Recently, I interviewed Dee, who suddenly faced hyperthyroid symptoms, including a racing heart, tremors, and eye issues, raising the question of what’s really happening. In this episdoe, we discussed we explore her lab results, possible triggers like infections and autoimmunity, and the unconventional steps she’s taking from diet and acupuncture to functional medicine testing, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
Welcome to another Save My Thyroid health audit. I’m excited to chat with Dee. She has a pretty interesting journey. She has been dealing with hypothyroidism since, I believe, 2014. More recently, in spring 2024, she started to experience some hyper symptoms. Thank you for joining us, Dee.
Dee:
Hello, thank you!
Dr. Eric:
Before we start, can you remind me how you found out about me?
Dee:
It was from Google searches. I found your podcast. I had bought two of your books, the Graves’ and hyperthyroidism one, and I recently bought the hyperthyroidism diet one. I have been listening when I can to find out more about what could possibly be going on with me.
Dr. Eric:
You were diagnosed with hyperthyroidism in 2014, and you have been taking levothyroxine for quite a while, 10 years. What happened in spring 2024, about five months ago from the time of recording this, is you started experiencing some hyper symptoms?
Dee:
We actually came back from a cruise. I have hay fever allergies. It seemed like both my husband and I got really hit with some allergies. I don’t know if it was being on the water and then coming back and being in the middle of springtime here in Illinois. I started with my eyes really being dry and sore and bagging. I think that is how I started looking it up. I saw my daughter, and she was like, “Oh my god, what happened to you?” I don’t know.
When I looked it up online with allergies and the bagging, eventually, because the bagging was so bad, and I kept pulling that string on Google, it eventually brought me to Graves’. I don’t know what’s going on with that. I really tried to put that out of my mind.
A couple weeks later, I started experiencing heart palpitations and feeling like my left arm was buzzing almost. It just felt weird. I didn’t know how to explain it. Trying to explain those symptoms to my doctor and husband, they were like, “Okay…”
After the heart palpitations went on for a couple weeks, I finally, one night, told my husband I thought we needed to go to the emergency room because I thought I was having a heart attack. I was hypothyroid, and I had been hypothyroid the whole time.
I did learn on one test prior to that- I was doing some weight loss drugs. The NP who I was going to ran a blood panel, and she asked me if I had ever been told I had Hashimoto’s. I had never even heard of it. My doctor, throughout the full time on hypo medicine, when looking back on my records, he had only run TSH. I don’t know if that’s common, but that’s what he had done. It seems like it goes all over the place because that is what it has been since April.
I have continued to take my medicine even though I had hyper symptoms because my doctor still wanted me to. Finally, he had me bump it down to half a pill.
Finally, in July, after putting up with more hyper symptoms, then hypo symptoms, I decided to take myself off the levothyroxine because I felt like I was doing it to myself at that point, given the hyper symptoms.
I was hoping that would resolve it because he really did think it was an overmedication problem at that point. But I am still having this stuff. I don’t know if I’m hyperthyroid now or hypothyroid, or if this is just Hashimoto’s. I really don’t know which way to go on it anymore.
Dr. Eric:
You stopped in July. We’re recording this in late September, so it’s been a couple months. You said you are still experiencing some of the hyper symptoms, like the palpitations?
Dee:
Not so much the palpitations, but the tremors. I don’t know if this has to do with it, but trouble sleeping, trouble going to sleep. I’m 55 years old, menopausal, so waking up every once in a while wasn’t uncommon. Now, it’s trouble going to sleep. It’s 10pm, and I’m still sitting in bed. Why am I not sleeping yet? I don’t know if that has something to do with being hyperthyroid, but I thought it did.
I do try to track it. I bought an Apple Watch, and I tried to keep track of my heart rate. Right now, it’s 78. My normal resting on the FitBit is 68 when I’m sleeping. I don’t think 78 while being up and a little nervous on a podcast is probably too high.
Dr. Eric:
68 when sleeping. 78, on the higher side. You haven’t noticed it in the 80s or 90s as far as resting throughout the day? Not moving around but just sitting like you are now.
Dee:
Sometimes, it goes up, but most of the time, it stays down. Resting normally is 68, like sleeping. There have been times where it did get- That’s why I ended up at the emergency room. It was 116 sitting on the couch. That time, they did pull a TSH when I was at the emergency room, and that’s when I had a low TSH. I started thinking this may be hyperthyroidism.
Dr. Eric:
How low did the TSH go?
Dee:
It went to 0.67.
Dr. Eric:
You said heart rate was at one time 116 beats per minute resting?
Dee:
Yes.
Dr. Eric:
That resting heart rate has been a lot better since then. You have been off the thyroid hormone replacement since then for a couple of months.
You mentioned Hashimoto’s. I know you had the Graves’ antibodies, the TSI, which is less than 89. Did they test the Hashimoto’s antibodies, either TPO, which is common in Graves’ but more closely associated with Hashimoto’s, or TG antibodies?
Dee:
Yeah, they did. The nurse practitioner for the weight loss drugs, she first did it when she ran my blood. 94 is what she had. Since then, I have run it a couple times. My TPOs in July were 17. That was on a scale of -34. I recently had it done just last week with the TSI lab, and it was 12. It was on a scale of 9. I guess there is two scales they run that stuff on, depending on what lab you’re going to.
Dr. Eric:
Different labs have different ranges. You said it was as high as 94 at one point?
Dee:
Yes, that blood test would have been about January/February, before I started experiencing any symptoms.
Dr. Eric:
You didn’t have the other antibodies I just mentioned. You don’t notice the TG antibodies in your report?
Dee:
I had one back in July that said less than 1.
Dr. Eric:
So negative. I will say this about Graves’. Usually, the TSI is positive. It’s not perfect. Antibody tests aren’t perfect. It’s possible you could have false negative antibodies. I will also say usually with Graves’, the TSH is undetectable, like 0.67 is definitely less than optimal, but usually, people with Graves’ will have less than 0.001 or .005. It depends on the lab. It will be undetectable.
The eye symptoms are interesting. With Graves’, you’re right, it’s very common to have thyroid eye disease symptoms. Were those thyroid eye disease symptoms? It’s definitely a possibility. A small percentage of Hashimoto’s develop thyroid eye disease. Most of the time, it’s Graves’. It’s a little unusual. Usually, the TSI is very high in those with thyroid eye disease. Yours was undetectable.
You have been off the thyroid hormone replacement for two months. Have you had a thyroid panel since being off the thyroid hormone replacement?
Dee:
Yeah. I had one done with the TSI. It gave me my TSH, T3, T4, all those figures. I just had that done the week before, September.
Dr. Eric:
We were chatting a little bit before. Did you say the TSH was over 2?
Dee:
Yes. It was 2.05.
Dr. Eric:
Definitely not hyper. It is interesting.
Dee:
Strange.
Dr. Eric:
I would say an optimal TSH is between 1-2, even between 1-1.5. Most doctors won’t consider a TSH of 2.05 to be hypo. Some functional medicine practitioners would consider it maybe a little bit higher than optimal. More hypo than hyper, let’s put it this way.
I don’t think it’s Graves’. With Graves’, the hyperthyroidism would persist even after stopping the levothyroxine. Usually, we would see the TSI, not perfect, but your heart rate is also a little bit higher than optimal. 78 is not too bad.
I’m thinking it’s not Graves’. Could be the medication. As far as Hashimoto’s, the TG antibodies are negative, which is good. TPO antibodies, that’s interesting. 94, not crazy high. I have seen people in the hundreds, sometimes even in the thousands with the antibodies. 94, definitely well above the range. There is no question. It was 17, which is within that lab’s range. It recently was 12, which is mildly high, even though it was a little bit elevated.
Based on your current numbers, without your past history, if you went to a doctor’s office, they might not even diagnose you with Hashimoto’s or hypothyroidism. Everything is borderline. The TSH is well within their lab range. The antibodies are slightly high. I don’t know if they would make a big deal out of it unless you were having a lot of hypo symptoms. They wouldn’t even talk about hyperthyroidism or Graves’, even with the tremors. They would be wondering if you were having any brain fog or fatigue or current weight gain or constipation, the hypo symptoms. If not, then they probably wouldn’t do anything honestly.
The question is: Where do you go from here? You have been off the thyroid hormone replacement for a couple months. You’re still experiencing the tremors. The palpitations aren’t there thankfully. The heart rate is definitely not 116 like it was previously. It’s not crazy high, so a little bit high.
Just before we talk about where to go from here, as far as what can cause the hyperthyroidism, we already mentioned maybe too much thyroid hormone replacement. That’s a possibility. It’s just odd that you were on it for 14 years, and then you figured it was too much, that you would just have to reduce the dose and not come off of it completely. You have been off of it, and your numbers are still looking good.
There is also Hashitoxicosis, where someone has the antibodies for Hashimoto’s. By damaging the thyroid gland, you get the release of thyroid hormone into the bloodstream. Hashitoxicosis sometimes can damage transient hyperthyroidism. I am not sure if that’s what we’re seeing, just because you can’t always go by how the antibodies are. They are really mild. Your hyper symptoms were not mild back then.
Who knows. Maybe it was a combination of the thyroid hormone. If someone has Hashitoxicosis, and they are taking thyroid hormone, they’re definitely going to feel really hyper. That’s a possibility.
There is also what’s called subacute thyroiditis, which is typically caused by a virus. Did you have COVID or anything?
Dee:
Throughout the course of COVID, I think I had it one time, and it was very mild. I think I’ve had three shots. I’d always gotten immunizations for it.
Dr. Eric:
Nothing in 2024? No viruses?
Dee:
No. The only thing is when we came back from that cruise, I was on antibiotics because the allergies were so bad the doctor thought I had a sinus infection, which was uncommon for me, too. I never get that kind of stuff. I’m a fairly healthy person, except when I had COVID. I tested positive, but I wasn’t really experiencing any symptoms. I think I’m just generally a pretty healthy person. That sinus infection was out of the blue.
That all transpired when we got back from that. I don’t know if I had an infection. They gave prednisone. I think it kills a lot of stuff when you get it. I don’t know if I had an infection that we didn’t address.
Dr. Eric:
Possibly. Subacute thyroiditis is usually viral; sometimes, it can be bacterial. That is usually temporary hyperthyroidism, and then the person would eventually be hypo. Difficult to know for sure.
I don’t think it was just the thyroid hormone replacement. I think something else caused the hyperthyroidism. It might have been temporary. I don’t think it was Graves’. Maybe Hashitoxicosis or subacute thyroiditis.
If you are not taking thyroid hormone, those could cause hyperthyroidism. On top of it, you were taking the thyroid hormone. Then you had transient hyperthyroidism, which made you really hyper and have those extreme symptoms, including the very high resting heart rate. Subacute thyroiditis, usually temporary. Hashitoxicosis many times is transient. Assuming it was one of those ones, or another infection, but when I say subacute thyroiditis, I am suggesting that an infection, whether it was bacterial or viral, affected the thyroid.
Back to where we are now. Let’s say it was that. Maybe the hyperthyroidism is behind you. As far as why you’re still experiencing the tremors, and you still are having the eye soreness, too?
Dee:
I did go to a TED specialist for it. He measured my eyes. They said there was pressure behind them. He thought I was having dry eyes. During this, my eyes have changed. He was like, “That’s just age.” I was like, “They’ve changed. Didn’t look like this last week.” I get the whole age thing, but during this period, my left eye bags more, it’s swollen underneath, still to this day. My right eye has more bags. I get that he can conclude that that would be just age, but this all occurred within those three months.
I did get a couple styes in the left eye during all this. I had never had a stye before in my life. I don’t wear contacts. I don’t wear my glasses as prescribed. They’re right here on my head. Once again, all of it happened at the same time.
When I went to the TED doctor, he actually removed the styes. I think he said they were chalazions. I actually had three of them in my eye. Maybe my eye could still be bagging from all that trauma or something. I’m still not convinced about the eye stuff. It really did change drastically during that.
Dr. Eric:
I would agree. I don’t know if it’s TED. You went to a TED specialist. I believe him if he doesn’t think it was TED. But as far as attributing it to getting older, and out of the blue, especially when it developed around the time everything else happened, I don’t think it was a coincidence. Maybe not TED, but you figure a TED specialist- He did say there was pressure behind the eyes, but there are other things that could have caused that, as well as other symptoms.
Do you still have something underlying? As far as what comes to mind, I can’t say it’s a typical case that I’m seeing. As far as doing further evaluation, further testing, it’s never going to hurt to clean up your diet and lifestyle. I’m glad you got my two books. It’s never going to hurt to change diet and lifestyle and see if that helps. You have already been doing that. If you’re following the recommendations, and it’s not helping, then further evaluations.
If you go back to a regular doctor, maybe they will blow it off. Maybe they will refer you to a neurologist with some of the symptoms you’re experiencing. It’s not a bad idea to do that. Maybe they detect something.
There is functional medicine testing, things like adrenal testing, gut testing, comprehensive stool panel. Would you find something if you saw a functional medicine practitioner, and they did those tests? Maybe. Even if you found something, does it mean that’s related to what you experienced? Maybe, maybe not.
There are viruses, but there are other infections that sometimes can cause weird symptoms, such as tick-borne infections, like Lyme, bartonella. When I dealt with Lyme in 2018, there was no evidence of a tick bite. There was no rash. Lyme could affect pretty much all the bodily symptoms. It’s called the great imitator because- I’m not saying you have Lyme, but maybe something to rule out and make sure you don’t have that or any other type of tick-borne or even transmitted through fleas sometimes. That could cause tremors. That could affect the eyes. That could also be a trigger for the thyroid autoimmunity.
In your case, you had autoimmunity a long time ago. We don’t know whether the antibodies were higher years ago. That might be something to look into.
There are also things like mold. That’s more of an infection. Sometimes, infections are transient. Other times, you’ll take the antibiotics, and they will help, but they might not completely eliminate it from the body. Something to keep in mind.
I’m not saying it’s a bad idea to go to a neurologist. They will do their sets of testing and see what they find. It could be another condition, another autoimmune condition. That’s also a possibility. Seeing a neurologist, a rheumatologist, might give information. They’re not going to address the cause of the problem.
If you go that route, like I said, it’s not a bad idea. You would be going to try to get a diagnosis. Once you get a diagnosis, with Lyme, for example, they would just give typically antibiotics. It really depends. From a medical standpoint, they won’t do a whole lot. If it’s another autoimmune condition, they’re not going to do anything to address the cause of the problem.
That’s why I’m saying it will always help to address diet and lifestyle. Whether or not you want to consider even some functional medicine testing or maybe looking into tick-borne infections.
I don’t want to lead you down a rabbit hole. It might not be that. But obviously, it’s not normal to have the tremors, and I agree with you with the eye symptoms. Something happened around that time. As I mentioned earlier, not a typical case. Most of the autoimmune markers are negative, and the only one that is positive is slightly positive. Odd that now without thyroid hormone replacement, your numbers are kind of stable. A little on the hypo side but not terrible.
Obviously, monitor that. I would continue to do an updated thyroid panel every 6-8 weeks. See how you feel. If you need to do one sooner than that, if you start feeling hypo symptoms. It’s important to figure out what the underlying cause is behind the tremors and other symptoms.
Like I said, those are the two routes. The medical route is not a bad thing, to try to get a diagnosis. Sometimes, they’re successful at that. Sometimes, they’re not. Going to a functional medicine doctor, sometimes you can get that diagnosis as well.
The question is, do you need a diagnosis? If you have one, the conventional medical world won’t do anything anyway, but still, sometimes it’s nice to know that they have Graves’ and Hashimoto’s. It’s nice to have the diagnosis. At least you know the reasoning behind your symptoms. It’s not a bad idea to look into that and maybe try to get a referral to another specialist.
At the same time, you still can go the functional medicine route. Do what you’re doing with diet and lifestyle. You could do both. You could work with a functional medicine doctor while going the other route as well. That ultimately is up to you.
Dee:
I do have an endo appointment scheduled. When all of this stuff was going on, my PCM did write a referral for the TED specialist. He did write one for an endo. The area I live in, the first available was the 27 of November. I figure with the results I just got on my bloodwork, if it stays like that, they won’t probably be able to do anything, which I should be glad. I’m on your Facebook page, too. I read all of the things, that they give you the-
Dr. Eric:
They won’t give you methimazole. In a way, it’s good that it’s a couple months from now. You’re right. If you went right now, they would look at your numbers. Assuming your numbers now were the same, if your TSH was still around 2, your TPO antibodies were slightly elevated, and you’re not experiencing hypo symptoms, they’d look at your thyroid numbers, too, your T3 and T4. I don’t remember what those were if you told me those numbers. With a TSH of 2, they are probably within the lab range, is my guess. Maybe they are less than optimal.
Dee:
T4 index is 2. This was very comprehensive. Free T4 is 1.1. T3 is 3.1.
Dr. Eric:
Which is great. Free T4 was 1.1. Free T3 was 3.1. Those are optimal numbers. They are not hypo or hyper. I would pay more attention to those than the index. They might have done the T3 uptake. TSH of 2.05, free T4 of 1.1, free T3 of 3.1. An endocrinologist will look at those numbers, even with the TPO slightly high, and probably be like, “Let’s just keep an eye on it.” Wouldn’t give methimazole because you’re not hyper; that’s for hyperthyroidism. If anything, they might lean more toward thyroid hormone replacement based on your history of hypothyroidism. Even that, honestly the endocrinologist might be puzzled.
This is kind of odd. You have been off levothyroxine for two months, and your numbers are not looking too bad. You’re not experiencing hypo symptoms. If anything, maybe a little bit more hyper with the tremors and the eyes, which aren’t a sign of hyperthyroidism, unless you have TED with Graves’. But I don’t think we’re dealing with that. I think your endocrinologist might be puzzled as well, not having an answer.
I think it’s good to give it a little bit more time. When you see the endocrinologist in November, it will be four months off thyroid hormone replacement. If you start going hypo, the endocrinologist will recommend to go back on levothyroxine, I’m sure. At that point, you can make the decision if you want to still do what we mentioned, like address the cause of the problem, and not just rely on thyroid hormone. There is a time and place for that. If it’s looking good, then again, it’s probably going to be a wait and see approach.
That is odd that you were on thyroid hormone for 10 years, and all of a sudden, you became hyper. Now you’re off the thyroid hormone for four months, and it’s still looking good. That probably will be the mindset if it’s still looking good. We won’t know for two months. Feel free to give me an update.
Wish I could have been more helpful with this. I think we need more answers. I don’t think it’s a matter of- Definitely don’t take methimazole. Seems like you would not need thyroid hormone replacement either, but let’s see what the endocrinologist says in two months with updated thyroid numbers.
I think you need to dig deeper. Continue with diet and lifestyle. It still might come down to going to a different specialist. When it comes to the tremors, if the endocrinologist is the right person for that. To me, I am going to be biased because I’m a natural health care/functional medicine practitioner. I will always say to go that route, to dig deeper, to look into further testing.
Dee:
I’m hopeful they will go away. They came on suddenly. I have never had tremors before all this stuff. Maybe they’ll go away.
Do you think it’s all right to use your natural protocol when I do have the tremors? Like motherwort?
Dr. Eric:
Are you taking bugleweed and motherwort currently?
Dee:
I take motherwort more than bugleweed. It’s Thyroid Calming. It has all three of them in there.
Dr. Eric:
From HerbPharm?
Dee:
Sometimes I take that. The sleep thing has been bothersome. It’s always at night more than during the day. It’s not even constant. The last couple days, it’s happened again, so I did take the motherwort.
I started acupuncture after reading your stuff, too. I had my first treatment last week. I’m hoping that will help with the sleep.
Dr. Eric:
Yeah. The acupuncture is great. Who knows? Maybe that helps with the tremors, too.
I wouldn’t take bugleweed based on your thyroid numbers. It sounds like you don’t need it. That’s antithyroid. Your numbers are definitely not on the hyper side.
I don’t think there is a problem with motherwort. It’s not really targeting the thyroid, but more the symptoms, cardiovascular symptoms. Even if someone doesn’t have symptoms, they technically could take motherwort without a problem. Unless someone has a negative reaction to this herb, like any herb, but assuming they are tolerating the herb fine, motherwort is fine if you want to continue with that.
Bugleweed, I wouldn’t take.
Lemon balm, which this formula has, too, some will say has antithyroid properties. It’s very mild if it does. I use it mainly for its calming effects, not so much on the thyroid, but more if someone is having some sleep issues and anxiety. Even lemon balm or drinking lemon balm tea would be fine along with motherwort.
I would say don’t take Thyroid Calming formula.
With the thyroid, wait until the endocrinologist appointment. Right now, your TSH is a little bit higher than I like to see, but your free T3 and free T4 look really good. Not too high or low in my opinion.
Two months from now, I’m sure the endocrinologist will do another thyroid panel, and let’s see what that shows. Maybe at that point, some of your other symptoms might feel better. Maybe the tremors go away. The eye symptoms also could improve. If that’s the case, maybe you don’t need to look into anything further.
If those symptoms persist, and if the thyroid numbers improve or don’t, whether or not the end result is you’re back on thyroid hormone replacement or the numbers still look good, and the endocrinologist says you’re good, if you’re still experiencing other symptoms, then you probably will have to look elsewhere.
That’s where unfortunately, not that you have to do the waiting game. Like I said, you could still see a functional medicine practitioner now while waiting. Even seeing the acupuncturist. It’s not like you’re not doing anything.
Do you need to spend a lot of money at this point, seeing a functional medicine practitioner? I’m conservative with testing. It depends on the doctor you see. Do you need to go in that direction? Maybe not.
Maybe for now, just work on diet and lifestyle. Get the acupuncture. Wait for the endocrinologist. It’s up to you. It’s not wrong to see a functional medicine doctor. I’m biased. I will always say it won’t hurt to see one.
If things resolve on their own, my concern is those antibodies. Even though they’re mildly high, ideally you want them negative. Retest them in a few months, and make sure they’re trending in the downward direction and looking good. If so, maybe you don’t have to do things to improve your immune system health.
Even if your thyroid is looking good, and you have elevated TPO antibodies, I will say you want to try to figure out why. The diet, the lifestyle, the acupuncture, those things are great, and those alone might make a difference. Definitely nothing wrong with waiting a few months.
Dee:
Okay.
Dr. Eric:
Thank you again for agreeing to do this, Dee. I’m sorry I don’t have a specific answer, like this is exactly what you need to do. This is a unique situation. I appreciate you taking the time to have this conversation. Definitely feel free to give me an update after your endocrinologist appointment in November.
Dee:
Sounds good, Dr. Eric. Thank you for your time.
Dr. Eric:
Thanks, everyone for listening. Hope you found this to be valuable. Look forward to catching everyone in a future Save My Thyroid audit. Take care, everyone. Take care, Dee.
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