Lithium for Depression: I have heard that Lithium... - Thyroid UK

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Lithium for Depression

I have heard that Lithium can affect thyroid function.

I am aged 35 and have been taking thyroid hormones since aged 16 due to Hashimotos Disease. My psychiatrist wants me to trial Lithium to help my Depression in addition to taking the antidepressant I am on.

Is this a good idea, or could it affect my thyroid hormone levels in a negative way or will it not matter that most of my thyroid gland has probably already been destroyed by the Hashimotos?

I would be grateful if anyone has any knowledge/experience of this.

Many Thanks ad blessings to you all.

15 Replies
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If you have Hashimoto's then vitamin levels are frequently too low this can hinder conversion of FT4 to FT3

Resistant depression can be due to low FT3

Psychiatrists can prescribe T3

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last dose 8-12 hours prior to test

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

1 like
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Hi Slow Dragon,

Thankyou so much for your kind advice. I take T3 which my Pyschatrist prescribes 20mcg daily and recently he suggested increasing this to 40mcg a day, I tried this but got some racing thoughts and I am not sure it is too much.

My Endocrinologist is very nice and he is very interested in the vitamin connection also. He is fairly new there and young and seems interested in the wider treatment of Hashimotos.

He agreed to test me for vitamin deficiencies. I make sure I don't take any thyroid hormones 24 hours before a blood test.

I take 150mcg of Thyroxine daily and Vitmain D 800 Iu daily.

These are my latest blood tests.

Vitamin D 89. Range 50 to 120

Serum Calcuim 2.41 Range2.15 to 2.5

Serum Adjusted Calcuim 2.37. Range 2.15 to 2.5

Serum Phosphate 1.03 Range 0.81 to 1.45

Serum Alkaline Phosphate 38. Range 35-104

Serum Total Protein 67. Range 66-87

Serum Albumin 42. Range 35-52

Serum Globulin 25. Range 18 to 36.

Serum Urea 3.1 Range 2.8 to 8.1

Serum Free Thyroxine 22.9 Range 12-22

Serum Free Tridothyronine 8.5 Range 3.1-6.8

Serum TSH 0.01 Range 0.27 to 4.2

Serum Ferritin 43. Range 13-150

Serum Reactive Protein less than 1. Range 0-5.

Serum Vitamin B 12 455. Range 197 to 771

Serum Folate 11.7 Range 1.9 to 25

Serum Iron 20.7 Range 5.8 to 34.5

Serum Transferrin 2.3 Range 2-3.6

Serum Transferrin % Saturation 36. Range 25-45

I started taking the 40mcg of T3 about a week before this blood test. Since being on Vitamin D my levels have gone up, last year my Ferritin level was at 18. I have been taking 12.5mg Iron a day (Contained in two high strength multivitamins). Do you think I need to get my iron level up higher and what is the best way to do this. Also do I ned to get my folate levels up a bit higher?

I am not sure if I should take Lithium, but it does frighten me how depressed I get.

I would be most grateful for any advice. With Kind Wishes and blessings to you all.

Reply

Ferritin needs to be at least half way in range

Taking daily vitamin C can help improve iron absorption. Eating liver or liver pate once a week should help improve levels.

B12 and folate on the low side. Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).

Or Jarrow B-right is popular choice, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

How do you take your T3?

Many of us take it as small divided doses......3 doses 8 hours apart. Eg on 40mcg daily it could be 20mcg 7am, 10mcg at 3pm and 7pm

When you did this blood test, how long before blood test was last dose of T3?

Your results suggest that 40mcg is too high dose as FT3 is too high

Reply

Thankyou so much for your kind reply, I will definitely try and get the vitamin levels up. I am not sure I have the willpower to go gluten free at the moment, but definitely something to consider for the future. Thanks for your superb helpful advice, warm wishes to you.

1 like
Reply

thyroid555,

Lithium can affect good thyroid function & if this were me, I would not consider medicating lithium before ensuring an adequate FT3 level for several months.

Low FT3 levels can be responsible for depression, anxiety, magnified emotions, psychosis and much more. Many members including myself have found medicating either T3 with T4, or NDT (that incorporates T3) has helped to alleviate these symptoms.

I would also ensure thyroid antibodies were low and nutrients & iron were optimised as good thyroid hormone synthesis depends on adequate levels.

Post any blood results complete with ranges (numbers in brackets) for members to comment.

3 likes
Reply

I think this is excellent advice.

Reply

Hi Radd,

Thankyou so much for your kind reply. My T3 levels are above the reference range. See post above with blood levels. I was advised to increase my T3 from 20mcg to 40mcg, but I am not sure if this is too much as I started getting racing thoughts.

Maybe I could try and get my iron and folate levels up a bit and see whether that helps.

I am unsure if to take the Lithium, but it does frighten me how depressed I get.

Thankyou so much for your reply and sending you warm wishes.

Reply

thyroid555,

I understand your resistance and fear. Depression is awful as we become a person we don’t recognise and our every day responsibilities become unmanageable.

I have no experience of a psychiatrist’s prescription/view point but would suspect that doubling your 20mcg T3 dose was too much, as the standard in the “thyroid world” is to increase by 5mcg every 1 - 2 weeks.

When hormones have been messed up for so long, we often have a slim margin available to regain any sort of recovery. Remember all hormones are dependant on each other so any deficiency (or elevation) may have repercussions up the line. My own experience was once that “sweet spot’ was eventually found, recovery demonstrated a cumulative effect.

Be aware that over range FT3 levels can unbalance sex hormones and it was the balancing of O & P that rid me of my depression. SHBG should positively correlate with thyroid levels so if T3 is elevated, so SHBG will be. Also, falling cortisol can cause oestrogen to soar, causing high SHBG.

Elevated SHBG protein will bind to thyroid hormone making less available for use in the cells (no matter how much the thyroid hormone amount is deemed as ‘normal’ in blood tests) as it has to be cleaved from SHBG to become “free-fraction” before it can activate cellular receptors.

Prolonged cortisol elevations caused by chronic stress (low/high thyroid hormone) also decrease the liver’s ability to clear excess oestrogens from the blood & this can increase levels of thyroid TBG (proteins that transport thyroid hormone). As with the elevated SHBG, elevated TBG can bind too much thyroid hormone.

Your ferritin is low but serum iron isn’t. Your transferrin saturation % indicates how saturated the body’s system is for transporting iron and yours is half way through range. A normal average is around 30% so yours is good. I would not recommend supplementing iron at this stage.

Your Vit B12 could be viewed as low, so in your position I would look to supplement. Remember folate needs to match Vit B12 levels as the two work together in helping to create, develop & regenerate red blood cells and make iron work properly.

Parietal cells secrete hydrochloric acid (HCl) located in the gastric glands found in the lining of the stomach and allow digestion/absorbtion of food/nutrients. Vit B12 should be naturally released for absorption by the activity of hydrochloric acid & protease (stomach enzyme) but low levels are commonly found in Hashi sufferers. Also failing adrenal glands may inhibit our ability to produce adequate stomach acid. So I would also be looking to supplement Betaine HCI with pepsin.

Lastly remember TFT's are only representative of what is within the blood stream & don’t represent actual cellular activity. Pulse & temp can be informative as useful tools to see progress.

I wish you well. 🙂

Reply

Hello Radd,

Thankyou so much for your kind reply and advice. I will try and get the Vitamin B12 and Folate levels up.

Thankyou for your kindness, it is much appreciated. All the very best to you.

Reply

There is comprehensive discussion about the effect of lithium on thyroid function at the site:

Lithium use is associated with an increased risk of hypothyroidism

thyroid.org › ... › Volume 8 Issue 12 December

In addition to the thyroid effects, there are many reports linking the use of lithium to kidney and parathyroid gland problems.

You access the site by typing into Google: Lithium effects on thyroid function and then scroll down to the site with the above heading.

Reply

Thankyou so much have a lovely day

Reply

I think the 'professionals' should have done a service by testing your Free T4 and Free T3. T3 in particular is needed in our millions of T3 receptor cells and the brain and heart contain the most.

I'd ask but they may not do so as (if you're in the UK) doctors seem to have been directed that a TSH and T4 is fine. NOT SO. The frees are more important and I'll give a link:-

thyroiduk.org.uk/tuk/testin...

There are private labs that will do home pin-prick tests and if you decide to do so make sure you are well hydrated a couple of days before blood drawn (finger pin prick) and that arms hands are warm on the a.m.

GP should also have checked for thyroid antibodies. Another important test.

Regardless of the TSH if antibodies are present we should be prescribed.

health.harvard.edu/newslett...

Levothyroxine, T4, is an inactive hormone and it should convert to T3. Also known as liothyronine which is the Active Thyroid Hormone.

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Thankyou so much for your advice it’s much appreicated

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I believe your psychiatrist needs more training on endocrine issues. A jump from 20 to 40 mcg is way too much. Why not try compromising by cutting a 20 mcg pill in half and just taking one and a half 20 mcg tablets per day? In fact, when I began taking T3, I titrated even more slowly, taking 1/4 of a 25 mcg tablet per day for two weeks, and increasing by 1/4 tab every 2 weeks.

Reply

Thankyou yes I could try this. When I tried to cut them in half in the past they broke up. Do you find you can cut them ok? My doctor wants me to take it twice a day so maybe 30 in the morning and 20 in the evening. Thanks for your kind advice 😀

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