Hello. I have recently in the month of November increased my Levo to 125 mcg from 100 mcg. This is my second month. I suffered from anxiety years before being diagnosed for Hashimotos. I am hyper . My last test results show that my TSH indicates I could be Hyper. I am currently weaning of my one anxiety med called Clonazepan. This is month 4. My anxiety is coming back. I am not sure if it’s because my TSH reads hyper or its rebound from the withdrawal. Attached are my last labs. Any advice would be appreciated. I CANT go back to being anxious. It was debilitating for me. I’m scared. Like I can’t leave the house. I was thinking to decrease the Levo back to 100 mcg. I don’t know if the longer you take the levo ... the more the levels can increase?
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A suppressed TSH on its own does not automatically mean you're hyper (over-medicated, you can't be hyper because you're hypo). It just means that your pituitary has decided you have enough circulating thyroid hormone and no-longer need to stimulate your thyroid.
Your FT3 is 68.65% through the range and your FT4 is 62% through. So, you're neither hypo nor hyper. But, if you still don't feel right, maybe a small increase in T3 is indicated.
Hi. Sorry. I can’t think straight very stressed. What I mean to say - could I be hyper... because my TSH is so suppressed... the longer I take the increased dose can my TSH become more suppressed. I’m really anxious and I have been coming of my meds with no issue ( Clonazepan) but my anxiety has just started up again. X
No, you're not hyper - you can't be hyper because you are hypo and your thyroid is incapable of over-producing hormone. I changed my response above to explain about the TSH. It's OK, don't worry about it, it doesn't mean anything much.
You have Hashi's, so your results are bound to jump around from time to time, and your symptoms with it. And, there are bound to be set-backs from time to time. But, the TSH cannot make you anxious. It doesn't make you feel anything. It's the T3 that causes symptoms when it's too high or too low.
My anxiety is coming back. I am not sure if it’s because my TSH reads hypo
Your TSH does not read hypo. Since your increase in dose of Levo your TSH is lower than last time. If you were going hypo your TSH would be high in range. In fact, your FT4 and FT3 are both much better than before - FT4 now 62% through range whereas before it was below range, and FT3 now 69% through range and before it was only 36% through range.
Your antibodies are higher than before, particularly the Tg antibodies, but these fluctuate with Hashi's anyway and can cause fluctuations with symptoms.
Are you taking any supplements? Your B12 is a lot lower than in June, and Vit D would be better at the recommended level of between 100-150nmol/L, your folate is a lot lower than last time, and your ferritin could be a bit better too.
Hi. Sorry. I can’t think straight very stressed. What I mean to say - could I be hyper... because my TSH is so suppressed... the longer I take the increased dose can my TSH become more suppressed. I’m really anxious and I have been coming of my meds with no issue ( Clonazepan) but my anxiety has just started up again. X
I have now doubled my vitamin D and b12 since last results.
What I mean to say - could I be hyper... because my TSH is so suppressed
No. Your FT3 would be over range if you were over medicated (you can't be hyper when you have hypothyroidism). My TSH has been suppressed on all but 3 occasions since 1994 (when I started keeping a record of my results, I've been hypo for 45 years), depending on which lab does the tests it comes back as 0.01, or <0.02 or <0.005 and I am definitely not overmedicated as my FT4 and FT3 are usually around 70% through range.
Why don't you try a 112 mcg dose? Maybe suites better for your needs, although values (tsh,ft4,3) would decrease. Why you increased the dose, you didn't feel good on 100mcg?
Hi. No I still had some symptoms. That’s why I increased. Do you know how long it would take for it to affect me if I decrease the Levo? To feel a difference if it was the Levo ?
You can try a dose reduction, in 3-10 days you should feel the difference, depending on how sensitive you are. I went through this as well, the problem is that over time the dose will have to be increased and the tsh will decrease and anxiety will increase. There would be two solutions, either add t3 to levo or take antidepressants (although not desirable) but not benzos(Clonazepan,etc).
Hi. I am actually on anti depressants also. I’m weaning off the Clonazepan as I now know it can’t b taken long term... also I have to come off the anti depressants .. as I want to try for a child end of 2020. This all seems to much to deal with. Sorry having self pity party. Just not sure what direction to go in. 😟 . Thank you.
I don't think it's ok to give up antidepressant at the moment, I would go on 112mcg levo and 5mcg T3 in the morning and 5mcg T3 in the afternoon. I don't think you are in hyper.
Hi. The truth is I was diagnosed with PTSD/ GAD and MDD 6 years ago. And Under active thyroid 2 years ago. After requesting results and questioning my endocrinologist he was like - oh you have Hashimotos. I am currently on to many Pysch medications. 2 x SSRI’s / 1 x SNRI / 1 benzo. I want to stop the benzo as the other or even one of them should carry me. At the time I know why it was done and it’s fine. However I have started a two year mission to wean off all except one that is Ok with pregnancy and does not affect a baby. Which I want to try for...
If you see my results in April I was on 50 mcg Levo and 10 mcg T3 ( from a Doctor in South Africa) my readings went a bit hectic..
Also my GP and endo have Both said no to T3... ( UK) .
It’s just so much to consider and I think it’s insane that we have to do so much persuading and extra tests ourselves because they don’t want to do them .
Thank you for message. I was not sure if I was Hyper because of TSH but from what I read - T3 would be the indicator to count on. X
I am on the lowest dose of each tablet possible. However at the time .. I was not capable of moving out a room... it took me 8 months to feel some semblance of human.. however then my mum passed. So I went a bit backwards.. then the Hashimotos was diagnosed... then I relocated countries ... in May and then moved house again...so I’m finally slowly getting settled... I have been coming off the one med for 4 months now. The benzo... it is a very slow process. And I know life throws you curve balls. I never had issue the rest of my life.. it just all happened over last 6 years. Some people just don’t have all the coping mechanisms. Unfortunately I was one of those. I do the best I can.
Do you eat high carb, low fat or low carb, high fat?
Are you vegan or vegetarian? Do you eat eggs, cheese, fish, meat?
Do you eat or avoid saturated fat?
Are you actually on a diet and trying to lose weight? If yes, how many calories do you eat a day? Are you always trying to cut calories?
Do you eat gluten?
I first reduced my anxiety by eliminating gluten completely.
Then several years later discovered that diet has a huge impact on anxiety and mood. I increased my saturated fat intake and my overall calories and my anxiety and depression have almost completely disappeared.
...
If changing your diet doesn't help then perhaps your problem is caused by too high or too low levels of cortisol. To test out this idea would require you to do a private 4-sample spit test that included DHEA. The best one, because it includes DHEA and has sensible reference ranges, is the Regenerus test :
If you asked a doctor to check your cortisol levels, and they agreed to do it, they would only do a single, early morning blood test. Or even worse, they might do a random cortisol blood test. Since cortisol has a circadian rhythm (it changes in a regular cycle throughout every 24 hours), a single result doesn't tell you anything very much at all.
Usually TSH is a good marker for thyroid status and it can be an early indicator of thyroid failure. However, in autoimmune thyroiditis high levels of thyroid hormone can lead to the hypothalamic pituitary thyroid axis becoming down-regulated with subnormal TSH secretion - the pituitary produces less TSH than it should. We can see this in your 12 Apr and 18 Jun results when your TSH should be very high with the combined low-normal fT3 and fT4 levels. Consequently, in cases like yours TSH is not a good indicator of thyroid status. TSH is a good indicator in many but not all cases. In your case TSH is not informative so you have to go by your signs and symptoms along with your fT3, fT4 levels.
You are almost certainly hyperthyroid at the moment, as indicated by how your feel and both fT3 and fT4 being above average. In the same way you were hypothyroid in June with both fT3 and fT4 being low-normal (even though TSH 1.20 looks good). I would skip your levothyroxine for a couple of days, resume on 100 mcg and see how you feel.
Whilst the extra 25 mcg levothyroxine will have increased your hormone levels a bit I think the major contributor might be your very high TgAb. With this level of antibodies thyroid secretion can be very erratic as the thyroid comes under attack and releases spurts of hormone. So, although your thyroid is failing and generally producing less hormone its secretion can be erratic leading to periods of hyperthyroidism. Your thyroidal secretion is on a downward slope but it is not a smooth decline, it can be a very bumpy ride with ups and downs until it packs in over the next year or so.
Eventually the thyroid dies and things settle down but if you continue to get these fluctuating levels it might be a good idea to ask your doctor if you can go on 'block and replace' where they give you carbimazole to suppress your thyroid output and levothyroxine to replace your thyroid hormones. This would give you more stable levels and allow better control. Subnormal TSH secretion also affects T4 to T3 conversion but I wouldn't worry about this for the moment, it gets too deep. It may be that your TSH will recover over the coming months if your fT3, fT4 levels settle down.
It is likely to be destroyed by the antibodies, remnants will still be there but probably non-functional. You will then need full thyroid hormone replacement. The immediate concern is to get your thyroid hormone levels stable at the right level.
I'm not knowledgeable on this and speaking loosely. In an autoimmune condition the body generates antibodies that attack its own tissues. I don't know the mechanism in autoimmune hypothyroidism but assume it is similar.
High titers of antibody against thyroglobulin (TG) and thyroid peroxidase (TPO) are present in most patients with Hashimoto's thyroiditis(17), and TPO antibodies are complement fixing and may be cytotoxic. However, the evidence for cytotoxicity is scant, especially since normal transplacental antibody passage of anti-TPO Ab to the human fetus does not usually induce thyroid damage.
This is getting too complicated for me! I do need to be more careful on this subject in future. As I understand it (not much!) antibodies have a role in destroying thyroid tissue, in co-opting other substances to attack the thyroid and in reflecting anti-thyroid activity. Elevated TPO or TBG antibodies are associated with autoimmune thyroid disease although they are also present in some of the healthy population.
It’s a poorly understood subject, at least in the thyroid arena. To the best of my limited knowledge TPO and TBG antibodies are associated with autoimmune thyroiditis and have a role in destruction of the thyroid. The importance of this role seems to be under debate at the moment.
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Results opinion please 
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