Hello all, I am on 100mg Levothyroxine, have been for nine months now and for the last three months I have been taking antidepressants [Fluxotine] on my doctors suggestion, she suggested it and I thought why not nothing else has worked. I asked on this website regarding this and was advised against antidepressants but I felt I had to give it a go as the doctor was saying my problems were mental not physical. Now I am being taken off the antidepressants as the did not make any difference to how I felt [Low/exhausted] I have now seen three doctors at my practice and none of them seem to know what to do next. I have just had a blood test:
Serum TSH Level 4.98 mu/L [0.27 - 4.2]
Serum Free T4 Level 11.4 pmol/L [11.0 - 20.0]
The doctor says he doesn't know what to do next as my results are in range, he is going to speak to a fourth doctor, I am due to see him in a weeks time, any suggestions as to what I should say to him would be much appreciated. Thanks all
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tom210
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No, they're not in range. The TSH range stops at 4.2. Your TSH is 4.98. And, actually, we are hypo as soon as the TSH hits 3, so you are hypo and should be treated - at least offered a trial of 50 mcg levo - no less! Your FT4 is also very low, so your FT3 - the most important number - is probably very low, too. And that's why you have symptoms - depression is a symptom of low T3, whatever your doctor thinks.
I don't know what you can say to the endo. Depends on the man himself - or woman. Are they open to suggestion, or are the hide-bound and firmly entrenched in the 'guide-lines'. I hope someone else can suggest something, but if it were me, I would stress how bad I feel, how the antiDs didn't work, and how I really believe that a trial of T4 would. Plus the fact that your bloods are in no way 'normal', however you look at it, even thought the FT4 is almost 'in range'.
Hello Greygoose, thanks for your reply, do you mean I should ask for an increase of 50mcg of Levo as I am already on 100mcg. What reasons could the GP give for saying no i.e. is taking too much Levo bad for you? I haven't seen an Endo yet just dealt with different GP's but I am going to stress to them that I cannot go on like this. Tom
Oh, gosh, I'm sorry! I misread your post and didn't see that you were already on 100 mcg levo! My bad. No, don't ask for an increase of 50 mcg, increases should only be 25 mcg at a time.
The reason he will probably give is that your results are 'in range', and therefore you do not need an increase. But your TSH is not in-range, it's over-range. And doctors do not realise that just being 'in-range' is not the same as being optimal - it's where in the range you fall that is important, not just being in-range.
Yes, taking too much levo would be bad for you - but you're a long way off taking too much! Taking too much would mean that your FT4 would be way over-range, and you would feel pretty bad. So, that's not an excuse.
You are under medicated and you need a dose increase. The goal of Levothyroxine is to restore the patient to euthyroid status and for most that will be when TSH is 1.0 or lower with FT4 in the upper range >17.0. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email louise.warvill@thyroiduk.org.uk if you would like a copy of the Pulse article to show your GP.
Hypothyroid patients are often low in ferritin, vitamin D, B12 and folate which can cause fatigue and low mood, so ask your GP to test and post the results and ranges in a new question for advice.
I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.
Hello Clutter, thanks fpr your reply, if I ask my doctor for an increase in Levo what reasons could he give to say no i.e. is taking too much Levo bad for you, To be fair to my doctor he did a large range of blood tests , namely
Thyroid function, Bone profile, Erythrocyte sedimentation rate, Full blood count, GFR calculated MDRD, Liver function, Plasma fasting glucose, urea and electrolytes, Rheumatoid factor level
All came back as within accepted levels, I am at a loss as to what to do next I don't want to be negative but I just feel terrible
Who knows what reasons your GP may come up with? Your TSH is not within acceptable levels because it is over range. As I said, dose should be increased until TSH is 1.0 or lower, which is still within range.
It is an endocrine disruptor and in days gone by was used to treat an over active thyroid. It has been discussed many times on this forum as shown in the link below
T3 was also used to treat depression back in the 50/60's too - but the Docs today do not know that as they would have trained later than that. So as Greygoose says you need to know your FT3 result as your FT4 is so LOW. No wonder you are depressed. The T4 has to convert into the active hormone T3 - so in your case there is not that much to convert.
How are you taking your T4 - away from food and milky drinks for at least an hour is the usual advice. This aids absorption.
Drop the anti -deppressants if you can there is little point in taking thyroxine alongside as the anti-depressants will negate the thyroxine. Depression is a SYMPTOM of hypothyroid!
Not always they're are people out there who are not hypothyroid that have depression. And the reason I think my depression/anxiety was this condition made me depressed as I was over thinking my symptoms which made me stress. I decided to go to my doctor and say I need something to help me get back on track and she didn't force me in anyway of this decision she said it was an option. I went ahead and she started me on 10mg citalopram, and I started to feel at ease after 2 weeks then I still felt abit anxious so she upped it to 20mg and I've been fine since. I eat a healthy diet to help with this with the odd treat too. My confidence and mind has felt so much better for it and now that I'm no longer tense or over thinking I feel much better in myself too. I just want to share my experience as not everyone is the same 😊 You have to do what's best for you and I just think Levo in high doses causes osteoporosis so I think I've made the right decision for me.
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Self Medicating didn't go so well for me, I have had to go back on Thyroxine - for now anyway!
Antidepressants 
Thyroid? Sent away with antidepressants 
