How Your Thyroid Can Send You To The ER

Thyroid In Emergency Care

Thyroid In Emergency Room

While most people enjoy summer and warm temperatures some of you might find it impossible to feel comfortable in the hot weather.

Unfortunately, rising summer temperatures also mean an increase in the number of emergency room visits. Certain health conditions are likely to cause you more symptoms on hotter days and it might be to do with your body’s ability to adapt to the heat and your hormones.

Have you ever had heart palpitations, chest pain, shortness of breath, anxiety or even a panic attack and you felt like going to the ER?

Then you may be interested to discover that all these symptoms can be due to your thyroid. Here is why:

You can experience these symptoms when you have the following thyroid related conditions:

  1. Thyrotoxicosis can occur in hyperthyroidism when your thyroid gland produces an excessive amount of thyroid hormones.
  2. Thyroid storm is a form of severe thyrotoxicosis. It is a life threatening condition that can be fatal if not treated. It can happen in people who have undiagnosed or untreated autoimmune Graves’ disease, toxic goiter or hyperthyroidism.
  3. Medication overdose can also be one of causes of thyrotoxicosis. It can occur when your dosage of thyroid medication is too high or you take too much thyroid meds such as levothyroxine, Synthroid, Armour or thyroid grandulas by accident.
  4. Hashitoxicosis can happen in people who have inflammation of the thyroid gland (thyroiditis) or Hashimoto’s disease.  An excess of thyroid hormones stored in the gland gets released into the blood. This happens without the accelerated hormone production by the thyroid gland which is typical when people with Hashimoto’s disease become temporary hyperthyroid.

Thyroid in Emergency Care

People with hypothyroidism are most likely to have the last two conditions. However, most patients are not aware that anxiety and panic attacks can be directly related and indicate Hashitoxicosis or medication overdose.  So let ‘s see why.

What Anxiety And Panic Attacks Can Tell You About Your Thyroid

…are high.

As a matter of fact, both panic and anxiety attacks can be the first signs of a thyroid dysfunction that has not yet been diagnosed. They can happen any time and without warning.

Connecting anxiety to autoimmune Hashimoto’s disease is not easy and there are two main reasons why it can be missed:

1. Patients are seldom tested for thyroid antibodies that are an indicator of Hashimoto’s disease

You can have Hashimoto’s years before it progresses to hypothyroidism. Your symptoms can be unspecific and lab test results can look normal but only thyroid antibodies can be high.

Standard thyroid lab tests include TSH and T4 but not thyroid antibodies. If you don’t have any other symptoms indicative of thyroid disease doctors are very unlikely to order thyroid labs in general and especially check for thyroid antibodies.

High levels of thyroid antibodies precede the diagnosis of hypothyroidism in people with euthyroid Hashimoto’s (normal labs) for 3-7 years on average. Anxiety could be one of the first symptoms of a starting thyroid disorder many years before you develop full blown hypothyroidism.

2. Unstable thyroid levels can fluctuate within normal reference range but cause symptoms

In Hashimoto’s when the thyroid responds to the autoimmune attack your thyroid levels can become very unstable and your TSH and thyroid hormone levels can go up and down substantially.

However, in many cases your numbers stay within a normal TSH reference range which is too wide to catch these abnormalities, doctors may not suspect the thyroid as a cause of your symptoms. These fluctuations are often misdiagnosed as an anxiety or panic disorder when in fact it is an early stage of autoimmune Hashimoto’s disease.

You may experience heart palpitations, excessive sweating, nervousness, tremors, insomnia, cold chills and dizziness and think that you are having an anxiety attack and make your trip to the ER. But in reality, some of the thyroid tissue became destroyed during the autoimmune flare-ups and the excess of hormones stored in the gland flow into the bloodstream causing all these symptoms.

Hashitoxicosis is a more advanced form of excessive thyroid hormones release into the bloodstream. It is a transient hyperthyroid phase that lasts between a few weeks and some months. Hashitoxicosis is most likely to occur in the early stages of autoimmune hypothyroidism.

Are You Overmedicated And Don’t Know It?

Thyroid Medication Overdose

Thyroid Medication Overdose

Thyrotoxicosis due to the overdose of thyroid medication happens more often than you may realize.

Regardless of the type of prescription thyroid drugs or the dosage, people still have many thyroid related symptoms.

Anxiety, insomnia, irritability, intolerance to heat, increased body temperature and excessive sweating are most common symptoms of an obvious overdose with thyroid drugs when taken in excess.

But today I would like to talk about two less known causes of being overmedicated with thyroid drugs:

1. Improper Combination of T4 and T3 Medication

People who are on desiccated thyroid medication that contains both T4 and T3 thyroid hormones should be aware that the proportion of T4:T3 in the drug is 4:3. This is NOT the physiological dose that is produced by the human thyroid gland which is somewhere between 14:1 and 12:1.

Even considering that some people have an under conversion of T4 into T3, desiccated thyroid medication supplies way more T3 than most patients require and this can result in anxiety, insomnia, irritability and hair loss.

T3 is a metabolically active thyroid hormone and your body has 4 protective mechanisms to regulate its quantities and effects:

  • Your thyroid gland produces T4 and T3 hormones in a fixed proportion
  • A portion of T3 is converted from T4 thyroid hormone on an as needed basis
  • If there is more T3 than necessary some of it can be converted into reverse T3 reducing the amount of metabolically active T3 hormone
  • Reverse T3 can block T3 receptors preventing the action of T3 hormone on the cellular level

When you take T3 with thyroid medication in a physiologically inappropriate dose you disrupt your body’s protective mechanism to regulate the T3 hormone. As a result you could have anxiety and panic attacks send you to the ER on a regular basis. Combined with stress it can be a recipe for disaster.

I am not saying that you shouldn’t use T3 medication at all. In fact, many hypothyroid patients can benefit from it when it is done correctly. What I am saying is that you should use it responsibly, only when necessary and in a proper dose.

Some patients go on desiccated thyroid medication and wonder why they start to experience anxiety, panic attacks, rapid heartbeat and insomnia after starting it. People who have their thyroid levels constantly fluctuated because of autoimmune attacks in Hashimoto’s disease are at a higher risk to experience these symptoms.

The combination of T4-only and compounded sustained release T3 medication or Cytomel is often a better option because it allows you to achieve a more accurate and individual dose titration. It is also easier to adjust your medication requirements if they are different than standard drug proportions or suddenly have changed.

2. Undiagnosed Secondary Hypothyroidism That Is Not Responding To Thyroid Medication

People who are on thyroid medication often are on a higher than necessary dose because they partially overcompensate for secondary hypothyroidism that occurs due to other hormonal imbalances like low adrenal function, under-conversion of T4 into T3 or estrogen dominance.

Your body has a sophisticated mechanism that allows it to adapt and compensate when some of its parts underperform. This is especially true when some of your glands produce fewer hormones than they should.

…know it!

2.1. TSH-Suppressive Dose Of Thyroid Medication

People who have underconversion of T4 into T3 and are on T4-only medication often take a TSH-suppressive dose of their thyroid drugs to better manage their symptoms.

However, there are 2 problems with that:

  • It doesn’t matter how much more T4-only drugs you take: if you don’t improve your T4 to T3 conversion your hypothyroid symptoms don’t get better because T3 is the metabolically active thyroid hormone and not T4.
  • The excess of T4 hormone in your system can cause anxiety and many other hyperthyroid symptoms. As a result you will have a confusing picture of a mix of hypothyroid and hyperthyroid symptoms due to not enough T3 and a buildup of too much T4 that occurs at the same time.

2.2. Secondary Hypothyroidism Due To Low Adrenal Function.

When your adrenals produce less cortisol than your body requires, your thyroid gland also slows down and releases less thyroid hormones making you hypothyroid. This is a part of a self-defence mechanism when the thyroid down-regulates your metabolism in order to prevent adrenal burnout.

You can have adrenal dysfunction alone or a combination of low adrenals and primary hypothyroidism. Many people with autoimmune Hashimoto’s disease have both adrenal and a thyroid problem at the same time.

When adrenals are not supported the chances that you are on a higher dose of thyroid medication than necessary are very high. Up to 80% of people with Hashimoto’s have some sort of adrenal dysfunction as well as thyroid.

In addition, low cortisol levels are one of the major factors why thyroid hormones are not getting to your thyroid receptors leaving you hypothyroid on a cellular level. Cortisol activates cell receptors and allows T3 thyroid hormone to perform its metabolic action.

Every cell in the body has receptors for both cortisol and thyroid that are required for nearly every cellular process to be at an optimal level. Cortisol makes thyroid hormones work more efficiently.

A physiologic amount of cortisol—not too high and not too low but just exactly right—is very important for activation of thyroid receptors, which is why a lot of people who have an imbalance in adrenal cortisol levels usually have hypothyroid-like symptoms that don’t respond well (if at all) to thyroid medication.

If low adrenals were the cause of secondary hypothyroidism, properly addressing adrenal dysfunction will correct hypothyroidism completely or at least partially in those who have hypothyroidism or Hashimoto’s due to other causes.

The problem is that adrenal dysfunction is missed by conventional medicine in most cases and very often symptoms and lab test results are interpreted and treated as hypothyroidism alone.

People are put on thyroid medication or the dose of thyroid meds goes up and up which also fits the picture of a slow and progressive thyroid destruction process in Hashimoto’s due to an autoimmune attack.

Taking thyroid medication can result in a temporary symptom relief and general feeling of more energy, however it usually doesn’t last long because in response the thyroid slows down again to prevent the adrenals from overworking.

The real problem occurs when you get in a very stressful situation and adrenals are forced and still capable to produce cortisol in response to stress. Since your cortisol level suddenly and quickly becomes adequate or high during periods of severe stress, your body becomes overwhelmed because cortisol activates your thyroid receptors and T3 thyroid hormones start to flood into your cells.

People who have low cortisol output and went through this dose increase cycle are more likely to be overmedicated because you cannot compensate for adrenal imbalance and low cortisol levels by increasing your thyroid medication.

In an extreme case you can experience severe thyrotoxicosis that can send you to the ER. If you are on a T4 and T3 medication your symptoms can be more severe than when you would take T4-only drugs.

In milder cases of thyro- and Hashitoxicosis you can feel “wired by tired” and experience intolerance even to a small amount of stress because it triggers an anxiety or panic attack.

Take Away

  • It is important to realize that if you experience anxiety and panic attacks it can be your first warning sign of underlying thyroid condition such as Hashimoto’s disease.
  • If you are already are on any type of thyroid medication but struggle with anxiety, irritability, mood swings and insomnia consider and get tested for other contributing factors to hypothyroidism such as adrenal dysfunction, estrogen dominance, underconversion of T4 to T3 thyroid hormone and others.
  • Review your medication and symptoms. Are you on the right type of thyroid medication that is best for you and taking the right dose? Improper medication dose, T4 to T3 ratio in the drugs and being overmedicated especially when combined with low cortisol and stress can be the cause of your symptoms.
  • Reduce stress in your life because it is the second biggest trigger of Hashitoxicosis and  thyrotoxicosis and can make it worse.
  • The only way to stop an autoimmune attack on your thyroid is to balance your immune system.

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About Marina Gutner, PhD

Marina Gutner, PhD, researcher, medical writer, thyroid blogger, founder and Admin of Outsmart Disease who writes about life-changing treatments for hypothyroidism, Hashimoto's thyroiditis and autoimmune disease and how to balance hormones in women