Hyper/Mania after starting Levothyroxine

[Jointhedots]

Hi All,

So, when I took Levo mid-Nov, I became manic again...

I am on sodium valproate to prevent mania but which can cause hypothyroidism...

ncbi.nlm.nih.gov/pubmed/264...

...which needs levo to treat it...which makes me manic....

I keep going around in cirlces....!!!!

Blood results :

07/12/2019

TSH 6.38 mU/L [0.35-5.5]

Free T4 11.2 pmol/L [10.5-21.0]

Serum Thyroid 553 iu/ml [0.0-60]

peroxidase antibody

Vit B12 629 ng/L [211.0-911]

Serum Folate 16.03 ug/L [>5.38]

Serum Ferritin 60 ug/L [10.0-291.0]

Serum C reactive <4mg/L [0.0-6.0]

Not requested

Vit D (25 OH) 63 nmol/L

FreeT3

31/10/2019

TSH 11.56 mU/L [0.35-5.5]

Free T4 11.0 pmol/L [10.5-21.0

02/02/2019

Serum Thyroid 846 iu/ml [0.0-60]

peroxidase antibody

[greygoose]

Are you sure it's the sodium valproate that caused you to go hypo? Because you have very high antibodies which means you have Hashi's. Hashimoto's Thyroiditis is the main cause of hypothyroidism. And, it doesn't happen over-night, so my guess would be that it is the Hashi's that caused your mania, not the other way round.

At the moment you are very hypo with a TSH of 6.38, and a low FT4. So, if it were me, I would be questioning my 'diagnosis' of mania and asking if I really need to be taking the sodium valproate, because it could be making things worse.

How much levo are you/were you taking?

[Jointhedots in reply to greygoose]

Thanks Greygoose.

Sadly I have felt the sodium valproate has caused these problems, and now I am stuck in a vicious cycle.

I don't know how to start again on the Levo safely...

All I can think of doing is finding a specialist who is conversant in both. even so, whatever I do has it's risks...

[greygoose in reply to Jointhedots]

I don't honestly know how you can say that with any certainty. Hashi's causes many and varied symptoms. But, you'd have your work cut out finding a specialist that knows anything about Hashi's, let alone about the two. Did you already know you have Hashi's?

[Jointhedots in reply to greygoose]

You are right, I cannot assume the sodium valporate has caused the hypo. It is one of the side effects but as you say, the causes are varied.

No one mentioned Hashi's.I just have assumed from what I have learned on this site...high antibodies. I was born with extensive psoriasis so I have had autoimmune issues all my life. Psoriatic arthritis is under control using turmeric and black pepper (the methotrexate they put me on hospitalised me!!)

There is a Psychiatrist who has successfully treated patients with depression with Levo who believes it may be a thyroid issue. If he gets people from down to normal using it, he will believe me when I say I go from normal to high with it!!!

psychiatrycentre.co.uk/wp-c...

As you say, he is not an Endo but at least he may be aware of the interactions....

I may be way off the mark with this approch but from what I read here, most Endo's would not help anyway!!!

[greygoose in reply to Jointhedots]

You should be treated for hypo, because with a TSH over 6, you are very hypo. And, yes, depression is a symptom of hypothyroidism. One of the major symptoms.

If he gets people from down to normal using it, he will believe me when I say I go from normal to high with it!!!

I have no idea what you mean, there. Are you talking about blood test results? That is the point of taking levo. The TSH reduces and the FT4 and FT3 rise. Are you saying that on a small dose your FT3 goes over-range? If so, that could be more to do with the Hashi's than the levo. Do you know how Hashi's works?

Anyway, we'd need far more detailed lab results, going back as far as you can, to understand what is going on.

[Jointhedots in reply to greygoose]

What I meant is, if a doctor can treat severe depression with Levo, then he can understand how it may impact me. I never suffer from depression, thank goodness, but I have periods of hyper/mania, two of which have directly followed the introduction of Levo..

He is a psychiatrist not an endo but the two seem to be interlinked (Dr Andy Zamar author of "High-dose levothyroxine for the management of bipolaraffective disorder")

I appreciate I am very hypo and need Levo. Maybe I should just try again. I will have to give up work though as I can't risk the Levo making me so hyper that I lose insight...it is really scary - hence my thought to contact the above doctor.

The frustrating thing is it is possible I had postpartum thyroiditis originally, 16yrs ago when I was given the sodium valproate, it would have suppressed my thyroid so worked intially but it is not working anymore.

I have not had my FT3 measured as of yet. I do not have lab results going back very far as my TSH has only been an issue for the last 3 years. I think it is best if I send off for a Medicheck Thyroid test so at least that will have my FT3.

Thanks again for your patience. I appreciate the help. Just taking Levo for me is a complex issue and as we all know, the medical system is not set up for crossover issues.

[greygoose in reply to Jointhedots]

What I meant is, if a doctor can treat severe depression with Levo, then he can understand how it may impact me.

OK, but that doesn't necessarily follow. And, I doubt he would know anything at all about how Hashi's works - which is so very important to understand. And, I am extremely sceptical that it is the levo making you manic. You may have had two episodes since you started it, but you had them before without levo, didn't you? So why would it be the levo causing them?

It is far, far more likely that you've had Hashi's for 16 years - rather than postpartum thyroiditis, the two are often confused - and that it was your Hashi's 'hyper' swings causing the mania. And, because doctors understand so little about thyroid - and nothing at all about Hashi's - that you weren't diagnosed before. And you never needed the sodium valproate at all, just thyroid hormone replacement.

The fact that your TSH has only been a 'problem' for the past three years proves strictly nothing at all. Just testing the TSH is totally inadequate and says nothing much about your thyroid status. Had they done proper testing 16 years ago, with TSH, FT4, FT3 and antibodies, the 'problem' would have been picked up then, and you would have been spared 16 years of suffering. But, you can't tell doctors anything. They know it all, even when they know nothing. Sorry about the rant, but it really makes me mad! Useless bunch of you-know-what.

It would be a good idea to get a private test, including all those tests mentioned above. But, a one-off test is not likely to show a pattern, and it's the pattern that is important, that really explains what's going on, because with Hashi's, levels jump around. But, I sincerely believe that levo is not the problem you're thinking it is. It's the Hashi's.

[Jointhedots in reply to greygoose]

Thanks again.

I will try the Levo again and get regular tests to keep a record going forward.

Looking forward now, with my own health in y own hands...

[greygoose in reply to Jointhedots]

Sounds like a good plan.

[humanbean]

One of the ex-admins of this forum, Clutter, was diagnosed as being bipolar, and correct treatment of her thyroid condition fixed it. (Clutter no longer posts on here.)

healthunlocked.com/user/clu...

If you look at Clutter's profile, at her description of what happened to her (near the top of the page, click "Read more" in blue), it may make you feel more confident about self-medicating.

You need the correct proportions of T4 and T3, or possibly just T3 only, to make treatment work for you. Unfortunately, relying on the medical profession is unlikely to help. They won't prescribe T3 apart from in a tiny handful of cases. Also, many doctors won't accept that brand of T4 or T3 makes a big difference in some cases. They put other road blocks in the way of patients by insisting that they are tested under circumstances that aren't consistent. They regularly under-dose patients because of the warped philosophy of relying on TSH to monitor treatment. You'll do much better to treat yourself in this case because you know better than the doctors exactly how you feel.

One thing to bear in mind is that the brain needs T3. If you aren't converting T4 into sufficient T3 for you then that could be causing all sorts of brain effects.

[Jointhedots in reply to humanbean]

Thanks for this, again, gives me hope that worth g my thyroid will help my other diagnosis.