Over-medicated, or Hashi's flare?

[raglansleeve]

How does one tell them apart?

I recently suffered what I thought was a reaction to too high a dose of T4, but since reading yesterday about something called a Hashi's flare, I'm now wondering if I had one?

In the past, I had suffered quite a bit of pain in my upper back/lower neck area that had been resolved once I had been prescribed T3. It had improved somewhat after 5mcg's were added to my T4 hormone supplement, and resolved entirely when that 5mcg's was boosted to 10. But because that T3 supplement caused my TSH to drop down below range, my endo said that I needed to stop taking it. I said that if I dropped the T3 down to 5mcg's, I would like to up my T4 from 88mcg's to 112, and he agreed. Unfortunately though, about a week or two after the change, my pain returned with a vengeance, and I decided to go back to the 10mcg's of T3 per day. That worked, and after about a week, I was good on that front again. I thought nothing of the fact that my total consumption would now be a fair bit higher, with the 112's of T4 and 10's of T3, and ended up with what I thought was an over-medication issue. I became almost unbearably anxious, and went so far as to get a prescription of Sertraline (was on that for about a year, many years ago). Just before taking the first pill though, it somehow occurred to me to wonder if this was at all thyroid-related. Luckily for me, I was just at the 3 month mark after the dose change, so had a blood requisition that I'd been planning to take to the lab in the next few days. I went the next day, and had the results in hours. My FreeT3 reading had soared from its usual place at about 50% through range to 95% through it! No wonder I was feeling so anxious (clearly, so close to the top of range was not at all okay with my body). I then dropped the T4 back from 112 to 88, and things began to slowly improve. I would say that I wasn't completely okay on the anxiety front until about the 8 week mark, but I felt good about slowly improving as I went along that time frame.

So, was this a Hashi's flare, or was I over-medicated? I was confused by some people saying that a flare shouldn't last long, but mine went on for 8 weeks. Also, does the flare affect the bloodwork, or is that not usually known, but I just luckily had the requisition available to take to the lab that day?

Just in case I'm asked, I am good on all vitamin, folate and iron fronts, took my last T4 24 hours before test and last T3 14 hours before.

[greygoose]

You tell by looking at your blood test results - it most certainly does show. What was your FT4 result when your FT3 was 95% through the range? A Hashi's 'flare' - stupid name because it's confusing, I prefer to call it a Hashi's 'hyper' swing, because that's what it is - affects both T4 and T3, usually. And they usually go a lot higher than 95% through the range. Unless there's very little left of your thyroid.

Ignore people who try to tell you how long things last where thyroid is concerned. It's all very individual. Obviously, the higher the levels go, the longer they will take to come down, but it does vary from person to person. And, it might not have been a full-blown swing. And, I doubt it's the same every time for anybody.

So, you're saying that you reduced your dose of levo and T3 - 112 mcg levo and 10 mcg T3 is not an especially high dose, BTW - and it took 8 weeks for the levels to come down? If it was dose related, it wouldn't have taken that long, because the half-life of T3 is only about 24 hours, so it would have been out of your system pretty quickly. T4 would take longer.

I think the only way to know for sure is to carry on taking your present dose for at least six weeks and retest. Then try increasing the dose again, and see what happens. If you feel that way inclined.

[raglansleeve in reply to greygoose]

My FT4 remained at about 50% through range, so probably not a hyper swing then. I've only had one thyroid ultrasound and the gland looked good. Normal size and no nodules.

I made a deal with my endo to reduce the T3 if he raised the T4 (I was then at 88 and 10, and changed to 112 and 5), so that I'd basically be in the same place. Unfortunately though, that T3 reduction caused me a great deal of pain on the muscle front, so I upped it again a couple of weeks after the drop. I didn't take into consideration the increase in T4 dose though, and thats what seems to have sent my FT3 reading soaring (I'm a good converter, btw), and my anxiety along with it. I haven't had another blood test, but my normal mental state took 8 weeks to be fully regained, so I'm guessing that my FT3 blood reading would be back down to its usual 50% range now.

I didn't reduce the T3, except at the beginning, and then restored it back up to 10, where it resolved my muscle issues. And yes, the T3 difference (putting it back up), resulted in a quick turnaround. It was the over-medication of T4 that took a full 8 weeks to gradually leave my system.

[greygoose in reply to raglansleeve]

I made a deal with my endo to reduce the T3 if he raised the T4 (I was then at 88 and 10, and changed to 112 and 5), so that I'd basically be in the same place.

Well, no, not necessarily. Depends how well you can convert T4 to T3. And, given that you needed to take T3, I imagine you don't convert very well. And, the fact that you didn't feel well on that dose, backs up the poor conversion theory. It raised your T4 but not your T3. So I doubt the increase in T4 'sent your T3 soaring'.

(I'm a good converter, btw)

Then how did you manage to get T3 added to your levo? And the facts don't back that up.

[raglansleeve]

I knew that it wouldn't be an exact trade off, but hoped that I'd be a little bit better off with the trade. I'd still had some hypo symptoms before the switch, but getting the endo to titrate up each dose was like pulling teeth, and I honestly thought that I'd reached my limit with him going along with my requests.

No, it never raised my FT4, only my FT3 soared. Both my FT3 and FT4 have always been in the 50% ish range, no matter how many increases I've had, but symptom-wise, each dose up has been an improvement until this last higher dose of T4. I am a very good converter, perhaps too good, because it was the increased T4 dose that sent me into distress (and caused my FT3 to go from 50 - 95% through range). I've had my early results put through the SPINA (?) app, and that showed really good conversion.

I hope that I didn't enter incorrect information above, leading you to think my FT4 had soared, rather than my FT3. I will go back now to see, since my hypo brain is not the same brain I used to have (and love!).