotos.
I’ve been feeling awful lately :
Nausea / vomiting , Very swollen feet, ankles & shins, cellulitis type rash all over my lower legs, conjunctivitis, blepharitis and orbital swelling. Tachycardia ( resting 108). I keep crying!
I had an ecg Monday and it showed normal waves with sinous tachycardia,
The GP( telephone appointment ) said I had eczema at first and now Lymphoedema along with blepharitis. Finally I managed to get a face to face appointment and GP requested some blood and it shows FBC - monocytosis , raised ESR , slightly raised ALT And weak positive ANA. They think lower leg swelling / rash is due to weight.
Then to my surprise my private blood today ( Thriva ) showed I’ve shifted into Hyperthyroidism.
Tsh 0.01 ( range 0.27 to 4.2)
FT3 11.2 ( upper limit 6.3)
T4 196 ( 66 to 181)
FT4 31.6 ( upper limit 22)
B12 538 ( upper limit 300)
Ferritin 177 ( 44 to 150)
Thyroid antibodies both in 500s .
My plan is to not take my thyroxine in the morning and try and call the Dr against . Getting an appointment is so hard these days! I already stopped the Amlodipine Sunday because I thought all the symptoms were side effects.
Any ideas : how I can suddenly turn hyper after 4 years being hypo. Normal my Tsh is approx 4 and T4 13 . And also , after stopped thyroxine how long should it take to stop my tachycardia .
Anyway - thanks Emma
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Do you follow this advice when you are having a blood test for thyroid hormones?
The earliest possible appointment. Fasting (you can drink water) and allow a gap of 24 hours between your last dose of levothyroxine and the test and take it afterwards? This advice gives us the best results.
GP should also check B12, Vit D, iron, ferritin and folate. Everything has to be optimal.
We feel best when TSH is around 1 or lower and our Free T3 and Free T4 (rarely tested) should be towards the upper part of the ranges.
When I took levo only I had consistent fast pulse rates. When some T3 was added to T4 it relieved me and pulse became normal. When I, eventually, took T3 alone (rarely prescribed in the UK at present due to the exorbitant cost) it resolved all of my symptoms. I am not saying that everyone would have the same affect.
The aim is a TSH of 1 or lower (most doctors think we've now become hypERthyroid but that's not the case. Ask if you can get Free T4 and Free T3 checked. Also B12, Vit D, iron, ferritin and folate. Everything has to be optimal.
When you quote numbers re blood tests, it is helpful if you also put the ranges (figures in brackets) as labs differ and it is easier to comment.
No, you haven't really 'shifted hyper'. It's what we call a Hashi's 'hyper' swing.
What happens is, the Hashi's is slowly destroying your thyroid by launching attacks on it, from time to time, as if it were the enemy - a virus, or something, that needs destroying. So, as the cells in the thyroid gland die, they release their stock of hormone - T4 and T3 - into the blood, causing the FT4 and FT3 to shoot up, and therefore the TSH drops to zero - which is normal under the circumstances. But, it's not true hyperthyroidism, because your thyroid isn't suddenly over-producing hormone - physically, it just can't do that - and the high levels are just temporary.
You did the right thing to stop your levo. But, if I were you, I would not consult your doctor, because doctors just don't understand how Hashi's works - the proof of that is that he didn't explain any of this to you! And, if he sees those numbers, he's going to want to stop your levo completely. But, those numbers are going to go down by themelves, and you're going to be hypo again, so you're going to need your levo.
What's more, if your TSH is normally 4 and your FT4 13, you've been grossly under-medicated for quite some time. So, not surprising you haven't been well. When taking thyroid hormone replacement - levo, or whatever - the TSH should come down to 1 or under, and the FT4 go up to the top third of the range.
So, just sit tight until you feel the need to start your levo again. And, eventually - like six weeks after restarting it - get another blood test and demand your doctor increase your dose!
Oh, and high blood pressuer can be a hypo symptom. So, the odds are, you don't need medication for that, you just need a decent dose of levo!
About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s
After a temporary Hashimoto’s flare you are likely to become more hypothyroid.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin D and folate levels Plus thyroid antibodies
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)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Come back with new post once you get vitamin D and folate results
I have been on amlodipine for years and I have never really had any symptoms ,if you are taking it for high blood pressure, you should not stop it without informing your doctor as your blood pressure will rise significantly
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Interesting paper on alternating hyper- and hypo-thyroidism
