Hashitoxicosis Signs and Symptoms - Hashimoto's Thyroiditis with a Twist

The autoimmune thyroid disease known as Hashimoto's Thyroiditis involves antibodies that attack one's own thyroid. The antibodies usually makes your thyroid work slower, causing what is known as Hypothyroidism. Hypothyroidism means your thyroid isn't producing enough thyroid hormone and is often treated by taking a thyroid hormone replacement medication like levothyroxine. This is the pattern when Hashimoto's runs its normal course and treatment is usually quite simple and effective. In some cases, this disease can take a far less common, but much more severe course. When Hashimoto's takes this course, the thyroid antibodies cause your body to swing back and forth, between normal, hypothyroid, and hyperthyroid, while you have a mixture of hypo and hyper symptoms, making treatment very difficult. When this swinging back and forth leads to suddenly going very hyperthyroid, it is known as Hashitoxicosis. I personally have Hashimoto's Thyroiditis and unfortunately, it has taken the far less common, much more severe course that has led to Hashitoxicosis twice. Knowing the possible signs and symptoms of Hashimoto's taking this less common, but more severe course, may help you with making decisions on your treatment options.

First Symptoms. I had a mixture of hypo and hyper symptoms from the beginning. I noticed a "tight" feeling on and off in my throat, I was getting easily overheated, and even though I didn't eat much, I was gaining a little weight. This slowly progressed into the muscles in my legs aching, being exhausted all of the time and needing to sleep more, heat making me feel absolutely horrible, and the "tight" feeling in my throat becoming more constant. Then one night, I woke up barely able to breathe for about a half an hour with that tight feeling in my throat. That's when I decided that I should see a doctor.

First Diagnosis and Treatment. I knew that thyroid diseases ran in the women in my family, so I let the doctor know that, along with my symptoms, at my first visit. He felt my thyroid, which was indeed swollen and then ran basic thyroid hormone blood tests (an antibody test was not done at this time). The tests came back normal, but based upon my thyroid being swollen, my symptoms, and my family history of thyroid disease, the doctor said it was obvious that I had a thyroid problem and decided to let me try the lowest dose of levothyroxine to see if it helped. The medicine did help alleviate the "tight" feeling in my throat and my daytime exhaustion. I was still achy and exhausted by evening and needing to sleep more though, so he upped my levothyroxine to the next dose. This helped more at first, but I soon started having problems with the medication, causing my health to quickly spiral downward, as my Hashimoto's (which I was not yet specifically diagnosed with) took the far less common path.

Further Diagnosis and a Vicious Cycle. When I started getting worse instead of better, my doctor decided that I needed to see a specialist. He said a specialist could run more specific tests to find out what was going on. The first endocrinologist I saw ran an antibody test and diagnosed me with Hashimoto's, but offered no help for my thyroid problems, but instead tried to tell me I was depressed and wanted me to try anti-depressants. I knew I wasn't depressed, so I declined the anti-depressants and went back to my regular doctor. He suggested a different endocrinologist who believed that suppressing my thyroid with more levothyroxine would help. In many cases of "normal" Hashimoto's, this does help, but in my case, it put me in the hospital for three days very hyperthyroid, with extreme heat intolerance, racing heart, palpitations, chest pain, shortness of breath, high blood pressure, uncontrollable shaking, and debilitating weakness from toxic levels of thyroid hormone in my body known as Hashitoxicosis. I was completely taken off of levothyroxine, had fluids pumped into me to help flush the medication out, and was put on a beta blocker to help stop the effects of the excess thyroid hormone in my body. While in the hospital, they gave me a new endocrinologist. The new endocrinologist kept me off of thyroid medication and on the beta blockers for a month to get my thyroid levels back to normal. Instead, I went extremely hypothyroid. I then had to be weaned off of the beta blockers and started on levothyroxine again. I was doing better at first, but as I came off of the beta blockers and onto more levothyroixine, my health went downhill again.

Intolerance to Thyroid Medication. Though my blood tests were still coming back hypothyroid, my body was acting hyperthyroid. My endocrinologist wasn't sure what to do, so I got bounced back and forth between her and my regular doctor. They decided to let me try a different thyroid hormone medication to see if that would help, but I didn't do well on that one either. Finally, they let me stop taking thyroid hormone medication altogether to see what would happen and what my body would do. As soon as I stopped taking thyroid hormone medication, I started to feel better and continued to get better for some time. My thyroid levels began to balance out on their own and a lot of my symptoms were alleviated. I swung back and forth a little between normal and slightly hypo, but my endocrinologist opted to keep me off of the thyroid hormone to see how I would do. Then I started having hypo and hyper symptoms again, including my heart rate racing on and off with palpitations and chest pain that would run down my left arm even though I wasn't on any thyroid hormone medication. We were in the midst of moving to a new area, so I had to find a new regular doctor and go from there. My thyroid tests continued to bounce back and forth between normal and slightly hypo. My new doctor tried a couple of different levothyroxine medications, but my body couldn't tolerate them at all. Every time I tried one, it caused me to have more heart racing episodes and chest pain and would make me shaky and irritable. It became obvious that I was unable to take any form of levothyroxine for some reason.

Put Back on Beta Blockers. Even without being on any thyroid hormone medication, my heart racing episodes, palpitations, and chest pain that ran down my left arm grew increasingly worse, along with shortness of breath and weakness. I finally ended up in the emergency room, where I was put back on beta blockers and given a cardiologist. The cardiologist ran a myriad of tests to make sure my heart was okay and found nothing wrong with my heart. He could find no reason for my heart problems other than he knew thyroid problems can cause heart issues and said to make sure I didn't take any thyroid hormone medication unless I absolutely needed it. It took several months of upping my dose of beta blockers and putting me on an extended release formula to finally settle my heart down.

The Cycle Continues. After getting the heart problems under control, I did better for a little while. Then the normal to slightly hypo cycle continued and I again tried a thyroid hormone medication. I would do well on it for three or four months and then have to stop. After trying this a couple of times, I had to stop altogether again and just deal with the symptoms. I was completely off of thyroid hormone medications for over a year battling through a cycle of feeling better and dealing with a mix of hypo and hyper symptoms. My thyroid levels then proceeded to get better than they had been in over three years and I actually felt really good for about two and a half months. Then I suddenly spiraled into being very hyperthyroid, with extreme heat intolerance, racing heart, palpitations, chest pain, shortness of breath, high blood pressure, uncontrollable shaking, and debilitating weakness that caused me to end up in the emergency room again. This time the Hashitoxicosis wasn't caused by any medication, but by my own thyroid producing too many thyroid hormones on its own. The ER doctor almost kept me, but after consulting several other doctors, he decided to put me on anti-thyroid medication and allow me to go home. It took about a month of upping my dose and another month of the dose taking full effect to calm the Hashitoxicosis down, but within a couple of weeks of getting it under control, I started going hypothyroid again from the anti-thyroid medication.

Plans for a Definitive Treatment. After my latest ER visit for Hashitoxicosis, my regular doctor and I worked together to find a specialist. I now have a wonderful endocrinologist that has actually dealt with Hashitoxicosis before and knows how to treat it. I will be getting a dose of Radioactive Iodine to kill off my thyroid to stop the vicious cycle. I will then go permanently hypothyroid and can be given thyroid hormone replacement medication without the adverse effects or the risk of going toxic again. I do have to be hyperthyroid in order to get the Radioactive Iodine treatment done though, so I had to completely stop the anti-thyroid medication to allow my body to go hyper again, which I am currently waiting for it to do. I am not looking forward to going through the vicious cycle again, but after four years of such cycles, I am truly looking forward to a permanent solution and am hopeful that this cycle will be the last one.

Altogether, from the first symptoms to now, has been about six years. I hope that my ongoing experience with dealing with Hashimoto's Thyroiditis and Hashitoxicosis will help others going through similar situations to be able to recognize what is happening to them and that it will be useful to them when considering their treatment options.

Warning. Sudden, severe hyperthyroidism from Hashitoxicosis can be dangerous. If you suspect you have suddenly become hyperthyroid, seek medical care.

Further Information. If you would like to learn more specific information about Hashimoto's, Hypothyroidism, Hyperthyroidism and their symptoms, just click on the words highlighted in this sentence to go to a thyroid disease website. I have also written Hyperthyroidism: Signs and Symptoms, a more in-depth article about going hyperthyroid. For the medical definition of Hashitoxicosis, click on the highlighted word.

Sources:

EndocrineWeb.com
Medical-Dictionary.thefreedictionary.com