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Suggest treatment for anxiety attacks

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Posted on Tue, 5 May 2015
Question: I am a 41 year old woman. I had a total hysterectomy 4 months ago and I went on bioidentical estrogen, progesterone and small amount of testosterone. This was working well. I then hit a patch of insomnia.. So we changed the hormones around. About three weeks later, I was on a flight, something I do a lot and had a huge panic attack. This has never happened to me before and I am a pretty easy going person. My left lymph nodes is very large and my t3 is low. I do not know what caused this but ever since that day three or four weeks ago I have had panic attacks every day. I would love any advice... I have been to the ER one time and see my own doctor...but we have running tests with no clear reason or answer...thanks so much.
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Answered by Dr. Olsi Taka (47 minutes later)
Brief Answer:
Anti anxiety medication is necessary.

Detailed Answer:
I read your question carefully and I am sorry about these complications you are experiencing.

Hormone fluctuations are a very common cause of anxiety attacks and other emotional changes. Replacement therapy as much as we can strive to is not equal to the physiological hormonal production and balances can be disrupted leading to emotional changes. The fact that you have had to change the hormones during a short span of time doesn't exactly help either. Added to that is having a hysterectomy at a young age which can have psychological effects.

So while hormone therapy should be reevaluated (if T4 and TSH are normal I wouldn't treat T3 low levels - though belongs more to endocrine specialty) in the meanwhile I believe treatment for anxiety is necessary.
Short term treatment for 2-3 weeks consists usually of benzodiazepines (lorazepam, alprazolam). If symptoms later persist and treatment for a longer period is contemplated then antidepressants which have also anti-anxiety effect are more appropriate (because benzodiazepines develop dependance and tolerance when used for long term).

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (18 minutes later)
Thanks so much. What is involved with t3 treatment and do you think I should take something for the panic attacks as they happen or being on something for two weeks consistently will help sort it out? Thanks!
Also..do you think the lymph node has anything to do with this? Can that cause panic attacks. .thanks!
doctor
Answered by Dr. Olsi Taka (46 minutes later)
Brief Answer:
Read below.

Detailed Answer:
Thanks for the follow-up

If there is only low t3 with normal TSH and T4, there usually is no real dysfunction of the thyroid gland. There can be several other causes for those altered values like variability in lab essays, depression, inflammatory states etc which can temporarily alter those values. For that reason often no treatment is started and there is no consensus on what would be the best management, so I believe better do no harm, especially since you've undergone other therapy changes.

If you take the benzodiazepines daily hopefully no extra treatment is necessary. Panic attacks usually last for a matter of minutes anyway, so by the time the drugs came into effect might be useless, I believe the benzodiazepines will help prevent them.

As for the lymph node, no, it doesn't cause panic attack, do not worry about that.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3657 Questions

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Suggest treatment for anxiety attacks

Brief Answer: Anti anxiety medication is necessary. Detailed Answer: I read your question carefully and I am sorry about these complications you are experiencing. Hormone fluctuations are a very common cause of anxiety attacks and other emotional changes. Replacement therapy as much as we can strive to is not equal to the physiological hormonal production and balances can be disrupted leading to emotional changes. The fact that you have had to change the hormones during a short span of time doesn't exactly help either. Added to that is having a hysterectomy at a young age which can have psychological effects. So while hormone therapy should be reevaluated (if T4 and TSH are normal I wouldn't treat T3 low levels - though belongs more to endocrine specialty) in the meanwhile I believe treatment for anxiety is necessary. Short term treatment for 2-3 weeks consists usually of benzodiazepines (lorazepam, alprazolam). If symptoms later persist and treatment for a longer period is contemplated then antidepressants which have also anti-anxiety effect are more appropriate (because benzodiazepines develop dependance and tolerance when used for long term). I remain at your disposal for further questions.