[Lavender]

#1018243

I had my thyroid removed in August because of my Graves. Since then, I have had trouble adjusting my synthroid dose, and I was wondering if anyone can offer me any suggestions.

I was initially on 125 after the surgery and felt great. A month later, TSH was 7, and my endo raised my dose to 150. I started to have heart palpitations and anxiety just like I did when I was hyper. BP was high one day and then I almost passed out the next day. Labs looked ok, TSH was 3.07 (.5-6), Free T4 was 1.5 (.7-1..

Endo reluctantly lowered my dose to 137 because of my symptoms. Well, the heart palpitations and anxiety stopped, but then I got really depressed, crying all the time, couldn’t get anything done. Went to see my primary care doc. TSH was 8. She said I was hypo and needed more synthroid. put my dose back up to 150. Within days, the heart palpitations started again.

Now, two weeks later, they are pretty constant, and I am anxious and jittery all the time. At least I am not depressed, but I am worried about my heart. Can’t even do moderate exercise without feeling stressed, out of breath, heart beating really fast. I was hospitalized in May due to thyroid storm and do not want to go through that again. I find that I get angry really easy when my heart is racing like this, it’s like I loose control of how I respond to things, and I do not want to be a jerk to everyone around me.

I saw my PCP again this week, and she suggested I take anti-depressants. Will not consider that this has anything to do with how my body is reacting to synthroid. I am very confused because two weeks ago, she said she felt uncomfortable prescribing me anti-depressants because I have many medication allergies and bad reactions to anti-depressants in the past.

I have decided that I need a new doctor and I have an appointment scheduled in December, but I am concerned about what I can do in the meantime. I really do not like the way I feel, and I am scared about my heart.

[Kimberly]

#1063480

Hello – Hopefully, you will get some responses from folks who have been through the process of adjusting synthroid dosing, but a couple of comments:

1. Hopefully, you can find a doctor who will take your symptoms seriously and find out the root cause…whether they are related to your Synthroid dosing, possible interactions with other drugs you are taking, or another medical condition. If your GP has a valid reason to believe that anit-depressants would help you, that’s one thing…but I would definitely discuss this with her further before going down this path.

2. I’ve heard of rare cases where patients were reacting to the dyes used to color-code the tablets. It might be worth changing your prescription to a non-color-coded version, which I believe is the 50 mcg version. (For example, instead of taking one 100 mcg pill, a patient would take 2 50 mcg pills). Your doctor or pharmacist will be able to give you more info on this.

[ewmb]

#1063481

Sorry you’re having so much trouble with feeling bad now. You really need to wait at least six weeks between dose changes to see if things worked. Sounds like you have been tested too much too often to really get a good picture of what’s happening to your TSH. It has taken me over a year to get the right dose of levoxyl after I had RAI in May 09 and went hypo in Sept. 09. I am really close now but it has taken some fiddling but I was warned that if we tested too early, before at least six weeks, that I wasn’t going to get a good snapshot of whether the new dose was really helping or hurting my numbers. I have to tell you that every time, I mean every time I changed doses even just a little bit I had at least a month of adjusting. It really stinks but it’s what you’re going to have to do to get better. Are you charting your BP and pulse rate every day? Are you drinking caffeine or taking any other medications that might be affecting your heart? I have gotten very sensitive to caffeine and am going through menopause and that can affect my heart rate when I am having hot flashes. Are you staying well hydrated? All these types of other forces can affect the way you feel your heart rate/etc. now that you are so sensitive to it.

Hope you get a better doctor and start to feel better soon.

ewmb

[Lavender]

#1063482

Are you saying that changing doses alone could cause my heart issues? I know you can’t tell me for sure, but if I stick this dose out, is there a good chance it will get better? I know changing so often is not good. I just haven’t been able to tolerate my symptoms on either 137 or 150. I am thinking of alternating doses every other day to see if this is gentler on my body. It seriously over-reacts to everything I take.
I don’t have a way to measure my BP at home. I was keeping track of my pulse, and a whole bunch of things in a daily journal. but when the doc just dismissed it all as anxiety, I gave up. Don’t see the point. I know it’s higher. I know I could walk miles a day 2 weeks ago when I first started this dose, and now I can’t get up a flight of stairs without my heart feeling like it will explode. I’m tired of fighting doctors. I just don’t have the energy to do it anymore, and hope the new one will help.
I don’t drink caffeine. haven’t been able to for years because it makes me too anxious. As far as other meds, I take Calcium, Vitamin D and Magnesium for parathyroid issues. Doc wants me to take antidepressant which could cause a fast or irregular heart beat. Scares me that it could make this worse.
I drink a lot of water. I don’t drink or smoke. I am 33 and menopause should not be an issue. I am not aware of anything I am doing to make my heart worse besides trying to get up and be more than a couch potato on occasion.

[Lavender]

#1063483

Kimberly wrote:2. I’ve heard of rare cases where patients were reacting to the dyes used to color-code the tablets. It might be worth changing your prescription to a non-color-coded version, which I believe is the 50 mcg version. (For example, instead of taking one 100 mcg pill, a patient would take 2 50 mcg pills). Your doctor or pharmacist will be able to give you more info on this.

I have never been aware of a reaction to dyes in the past, but I have been on both levothyroxine and synthroid 150 and have had the same reaction with my heart. Right now, I just have a bunch of samples of Synthroid at home, and will have to make do with that until I can see the new doc. Next endo appointment is in December as well.

[Bobbi]

#1063484

Sometimes, we "feel" a dose increase, and then settle in and feel ok. Whether that is what is going on with you is something for you and your doctor to try to figure out. But, if I were in your shoes, and had experienced thyroid storm, I would likely be really alert to any signs of hyper symptoms and worry/fret about them. Another thing I would do, though, would be to keep a log of heart rate — particularly when I felt it was fast, to double check. That will either reassure you, or give you something to show your doctor. Doctors tend to be swayed by "objective" data more than subjective commentary.

There’s something else to know about, too. Heart palpitations — which we typically have when we are hyperthyroid — is simply an episode where we actually feel our heart pounding, seemingly out of control. It doesn’t mean it IS pounding out of control, just that we feel it, when normally we do not feel our heart beat at all. The majority of time — the vast majority of time — it doesn’t mean anything at all is wrong. But it’s frightening. Whether that is what you are experiencing is something to figure out with your doctor as well.

In addition, sometimes our doctors are willing to split a dose. I.e. on some days you would take 150mg and somedays you would take the 137. The active ingredient in synthroid has a long "half life" — or relatively long half-life, and splitting the dose can give you a base level that is higher than the 137 — where you are hypothyroid — and the 150, where you feel hyper symptoms. But know, that whether or not the doctor is willing to do this depends completely on what you blood tests show on each dose. If your thyroid level isn’t high on 150, your doctor might want you to tough things out a bit longer, to see if you stop feeling whatever symptoms are causing you worry.

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