Jittery, high blood pressure related to overseas Minocin?

[redrock]

I’ve been experimenting with some new imported Minocin capsules (Minomycin, then Aknemin) because I don’t do well on generics. For the past few months I’ve been feeling hyped up, jittery, “wired but tired,” and have higher blood pressure than normal.

I thought my problem was thyroid so I reduced my dose. But I just got tested an am severely HYPOTHYROID so the problem was not too much thyroid meds. My doctor’s office suggested there could be some unknown stimulant I’m consuming and I”m wondering if these new Minocins could be to blame. Has anyone had similar experiences with either Minomycin or Akenmin? Perhaps additives I’m unaware of?

[PhilC]

Those both contain erythrosine (Red No. 3), which contains iodine and can affect the thyroid. It has also been linked to hyperactivity in children.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[redrock]

Well I guess I’m back to the drawing board then. Unfortunately my AP doctor is not that well-versed on AP and basically prescribes what I tell him to after researching, and I’m out of ideas. Such a shame. I was doing just fine on Brand Mino.

[Maz]

Redrock, did you ask your doc to trial stopping your mino for a few days to do a washout and see if the jitteriness stops?

Any chance you’ve used prednisone recently? Also, if you could share your thyroid lab results and thyroid med dose, it might help a little to look at these. “Normal” ranges for healthy peeps are not necessarily normal for rheumatics, if inflammation is present, there is iron-deficiency anemia, low Vit D or B12, because thyroid conversion issues can occur, shifting T4 into Reverse T3, which is basically not enabling T3 to get into tissues. Of course sensitivity to dyes and fillers like iodine, as Phil mentioned, can also be a prob for some but the only true test is to stop the med for a washout to check. I had a RAI thyroid scan a few years back and it certainly did send me into a jittery spin, but I also had a toxic (hyper) goiter.

[redrock]

Hi Maz,

I spoke with my doctor’s office today and was told to stop the Aknemin for two weeks and see how I feel. I’m a bit scared to go without as I haven’t been on some form of AP since 2010, but having never experienced outright symptoms, aside from a bit of Raynaud’s I’m hoping for the best and to see if it calms my jittery feeling.

Regarding prednisone, I was on either a 5- or 10-day treatment back in April (can’t remember) to deal with some pain and inflammation that I get randomly due to my breast cancer surgery 8 years ago. But that was months ago. Is there a known correlation?

I’ve posted my labs below. My doctor tends to encourage dosing based on symptoms rather than labs. I was on 2 grain Nature-throid (my preferred WP is on back-order) until October of last year when I started feeling sluggish, so he said to move to 2.5 grain. I took that til the beginning of May when I started feeling like I was over-medicated so I dropped to 2 grain and then when things didn’t improve, to 1.75. The doctor has said to go up to 2 grains again which gives me trepidation as I already have the “tired but wired” feeling.

TSH 10.75 (.45-4.5)
Reverse T3 14.2 (9.2-24.1)
Thyroxine (T4) 4.3 (4.5-12.0)
Triiodithyronine (T3), Free 2.5 (2.0-4.4)
Thyroid Antibodies 7 (0-34)
Thyroglobulin Antibody <1.0 (.0-.9)
Cortisol 13.2 (AM 6.2-19.4)
Hemoglobin A1c 4.8 (4.8-5.6)
Glucose 90 (65-99)
Vitamin B12 1203 (232-1245)
Vitamin D 50.3 (30-100)
Ferritin, Serum 36 (15-150)
Anti-Centromere Pattern 1:1280 (on Brand Mino it was 1:80 :()

[Maz]

Wow! Great job, Redrock – ranges and everything! One question before I blabber on about the thyroid labs – were these labs drawn early morning before you took your Nature-throid?

The break from the Aknemin should help you to see if the jitters are connected or not. I suspect it is connected to thyroid, but will share more when you have a sec to reply to above.

[redrock]

Yes, I always have it drawn fasting and with no meds taken.

[Maz]

Hi Redrock,

redrock wrote:

I’ve posted my labs below. My doctor tends to encourage dosing based on symptoms rather than labs. I was on 2 grain Nature-throid (my preferred WP is on back-order) until October of last year when I started feeling sluggish, so he said to move to 2.5 grain. I took that til the beginning of May when I started feeling like I was over-medicated so I dropped to 2 grain and then when things didn’t improve, to 1.75. The doctor has said to go up to 2 grains again which gives me trepidation as I already have the “tired but wired” feeling.

Natural Thyroid 101 (talks about the symptoms you’re describing as being dose/cortisol/iron-related)

The issue with some brands of NDT is that they can contain more of the active Free T3 hormone, which can produce an almost immediate jittery feeling. Have you noticed this at regular times of day after taking your split NDT doses? Have you considered trialing a different brand of NDT?

TSH 10.75 (.45-4.5)
Reverse T3 14.2 (9.2-24.1)
Thyroxine (T4) 4.3 (4.5-12.0)
Triiodithyronine (T3), Free 2.5 (2.0-4.4)

Your doc sounds to be really thorough and is covering all the critical thyroid bases to ensure optimal levels of everything needed for adequate use of your thyroid replacement, but seems like there is still work to be done to get your labs in optimal ranges. One can also get jittery when hypothyroid (anxiety, hair loss, palps, iron-deficiency anemia, low stomach acid leading to GERD, etc). Some of these symptoms overlap with rheumatic disease symptoms, which blurs the picture. Just glancing at your fasting thyroid labs, I’m guessing you could be undermedicated. With rheumatic disease, the goal is to get TSH to .5 to 1.5, Free T4 at mid-range, and Free T3 in the upper quartile. Thyroid advocacy groups often recommend gradually increasing NDT up to around 4 grains, which is scary when experiencing what feels like hyper symptoms, for sure, so it needs a doc who knows how to monitor it all very well and can make the distinction between symptoms of undermedication and over-medication.It can take a while to build up to this dose due to the amount of T3 in some NDT brands. Not offering dosing advice, because I’m just a fellow patient, and just sharing what I’ve gleaned from literature I’ve read.

Ferritin, Serum 36 (15-150)

The serum ferritin lab isn’t really in optimal range. Some folks don’t absorb enough nutrients when hypo, because their stomach acid is depleted. It’s not unusual for someone to think they have a GERD prob with hypothyroidism, when it can be due to a lack of ability to break down food in the stomach and reduced ability to properly absorb nutrients. Food just sits there, waiting to go down. Ferritin is a protein that controls iron level in our cells by binding to iron. When ferritin is low, it is an indirect marker for iron-deficiency, but getting a full iron panel to check this is a good idea, because people with rheumatic diseases can have odd ferritin levels at times (See STTM Optimal Lab link below which discusses ferritin and other critical thyroid and related labs).

Here’s the rub – the very cells that scavenge microbes in the body – macrophages – contain a good amount of ferritin. If ferritin is low, immunity is reduced, because macrophages are ferritin-deficient, weakened, and unable to engulf (called phagocytosis) infections and dispose of them properly.

Here are some symptoms of low ferritin:

Ferritin Deficiency Symptoms

So, if this makes sense, it can be a bit of a vicious cycle with hypothyroidism.

Hypothyroidism—-> low stomach acid and inability to absorb nutrients (e.g., vitamin C, B12, Vit D, iron) from the diet —-> iron-deficient anemia (low ferritin) —-> inability to properly convert T4 (thyroid storage hormone) to T3 (thyroid active hormone) —-> hypothroidism. What can happen in some instances where there are nutrient deficiencies or chronic inflammation (which can cause anemia of chronic disease) is that T4 winds up being shunted off into the inactive Reverse T3, instead of being readily available to the cells in its active form to perform normal cellular functions (like transporting oxygen/carbon dioxide). People who are hypothyroid feel sick, like chronic fatigue, have muscle pain, joint aches, hair loss, sluggish digestion, food intolerances, rashes, etc. Some also feel anxiety and have palps. Iron-deficiency anemia can also produce similar symptoms to hypothyroidism, so differentiating between the two (often coming together) can be tricky. It may be no use taking an iron supp if the body can’t absorb it due to low thyroid, so the real root of the problem may just be hypothyroidism and getting levels licked into shape can really improve the landscape over time (i.e., improved digestion and nutrient absorption needed for proper thyroid conversion).

Anti-Centromere Pattern 1:1280 (on Brand Mino it was 1:80)

Yea, this is a real shame, RedRock. I feel for you, because I’m unable to use mino at all and know it just stinks. The thing is, though, is that you could well pick up on your AP once your thyroid is optimal, because when a person has an imbalanced thyroid, it’s one of the major factors that prevent progress on AP. If you adhere to infectious theory, too, with disabled macrophages and an increased propensity to infection and lowered ability to fight infections with hypothyroidism, it just makes good sense to keep the focus on getting it straightened out before placing blame on the brand of mino. That’s not to say that iodine in the cap dye/filler isn’t an issue – it could be due to iodine (a nutrient) intolerance, but the ideal would be to find yourself less reactive with normalized thyroid labs.

The Reverse T3, on paper looks good – it’s almost mid-range – but the real test is when you calculate the ratio between Free T3 and Reverse T3. I think yours is around 17.6 (optimal is over 20). This, however, could just be further evidence of inadequate thyroid hormone rather than an inability to convert.

Reverse T3/Free T3 Calculator

A really good thyroid patient advocacy website is: Stop the Thyroid Madness (STTM)

Cortisol 13.2 (AM 6.2-19.4)

The ideal way to test cortisol levels is to run a diurnal panel, measuring cortisol at 4 different times throughout the day. Normally it peaks in the AM and wanes throughout the day, so the patterns seen in cortisol levels can also help the overall diagnostic picture (also described in the STTM labs link above).

Hope these links may provide some help for you, though I suspect you are pretty on the ball with all this stuff, as an old-timer now. So forgive me if it’s all stuff you have already read and know. It’s late here and I’m rambling, but wanted to get back to you today. It may be worth running more testing and get a full iron panel and diurnal cortisol. Pred use in the spring may have knocked your thyroid out of whack (cortisone temporarily suppresses TSH and can cause symptoms of feeling hyper – tired and wired), but hopefully your adrenals are catching up a bit now and things will begin to turn around by slowly increasing thyroid replacement. Not sure of your age, but mid-life hormone shifts can also lead to issues with thyroid balancing. E.g., estrogen dominance in mid-life is antagonistic to thyroid hormone. The endocrine system, as a whole, is like a symphonic orchestra, so that when every endocrine gland is playing “in tune,” the melody is beautiful. However, when one gland gets knocked out of balance, it’s like an untuned instrument that causes the whole orchestra to sound terrible.

[redrock]

Wow Maz, thanks for your comprehensive response.

I used to be on WP thyroid but it is on backorder so I’m using Nature-throid. Regardless of my dose I always take it all at once. I can’t be bothered with timing of foods, etc. as doing that with the Mino is a big enough headache.

I have to say that after three days of upping my dose, I feel fantastic and knock wood no heart palps yet. I have poked around STTM every now and again. The whole thing is very complicated. I’m going to print out your reply and take it to my doctor with my questions.

[Maz]

If this helps, Redrock, every dose change of thyroid meds will ring in new symptoms (even if on just a T4 only med, like levothyroxine). It really isn’t fair, but few people get away with no symptoms when adjusting their thyroid meds. It can also take 4-6 weeks to get an accurate lab reading on a new dose.

As you increase your thyroid dose, you may want to ask your doc if you can split it throughout the day. This is normal scheduling for the natural thyroid replacements and with cytomel (liothryronine) because they are T3 containing meds (immediately active hormone) and will definitely make you feel jittery, anxious, with palps, if you take it all in one dose in the AM. Best of luck getting your thyroid licked into shape!

[Author]

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