Hashi's Flare? Lab Results Help

[cam92]

Hello!

About a month ago, I had worked my way up to 45 mg of NP Thyroid. I felt okay but not great. I started working on my vitamin levels and cracking down on gluten again. At the same time, I went through a few weeks of severe stress, which suddenly led about a week of feeling what I would describe as hyper: extreme nervousness and dread, slightly elevated HR and BP, stuffy feeling in head and neck, trembling/internal tremors, muscles twitching in my feet, muscle jerks when sleeping, raised basal body temp, burning upper arms, etc. I take my meds in the AM around 9 and these symptoms always seem to get worse in the evenings around 7/8 pm, then taper off.

I decided to skip a few days of meds, because I felt awful and scared and was worried I was overmedicated. It took a few days, but the internal tremors, muscle twitching, heart pounding did subside. In its place, around late afternoon/evening I get a squeezing feeling of pressure around my throat as if I'm being lightly strangled. Of course, other symptoms of my hormones going crazy and likely being undermedicated also followed. But to be honest, I hate the "hyper" like symptoms the most.

My theory is that I had a Hashimotos's flare (brought on by stress?) that made my thyroid temporarily kick on and cause the hyper feeling. (Unfortunately I don't have labs from this exact time to confirm hyper).

Is this type of swing/flare common? Have you experienced this before and how did you adapt?

I went down to taking only 7 mg of thyroid for a few days, now up to 15 mg, and feeling pretty horrible and hypo, but I'm scared to take too much and just don't know what to do.

I got private blood tests done after the hyper period and shortly after backing way off my meds:

TSH: 4.93 (.4 - 4.50)

FT3: 2.8 (2.3 - 4.2)

FT4: 1.2 (.8 - 1.8)

TG antibodies: 4 (<1)

TPO antibodies: 66 (<9)

Iron: 62 (40 - 190)

TIBC: 345 (250 - 450)

Ferritin: 34 (16 - 154)

% saturation: 18 (16 - 45)

B12: 939 (200 - 1100)

Vit D, 25-OH: 42 (30 - 100)

TSH and antibodies are the highest I've seen them; but strangely my FT3 and FT4 (while not great) look about the same or higher as when I was taking my full dose! I don't understand that.

Also, I think ferritin and D could stand to come up quite a bit.

[SeasideSusie Remembering]

Cam92

Iron: 62 (40 - 190)

TIBC: 345 (250 - 450)

Ferritin: 34 (16 - 154)

% saturation: 18 (16 - 45)

Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are:

Serum iron: 55 to 70% of the range, higher end for men - yours is 14.67% through range so is very low.

Saturation: optimal is 35 to 45%, higher end for men - yours is 18% so far too low.

Total Iron Binding Capacity (TIBC): Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is 47.5% so mid range.

Ferritin: recommended to be half way through range with some experts saying the optimal level for thyroid function is 90-110ug/L - yours is 13.04% through range so it's very low.

So it's not just ferritin that needs to come up a bit, your serum iron and saturation percentage need improving too. Maybe discuss with your doctor and supplement with iron tablets under guidance with regular iron panels every couple of months to check your levels.

Vit D, 25-OH: 42 (30 - 100) ng/ml

The Vit D Society and Grassroots Health both recommend a level of 40-60ng/ml with studies suggesting that a level above 50ng/ml has no benefit.

You can check out a post about Vit D that I wrote recently which has a link to the old Vit D Council website where you can work out how much Vit D is needed to increase levels from current level aiming for their recommended level:

healthunlocked.com/thyroidu...

If you look at the appropriate table for your current level of 42ng/ml and aim for the recommended 50ng/ml then you'll see the recommendation is to take 900iu D3 daily. If you get decent summers with plenty of sunshine you may make Vit D naturally from the sun which should improve your level over the next few months without supplementing, then you could retest end of October/beginning of November to check your level then see how much you might need to supplement during the winter months.

As I don't have Hashi's, so no personal experience, I'm afraid I can't comment on anything else.

[cam92 in reply to SeasideSusie]

Thank you! I do take 1 iron pill daily but thinking of increasing to 2. I also was previously taking my iron at night with magnesium, which I just learned might block absorption.

[tattybogle]

if those labs were done shortly after a few days of 7mcg then 15mcg then they don't tell you anything useful . Blood tests for TSH / fT4 / fT3 are only useful when you've been on stable dose for about 6 weeks.

if you increased your dose 3/4 weeks before feeling hyper , then overmedication / or increasing too fast is a more likely explanation than a hyper swing. ..( yes ,they do happen , but it's rather a big co-incidence for one to happen at the same time as you increased dose )

What dose were you on before you increased to 45mcg ?

Do you have any results from at least 6 weeks on that dose ?

[cam92 in reply to tattybogle]

Thanks for responding! Yes, so I was taking 37 mg for a while before stepping up to 45. I was taking the 45 for maybe 3-4 weeks before this all happened.

Here's the results from March when I had been steadily on 37 mg:

TSH: 2.16 (.4 - 4.50)

FT4: 1 (.8 - 1.8)

T3 total: 83 (76 - 181) -- annoyingly, my doctor always orders total T3, not FT3, so I don't think this is very helpful

Back in November when I think I was taking 30 mg:

TSH: 1 (.4 - 4.50)

FT4: 1 (.8 - 1.8)

FT3: 2.9 (2.3 - 4.2)

Worth noting, I don't split my dose of NDT the day before the test, so all my labs are about 24 hours since last dose. I continued doing it this way to be consistent with earlier testing.

[tattybogle in reply to cam92]

Mmm .... weird that your TSH went higher with increase from 30 to 37.5mcg... wonder why ?

Your current TSH of 4 ish is ? probably still high as a result of those days where you only took 7mcg / 15mcg .... it will have gone up quite sharply in response to the 7mcg days.

TSH is 'a bit behind the times' ...

TSH results basically tell you "what happened a week or so ago" ..

fT4/ fT3 results basically tell you "what happened in the last few days" ..

Your current fT4 is a bit higher than you'd expect given you've had several days of reduced dose .

But because TSH /fT4 /fT3 change at different rates in response to dose changes, any bloods done within a few weeks of any changes will not tell you "where you are now " accurately.... fT4 / fT3 levels will probably keep fluctuating a bit till the TSH settles... and TSH takes weeks to settle.

So the only information you have to go on is those bloods from 30/ 37.5mcg .. and the fact that on 45mcg you ended up with symptoms of overmedication ..... i think 3 /4 weeks timescale is possible for 'overmedication' .. if it was just a little bit too much for you then it might have just taken a while to build up. So perhaps that why you didn't feel it was to much in the first few days ?

if it was me . i think i'd go back to 30 mcg and let that dose settle with your improved vitamin / gluten free efforts , wait for at least 6 weeks , test TSH /fT4/ fT3 again .... then decide what to do next ... perhaps 45mcg was just a bit too much .

( although as you know .. 37.5mcg is not a big dose at all .. and your previous blood results on 37.5mcg did also suggest you needed the increase)

....I don't take NDT .. just levo .. so you probably need advice from someone who is used to taking it .

[cam92 in reply to tattybogle]

Thank you for breaking this down!

I agree it is weird that my labs seemed maybe better on 30 mg than 37 mg. I didn't feel 100% on either dose. Maybe a vitamin issue like low iron is playing a bigger part than I thought. Or could it be a cortisol/adrenal issue?? I just don't know--so hard to figure out!

Like you said, since 30 mg of NDT is not a large dose, I've assumed I need to keep titrating up to feel full symptom relief, but maybe that's not the case...

[tattybogle in reply to cam92]

? perhaps low vitamins etc is getting in the way of being able to increase thyroid hormone successfully ? my thinking was ... optimise them first while sticking at 30mcg. then try again if needed.

[cam92 in reply to tattybogle]

That was my general thinking as well. Thanks again!

[greygoose]

My theory is that I had a Hashimotos's flare (brought on by stress?) that made my thyroid temporarily kick on and cause the hyper feeling.

Just for your information, that's not how it works. Nothing can make a thyroid damaged by Hashi's 'kick on'. What happens is, the immune system attacks the thyroid, and the dying cells release their stock of thyroid hormone into the blood, causing the Frees to rise sharply, and the TSH therefore drops. That is what is called a 'Hashi's flare', or a 'Hashi's 'hyper' swing'. You do, temporarily, become hyper.

Whether or not that is what happened to you, I don't know. We can't know because you didn't have any labs done. But, I think it was more likely to be that than over-medication.

[cam92 in reply to greygoose]

Thanks for clarifying! Have you experienced the flares, and if so, how do you adjust your medication?

[greygoose in reply to cam92]

I have experienced the flares. But I didn't know what they were, at the time, and by the time I got diagnosed, my thyroid was practically dead, so I didn't have any medication of adjust.

[cam92 in reply to greygoose]

Thanks so much for weighing in. I just saw that I bookmarked this post a while back, because your comment was such a great explanation of a flare! healthunlocked.com/thyroidu...

[greygoose in reply to cam92]

You're welcome.

[Rhannii7]

Hey there, yep felt that way many times , have you tried splitting your dose , 1/2 in am and 1/2 2pm ? Also check out LDN for hashimotos

[cam92 in reply to Rhannii7]

I have thought about doing the split dose, but it seems to be hard for me to time the second dose around meals, since I find I feel better when eating often throughout the day, and because I have to take my iron at some point and I know that has to be four hours away from thyroid. Do you split yours? If so, do you fast on either side of the second dose?

[Rhannii7 in reply to cam92]

I take it at 6am and at 11.30am, the vitamins later in the day,, I feel terrible on it its causing bone pain. Dr thinks I might be t4 intolerant so im going to trial t3 only, started yesterday and no no bone pain but breathless by the end of the day. Trying it again today to see what happens. I give up to be honest, its been a total hell run

[cam92 in reply to Rhannii7]

I can totally relate—this feels so hard to figure out. I’ve also wondered if I should try another type of thyroid med; the NP has worked generally well for me after a very brief trial of generic levo at the beginning that I did not feel I responded well to.

[Rhannii7 in reply to cam92]

Its a real gamble isnt it.

[HowNowWhatNow]

hi Cam92,

How are you feeling now?

Have your symptoms improved or worsened?

[cam92 in reply to HowNowWhatNow]

Thanks for asking, and sorry for the delay! I am feeling sooo much better than I did at the time of this post, but it took a few months to get there.

In case it is useful, some of the things that helped (some of which was advice from this forum!):

- I got myself up to a consistent dose of 30 mg of NP Thyroid a day. I would take half in the AM and half in the afternoon, about six hours after the first dose. I stayed on this consistently for at least 6-8 weeks, then got labs done, and saw only modest improvement in my numbers, but I felt better. A couple months in I felt tired and generally kind of ill again, so I added 7 mg of NP to the morning dose. Any dose changes I make are very small and carefully done, and I'm going to stick with a dose for a while and test before changing again!

- Still gluten free. Cut back on dairy a bit too.

- Late morning supplements: ashwagandha (350 mg), l-theanine (200 mg), B2 (400 mg, for migraine prevention), probiotic. I swear that the combination of ashwagandha and l-theanine have been LIFE CHANGING for me in terms of cognition and mood. My anxiety and depression have essentially evaporated. I just "don't care" about things that once sent me into a spiral, and I feel so mentally clear. Of course, I'm not totally sure if all of these changes combined has me feeling so good, or if it's these supplements in particular, but adding them has been a game changer.

- Afternoon supplements (after 2nd thyroid dose): fish oil, turmeric with ginger, vitamin D (6000 IU/day)

- Evening supplements: iron (ferrochel) w/ vit C (every other day consistently; this is supposed to be better than daily for absorption), multi vitamin, selenium (170 mcg total)

- Before bed supplements: myo-inositol, magnesium (400 mg, also recommended by neurologist for migraine prevention), l-theanine (200 mg)

- Reducing stress in a meaningful way, which was a combination of getting hormones/chemicals right, as well as changing thought patterns. I know I have to keep stress under control to prevent from "flaring" again or having a Hashi's swing.

- Keeping a journal of what supplements I took in a day, and what I ate, and the symptoms/signs I experienced, until I started to reach a point where I got the combination right. This was extremely helpful for fine tuning my regimen, and I love that I have a record to look back on when making decisions. This helps my health anxiety as well to look back and realize I've experienced a symptom before.

- Wearing a night guard at night and using massage tools on my head and neck for TMJ issues.

[HowNowWhatNow in reply to cam92]

This all sounds very positive.

You must be spending a small fortune on vitamins but you only have one health so you have to do what it takes!