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What Causes Internal Body Tremor?

Posted on Tue, 8 Apr 2014

Question: I have developed internal tremor. I feel like I am shaking but visibly I am not. I take synthroid 150mcg after thyroidectomy for pappillary cancer. I believe the shaking is from the synthroid dose but the endocinologist says no. I also feel hyperactive and feel chilled at times. Labs all normal. I do have idiopathic peripheral neuropathy. I take toprol, hctz, Xanax 5 before bed, flax seed oil, high dose vitamin d and multi vitamin. I have osteoarthritis with issues at all levels of my spine. What might be causing this shaking feeling - not just extremities, but in my abdomen, etc. TSH .5 Thank you.

Answered by Dr. Vinay Bhardwaj (24 minutes later)

Brief Answer: More information is key. Detailed Answer: Hi. I'm so sorry to hear about your tremor. Considering the multiple health issues you have been facing I am so happy that you have gotten this far. Congratulations on getting your surgery done and beating back the Cancer. Now, to the Tremor. On first blush, I personally agreed with you when it comes to the suspicion of your thyroid medications causing your tremor. The endocrinologist knows better, has more information and has actually examined you though, so i am loath to disagree with their assessment. Is there any way you could send me your complete Thyroid profile (maybe scan it or take a picture and upload it). I would like to see your free T3 and Free T4 levels as well (these are measurements of different fractions of the Thyroid hormone in your blood). You TSH seems to be on the border of Normal and low. Which makes those other labs much more useful. If you haven't gotten those tests done, might be a good idea to discuss it with your doctor. The other course of investigation is to look into the management of your peripheral neuropathy. Patients suffering from Neuropathy have been known to develop resting tremors late in the course. These tremors can be managed through medications. Talk to your doctor or a neurologist about that. Lastly, I would encourage you to give your body some time to heal from the massive changes brought on by the thyroidectomy. Natural hormones produced in your body always work better than synthroid and the receptors on your cells may need time to get used to the synthroid before you go back to normal. When did you have your surgery? How long have you had to heal? My educated guess is that if your tremor is caused by these fluctuations in thyroid hormone, then they should settle in 3-4 months post surgery. If you would like to. Send me your labs and whatever else you have and we can follow up on this with more information. All in all. I would focus on getting your endocrinologist to rule out the possibility of any lingering issues with the thyroid and your dosage of synthroid. If that is succesfully ruled out then I would work on getting treatment for the Neuropathy. And last but not least, try to give yourself and adequate amount of time before worrying too much about these symptoms post op. I hope this has helped. Feel free to contact me through HealthCareMagic.com and follow-up

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Vinay Bhardwaj (1 hour later)

T4 Free is 1.31 TSH .689 These were labs from last week. Surgery was 5/10/13. My synthroid dose has been adjusted several times. On 2/4/24 T4 Free was 1.59 and TSH .233. Dose was reduced to 150 6 days per week and 75 one day per week. I am also taking alpha lipoic acid for the neuropathy. I have no record that a T3 was done and I have all my results online. Is there a possibility that high dose vitamin D or alpha lipoic acid might cause the tremor? Also, I had an episode of vertigo one year ago and had a brain MRI which was normal. I have ringing in my ears. My neuropathy started out about two years ago as small fiber but has progressed to the next stage and is higher up on the legs - to almost the knee. Thank you.

Answered by Dr. Vinay Bhardwaj (2 hours later)

Brief Answer: Looks like the Thyroid is being managed well Detailed Answer: Hi. Looks like your Synthroid dose is being managed well. The dose was pretty high at first. But it's being cut back. It will take awhile for the blood levels of thyroid/Synthroid hormone to level out. I'm hoping your tremors will subside by then You've spent a good amount of time recovering from the surgery. So that issue shouldn't be bothering you at this point. You raise a very interesting point by talking about your Vitamin D and Alpha Lipoic Acid supplements. Yes. Fat soluble vitamins like D can interfere with electrolyte levels in your blood. In your case it's very tough for me to theorize how that may affect you. But a tremor is one of the possibilities. May I ask WHY you are taking these supplements? Where they prescribed or did you start them on your own. If so, why? Vertigo and Tinnitus are issues affecting your inner ear, your joints and your Central nervous system. I'm glad the MRI ruled out anything in the CNS and inner ear. But the tinnitus persistin makes me think that the neuropathy may be related here. But before I link THOSE two issues together. I have another question for you? What's your caffeine intake like on a daily basis. Because even minimal doses of caffeine can worsen tinnitus and either start or worsen an existing tremor. If you are like me.. then you need some sort of pickmeup in the morning.. afternoon and unfortunately even the evening. I switch from drinking coffee and redbull to Tea and my issues went away and I still go my stim. You might want to consider that if you are a caffeine user. Lastly the Neuropathy. It seems like the issue is progressing like it does in most people. I really wish I had better news for you here, but it's a problem that hasn't been cured yet by medical science. All we can do is mask the pain with meds like Neurontin (Gabapentin) or Lyrica (Pregabalin). And both of those drugs have their own side effects that you need to worry about. So, again to sum up. Yes high doses of Fat soluble vitamins like D can cause tremors. I'd like you to speak to your local doctor and see if you really need to take this supplement at all. I'm hoping that cutting down on a few meds will help you with the tremor there. As to the Thyroid, I'm happy with the progress and checkups there. I know it can be difficult to live through but it just takes time and alot of checking in between to tweak the dose of Synthroid to the right dose for a given patient. Lastly, Your neuropathy can also cause the tremor, but in my opinion it doesn't seem to be the cause. Try to talk to your doctor about your vitamin and supplement intake. Lastly, Physical Therapy is a good option for people with uncontrolled tremors. It retrains the nervous system and many patients have had great success with it. Again. I hope I'm being helpful to you. You can follow up with me whenever you like and have yourself a lovely evening.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Vinay Bhardwaj (11 hours later)

In 2008 my vitamin D was 11. At that time my doctor prescribed 50,000 units per week. From 2008-2013 it ranged between a los of 32 and a high of 52. When it was 32, in late 2013, the dosage was changed to 50,000 once per week and 2000 6 days per week plus what I was getting in my multi-vitamin, for a total of 67,600 unit per week. I had labs on 2/4/14 and again was called and told to increase the over the counter to 5000 6 days per week, for a total of 85,600 per week. I then had labs last week and my vitamin D was 70 and I received a call that it was too high. I asked if I should decrease the dose and she said that her nurse had made an error in February. She was supposed to tell me to discontinue the 50,000 and start the 5,000, but rather she told me to increase to 5000 without telling me to stop the 50,000. So now my instructions are to take 5000 over the counter per day plus the 800 I get in my multi vitamin for a total of 40,600 per week. So - my question is, therefore, do you think this vitamin D dose might be the cause of the tremors. I do correlate them with the increased dose and I also correlate them with worsening as the dose increased. I want to add that as stated initially, the tremors are internal feeling and no tremor is visible externally. I take the alpha lipoic acid because I understand that it is an accepted treatment for many years in Europe for neuropathy symptoms. My doctor said it can't hurt and I preferred it to a prescription drug because of my kidneys. I take 600 mg per day. Thank you very much. I appreciate your opinion and your compassion.

Answered by Dr. Vinay Bhardwaj (9 minutes later)

Brief Answer: Certainly a possibility Detailed Answer: Yes. High doses of Vitamin D can cause tremors by altering your electrolyte levels and the absorption of electrolytes from your gut when you eat. In my opinion it is certainly a strong candidate for the cause of your tremor (or since it's not external.. lets call it a shakiness or jittery feeling). But there are alot of other causes that haven't been ruled out. The caffeine I mentioned earlier is one of the more common causes of such a feeling. So. How bout we do this. Lets wait and watch and see if your jitters come down with the lower doses of vitamin D. At the same time, lets try and eliminate (or at least cut down) on your caffeine intake. I think doing those two things should get you on the right track. What do you think? Again. I hope this helps. These kinds of sensations are really tough to nail down as to what has caused them and I will do my best to help you work through it all. Thanks for coming to HealthCareMagic.com

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Vinay Bhardwaj (7 minutes later)

I have one cup of coffee in the morning. I have one 16 ounce bottle of diet green tea in the morning and I have once cup of coffee around 2:00. I do not drink caffeine (or even have dark chocolate) after late afternoon. If you think I should cut some of that out I will. I agree with your suggestion and will see how things go with the lower dose of vitamin D. There's a best selling book right now regarding a short list to a long life, and the author (M.D.) suggests no supplements or vitamins at all. In his opinion they are useless. I'm very tempted to stop the extra vitamin D and just take the 800 I get in the multi vitamin plus what I get in food. I should also mention that I have intentionally lost 25 pounds so far this year and the vitamin D dose (or synthroid dose for that matter) were not reduced. Does a smaller body need less or are the labs the final word on what's needed? Final questions therefore: Should I cut out some of the caffeine and what do you think of vitamins and supplements.

Answered by Dr. Vinay Bhardwaj (22 minutes later)

Brief Answer: Taper the caffiene and trust the labs Detailed Answer: Yup. So that's alot of caffeine. Maybe you could switch one or both of those cups of coffee to plain tea (black tea). Also remember that Green tea has about as much caffeine as coffee cup for cup. Also remember that sodas like Pepsi, Coke and RC have alot of caffeine in them as well. So stay clear of those. My opinion on supplements is that they are useful when there is a deficiency that you can't make up for through your normal diet. The vitamin D issue sounds like an example of that. So I would say, keep taking them till you doctor says not too. Weight loss will certainly lower the requirements of practically every medication you take, but if your latest labs were taken AFTER you lost the weight.. then they would reflect the loss. Labs are our best way of knowing what levels are present in the body and I have learned to trust them when they are done for the right reasons and backed up by clinical findings. A lab value ALONE (without the examination and clinical findings) is borderline useless. So, Trust your labs and bring down your caffeine intake over time. That should help, maybe even stop the jitters. Thanks again my friend and feel free to contact me whenever you want.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj