Managing the symptoms of an overactive thyroid

[JenniferW]

I have hashimotos, I take levothyroxine. I am ridiculously sensitive to my thyroid levels. At the moment I am going through the menopause, which affects my thyroid levels. They swing up and down. We have fiddled with my meds to get them to the best average and there is no point changing them again because by the time any change has kicked in, things have swung the other way.

So my question is - I started with the symptoms of an overactive thyroid Saturday night, given that this is a temporary situation, can anyone give me any help managing the symptoms of

nervousness, anxiety and irritability

hyperactivity – you may find it hard to stay still and have a lot of nervous energy

difficulty sleeping

feeling tired all the time

needing to pee more often than usual

I also get the following but they are more temporary

sensitivity to heat

muscle weakness

It's the anxiety and waking up upteem times a night to pee that are the biggest problems. That's when I am asleep and not just lying awake with tense muscles.

Apart from sleeping pills and magnesium gel, can anyone suggest anything? My caffeine intake is reduced to one cup of tea today.

[GlowCoach Administrator]

If you have Hashi's and are on levo then you don't have an overactive thyroid, actually you have the opposite, an underactive thyroid and symptoms can be very similar if you are under replaced or have a low FT3.

What dose of levo are you on now?

What supplements are you taking?

What were your latest blood results for TSH, FT4 & FT3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test. Well worth trying gluten free to start with to see if it helps symptoms.

[JenniferW in reply to GlowCoach]

Hi, I used the wrong description, I am not very with it

13/02/2023

Component Your Value Standard Range

TSH 0.88 mU/L 0.35 - 5.50 mU/L

Free T4 20.4 pmol/L 10.5 - 21.0 pmol/L

16/11/2022 09:00 from Venepuncture (Serum)

TSH 2.16 mU/L 0.35 - 5.50 mU/L

Free T4 18.0 pmol/L 10.5 - 21.0 pmol/L

I am taking 50 mg 3 days a week, 75 mg four days a week

In december I had the symptoms of being underactive so I upped my dose a little (75 mg six days a week). I felt better to begin with and then ended up feeling overmedicated and got the result 0.88 in February. I feel at my best at around 1.5.

So I took it back down to 75 mcg 4 days a week. I feel okay some of the time, a bit underactive some of the time and now I feel over medicated. This is because the menopause is changing how I feel. I take HRT but of course that is just a set amount and your hormones move around. I had my first period in a year in Feb, just after the blood test.

I just want to stop feeling as rubbish while I go through the next few days and wondered if anyone had any tips.

[greygoose in reply to JenniferW]

Just stop your levo until you feel hypo again. If you've had a Hashi's 'hyper' swing, the excess hormone in your blood will soon be used up/excreted.

[JenniferW in reply to greygoose]

I had forgotten about hyper swings with Hashis, thanks

[GlowCoach Administrator in reply to JenniferW]

So neither blood result is showing you as over replaced and definitely don't stop taking your Levo. That would indicate that either you are not converting well and/or your vitamin results are low due to poor absorption caused by low stomach acid which is common when hypo.

Could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

You also need a blood test to show TSH, FT4 and FT3 which the NHS is unlikely to do. See link with blood testing companies to buy your own.

[JenniferW in reply to GlowCoach]

My vitamins are okay and were tested last year, I take vit D3 and K2 and Iron (Better you oral spray to avoid stomach absorption issues). I'll have a look at the tests for T3, it would be good to know if I am converting badly. I know I feel better generally when I take the iron.

[greygoose in reply to GlowCoach]

How do blood results tell the difference between over-medication and a Hashi's 'hyper' swing?

[GlowCoach Administrator in reply to greygoose]

Well no results here show over medication. It’s never recommended to stop thyroid replacement. Better to reduce by a small amount and retest in 6-8 weeks. Stopping thyroid hormone can make someone very ill very quickly with up to a year to get back to where they were.

PS I have have personally experienced this and it’s definitely not to be recommended!

[greygoose in reply to GlowCoach]

But, do you have Hashi's?

Those labs are quite old, in lab result terms. And her 'hyper' symptoms have come on recently. She could very well be having a Hashi's 'hyper' swing now. In which case, the last thing she needs it adding more T4 to her system. I said to stop them until she feels hypo again, which is a normal thing to advise in the case of a 'hyper' swing. I in no way suggested she should stop them permenantly. And I wouldn't suggest it to anyone who didn't have Hashi's. But, I have Hashi's, and I know what it feels like.

I feel your reply to the OP was very misleading.

[GlowCoach Administrator in reply to greygoose]

I have suggested that JenniferW gets a full thyroid panel to include FT3 plus full vitamin testing. It's far more common in this group to see someone who is either under replaced, not converting or low/deficient vitamin levels than simply having a Hashi swing. At no point have I suggested she increase her dose going by older blood results.

Not relevant but I do have Hashi's.

[greygoose in reply to GlowCoach]

Well, it is relevant because you have to consider that, going by what she's said, she could have had a 'hyper' swing since her last labs. And her FT4 was quite high in those, anyway. If she feels 'hyper', she's neither under-replaced nor suffering from sub-optimal nutrients. So, we have to consider the other possibility.

I've been on this forum for about 20 years and I've seen lots of people who've had a 'hyper' swing and didn't recognise it. Or, didn't know how Hashi's works. And, btw, there's nothing 'simple' about a 'hyper' swing. It can be very unpleasant.

[GlowCoach Administrator]

Vitamins should be tested annually. Most hypo people need to take an active/ methyl B complex.

Definitely recommend getting full thyroid panel to include FT3.

[RedApple]

JenniferW 'It's the anxiety and waking up upteem times a night to pee that are the biggest problems. That's when I am asleep and not just lying awake with tense muscles.'

One of the big problems about having autoimmune thyroid dysfunction, is that no symptoms are necessarily guaranteed to be from over or under medication, or hypo/hyper swings.

My personal experience is that the same symptoms cross over and it can sometimes be impossible to know which way to jump. The symptoms you describe (especially in the bit I've quoted here), are what I get when my T4 and T3 are out of balance.

To make a better informed decision about how to tackle this, you really need to have FT3 tested alongside the TSH and FT4.

I would suggest getting this done asap before you make any changes to your thyroid dose.

[JenniferW in reply to RedApple]

Thank you, it's all rather complicated. I shan't change my dose, it seems to be about right on average.

[tattybogle]

.i became overmedicated following menopause ,and i ended up on a slightly lower dose than i'd been on for 17 yrs previously .

(i have autoimmune hypo, but that wasn't the cause of the overmedication in that instance , it wasn't a hyper swing .. i just needed a bit less levo than i did before ~ possibly because changes in estrogen level affect levels of Thyroid Binding Globulin~ which binds T4, so it affects the amount of 'free' T4 we have circulating)

.... those symptoms you are describing are a very good fit for how i felt when overmedicated. especially the lying awake with tense muscles / frequent urination.

in an ideal world then obviously you would just get out your star trek body scanner and read your fT4 / fT3 /TSH results before changing anything ... but its not an ideal world , and if you are suffering a lot with symptoms that fit with overmedication , and if you can't get a blood test sorted quickly / can't afford it , and your previous experience tells you that it is likely to be overmedication / or a hashi's hyper swing .... then personally i would just miss a days or two's levo then resume at a VERY SLIGHTLY lower dose.

That will give you pretty instant dose reduction .. and if overmedication is the problem, it should hopefully improve how you feel within a day or so.

then carry on at lower dose unless you start to get signs of hypo ,...and if you do, go back up .

the only problem with acting on gut instinct like this without testing first is that you then have to wait another 6 weeks on a stable dose before you can get a blood test... so if you're wrong and lowering dose didn't improve how you feel . then it's a long wait. to figure out your next move .

But if you are fairly confident it feels like overmedication then it certainly won't cause any harm to miss a day or two and resume at lower dose , and will deal with the issue of symptoms quickly and effectively.

(obviously i'm not suggesting stopping for more than day or two , and i wouldn't suggest it at all unless the symptoms of overmedication were causing urgent problems... it's best to test first/ act later if at all possible)

[JenniferW in reply to tattybogle]

Hi TattyYes that's exactly the problem, when I started the menopause I needed to lower my dose a little and then when I started HRT it needed to go back up again.

I have had problems since I had covid last year with my thyroid swinging around. I had adrenal fatigue which eventually improved with a small increase in my dose and lots of salt. Now I am mostly okay. But sometimes I get the symptoms of being underactive for a while then normal then over medicated.

I think I am coming out of this one now, which is good because it normally goes on longer. I will take your advice and miss a day or two of meds next time and see if it helps. I looked at the blood tests and they are very expensive to get an in person blood draw. I struggled to get blood out for a covid antibody test at home.