I’m currently on Levothyroxine 50mcg after being diagnosed with Hashimoto’s (ultrasound and blood tested). I’m also on Setraline 75mg for depression, anxiety and insomnia.
I’ve only been on Levo 50mcg for a week so no improvement yet and on Setraline for a couple months.
My mood and sleep improved significantly on Setraline. When I started, it made me extremely tired but then that went away after a week.
Recently, I started to feel fatigued again and want to try switching the time I take my medications.
I take Setraline in the morning and Levo in the evening. What’s the best way of switching them around safely?
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blueberryoats
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Levothyroxine doesn't have immediate effect like you might expect an aspirin to ease a headache; it can take 6 weeks or more to build up to full effect and at that point you will need to have your hormone levels re-tested and adjustment be made to your dose as necessary - and so on until you are optimally medicated. You may have been suffering the consequences of an under-active thyroid for a long time so equally it will take time for issues to resolve. You may in fact find that your depression, anxiety and sleep issues will be some of the symptoms that abate with thyroid treatment. Rather than swapping your meds at this point, since tiredness/fatigue will hopefully abate with successive Levo dose increases, why not wait to see if it does? I can't speak to sertraline, but if you really wanted to swap, you could easily take your night time dose of Levo and then take it the following morning to start your new morning dosing - some patients safely take their week's dose in one single dose every seven days, and on 50mcg after only one week it will be very unlikely that you are already over-medicated. However the key really, is to wait and allow the Levothyroxine time to benefit youbefore making further changes.
Thank you. I’m aware I won’t feel any improvement for a while. I wanted to try switching them because I think the setraline might be contributing to the sleepiness and would be better taken at night.
I have just weaned off Sertraline after 18 months.It was a very positive experience(acute anxiety state with depression)
I would use Sertraline again if I needed to,but it does have side effects.After I started to feel a lot better(after a few months)I reduced from my dose because I felt tired,sleepy & spaced all the time.I then gradually started reducing it with the help of an antidepressant tapering off forum & have reached zero after months of reducing my dose by 10% per month.
When I was diagnosed with an underactive thyroid 20 years ago,I went up from a 14 to a 16 dress size..On Sertraline I have gone up to an 18 dress size.Sertaline can affect thyroid hormones.
I always took my Sertraline at night,but advise you to take it before bed with a full glass of water.I have experienced horrendous heartburn twice by lying down too soon,and have since learnt you can damage the oesophagus if it gets stuck.
My niece takes hers in the morning,as it made her insomnia worse.Sertraline gives her energy,but she does not have thyroid issues.
We have to start slowly and it takes a few weeks for each dose to take full effect. Then retest bloods 6-8 weeks after each dose increase
Dose is increased slowly in 25mcg steps, (retesting each time) until TSH is around one and FT4 towards top of range and FT3 at least half way in range
Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.
Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients
Depression is common hypothyroid symptom, so as dose of Levothyroxine is slowly increased this should help
For full Thyroid evaluation you need TSH, FT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12
ask GP to test vitamin levels and thyroid antibodies if not had these done yet
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.
All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
"One study found that it may increase levothyroxine metabolism. ... The selective serotonin reuptake inhibitor (SSRI) sertraline (ZOLOFT), widely prescribed for depression, has been associated with a decrease in the effect of levothyroxine. Further studies are needed on this, and on any similar effects of other SSRIs.
29 Medications That May Cause Adverse Interactions with ... - Worst Pills
Most doctors don't know clinical symptoms but will prescribe something other than thyroid hormones for them.
He should test your Free T4 and Free T3 as both should be towards the upper part of the ranges. T4 - an inactive thyroid hormone hould convert to T3 but doesn't always do so effectively. T3 is the Active thyroid hormone which is needed in our millions of T3 receptr cells so that our metabolism works normally.
The aim is a TSH of 1 or lower but many GPs think that somewhere within the range is fine (in your case up to 4.90). It does take some weeks for us to gradually feel an improvement. It has probably taken a long time for the TSH to reach a level in which we get diagnosed if GP thinks to do the blood test. You should have a 25mcg increase every six weeks until TSH is 1 or lower. Going gluten-free helps reduce the antiboies that attack the thyroid gland until we're hypo.
As your dose is gradually increased, hopefully you will begin to feel much better.
Because Levo has a long half life that’s the best one to switch - just take it in the evening instead of the morning from now on. You won’t notice the difference.
I felt heavy fatigue on Levothyroxine after about the 3rd day. It made my heart feel weak. Read a lot of reviews about others having the same experience. I had to stop taking it. Only on it for about 3 weeks. Seems most people are lying about its effectiveness. I'm not entirely sure why.
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