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Complains of severe anxiety on armour thyroid therapy.

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My dr a family practice dr is gone. I developed intolerable anxiety
Went to er. Just got a refill on my armour thyroid. I know i have missed some doses. Tsh was 1.2. Much lower than my dr treats me. I didnt see the connection and went home. Then itcdawned on me. We had this problem 2x before. Once at 125 when it was lowered to 90. Heart palitations, wired. Second time felt like a rocket ship and it was lowered to 75. This time anxiety, feel on edge of heart palp. Skipped two days and then did 60 and 60. Tonight I know I cant take it. Too wired but not anxiety. I have a dr to see tomorrow and she told me she could manage it but i dont think she knows much about armour. What can I suggest to her?

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello,

Thank you for your query at DoctorSpring.com.

I am curious as to how long you have been on armour thyroid therapy. It seems like your TSH levels are getting regulated to normal levels, but you are experiencing side effects of the therapy which is a bit concerning to me. Long term effects of armour therapy can cause hyperthyroid symptoms like what you are describing ~ anxiety, palpitations, etc. Here is what I suggest:

1. Your TSH levels are in the normal range currently. Cut your meds down to a lower dose such as 15 mg or 30 mg per day (as 60 mg is still intolerable). Monitor your symptoms as well as your TSH levels. If your anxiety is relieved at a lower dose and your TSH levels are normalized then stick with this regime. Otherwise, gradually increase by 15 mg until you find a balance.

2. After lowering and adjusting the dose, if you are unable to find a balance of a euthyroid state with minimal symptoms of side effects then consider an alternative therapy. Armour thyroid therapy can give variable results for different patients. It may not work for you in the long-run due to the hyperthyroid effects you are already experiencing.

3. Levothyroxine is an excellent alternative and can give good results in normalizing thyroid hormones in different individuals. If you haven't already tried it, it is worth a try.

I hope these suggestions are helpful or can at least give you a starting point to discuss with your local physician.

Thank you. Please ask any further follow-up questions, if any. Take care and be well.


Patient replied :

I was unable to take any thyroid tonight. The horrendous anxiey gone but i ammaxed out i can tell nd cant take any more. Do i start lower dose tomorrowor wait a day. Also one of the teeth i had extra does not have axry socket but has swollen up face. First stop is oral surveon. I may not see that dr tomorrow. Xepends on what oral surg has to do.



Hello again,

First get your oral issue taken care of. It sounds concerning and that takes priority.

Do not take your thyroid meds tonight. However, if you are scheduled for surgery tomorrow morning, you will need to be in euthyroid state before anesthesia for any procedure. If you are feeling fine, then take your thyroid medication tomorrow at the lower dose as per my suggestion at your regularly scheduled time.

Your surgeon may want to check your thyroid levels before proceeding with any procedure. Explain to him/her what you are experiencing and the status of your thyroid treatment beforehand.

Thanks for your question and don't hesitate to ask any further questions if necessary. Take care and be well.


Patient replied :

I cannot see your original reply. Can i get it? The oral surgeon said eveything was fine. He sent me to the ENT who said.my ear tube hsd too much moisture behind it. He gave cipro drops. Used some when i.got ho
E. Swelling down. Have not dosed tbyroid tonight yet. Still a bit up but i yhink could handle small dose





Reply to current follow-up:
That is great. Keep using the ciprofloxacin drops as suggested by your ENT physician. If you are feeling up to it, start with the lower dose thyroid medication. Otherwise, wait for one more day. Nothing will happen in day, and then you can start with the lower dose and see how you feel on it. You should be feeling better if you stick with lower dosages, and meanwhile monitor your TSH levels to ensure they are in normal ranges. Take care.

-------------------------------------

Previous reply 1:

Hello,

Thank you for your query at DoctorSpring.com.

I am curious as to how long you have been on armour thyroid therapy. It seems like your TSH levels are getting regulated to normal levels, but you are experiencing side effects of the therapy which is a bit concerning to me. Long term effects of armour therapy can cause hyperthyroid symptoms like what you are describing ~ anxiety, palpitations, etc. Here is what I suggest:

1. Your TSH levels are in the normal range currently. Cut your meds down to a lower dose such as 15 mg or 30 mg per day (as 60 mg is still intolerable). Monitor your symptoms as well as your TSH levels. If your anxiety is relieved at a lower dose and your TSH levels are normalized then stick with this regime. Otherwise, gradually increase by 15 mg until you find a balance.

2. After lowering and adjusting the dose, if you are unable to find a balance of a euthyroid state with minimal symptoms of side effects then consider an alternative therapy. Armour thyroid therapy can give variable results for different patients. It may not work for you in the long-run due to the hyperthyroid effects you are already experiencing.

3. Levothyroxine is an excellent alternative and can give good results in normalizing thyroid hormones in different individuals. If you haven't already tried it, it is worth a try.

I hope these suggestions are helpful or can at least give you a starting point to discuss with your local physician.

Thank you. Please ask any further follow-up questions, if any. Take care and be well.


Previous reply 2:

Hello again,

First get your oral issue taken care of. It sounds concerning and that takes priority.

Do not take your thyroid meds tonight. However, if you are scheduled for surgery tomorrow morning, you will need to be in euthyroid state before anesthesia for any procedure. If you are feeling fine, then take your thyroid medication tomorrow at the lower dose as per my suggestion at your regularly scheduled time.

Your surgeon may want to check your thyroid levels before proceeding with any procedure. Explain to him/her what you are experiencing and the status of your thyroid treatment beforehand.

Thanks for your question and don't hesitate to ask any further questions if necessary. Take care and be well.


Patient replied :

I took 30 of armour last night. Not doing well. Worst ive been. I alsovused ciprodex ear drops which i was just given by ent to dry ear out. These havenever agreed with me. I think anxiety might be a side of thisn two drugs in this. The 30 is worse than skipping it for two days and taking it.


It seems like the armour thyroid is not working for you. I advise you try levothyroxine if you haven't already. You will need a prescription through your local physician.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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