Thyroid UK
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Mental health or Thyroid issues?

Hello, me again! Ive been having extreme anxiety since January, when I think I might have been on too high a dose of Levothyroxine (my TSH had crept up from the 1s to the 2s and I increased my dose from 125mcg to 150mcg). After I realised I might be overmedicated I reduced right down and became hypo (TSH of 12.5 [0.27-4.20), and my anxiety stayed the same, so I increased my dose back to what it had been before when I felt reasonably OK, a bit tired but no anxiety, (125mcg). After 4 weeks had my bloods checked by Medichecks and they came back as follows:

TSH 2.94 (0.27-4.20)

Free T4 16.200 (12.00-22.00)

Free T3 4.62 (3.10-6.80)

After that increased my Levothyroxine to 150mcg (Mon, Wed, Fri, Sat) and 125mcg (Tues, Thurs, Sun). Didn't want to go up to 150mcg daily because I thought I was probably overmedicated on that dose, although I have no blood results to confirm this other than the NHS TSH result which did go down to a reasonably good level (probably 1 or below).

That was nearly three weeks ago and I'm still having terrible anxiety (feeling panicky, anxious and low in mood). At what point do I give up and accept this as a mental health issue and seek support from my GP. Feeling despondent that things aren't getting any better. My vitamins, minerals and antibodies are all ok. Any advice or recommendations from any of you kind people?

18 Replies
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Did you get your vitamin D tested? Couldn't see it in previous test results

Low vitamin D can cause anxiety

Vitamindtest.org.uk £29 postal kit.

A daily vitamin C to support adrenals can help

Did you try strictly gluten free diet? Gluten intolerance is extremely common with thyroid and can be cause anxiety

hypothyroidmom.com/12-shock...

ncbi.nlm.nih.gov/pmc/articl...

Being under medicated and hypo can also cause anxiety. People tend to assume it's only hyperthyroid that causes anxiety

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Thanks, I've just ordered a vitamin D test. Looking at the results that I just posted, do they look OK to you, or could those results be causing my anxiety (although, obviously I've had almost 3 weeks on the higher dose of 150mcg four times a week, so the results have hopefully improved). Would you let me know what you think please ?

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With those results, there's no way an increase of 25 mcg every day is going to make you over-medicated! Your TSH is too high and your Frees aren't even mid-range. I'd go up to 150 a day, if I were you, and retest in six weeks.

Most definitely those results could be causing your anxiety.

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Really? Where should my frees be?

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Most people need their FT3 up the top of the range to feel well. So, at least about 5.5, I would say. It's low T3 that causes symptoms. And the brain needs an awful lot of T3 to function correctly.

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Thanks for replying. When my anxiety started, it was a few months after increasing my dose from 125mcg to 150mcg. I assumed that I was over-medicated. However, I had had major surgery for a twisted bowel the year before, followed by another major operation for a very large incisional hernia a few months before increasing my dose, and in both cases I was very ill for around 2 months. Might it be that those two large operations had affected my thyroid and created the need to increase my Levothyroxine? Even though I had increased my dose, and according to my GP, my TSH was back to where it had been (1 or below), could it be that I was continuing to need more and more Levothyroxine? Can this happen? The anxiety started around 3-4 months after increasing my dose to 150mcg. Could the stress of those two operations in fairly quick succession (a year apart) have caused me to need more Levothyroxine, and should I increase my dose now before waiting for blood results? I'd be very grateful for your advice. Thanks again.

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Whilst the operations would have had a temporary effect, slowing down your conversion whilst you recuperated, I doubt it would have had a permanant effect on your thyroid gland. Your thyroid is just deteriorating. It happens.

When are you going to get the results? If it's quite soon, I would wait, if I were you.

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I'll get another blood test done in about week, so I should probably wait to see what the results are. Is it common that as you get older your thyroid gland deteriorates and your need for Levothyroxine increases (I'm 62)? Do many people have to take in excess of 150 mcg of Levothyroxine??

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150 mcg is not at all a high dose. Some people take up to 300 and more. I, myself, take 75 mcg T3 - possibly 3 times 'stronger' than T4 - plus 25 mcg T4. I'm 73. :)

But, yes, the whole endocrine system deteriorates as we age.

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Thanks for getting back to me. I really appreciate it :-)

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You're welcome. :)

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About 70-75% of the way through the range, so free t4 >=19.5 and free t3 >5.5

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Two things come to mind about your operations.

First - Anaesthetic can affect B12

b12-vitamin.com/anesthesia/

2nd. Any operation on bowel or gastric tract may have upset your ability to absorb B12

Obviously don't know exactly what you had done

B12 is absorbed in specific part of the gut, the terminal ileum, could this have been affected?

pennlive.com/bodyandmind/in...

ncbi.nlm.nih.gov/pubmed/170...

msdmanuals.com/en-gb/home/d...

psychologytoday.com/intl/bl...

To test in depth B12, it's advised to also test MMA and homocysteine

nutris.viapath.co.uk/pages/...

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Judthepud, I would definitely not accept it as a mental health diagnosis yet. Not until you've seen how you feel with that freeT3 at the top of the range, which may take a lot of trial and error.

If the anxiety started as you tried to raise your dose, it may be adrenal related. Unfortunately the NHS is not much good with this, but you can get a private test for 24 hr saliva cortisol. Its likely to be low, and then you can self treat with adaptogens (mainly herbs), and/or adrenal extracts.

It can help to increase super slow, taking a few weeks to get to the increase you wanted. I agree with Greygoose that your current thyroid hormone levels are low, and a 25mcg increase is very unlikely to take you over. It took me about 6 larger increase to get from the bottom to the top of the range, but everyone is different.

Its very worth looking into vitamins, too. These contribute to supporting your adrenals as well as use of thyroid hormone, and you'll get symptoms if they're low. Others have gone into detail above, but make sure you've tested vit D, but B12, folate and ferritin.

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Thanks SilverAvocado, I work as a nurse and I'm aware that the majority of health professionals would be casting their eyes to heaven and muttering, "it's an anxiety disorder"! They might be right - before I came on this forum I associated anxiety with hyperthyroidism, and not hypothyroidism - that's the received wisdom amongst medical professionals.

I've just ordered a Vit D test on SlowDragon's advice, and the results of the other tests that you mention, done by Medichecks in April, are as follows:

Active B12 133.000 (25.10 - 165.00)

Serum Folate 19.98 (2.91 -50.00)

Ferritin 53.9 (13.00 - 150.00)

I think they all seem OK.

The anxiety started 3-4 months after raising my dose from 125mcg to 150mcg (as I noticed on a routine blood test that my TSH had risen from the 1s to the 2s). When I had my bloods rechecked by my GP approx 6 weeks after increasing to 150mcg, my TSH had gone down to 1 or below. Then a while after that I started feeling anxious and panicky. It took me a while to realise that I could be over-medicated, so I cut right back to 100mcg before going back to 125mcg after a couple of weeks or so. Then after my last blood test (results given at the start of this thread), I increased my dose to 150mcg Mon, Wed, Fri, Sat and 125mcg Tues, Thurs, Sun (I didn't want to go straight to 150mcg daily in case I had been over-medicated when I had taken that dose a few months ago). However the anxiety has never abated - it's the most ghastly feeling! Presumably if I get my thyroid levels to where they should be my adrenals should follow suit?? How does it work? Does the adrenal cortex start producing too much/too little cortisol because the thyroid is under stress? And does adrenaline have a part to play in any of this? How common is it to have anxiety with hypothyroid?

Really grateful to you, SlowDragon and Angel Of The North for taking the time to read my posts and respond. Thank you so much :-)

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You're very welcome :)

I don't know that much about adrenals. But I think the main idea is you need more cortisol to deal with the stress of being hypothyroid. Cortisol is only supposed to be for occasional use, but because the illness is ongoing, while hypo we need extra cortisol all the time. The glands aren't able to keep up demand, so we get a situation where cortisol is too low.

One of the symptoms of cortisol being out of whack is to make it difficult to increase thyroid hormones. I heard this explained that as the metabolism increases closer to its normal level, the demands on the adrenals increase. It causes a speeded up, overmedicated feeling that can include anxiety.

Your situation doesn't sound exactly like that, because the anxiety continued even after you lowered your dose again. As Greygoose was saying, having too low a dose definitely causes anxiety, so it could possibly be a combination of everything.

I'm looking into treating my adrenals myself. Its hard to find good information! There was a good thread today, I'll look up the URL for you in a minute.

Those vitamins look a little low. Particularly Ferritin, which is well below halfway. Generally the rule of thumb is that you want them halfway at least, and some at the top of the range, so folate is also on the low side. Unfortunately I don't know how to interpret the active B12, although it should be a better test than serum B12, I don't know what number you're aiming for.

I believe ferritin is a bit of a tricksty one, and maybe you should try to get a full iron panel to look into it. If you search around the forum you will hopefully find knowledgeable people like Seaside Susie talk about it. Folate can be supplemented with a good B-complex.

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Here's the thread discussing adrenals today: healthunlocked.com/thyroidu...

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Thanks SilverAvocado, appreciate it :-)

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