Advice needed hyperthyroidism

[Abbie10101]

So I had a baby Jan 2024 I started getting severe panic attacks again which I hadn't had in about 2 years since starting sertraline

My heart was 177 pushing a double pram up the hill home whereas when I was heavily pregnant it was 153 doing the same thing so I contacted my Dr and advised my iron is low or it's my thyroid I was also getting boiling hot just doing small things and my temp would be 37.7

I had bloods done and it was both,

Iron only a small bit low at 8.4

Thyroid levels are as follow

T3 12.4

T4 29.8

Tsh 0.01

I then booked in to see a private endocrinologist and he advised I'm only a bit overactive and he's only giving me carbimazole as my family have underactive and because I'm so symptomatic he gave me 10mg carbimazole once a day.

He said he thinks it's graves disease as I was near the end of where you get postpartum thyroiditis, anyway my results came back and this is what he said ....

I now have the results of Abbie’s investigations. Her thyroid function tests continue to show a biochemical

picture of thyrotoxicosis with an undetectable TSH at less than 0.01 and raised free T4 and free T3 at 28.2

and 9.1 respectively. Her TSH receptor antibodies however, are undetectable which is against a diagnosis of

autoimmune thyrotoxicosis. I will review her again as arranged

These results were before I started the carbimazole also and they are lower then the 2 weeks before when I had the first bloods

Anyway I'm on carbimazole been om it for 7 days and I feel so rotten I feel sick and my panic attacks are extreme I constantly feel like I'm burning up

Is this normal? My b12 etc are fine from what I can see on my bloods. Is it possible for white blood cell count to drop low just after 7 days of taking the tablets ? Is it postpartum thyroidits ? Is it possible to go hypo after 7vdays of tablets ?

[SlowDragon Administrator]

T3 12.4

T4 29.8

What are ranges on these results

can you also add vitamin D, folate, B12 and ferritin results and ranges

Autoimmune HYPOthyroid (hashimoto’s) frequently starts with temporary hyperthyroid type symptoms and results

It’s not true hyperthyroidism, it’s just excess thyroid hormones being released as thyroid is attacked and cells are destroyed

You need TPO and TG thyroid antibodies tested for Hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[Abbie10101 in reply to SlowDragon]

Here are my blood results from the first test I had apparbetly my liver marker was high due to the thyroid ? My nhs Dr's aren't helpful atall but the endocrinologist was sure I had graves so I don't know what's going on all I know is that it started 2 months after having my baby but I just put it down to getting the depo injection

Blood test results

[SlowDragon Administrator in reply to Abbie10101]

So iron was very low

Were you prescribed iron supplements

you need ferritin levels tested (storage form of iron)

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Generally iron/ferritin are higher with Graves’ disease and lower with Hashimoto’s

B12 and folate levels are low

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

No vitamin D test result

Or TPO and TG antibodies for Hashimoto’s

[Abbie10101 in reply to SlowDragon]

Thank you very much for your help, also I got the depo injection which is a contraception injection 10 weeks post partum and my husband was googling and apparbetly this can affect your thyroid results ? I was due to have the second one on the 6th June but I decided against it to see if this was also what was causing all of this

[SlowDragon Administrator in reply to Abbie10101]

Good point

[PurpleNails Administrator]

Welcome to forum

Congrats on the baby.

Do you have lab ranges? Ranges vary between labs. By most ranges your levels are elevated.

With Graves autoimmune hyper (continuous) either TRAb or TSI are positive. The thyroid is being stimulated. Levels often go very high eg 3x normal range but not always, any continuous elevation needs treatment.

The doctor acknowledges TSH receptor antibodies (TRAb) is negative but has still treated as if you have graves.

Dr haven’t appeared to test TPO or TG antibodies which would show if you have autoimmune thyroiditis (Hashimoto’s) which causes transient hyper. Often occur post partum but can occur any time.

With Hashimoto’s the immune system attacks thyroid and the damaged thyroid releases stored hormone. Over time the damage cause low levels. Over 90% of hypothyroidism is due to this and it can run in families and likely what your family have.

10mg carbimazole is quite a low dose but if your levels are naturally dropping reducing what new hormone can be made isn’t going to help. You would become hypothyroid quickly. Carbimazole is for continuous hyper only.

Propranolol can be used for temporary hyper. As relieves symptoms. Or you can ‘ride it out’ Propranolol can’t be taken if asthmatics, and need to be reduced slowly when stopping, but it’s an option.

Ask GP to test TPO & TG antibodies and confirm what you are dealing with.

Are you having a re test soon? TSH, FT4 & FT3

[Abbie10101 in reply to PurpleNails]

I went Dr's today and had full blood count as I have health anxiety and convinced myself my white blood cells are low and he also tested my thyroid again but this test was at 4pm, I was prescribed propranolol a low dose but I'm to scared to take it as I had a very bad experience with it after I had my son in Feb 2023 it made my heart go to 39,

T3 range is 3.5 - 6.5

T4 range 9.00-22.00

Tsh 0.10-4.00

I'm.not due to see the endocrinologist until the 16th July

My biggest concern is my husband is away on and off for work until August and I have 2 young ones and I won't get answers until the 16th, he did say I have no lumps etc that he can see nor feel...here is what he put down on the visit when I saw him...

Diagnosis: Possible Graves’ thyrotoxicosis

Possible postpartum thyroiditis

Anxiety

Medication: To be commenced on propranolol 10 mg BD

To be commenced on Carbimazole 10 mg OD

Sertraline 50 mg OD

Many thanks for coming to see me in my clinic at the Alexandra Hospital this afternoon. You have developed

symptoms of increased anxiety, hot facial flushes, increased heart rate and frequency of bowel motions.

Your GP checked your thyroid function test and found your TSH to be undetectable at less than 0.01. Free T4

and Free T3 were raised at 29.8 and 12.4 respectively. Other blood test showed your ALT to be slightly raised

at 45. Your iron transferrin and transferrin saturation index were also slightly low and you have been

commenced on iron tablets. There is no past medical history of significance apart from anxiety. In your

family history your mother and your maternal aunt have an under active thyroid. There is no other family

history of significance. You are an ex-smoker but you now vape. Your alcohol intake is minimal.

On examination you weighed 68 kg. Your blood pressure was 140/80. You had a fine tremor of your

outstretched fingers. I was unable to palpate a goitre and there was no bruit on your neck. Heart sounds

were normal. There was bilateral lid retraction and lid lag. I explained to you that the differential diagnosis is Diagnosis: Possible Graves’ thyrotoxicosis and postpartum thyroidits

[mstp]

Hello Abbie, you say your main worry is because your husband will be away sometimes in the coming weeks. Do you have any family or friends who can see you through this difficult time? If so, please tell them how you are feeling and ask for their help. Do not try to go through this on your own. I did this and it was not a good time. I notice you nention the Queen Alexandra hospital. Are you in Portsmouth? If so, and you do not have a viable support please pm me as I might be able to help.

[Abbie10101 in reply to mstp]

Oh yes I have my neighbour she's brilliant but she's away that certain week i just keep thinking what if the worse happens to me and there's noone In the house to look after the babies, I think my mother in law is coming over on the dags where I have no-one atall , I'm.in manchester not Portsmouth but thank you xx

[mstp]

So glad you have your mother in law coming over. I didn't really tell anyone when my thyroid problem was undiagnosed and it was the worst thing I could have done.

[Abbie10101 in reply to mstp]

I suppose the good thing is that I know I haven't had it long as it was tested in October and it was fine it's my anxiety with knowing my heart rate all of the time which is how I picked up on something was wrong, I hope you're doing better now xxx

[helvella Administrator Thyroid UK]

You just might find it worth having a read of my blog:

helvella - Splitting Carbimazole Doses

A short discussion about Carbimazole primarily focussed on splitting doses but containing some other information.

helvella.blogspot.com/p/hel...