Anxiety - what's the cause??

[Judthepud]

Hello, posted earlier, but no replies as yet, so thought I'd try again with a different title (sorry to be persistent!!) I'd be very grateful for some advice. Below are my results from Medichecks. The results preceded by an asterix are the anomalous ones. It turns out I’m hypo rather than hyperthyroid, which is not what I expected. As a reminder of my situation, in October 2017 I increased my dose of Levothyroxine from 125mcg to 150mcg as my annual blood test showed that my TSH had crept into the 2s from the 1s the previous year (I had had major surgery for a twisted bowel in March 2017 – don’t know if something like that can have an impact – but recovered from surgery without a problem and was back at work by June). In January this year I developed symptoms of anxiety, diarrhoea, weight loss, sweating, exhaustion. In February I realised these could be symptoms of hyperthyroidism possibly due to over-medication so I reduced my dose back down to 125mcg, then when the symptoms didn’t abate, I reduced my dose down further to 100mcg (and a couple of weeks ago I missed out a couple of doses completely). I’ve been on a reduced dose now for over a month, and it turns out that my blood results show that I’m hypothyroid. However, I’m still having the symptoms I described (especially the anxiety which is horribly debilitating). Does anyone have any theories? Could it be that I was over-medicated and it’s just taking time for my symptoms to abate (a pharmacist I spoke to said it can take a good while for things to level out)? Could it be that my anxiety is caused by hypothyroidism (unlikely that that would cause symptoms of diarrhoea and weight loss, but obviously these could be symptoms secondary to the anxiety)? Or, looking at my results, which are pretty marginal, is it more likely that my anxiety and other symptoms are unrelated to my thyroid? Does anyone have any theories and advice to offer? Would be very grateful for anyone’s comments. Thank you so much

Thyroid Function

Thyroid Stimulating Hormone*12.5(0.27 - 4.20)

Free Thyroxine *11.9(12.00 – 22.00)

Total Thyroxine (T4) 69.2(59.00 – 154.00)

Free T3 *2.86( 3.10 - 6.80)

Thyroglobulin Antibody 14.200( 0.00 - 115.00)

Thyroid Peroxidase Antibodies 13.9( 0.00 - 34.00)

Vitamins

Active B12133.000(25.10 – 165.00)

Folate (Serum) 19.98 ( 2.91 - 50.00)

Inflammation Marker

CRP – High Sensitivity 0.74( 0.00 - 5.00)

Iron Status

Ferritin 53.9(13.00 – 150.00)

[shaws Administrator]

You are on too low a dose of levothyroxine due to your high TSH and very low FT4 and FT3 being below the bottom of the range. You need a dose increase. To bring both Frees towards the upper part of the range you need increases.

You will see most of your symptoms listed below:-

thyroiduk.org.uk/tuk/about_...

[Judthepud in reply to shaws]

Thanks Shaws, how quickly do you think I should up my dose? I've been on 100mcg for over a month, and today (after getting my blood results) I took 125mcg. The anxiety started about 2 months after I'd increased my dose to 150mcg. Do you think that was probably too high a dose? How best to proceed do you think?

[shaws Administrator in reply to Judthepud]

I cannot tell how quickly you should increase your dose. It is usually 25mcg of levo every six weeks after a blood test.

Unfortunately there's not a quick solution but the majority seem to do well on levo when they have an optimum dose.

For others we may need the addition of T3 with T4 but the NHS has stopped the prescribing of T3 but we can source our own but would have to ask for a Private Message as no info re sourcing prescription medications is permitted but private messages will be sent. Researchers have also found that many prefer T3/T4 combination.

It looks as if you may be a poor converter of levothyroxine as both Frees are too low and TSH still too high. When taking thyroid hormone replacements it's best to go by our clinical symptoms, i.e. are they being relieved. Some people are poor converters of levothyroxine.

There is also the original replacement called, Natural Thyroid Hormone which, at one time, was all that was prescribed and it is made from pigs thyroid glands and members also source this themselves.

NDT contains all of the hormones a healthy thyroid gland would produce, i.e. T3, T4, T2, T1 and calcitonin and some find it better for them than synthetic.

You must give sufficient time for whatever you decide with increases in dose. Chopping and changing too often might mean we don't find a dose or hormones which make us well . I think it must have taken me about four/five years years at least to figure it out with the help of TUK.

I also think it is pot luck as many are fine on levo but due to doctors not being allowed to prescribe options (like they used to do) patients can have difficulties.

[Judthepud in reply to shaws]

Thanks so much for your reply. Appreciate it. I'll keep on 125mcg for six weeks then get retested and decide where to go from there.

[silverfox7]

I would keep to the 125 for 6-8 weeks then resets and share your results. It may be that 125 is low but 150 too high so may need 125/150 but results should help to sort it out. Just in case you are, through no fault of you own, doing something else wrong so have a look at the Thyroid Uk site to see if there is anything you should be doing differently.

[Judthepud in reply to silverfox7]

Thanks for your advice I'll get retested in around 6 weeks. Shaw's thinks it might be worth seeing a private endocrinologist, but I'll probably hold off to see how things pan out before rushing into that.

[shaws Administrator]

Have you consulted an Endocrinologist. I think you should ask to be referred as your symptoms could have been due to taking too much hormones but I think seeing FT4 and FT3 being so low you may not be converting levothyroxine and may need an alternative.

If you want to see a private Endo, you can email Dionne at TUK at [e-mail], she has a list of sympathetic ones.

[Judthepud in reply to shaws]

Thanks Shaws, what sort of cost is involved in seeing a private Endo?....and should I wait to see how I get on over the next few weeks to see if things stabilise?

[humanbean]

I'm sure there are dozens of reasons why people can develop anxiety, but some that are quite common to this community are :

1) The wrong levels of thyroid hormone - too much or too little. Free T3 levels are the most important and everyone needs to find out their own ideal level. Almost everyone with an underactive thyroid feels best with a Free T3 in the upper half of the range, and may possibly feel best with it in the upper third or quarter of the range.

2) Non-optimal levels of nutrients make people anxious too.

B12 : I'm not used to interpreting active B12, and I don't know what is optimal for it. But your level looks pretty good.

Folate : This needs to be mid-range or in the upper half of the range.

Ferritin (Iron stores) : Yours looks to be too low. However, there are some people who end up with ferritin which is too low and high serum iron. An optimal level of ferritin is roughly mid-range or a little bit over. But if people supplement and end up pushing their serum iron over the range by doing so then this is a really, really bad idea. So I won't suggest you supplement, because I simply don't have enough information. For a full set of results for iron you could do this private test bundle :

medichecks.com/tests/iron-s...

3) The wrong levels of cortisol - too low or too high. At the very extremes - practically non-existent cortisol (Addison's Disease) or incredibly high levels of cortisol 24 hours a day (Cushing's Disease or Cushing's Syndrome) - people must seek fully qualified medical help. But if cortisol levels are not at those extremes then people can use some self-help measures and supplements which might help. (Doctors reject the idea that there is a problem with cortisol at all if people don't have Addison's or Cushing's.) Unfortunately, there is no way of telling just by symptoms whether cortisol is high or low. It must be tested. And the best test is a saliva test which doctors in the UK won't do and won't pay attention to, so they have to be done privately, and they usually have to be analysed by patients themselves.

[Judthepud in reply to humanbean]

Thanks for taking the trouble to send me your comprehensive reply. I appreciate it very much.