Can I discontinue Levothyroxine 50mg ? I started getting thyroid problems after taking antidepressants and mood stabilizers. Not taking now.

[AAP10]

Finished antidepressant treatment two months ago. Currently taking pms supplements for my pmdd, CBD for anxiety and last SAM e for mood support.

07/29/20

T3 uptake 32 range(22-35%)

T4 total 6.8 range (5.1-11.9 mcg/dL)

Free T4 index (T7) 2.2 range(1.4-3.8)

THYROGLOBULIN ANTIBODIES 1 range <or=1 IU/mL

THYROID PEROXIDASE ANTIBODIES 4 range(<9)

07/9/20

TSH (REFL) 2.53 range(0.40-4.50)

Continue Wellbutrin 200mg sr added lamotrigine 25mg

04/30/20

TSH W/REFLEX TO FT4 7.56 range(0.40-4.50)

T4, FREE 1 range(0.8-1.8)

T3 uptake 31 range(22-35%)

T4 total 5.5 range(5.1-11.9)

Free T4 index (T7) 1.7 range(1.4-3.8)

Discontinue Prozac and lithium started Wellbutrin xl 150mg

01/09/20

TSH 5.96 range(0.40-4.50)

T3 uptake 33 range(22-35%)

T4 total 5.9 range(5.1-11.9)

Free T4 index (T7) 1.9 range(1.4-3.8)

T3 free 3.1 range(2.3-4.2)

THYROGLOBULIN ANTIBODIES 1 range <or=1 IU/mL

THYROID PEROXIDASE ANTIBODIES 3 range(<9)

Started lithium and continued Prozac

11/29/19 on lithium for two weeks

Lithium <0.3L range(0.6-1.2 mmoI/L)

TSH 4.72 range(0.40-4.50)

T3 uptake 30 range(22-35%)

T4 total 4.8 range(5.1-11.9)

Free T4 index (T7) 1.4 range(1.4-3.8)

T3 free 2.7 range(2.3-4.2)

THYROGLOBULIN ANTIBODIES 1 <or=1 IU/mL

THYROID PEROXIDASE ANTIBODIES 2 range(<9)

08/2019 started Prozac

07/20/2018

TSH W/REFLEX TO FT4 1.77 mIU/L

T4, FREE 1.5 ng/dL range(0.8-1.8)

T3 free 2.6 pg/mL range(2.3-4.2)

T3 uptake 33 % range(22-35%)

T3 total 75 L range(76-181 ng/dL)

T4 total 6.1 mcg/dL range(4.5-12.0)

T4 free 1.5 ng/dL range(0.8-1.8)

Free T4 index (T7) 2.0 range(1.4-3.8)

THYROID PEROXIDASE ANTIBODIES 2 range(<9 IU/mL)

Folate 19.2 ng/ML

B12 672 pg/ML range(200-1,100 pg/mL)

Vitamin D, 25-OH total 48 ng/ML range(30-100)

Ferritin 27 ng/ML

Complain major fatigue, loss of interest in exercising, and as all my life cold with IBS

05/22/2018

TSH W/REFLEX TO FT4 0.04 mIU/L

T3 free 4.2 pg/mL range(2.3-4.2)

T3 total 122 range(76-181 ng/dL)

T4 total 7.7 mcg/dL range(4.5-12.0)

THYROID PEROXIDASE ANTIBODIES 3 range(<9IU/mL)

[greygoose]

I would very much doubt if you can. But, first of all, you need decent labs.

07/29/20

T3 uptake 32 range(22-35%)

T4 total 6.8 range (5.1-11.9 mcg/dL)

Free T4 index (T7) 2.2 range(1.4-3.8)

Those three tests are obsolete. I'm surprised to see a doctor still using them. They give you no useful information, so we have no idea what your thyroid status is.

What you need are TSH, Free T4, Free T3

THYROGLOBULIN ANTIBODIES 1 range <or=1 IU/mL

THYROID PEROXIDASE ANTIBODIES 4 range(<9)

You wouldn't appear to have Autoimmine Thyroiditis, though.

07/9/20

TSH (REFL) 2.53 range(0.40-4.50)

That TSH is too high, bordering on hypo. So, 50 mcg obviously wasn't enough for you, you were under-medicated.

04/30/20

TSH W/REFLEX TO FT4 7.56 range(0.40-4.50)

T4, FREE 1 range(0.8-1.8)

You were very hypo, there. TSH should be around 1. And, your FT4 is only 20% through the range. should be about 50 % at least.

T3 uptake 31 range(22-35%)

T4 total 5.5 range(5.1-11.9)

Free T4 index (T7) 1.7 range(1.4-3.8)

All useless tests.

I could go on, but I'm sure you get the picture. But, I can't see where you started levo. So, how long have you been on 50 mcg?

[AAP10 in reply to greygoose]

Thank you so much ! I started on May 20, 2020. I guess what I want to know if you see a pattern ? In 2018 when tested for my thyroid through mid 2019 I was always told medication wasn’t necessary. Do you think I became hypo after taking antidepressants? Should I discontinue the Levothyroxine altogether for two months and get my levels tested to see if I still need to take it ?

[greygoose in reply to AAP10]

Well, it's difficult to see a pattern when you don't always have the same tests. And, your last tests, in July, the TSH was saying that you were under-medicated on 50 mcg and needed an increase in dose. So, I really don't see how you can come off it at this point.

In May 2018, you were almost hyper. But, by July, you'd swung the other way. So, even though your antibodies are low, it rather looks like you have Hashi's. And, your symptoms certainly would seem to be hypo.

I wouldn't recommend coming off it for two months, to get a base-line, because it would probably make you pretty ill.

[tattybogle]

From 2018 pre Lithium~TSH 1.77 [range?] ~FT4 1.5[0.8-1.8] ~ FT3 2,6 [2.3- 4.5] probably too long ago to use as a baseline though.

I can't quite work out time line of lithium and blood tests, but it looks like;

2 wks on Lithium TSH 4.72 [0.4 -4.5] ~ No FT4 ~ FT3 2.7 [ 2.3-4.2]

While on Lithium TSH 5.96 [0.4 -4.5] ~ No FT4 ~ FT3 3.1 [2.3 -4.2]

....................................TSH 7.56 [0.4 -4.5] ~ FT4 1 [0.8 -1.8] ~ No FT3

Discontinue Lithium .

Start Levo.

3 mths on Levo TSH 2.53 [0.4 -4.5] ~No FT4 ~No FT3

I believe Lithium use is directly related to thyroid , but can't remember exactly how, hopefully someone else who knows will come along ?

What you can see from these results is that TSH dropped when starting Levo , which is what is supposed to happen, but that the dose isn't high enough yet , since TSH should ideally be closer to 1.

Ps

I don't think stopping Levo at this point ,when just stopped antidepressants is a good idea.

I f you do need Levo , then stopping it will make you Hypothyroid, and depression is a symptom of being Hypothyroid.

Even if it turned out that you didn't need Levo , the swing in hormone levels from stopping it , could have unwelcome effects if you are currently feeling better than you have been .

Taking Levo when you don't need it simply replaces your own FT4 production, so no great harm in carrying on, But you need to get an FT4/ FT3 /TSH done together to see how much T4/T3 you are now getting from the Levo .

[Hidden]

So, you were put on levothyroxine as a result of symptoms appearing on antidepressants/anti-epileptic drugs? What were your symptoms? In my experience, doctors in general are reluctant to prescribe thyroid hormone unless your TSH is out of range (as well as your free T4; FT3 unfortunately not routinely tested). So, did you have a TSH above range (and FT4 below range) before going on levothyroxine?

If you have any form of hypothyroidism except transient hypoT (after pregnancy or taking lithium then discontinuing it), symptoms won´t just appear as a result of other treatments. Symptoms may be aggravated, as some drugs will interfere with the absorption of thyroid hormone, but depression in itself won´t cause hypothyroidism as the latter is caused by a dysfunctional thyroid gland.

A friend of mine developed PTSD as a result of extreme stress, developed symptoms that the doctors misdiagnosed as epilepsy, and she tried four different anti-epileptic drugs, AEDs (incl Lamotrigin) before she gave up on doctors and found a psychologist who was able to diagnose and successfully treat her. But she developed horrible symptoms on AEDs, especially on lamotrigin which she found to be the worst of them all. She has been hypoT for over 20 years and takes levothyroxine. While on AEDs, she felt the thyroid hormone working less well, and some hypo symptoms appeared (weight gain, depression, increased fatigue). The neurologist denied symptoms had anything to do with the AEDs...but she really felt they messed her up, and she is symptom-free today after going off them (but of course, she did not have epilepsy to begin with, all neurological exams were normal, but doctors just decided it had to be epilepsy of unknown origin). But her problems started after years on levo after adding AEDs, and I understand for you it´s the opposite...however, I wanted to mention this as I know that AEDs can affect people on thyroid hormone replacement, and possibly that goes for antidepressants as well.

But, the main question is: why were you put on levothyroxine in the first place?

[tattybogle in reply to Hidden]

? I'm wondering if Lithium caused TSH to go up to 7 ?

Can't remember what exactly the connection with lithium and thyroid is though, but i know there is a big one.

[Hidden in reply to tattybogle]

thyroid.org/patient-thyroid...

[tattybogle in reply to Hidden]

Thank you ..... yes ,that.

"The conclusion of this study is that the use of lithium is associated with an increased risk of developing hypothyroidism, especially in younger women. This is important for patients because mood disorders are relatively common and lithium is still widely used to treat them. The authors suggest that patients, especially young women, should be monitored for thyroid function problems when they are managed with lithium. Although this is not a recommendation stated in the current guidelines of the American Thyroid Association, consideration might be given to certain patients who are at a higher risk, such as those who have a strong family history or who have a goiter prior to start treatment."

[greygoose in reply to tattybogle]

But, what caused her to need the lithium in the first place? Could it not have been the beginnings of hypothyroidism?

[tattybogle in reply to greygoose]

Indeed. In 2018 between May and July;

TSH rose from 0.04 to 1.77 while

FT3 fell from 4.2 [2.3 -4.2] to 2.6 [2.3 -4.2]

In Aug 2019 Prozac appears..... Mmm .Perhaps some Thyroid Hormone might have been better.

[greygoose in reply to tattybogle]

I really think so, yes. I think it was under-lying hypothyroidism that caused the depression. Not the antidepressants causing the hypothyroidism. But, doctors are absolute geniuses at putting the cart before the horse! They do it all the time.

[AAP10]

Thank you all ! I will stay on Levothyroxine 50mg and retest in two weeks. Once I get my results I will post for your kind interpretation.

I was just borderline once in 2018 and retested two months later and thyroid was back in range. The same happen early 2019 and still I wasn’t given thyroid medication because they said I didn’t need it. Unfortunately even though this is true I wasn’t feeling like my real self. I was and still continue to feel fatigue.

And yes Lithium made matters worst and I stopped two weeks later. I changed my general Doctor and psychiatrist twice to get a second opinion.

At that point my new psychiatrist strongly thought my depression etc was from my thyroid. In conjunction with my primary they decided to start me on Levothyroxine 50mg which I’m still taking.

Saw an Endocrinologist two weeks ago and said she might add T3 for energy, but not sure yet until test results come back.