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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Are The Treatment And Symptoms Of Hyperthyroidism?

I am a 30 y.o. female, history of menorrhagia (B.C. since first cycle@ age 14), migraines, seasonal allergies/sinus infections. Overall health well, I have always been very athletic/active. No history of alcohol/smoking/recreational drugs. I've had about 4 surgeries in all my life, 3 under g.a., the last under local-anesthesiologist spoke to me prior to surgery, let me know fainting after GA wasn't normal. Keloid scarring. These surgeries have been on my femur/patella over 15 years ago, extraction of all four impacted wisdom teeth 10 years ago, a lap chole 9 years ago, and a cervical biopsy after the birth of my second child 7 years ago. They suspected I had cervical cancer; all cleared post-op. Married at 19, first child@ 20, second@ 23. Have always been underweight, I'm 5'1. Was placed on disability with both pregnancies due to hyperemises throughout entire pregnancies. Often hospitalized. No drugs used for deliveries, episiotomy on first delivery. Both natural births, no complications. Uterus retroverted. In summer 2008, my menses was often confused as a miscarriage due to the signs/symptoms. No D&C ever performed. I had to go to urgent care one day due to the horrible pain. Referred to follow up with GYN for IUD consultation. GYN suggested Mirena IUD was my only choice because of history (menorrhagia/migraines). IUD was inserted without complication, except when I was asked to cough, the room spun, she sat me up and I was dazed, the GYN and MA appeared worried, and said I was pale..they frantically insisted I lay down and drink O.J. I was dismissed after 15 minutes of observation. Drove home hunched over with lower back pain and pelvic cramping. Lasted weeks, but didn't miss a day of work. Bleeding stopped immediately, as did cramping and menstruation all together. Migraines lessened. I slowly realized my metabolism disappeared and weight gain of 20-30 lb within the time the IUD was present. No depression, just irritability increased, realized now pulse & BP also slowly climbed. Whenever I would bring it up to the Dr's, NP's or GYN, it was dismissed. Had physicals and immunizations every year, as I work/ed in many health facilities. OR tech for various laminectomy surgeries, etc. Always used proper shields, or stepped out during xrays. 3 months ago, I started feeling hot flashes, night sweats, insomnia, anxiety, nervousness, hand tremours, persistent eyelid twitching, dry mouth, shortness of breath, labored breathing, heart palpitations, rapid pulse/heart rate at rest, EXTREME fatigue, etc. I made an appointment with my NP to have my TSH and T levels tested. At my appointment she insisted I did not have hyperthyroidism as I suspected (after palpation) & work/home overview. She recommended I drop one of my child's activities, or one of my jobs/activities or start anti-depressants. I assured her I was NOT depressed. She humored me & requested the labs. The next day, my T3 result was normal, my TSH was 0.01! She scheduled a follow up, palpation was done again, she ordered my T4 (she didn't the 1st time), & referred me to an Endocrinologist. I suggested that the Mirena caused this, she said there was no such case. I disagreed and said I had made an appointment to have it removed. She suggested I cancel until I get an OK from the Endocrinologist. I met with the Endocrinologist the next week, who rushed through the exam. I informed her of my suspicions, & she said there was no possible way the Mirena would cause Hyperthyroidism. I informed her there was no history of thyroid problems in my family, and inquired about how my TSH was almost non-existant, and T levels were normal. I questioned how the "low dose" levonorgestrel IUD could not cause these side effects. She assured me that was not the cause and brushed me off, recommended we discuss meds, I declined, she then suggested a thyroid scan. I felt it would be misleading at this point, and asked if I could schedule my IUD removal for the following day. She OK'd, and I asked how long it takes for something like tha to clear from your system. She said 6 weeks, and I said fine, I'll retake my labs in 6 weeks, follow up with you, if at that point I'm still not back to normal, I'll do the scan and discuss my treatment options then. She seemed irritated with me and ordered the labs for 07/11. I again mentioned that TSH was in the 2 point range before the Mirena and it slowly crashed since insertion. She seemed tired of hearing it from me, and wrapped up the exam after checking my hands for tremors. The day after removal, the hot flashes, night sweats, eye twitching, insomnia, anxiety, nervousness ceased. I lost two inches off my Mirena belly in two days, 5 lb in 4 days. Heart palpitations, rapid pulse, exhaustion after work-out, fatigue, weakness, SLOWLY decreasing. Tried to stay away from Thyroid stimulating foods as advised by Endocrinologist. Gained back 2 lb, then yesterday a work, 5 people pointed out my pale appearance, I couldn't concentrate, hands were shaking on keyboard, pulse (carotid) @ 10 sec was 16! I took a 15 minute break to relax, took my carotid, counted 30 in 15 sec. Waited and took my radial- 55 in 30 sec. Went to the bathroom& back to work, vision blurred when looking around, slow/difficult speech. I walked out at the end of the workday, about an hour later, and again a coworker mentioned I appeared very pale, I sat in my car and felt as if I was to faint. I passed by my parents (mom has DM), and asked to check my blood sugar. It read 48. My mom tried to get me to take one of her tablets, I declined and drank OJ instead, she gave a piece of chocolate for the 1 hr drive home since I refused to stay (had to pick up my kids), she called my sister and my sister called me on my drive home (she's an EMT), and insisted I drive-thru somewhere for protein. I did, I ate a sourdough grilled chicken sandwich and had an oreo cookie ice cream shake. I haven't had fast food in months, so I felt nauseated and got a headache. I took my kids to nearby in laws, and I waited to feel better to go home (5 mins away), & my in law suggested I leave the kids there. I went home and my sister suggested I go to the ER to check my sugar again. I said I was better now, & that I would call my insurance after hours RN advice line. The RN suggested I have somebody take me to the ER or call an ambulance. My sister took me to the ER, but to the hospital I prefer, not my insurance hospital. They checked my sugar, I thought I overheard the nurse say 127, then waited for 3 hours after triage (there was lots of crying babies/people in serious pain). I was fine with the wait, just tired. The Dr. Requested blood work, urinalysis, chest xray, & an EKG. Waited another 4 hours and all the results were normal, but the Dr. Thought I confused my TSH for Hyper when it was Hypo. I assured him it was low when tested 2-3 weeks ago, and all my symptoms were Hyper. He said my current results were Hypothyroidism, with a TSH displayed as 97.02 & Free T4 of 0.6. There's also an H& L on some results (I'm guessing Hi/Low?). TSH H, T4 L, & MPV H (10.9). This ER Dr is the best I've seen so far: very professional/receptive/efficient. He recommended I follow up with my PCP/Endocrinologist next week, but I don't see a point. I feel as if my body/hormones are trying to adjust/compensate (whether over/under) due to the damage of the Mirena, and I added stress to my diet/sugar intake when trying to remove Thyroid stimulating foods (to try and not aggravate my condition). Which led to the hypoglycemic incident even though I had just eaten, and ate shortly after (chicken breast cesar salad with croutons/salad dressing, ziplok bagful of strawberries, 16 oz of water, 3 ritz crackers-lunch). Sorry for the too much detail, I just want another professional/educated opinion. What's your take?
Mon, 3 Jul 2017
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  Anonymous's Response
's  Response
thanks for asking
few questions

*Do you have any breathing difficulty/ swallowing difficulty or any voice change?
*Any history of weight loss/palpitations/ tremors/diarrhea?
*Any associated weight gain/ hairloss/ tiredness/ constipation?
*Any history of recurrent fever / thyroid pain/ eye pain / bulging eye ball/ tiredness?
*Periods- is it regular now?
*Do you have raised cholesterol?

in my opinion you had subacute thyroiditis probably viral . It had nothing to do with mirena removal or insertion.
there are 4 phases in subacute thyroiditis
1. toxic phase like hyperthyroidism
2. normal thyroid status
3. hypothyroidism phase with elevated TSH
4. lastly normal thyroid phase

although 90 percent of people becomes normal thyroid status after stage 3 but 10 percent of people stays hypothyroid they require treatment for hypothyroidism.

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
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What Are The Treatment And Symptoms Of Hyperthyroidism?

thanks for asking few questions *Do you have any breathing difficulty/ swallowing difficulty or any voice change? *Any history of weight loss/palpitations/ tremors/diarrhea? *Any associated weight gain/ hairloss/ tiredness/ constipation? *Any history of recurrent fever / thyroid pain/ eye pain / bulging eye ball/ tiredness? *Periods- is it regular now? *Do you have raised cholesterol? in my opinion you had subacute thyroiditis probably viral . It had nothing to do with mirena removal or insertion. there are 4 phases in subacute thyroiditis 1. toxic phase like hyperthyroidism 2. normal thyroid status 3. hypothyroidism phase with elevated TSH 4. lastly normal thyroid phase although 90 percent of people becomes normal thyroid status after stage 3 but 10 percent of people stays hypothyroid they require treatment for hypothyroidism.