Thyroid And Dysautonomia

[firewatcher]

Tohoku J Exp Med. 2012;226(3):191-5.

Cardiac autonomic regulation is disturbed in children with euthyroid hashimoto thyroiditis.

Kilic A, Gulgun M, Tascilar ME, Sari E, Yokusoglu M.

Source

Department of Pediatric Cardiology, Gulhane Medical Academy.

Abstract

Hashimoto thyroiditis (chronic autoimmune thyroiditis) is the most common form of thyroiditis in childhood. Previous studies have found autonomic dysfunction of varying magnitude in patients with autoimmune diseases, which is considered a cardiovascular risk factor. We aimed to evaluate the heart rate variability (HRV), a measure of cardiac autonomic modulation, in children with euthyroid Hashimoto thyroiditis (eHT). The study included 32 patients with eHT (27 girls and 5 boys; mean age 11 ± 4.1 years, range 8-16; body mass index 0.47 ± 0.69 kg/m(2)), as judged by normal or minimally elevated serum TSH levels (normal range: 0.34-5.6 mIU/l) and normal levels of free thyroid hormones (FT4 and FT3) and 38 euthyroid age-matched controls. Patients with eHT and control subjects underwent physical examination and 24-hour ambulatory ECG monitoring. Time-domain parameters of HRV were evaluated for cardiac autonomic functions. Children with eHT displayed significantly lower values of time-domain parameters of SDANN (standard deviation of the averages of NN intervals), RMSSD (square root of the mean of the sum of the squares of differences between adjacent NN intervals), NN50 counts (number of pairs of adjacent NN intervals differing by more than 50 ms) and PNN50 (NN50 count divided by the total number of all NN intervals) for each 5-min interval, compared to healthy controls (p < 0.05 for each), indicating the decreased beat-to-beat variation of heart rate. In conclusion, eHT is associated with disturbed autonomic regulation of heart rate. Hence, the children with eHT are at higher risk for developing cardiovascular diseases. PMID: 22343434

[julieph85]

Wow! I have always known there was a connection!

[jenglynn]

Julie, I so agree with you!!! I have had thyroid issues ever since my dysautomia conditioned worsened... And the worse it gets, the more my levels are off.

Thank you, Firewatcher for posting!!!! So far, I have no real diagnosis for my thyroid "condition" or non condition???? TSH very hyperthyroid yet T3 and T4 are hypothyroid.... Yet no one will or can figure this out... I guess the two cancel each other out??? So far the only answer I've gotten is I have sick thyroid- that there is nothing wrong with my thyroid just my body reacting to being so ill. Why shouldn't I believe that???? The doctors have been SOOOO right about everything else in my treatment... Sorry for the cynicism and sarcasm..

Jen

[firewatcher]

What interested me in the article was that these patients show NO "symptoms" or lab indications other than positive antibodies. But, the antibodies are enough to predispose the body to dysautonomia!

[ramakentesh]

Yeah great link. I just got the official tag of autoimmune POTS so this is cool.

There are somewhat similar results in Sjorgen's - those nasty anti AChr muscar autoantibodies at it again:

http://arthritis-research.com/content/10/2/R31

Introduction

The aim of this study was to compare cardiovascular autonomic nervous system function in patients with primary Sjögren's syndrome (pSS) with that in control individuals, and to correlate the findings with autonomic symptoms and the presence of exocrine secretory dysfunction.

Methods

Twenty-seven female patients with pSS and 25 control individuals completed the COMPASS (Composite Autonomic Symptom Scale) self-reported autonomic symptom questionnaire. Beat-to-beat heart rate and blood pressure data in response to five standard cardiovascular reflex tests were digitally recorded using a noninvasive finger pressure cuff and heart rate variability was analyzed by Fourier spectral analysis. Analysis was performed by analysis of variance (ANOVA), multivariate ANOVA and repeated measures ANOVA, as indicated. Factor analysis was utilized to detect relationships between positive autonomic symptoms in pSS patients.

Results

Multiple, mild autonomic disturbances were observed in pSS patients relating to decreased heart rate variability, decreased blood pressure variability and increased heart rate, which were most evident in response to postural change. There was a strong trend toward an association between decreased heart rate variability and increased severity of the secretomotor, orthostatic, bladder, gastroparesis and constipation self-reported autonomic symptom cluster identified in pSS patients. This symptom cluster was also associated with fatigue and reduced unstimulated salivary flow, and therefore may be an important component of the clinical spectrum of this disease.

Conclusion

There was evidence of mild autonomic dysfunction in pSS as measured with both cardiovascular reflex testing and self-reported symptoms. Pathogenic autoantibodies targeting M3 muscarinic receptors remain a strong candidate for the underlying pathophysiology, but practical assays for the detection of this autoantibody remain elusive.

But here they correlate inflammation with autonomic abnormalities in Ank Spond:

http://www.springerlink.com/content/f47015044p4724t2/

[MomtoGiuliana]

"Previous studies have found autonomic dysfunction of varying magnitude in patients with autoimmune diseases, which is considered a cardiovascular risk factor."

Is this saying that having POTS is a cardiovascular risk factor? I think this is the first time I have seen this. It makes sense. But then it also means POTS is not as benign as it seems doctors tell us it is? And what should we be doing to manage this risk factor...?

[firewatcher]

http://www.sciencedaily.com/releases/1999/02/990209072908.htm

Early link between Autoimmunity and Heart Failure.

http://www.sclerodermatt.org/articles/news/407-clinical-manifestations-of-heart-disease-in-autoimmune-disorders

Clinical Manifestations of Heart Disease in autoimmune Disorders

This one has some risk reduction suggestions

[issie]

There is also a connection with this type of autoimmune thyroid and alopecia. They keep checking my thyroid because they keep thinking my alopecia could be related to my thyroid. But, then vitiligo is also connected to alopecia. All are autoimmune disorders. Other than a one time thing of steroids and shots in my head of cortisol (monthyly) to stop the autoimmune attack into the spot where my hair came out in a bunch. That's all I've been offered for it. The POTS doc at Mayo also told me my POTS does definitely have an autoimmune connection but, much more too. EDS, MCAD etc. He said I'd be terribly hard to treat - he was not wrong.

[julieph85]

I have RA and was told I have a four fold increased risk of valve disease. Lovely. I can only imagine what else is gonna break from the autoimmune pots! The cardio i just saw said my tricuspid valve looks like a 40 year olds . I'm 26. Great!

[MomtoGiuliana]

Thank you for the links firewatcher!

[Anoj]

this is very interesting to me, as i was diagnosed with hashi's yeeaars ago, before the dysautonomia. my antibodies were way high, and my other values were considered "normal." i am on synthroid but only the lowest dose. i struggle with anything that has a stimulant effect, so i have been unable to increase my dosage! does anyone else have this sort of problem, very symptomatic with stimulants of any kind, including coffee?

recently my doctors wanted to increase my dose of synthroid because i broke out in a rash/hives, and they related it to my low-functioning thyroid. i couldn't even take the dose up to .5 mcg. i ended up dizzier and almost fainted in the mall. had to be taken out in a wheelchair by security.

[issie]

Anoj,

Some people seem to do better on Armour thyroid - it has both T3 and T4 properties in it. I have problems with stimulants also - they hike my sympathetic system so badly and haven't been sucessful with anything that boost it. (Sorry you had such a drastic reaction.)

Issie

[MomtoGiuliana]

I also cannot handle caffeine, etc. For me it seems the Hashimoto's and POTS came on together, although I did not have severe POTS until pregnancy several yrs after diagnosed with Hashimoto's. I have had problems with getting an appropriate dose too, but once I did seem to stabilize pretty well I was hesitant to try something different. My endo was very opposed to me trying armour bc he said it is much more variable and unstable than synthroid. I know it works well for some.

[Maiysa]

I had thyroid issues, toxic-cancer and they think it was a possibly autoimmune hashimotos before they took it out. I take levothryoxine every day because I no longer have a thyroid. I miss it. haha. Anyhow, the medication makes me not feel so well. I was just diagnosed Friday with Mast Cell Activation so now they want me to try a different thyroid medication because it makes me feel sick in the morning. They want to do the armour. I'm concerned about it too because I have heard and read that it is not as reliable as well. I have to be kept hyperthyroid to keep the thyroid from growing back, which hence keeps the cancer from growing back. So I'm on the fence about the natural stuff since I need to have consistent numbers and a reliable medication.

[Anoj]

wow, maiysa, sorry to hear about your troubles.

i have tried armour in the past and didn't find it any better than synthroid.

i should have been more specific - any stimulant seems to have the opposite effect - i get tired, dizzy, slow, can't function, no cognitive abilities, etc. i still can't figure that one out! any insight would be fantastic! i can't even handle decaf tea, as there is still a small percentage of caffeine in it.

[issie]

i should have been more specific - any stimulant seems to have the opposite effect - i get tired, dizzy, slow, can't function, no cognitive abilities, etc. i still can't figure that one out! any insight would be fantastic! i can't even handle decaf tea, as there is still a small percentage of caffeine in it.

For some people stimulants do the opposite. Like for example for people who have ADHD and are usually in overdrive all the time - one thing that calms them down is a stimulant. It ups the dopamine levels. Coffee is something they tell Parkinson's people to drink because it helps them to tame down the tremors and the overdrive symptoms in their bodies. Do you find the same effect with walnuts? They are also high in dopamine properties.

[Maiysa]

HI Issie.

Anoj, thanks for the compassion. I'm such a baby-but I didn't mean to complain. But, yes, I have the same issue. Anything that stimulates makes me so dizzy. And I think the thyroid is causing too much stimulation, so I agree, I wonder if another thyroid pill would just do the same thing to me. I was told by the neurologist and endo that they want me to get back to a normal thyroid level because it is a catalyst to dysautonomia.....it being hyper thyroid. But I only have 2 and half years to get past the cancer free and can relax a bit on the dose. I'm getting closer. Yay!

[Anoj]

i should have been more specific - any stimulant seems to have the opposite effect - i get tired, dizzy, slow, can't function, no cognitive abilities, etc. i still can't figure that one out! any insight would be fantastic! i can't even handle decaf tea, as there is still a small percentage of caffeine in it.

For some people stimulants do the opposite. Like for example for people who have ADHD and are usually in overdrive all the time - one thing that calms them down is a stimulant. It ups the dopamine levels. Coffee is something they tell Parkinson's people to drink because it helps them to tame down the tremors and the overdrive symptoms in their bodies. Do you find the same effect with walnuts? They are also high in dopamine properties.

interesting ... i knew about the theory with ADD. i never had a problem with caffeine before i had dysautonomia.

my doctor was going to put me on wellbutrin to counteract the weight gain from zoloft, but i couldn't take it becs it has a stimulant effect. i am so frustrated! i also really would like to up the synthroid, but it's just too hard.

[issie]

It may be that wellbutrin would affect you the same way that coffee does. It also affects dopamine levels.

[~elizabeth~]

The symptoms of thyroid disease are virtually the same as POTS, it's very difficult to distinguish between them. In theory thyroid-related symptoms should resolve with hormone replacement, but for many they don't, I'd guess because it has already caused some autonomic nerve damage.

I don't see how anyone could be confused as to whether they have autoimmune thyroiditis or not. If you have tested positive for anti-thyroid antibodies, you have Hashimoto's thyroiditis, doesn't matter what your TSH or T4 readings are. I think Thyroid antibodies in your system are a bad idea, they might not only destroy the thyroid but might attach to other tissues with thyrotropin receptors, such as the eye. In my opinion the only way to get rid of them is to take thyroxine and get your TSH as low as possible without completely suppressing it. I think that most doctors don't understand any of this, they only look at hormone levels without the least bit of understanding of the autoimmune and neurological elements of thyroid disease.

I think Armour might not be a very good idea at all, and I'd be extremely cautious about taking any form of T3 with tachycardia problem, it might make it worse and could cause quite bad angina pain. I think that even endos who believe that T3 is beneficial don't recommend Armour, as the proportion of T4 to T3 are wrong. Also, as far as i know armour is essentially pig thyrotropin, the substance which your bodies makes anti-bodies against so I think it can reactivate thyroid antibody activity.

If you need to suppress your thyroid completely, I think it's probably better to take a measured amount of synthetic T3 and leave armour well alone. I was taking 5mcg of T3 as a supplement to 100mcg T4 for what I thought were thyroid problems but which I now realise were due to POTS. It worked to some extent, overstimulating the metabolism probably does help the brain fog/energy stuff but possibly has been making the tachycardia/POTs issues worse.

Edited March 5, 2012 by corina
medical advice

[issie]

Years ago, I was being treated for a problem with my thyroid converting T4 to T3 - called Wilson's Syndrome. The treatment was T3 - it caused severe tacky with me. That's one of the side effects of T3 - if you take too much. So, that alone - unopposed to T4 may imbalance things more?????? When they were trying to do the suppression on me - I used Armour and it was the only one that didn't cause the tacky - I tolerated it much better than Synthroid and it stablized the mood better than the T4 without the T3. They can do a combination of Synthroid with T3 - but, that would be taking two pills if you're concerned about getting exact amounts. Some alternative docs feel that both are necessary for a person to feel half way decent on replacement thyroid.

[~elizabeth~]

I wouldn't want to say that it's not possible to have a condition that closely mimics thyroid disease with normal hormone levels, but autonomic problems can also account for all these symptoms, including the poor thermostatic control. Knowing what I do about POTS, all my unresolved 'thyroid' problems fall entirely within this spectrum I just wish I'd found out about it 20 years ago.

As far is I know, very few endos think T3 is a good idea, it seems very controversial and having tried it I'm not sure I'm convinced either, my POTs type symptoms just got worse over the time I was taking it. The Endo who prescribed it for me believes that any effect it has is largely due to the brain not converting T4 as efficiently as other tissues, but that apart from this sole possible cognitive benefit, it doesn't help with any of the other problems people complain about with thyroid disease, probably because they might be caused by autonomic failure or additional auto-immune activity.

Edited March 5, 2012 by corina

[~elizabeth~]

Re Wilson's:

The American Thyroid Association (ATA) describes Wilson's syndrome as at odds with established knowledge of thyroid function. The ATA described the diagnostic criteria for Wilson's syndrome as imprecise and non-specific, and found a lack of any scientific evidence supporting Wilson's claims. The ATA further raised concern that the proposed treatments were potentially harmful.^[2] Florida State Medical Board members described Wilson's syndrome as a "phony syndrome" and a scam during disciplinary action against Wilson,^[3][4] while Quackwatch has stated it is "bogus diagnosis".^[5]

^{http://en.wikipedia.org/wiki/Wilson's_temperature_syndrome}

[issie]

Yes, I found the T3 to make me much worse. I've read the controversial statements about the Wilson's Syndrome idea - but, the doctor I had at the time - fully believed in the idea and tried many of his patients on it. It did not work for me and also made my tacky much worse. I never could get my body temp. to come up either. So, you very well could be right about the connection to autonomic dysfunction and possible autoimmune connections.

[Maiysa]

I don't see how anyone could be confused as to whether they have autoimmune thyroiditis or not. If you have tested positive for anti-thyroid antibodies, you have Hashimoto's thyroiditis, doesn't matter what your TSH or T4 readings are.

Elizabeth I assume you were possibly referring to me in this quote, not sure since it was an open ended comment. Anyhow, the reason for the confusion about hashimotos was because I had several diseases going on at the same time along with thyroid disfunction that didn't show up anywhere except accidentally on a CT scan. They did a biopsy that didn't show much, so except that the thyroid was growing and was large. I was put into emergency surgery. Not a lot of time for blood tests or thyroid doctors since I was not long for this world at the time. They sent me straight to a surgeon. I was told they thought it was a severe case of Hashimoto's, that was making me sick and that it looked as if it had turned into cancer but it didn't show up on the biopsy so they had to go in to get a better sample. But my numbers were completely normal except for the thyroid globulin which they said was from the cancer. They said it was very unusual for what my thyroid was doing and to have normal TSH numbers and all normal thyroid numbers. They said it didn't make sense. They removed the thyroid lobe and the cancer didn't show up during the freeze, so they sewed me back up. The cancer showed up a few days later at the lab. They thought I would be better after removing the cancer, but I got sicker over the next few days. They did an ultra sound and it looked like cancer on the remaining lobe and since the one side was positive for cancer they had to go in anyhow to remove the rest of it. But when they took out the entire thyroid, that side did not have cancer but it was growing backwards into my neck which is why it didn't show up as a lump in my throat. They said it was toxic but could not know for sure what was in it even though they sent the biopsy to Mayo and another lab. Whatever it was, it was poisoning me every time it secreted thyroxine. I finally had an appointment with a thyroid doctor, but it was almost two months after the surgery in which I was not given any thyroid pills, which the hospital and surgeon missed. I was told I was a patient that had slipped through the cracks. The doctor who had done the thyroid ultra sound earlier had resigned in the mean time and he was negligent in diagnosing me and doing blood tests. So by the time I got to a new competent endo doctor, in which I was in a life or death situation again, since I was not be given thyroid pills since surgery, anyhow, the doctor told me he found some old records and it looked like I had the symptoms of Hashimoto's and that's why I was so sick along with the cancer and toxic thyroid, which he thought was from the fungal infection I had for the past few years which had not yet been diagnosed. That's why the confusion.