Levothyroxine and anxiety

[Molly139]

Hi, I’m currently taking 125mg of Levothyroxine daily and suffer with mild anxiety. Just by chance I came across a link between Levothyroxine and anxiety. Any advice would great 👍

[Lalatoot]

For me the anxiety was caused by being undermedicated on levothyroxine rather than caused by levo itself.

What was happening was the hormones my body was lacking to keep it going each day it made up for with adrenalin. So I kept going fuelled by hormones and adrenalin - not a great way to live.

I would suggest you post blood results here with ranges and tell us how much levo you are on then we will try to advise.

[Molly139 in reply to Lalatoot]

Thank you Lalatoot for your reply. I’ll post my results as soon as I get them from my doctor. I’m new to testing and results but I did ask my doctor six months ago for a full result and he said I didn’t need them as my result was within the normal range!

[shaws Administrator in reply to Molly139]

I think you need Free T3 and Free T4 tested. Hypo can cause lots of unpleasant symptoms:-

nhs.uk/conditions/underacti...

[greygoose]

For me, anxiety is an under-medicated symptom. If i raise my dose slightly, it goes away.

[Nanaedake]

For me, anxiety comes with sudden unexpected changes in thyroid status. Also experienced it with other medication as side effect and with poor quality levothyroxine. Has the pharmacy changed the type of levothyroxine they are providing?

[Molly139]

When I asked for my results before my GP said I was in the normal range so I believed I was on the correct dose until I found this site today. I did think of increasing my dose without consulting my GP my resting heart rate is 54 and I get fluttering sensations during the day (hr at the time 59 or 60).

Years ago my tablets were changed to Levothyroxine, I thought all medication was the same until I found this site. I also realise it could be when anxiety began!

[Angel_of_the_North in reply to Molly139]

You are entitled by law to see your results, free of charge. I suggest that you remind your surgery of that and threaten to do a subject access request for ALL your medical records if GP doesn't give you your last set of results.

[Molly139 in reply to Angel_of_the_North]

Thank you, I’ve requested a full report today. I’m looking forward to seeing it rather than just being told it was ‘normal’

[Molly139 in reply to Angel_of_the_North]

I’d be grateful for any help on my results below. The first set of results on the report are ref ranges for patients not on hormone therapy, will you let me know if these are needed.

Thyroid function test: Hypothyroidism on L-thyroxine replacement, presumably, not ‘hyperthyroid’ as originally stated. Replacement dose adequate. Ignore free T4 not helpful.

Serum TSH level 0.39 miu/L (0.27-4.2)

Serum free T4 level. Above recommended range. 25.1 pmol/L (12-22) outside reference range

[SlowDragon Administrator in reply to Molly139]

Well just testing TSH and Ft4 is completely inadequate ....but is all NHS does as standard

Doesn’t tell you how well you are converting Ft4 to Ft3. Essential to test all four vitamins and both antibodies..if not been tested yet

You could ask GP to test vitamins (and thyroid antibodies if not been tested before)

NHS frequently refuses to test Ft3...despite it being the most important result of all

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Never agree to dose reduction based just on TSH and Ft4 test

First step is to get full testing. See exactly where you are and what’s the problem....frequently poor conversion and low vitamins

Improving vitamin levels to optimal will help improve conversion

Few examples of posts with private testing results

healthunlocked.com/search/p...

healthunlocked.com/search/p...

[Molly139 in reply to SlowDragon]

Thanks for your reply. It says my T4 level is above the recommended range, what does this mean? I have to admit I’ve no knowledge on the thyroid and have never questioned the tests. Put all my faith in the doctors!

[SlowDragon Administrator in reply to Molly139]

Likely you have low vitamin levels, causing poor conversion of levothyroxine

Levothyroxine is Ft4. Before we can use Ft4 it has to be converted in liver, gut and cells to Ft3

Conversion is often poor with Hashimoto’s, poor with low vitamins, poor as we get older, especially after menopause

So first step is to get FULL Thyroid testing privately...including vitamins

Come back with new post once you get results.

Members can advise on next steps

Mix of High Ft4 and low Ft3 can often cause anxiety

[SlowDragon Administrator in reply to Molly139]

About 90% of primary hypothyroidism is caused by autoimmune thyroid disease (Hashimoto’s) - diagnosed by testing thyroid antibodies

Hashimoto’s patients frequently become gluten intolerant

Gluten can cause anxiety too, if gluten intolerant

Hashimoto's frequently 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

While still eating high gluten diet 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...

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

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

[SlowDragon Administrator]

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels if not been tested recently

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood 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)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

[Molly139 in reply to SlowDragon]

Hi SlowDragon, As I’m new to this I just wanted to let you know I’ve posted my results

[asidist]

I've experienced anxiety from both too little levo as well as too much.

It may be the case that you need to reduce levo but add T3 based on what your blood results show.

I've had notably increased anxiety since becoming hypothyroid a decade ago but have also taken levo only and had low T3 blood levels that entire time until the recent past, so may have been largely just lack of proper T3 in my case.

[Molly139 in reply to asidist]

Thank you asidist, I hope there is a link between Levo dose and anxiety, I seem to have tried everything!

I’m going to get a thyroid and vitamin test done just deciding which company to use and I’ll post my results

[princess2k21]

Hi, I am the same as you apart my anxiety has got worse in the past 8 months to the point that I want to self-harm or worse, but I'm trying to stay strong for my mum and Grandad as my Grandad is very unwell and I was unable due to see him due to covid and there's about 600/650 miles difference between me and my Grandad, I'm due to see him on the 8th August after waiting 18 months to see him.

Anyway according to my records that I can see on my test results on my go app that I've registered to years ago, my thyroxine is becoming normal again as it was out of range (on the low side) when I was on 100 but now I'm on 125 my thyroid levels are normal

so does anyone know if any anxiety medication affects levothyroxine as my doctor keeps referring me to therapy but I am not finding that useful, I even told the doctors that, even the therapist, but at the moment I still have to go apparently, I've been going therapy for 5 or so years, the session lasts 6 months, then 6 months down the line I'm back again, so its an endless cycle

[T808]

Did you ever get it straightened out? Hope you're doing much better now 🙏