Question on Absorption, Dose Increase, and Zoloft interaction. Doctor taking too much time!

[Andyb1205]

Hi. Just wanted to start off by saying that I've been going through many older posts on this forum. It has been a great learning experience. While I joined two years ago I was on and off here but with the slowly lifting fog I'd like to move forward with the proper guidance. This community has been so helpful for me.

I am afraid I'm wasting unnecessary time in between dose increases. I will begin on what I've noticed about absorption of Synthroid.

1) Lets go back to around a year ago. I finally noticed something that makes a lot of sense now, including the increased frustration with optimization which has taken unnecessary time.

May 18 2017

TSH 2.19 (0.32-5.04) FT4 14.1 (10.6-19.7) FT3 4.06 (3.00-5.90)

July 6 2017

TSH 0.57 (0.32-5.04) FT4 17.8 (10.6-19.7) FT3 3.89 (3.00-5.90)

The drop in TSH with subsequent increase in FT4 to slightly over top quarter of range came with the change from 75mcg to 100mcg Synthroid, 6 weeks in between. Feeling some hyper symptoms, such as bowel movements and hand tremors, I asked the doctor to decrease to 88mcg. Made perfect sense.

A few days later, now having begun 88mcg Synthroid, I also began Adderall for ADHD. Previously keeping an hour between Synthroid and breakfast, I would take Adderall 20-30 minutes after Synthroid. It is from here that my thyroid treatment went downhill due to:

- increased metabolism from Adderall decreasing absorption of Synthroid, therefore decreasing thyroid hormones

- dopamine interference suppressing TSH, thyroid adapting and hence change in my "set point" to the bottom part of the range, thanks to diogenes for helping me understand this

Hence while the sharp decrease in TSH was initially from a dose increase of 75mcg to 100mcg, subsequent TSH results would linger around ~.50 as I was now on 88mcg, then reduced to 75mcg, back up to 88mcg, 100mcg, and now 112mcg.

Fast forward to now.

2) For over two months I was on 100mcg Synthroid.

TSH 0.43 (0.32-5.04) FT4 13.8 (10.6-19.7) FT3 3.91 (3.00-5.90)

I have been on 112mcg Synthroid for two and a half months. Most recent labs performed 3 weeks ago, hence on 7 weeks of 112mcg.

TSH 0.26 (0.32-5.04) FT4 14.0 (10.6-19.7) FT3 4.05 (3.00-5.90)

As I had been trialing different ADHD medications, two weeks ago I settled back to Adderall (was on Concerta and before that Vyvanse) and am titrating that. In around a week, having decided on my Adderall dose, the doctor will add 25mg Zoloft for OCD. The plan was to rerun labs, TSH, FT4, FT3, 6 weeks after.

3) Here's my main question. I have already been on 112mcg for 2.5 months now. Furthermore I've read that Zoloft can interfere with Synthroid requiring dose increases. I would take Zoloft and Adderall together 30 minutes after Synthroid. I am wondering if it's not best to run the labs in a week or two, I mean how much more could the current dose possibly be absorbed. Then see how my levels are and increase to 125mcg Synthroid, add in Zoloft, and retest 4-6 weeks after (that seems to be the recommended time here?). What do you think?

4) Not important right now but thought I'd ask anyways.

Is there often much of a difference between dose increases by 25mcg compared to 12.5mcg for the body to properly adjust?

I will need to wage a strong battle with this doctor, who has been cooperative so far, to focus entirely on my actual thyroid hormone levels along with accompanying symptoms.

Thanks in advance.

[greygoose]

So, you're continuing to take your Zoloft and Adderall 30 mins after taking synthroid? Why can't you wait two hours, and improve your absorption of Synthroid?

[Andyb1205 in reply to greygoose]

I’m only taking the Adderall right now but will have the Zoloft added in soon. Being ADHD means needing to take my meds as soon as possible in the morning.

I’d take them all in one go if I could to further reduce OCD but that’s something I’d consider after all is finally set and done.

Have tried taking Synthroid before bed but that’s never worked well for me. With the sleep problems, setting the alarm a couple hours earlier isn’t an option either. ☹️

[greygoose in reply to Andyb1205]

Well, if you ever manage to get your thyroid hormones optimised, you might find you don't need the Zoloft and the Adderall, because depression and ADHD are hypo symptoms.

[Andyb1205 in reply to greygoose]

ADHD is a neurological disorder, distinct from the inattention symptoms that mimic hypothyroidism. A neurological disorder just how autism is a neurological disorder. We have actual scientific evidence for this today unlike the stigma from older generations, not that I’m referring to you or anything. I’d like it if you do not bring this up again as it’s not the first time, I’m still grateful for your help of course. 🙂

I know myself the difference between the two. My mind was sharper, memory was better, and clearer, when I didn’t have these hypothyroid symptoms. However I was always inconsistent and without direction. It runs in the family, and those family members are healthy and fit like anyone else. I hence also know how the Adderall helps and how lingering slowdown of cognitive abilities - brain fog - comes most likely from hypothyroidism.

Increasing hypothyroid symptoms have gone hand in hand with increasing depression and anxiety. But I also have perfectionist OCD, and PTSD from life long physical and emotional abuse. That is what the SSRI will be for. That said, if I can get off of it one day I would in a heartbeat. I will revisit that then.