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Difficulty sleeping, anxiety attacks and fatigue. Prescribed thyroxine. Is it Hashimoto's thyroiditis?

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General & Family Physician
Practicing since : 1980
Answered : 1 Question
My Daughter, age 18, started feeling this past spring. Saw Doctor, found two extremely small nodules on thyroid (ultrasound) then ran blood test. All chemistries fine except SGPT low @9, Alk Phos low @ 37, TSH high @ 5.2 & TPO high @>1300. Dr. suspects Hashimotos Thyroiditis and prescribed thyroxine .05mg per day.

Now 2 months later: Difficulty sleeping, increased anxiety attacks and continued fatigue.

Confidential Opinion & Suggestions:

Thank you,
Posted Tue, 8 May 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. Rahul Tawde 10 hours later
Thanks for the query.

Your daughter's reports are consistent with the diagnosis of Hashimotos thyroiditis. She has rightly been started on thyroxine replacement.

The small thyroid nodules may not be related to Hashimoto's thyroiditis they are just incidental findings. You need not bother about them.

Your daughter is having very mild symptoms and in an early stage. It would not cause symptoms such as difficulty sleeping and anxiety attacks. Infact patients with any form of hypothyroidism having decreased sleepiness and anxiety is very unusual.

So you cannot attribute these symptoms to Hashimotos or its treatment. They have to be dealt with separately. For weakness I would advice her to take Calcium, Vitamin D3 and B-complex medicines.

For difficulty sleeping and anxiety attacks I would request you to have a psychiatry consultation. It is also right time to repeat T4, TSH(Thyroid stimulating hormone) to ensure they are now in normal range.

I hope this answers your queries. I will be available for follow up.

Above answer was peer-reviewed by
Follow-up: Difficulty sleeping, anxiety attacks and fatigue. Prescribed thyroxine. Is it Hashimoto's thyroiditis? 11 hours later
Thank you for your response. My apologies for leaving out the word started feeling "tired" the past spring in my first sentence. From your response, I agree that the trouble sleeping (on occasion) is probably not associated with Hashimoto's.

I'm still concerned about her two most troubling symptoms - tiredness (feeling sleepy) and having occasional panic attacks (shortness of breath/pounding heart) being attributed to Hashimoto's because everything I read says that these two symptoms are conditions of hypothyroidism. Nevertheless, I will accept your opinion over what I have read on the internet as I value your opinion as a specialist.

So, would you please mind clarifying/elaborating about these two symptoms in relation to Hashimoto's. (1) Can these two conditions be symptoms of Hashimoto's? (2) Should they be treated with additional meds in conjunction with synthroid? (3) Are you saying that because of her mild condition that she should not have these type symptoms? (4) With proper medication will she ever feel good again?

That you so much for your time and for the service you provide.
Les Currey
Answered by Dr. Rahul Tawde 12 hours later
Thanks for the follow up.

1. Tiredness is a common symptom of hashimoto's but panic attacks are distinctly uncommon. Mild TSH (Thyroid stimulating hormone) elevation seen in your daughter should not actually cause any symptoms to be XXXXXXX and hence it is called subclinical hypothyroidism.

Although TSH is mildly elevated Thyroid hormones, (T4, T3) will be in normal range and it is only when these hormones are deficient patients get typical symptoms.

2.Yes ,they will have to be treated with additional medications in conjunction with synthyroid.

3. Yes, especially so because mild hypothyroidiam cannot be expected to cause extreme symptoms.Treatment has been started 2 months back and in this duration any symptoms due to hashimoto's should have improved.

4. Definitely given proper medications she will fell good again.But she will have to consult a psychiatrist and maybe a physician for the treatment of these symptoms.

Wishing you good health.
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