Newbie needs help please - new to the meds (T4 and T3) and this forum

[jeanie245]

Hello I am new to this board, and need some advice/help please. I am so grateful to have found this board. I have read many posts and see the wonderful helpful comments

My thyroid levels from 2017 to 2019 were normal. Then in January 2020, the doctor prescribed citalopram (celexa) 20 mg and then eventually 40 mg. I felt better mentally but over the next few months, was very tired, fatigued, and by May 2020 started losing a lot of hair. I do have thyroid nodules, benign, and finally in September, 2020, and December 2020 got the following tests redone.

8/2019 Tests: (fairly good results) before the celexa

TSH 1.18 uIU/mL (normal 0.45 to 4.5)

Thyroid Stim immunoglobulin 0.10 IU/L (normal 0.00 to 0.55)

T3, free 2.40 pg/mL (normal 2.0 to 4.4)

T3, bound 92 ng/mL (normal is 71 to 180)

T4. Free Direct 1.29 ng/dL (normal 0.82 to 1.77)

Thyroid peroxidase ((TPO Ab)) 7.00 IU/mL (normal 0 to 34)

9/2020 levels

TSH 0.86 uIU/mL (normal 0.45 to 4.5)

Thyroid Stim immunoglobulin 0.10 IU/L (normal 0.00 to 0.55)

T3, free 1.90 pg/mL (normal 2.0 to 4.4)

T3, bound 64 ng/mL (normal is 71 to 180)

T4. Free Direct 1.05 ng/dL (normal 0.82 to 1.77)

Thyroid peroxidase ((TPO Ab)) 9.00 IU/mL (normal 0 to 34)

The new Doctor (my 2nd endo) reviewed the results of 9/2020 and was hesitant but agreed to give me Liothyronine. After taking liothyronine 10mcg for 90 days, taken at every night at 12:30 am, with water only, 6 hours before drinking coffee,decaf or food I was tested again on 12/2020.

12/2020 levels (no food or med was not taken at 12:30 am night before the test)

TSH 0.571 uIU/mL (normal 0.45 to 4.5)

Thyroid Stim immunoglobulin 0.10 IU/L (normal 0.00 to 0.55)

T3, free 1.90 pg/mL (normal 2.0 to 4.4)

T3, bound 65 ng/mL (normal is 71 to 180)

T4. Free Direct 0.82 ng/dL (normal 0.82 to 1.77)

Thyroid peroxidase ((TPO Ab)) not tested

Hemogloblim is 13.3.

Iron – ferritin good

B12 good

Vitamin D excellent

So, still losing a lot of hair, tired, body temp is usually between 95.1 to 96.7. F. cold all the time, fatigue and not losing weight – even though on a measured, restricted diet. Want to drop 15 pounds. But not depressed. I take in the mid afternoon, around 11 am, B12 1000 mcg, Zinc picolinate 50 mg, Folic Acid 400 mcg. 1 bazil nut, Magnesium 200-300 mg, Potassium for leg cramps, Taurine 1000 mg, and later on I take Iron – Ferrous Sulfate 65 mg with Vitamin C. I stopped taking a multiple vitamin.

The endo will not increase the liothyronine past 10 mcg so agreed to include Unithroid 25 mcg (levo) – So I will take both meds at 12:30 am with water only. He also said he doesn’t know or understand why the levels decreased after 90 days taking T3.

Is it possible that the citalopram (celexa) caused the lower thyroid levels since when I started them everything else went into hypo.?

If it is possible, then I will cut down and cut out this med. I would rather have good thyroid levels.

Is it possible that the magnesium, calcium (coming from cottage cheese daily and a calcium supplement every 3 days) and Iron tab are not allowing absorption? Even though I take these 6 to 10 hours later? Is consuming 4 cups coffee/decaf causing the low levels? And 1 – 2 diet soda (containing caffeine)?

I dont have Hashi.

Could the lower levels be due to less calories consumed? I am trying to lose 15 pounds, am weighing and measuring my foods, on low calorie restriction (900 -1200 cal) but only lost 3 pounds in 3 months.

I know I am now going to start the Unithroid 25 mcg with liothyronine 10 mcg. And will get tested again in 8 weeks. Could the citalopram (celexa) interfere with my thyroid? With thyroid meds, I see articles about not eating certain foods or decreasing them. Is caffeine levels too high in your opinion.?

This is a long post, and I am grateful for all who respond. Thank goodness for this forum. Thank you.

[SlowDragon Administrator]

As soon as you take any replacement thyroid hormones the feedback mechanism is broken, but this is especially true with any dose T3

Levothyroxine (and T3 especially) don’t top up thyroid output. They replace it, so important to be taking enough

But your first results don’t suggest an obvious thyroid problem

If you do need to be on replacement thyroid hormones, it’s best to start on levothyroxine

[Lalatoot]

Jeanie SSRIs such as citalopram affect the serotonin in the gut which in turn alters absorption of thyroid medication. As a result of this some find they need to increase their dose of levothyroxine/ synthroid to compensate. This may not have applied to you if you were not on medication at the time, though.We need calories to convert T4 to T3 effectively. On a calorie restricted diet this conversion can be compromised. Calorie restrictive diets can actually make us more hypo and add to weight gain.

Taking liothyronine tends to reduce FT4 levels. This would explain your reduced FT4 result.

Our body can be quite fussy when it comes to getting the correct type and level of thyroid hormones and it lets us know. Am I correct in thinking that you were on liothyroinine 10mcg only? I would have tried levothyroxine first and at increasing levels. Why? Because this is the way our body normally works by converting T4 to T3. Also it is only when we are on a decent, steady dose of levo can we compare FT4 and FT3 to see if we have a conversion problem. Levo is easier too if you can feel well on it as you only have 1 hormone to adjust. Once you start taking a combo of T4 levo and T3 liothyronie it becomes harder to adjust the levels of both hormones to suit these fussy bodies of ours. For example I recently increased my levothyroxine dose and at the endos advice then reduced my liothyronine dose. When my body had had time to stabilise I was not feeling well - bloods showed that the opposite to what I wanted had happened - my FT4 had gone down despite the increase and my FT3 had gone up despite the decrease. My body obviously didn't like that mix!

[shaws Administrator in reply to Lalatoot]

Levothyroxine - for me - was awful and gave me far more symptoms than I had before I diagnosed myself with a TSH of 100 - being told by the GP the day before that I had no problems at all and all my results were fine.

A good thing I also had requested a blood test form a number of days before so I collected it from the surgery and then I got a phone call asking who'd given me a blood test form.. The best thing for me was finding Thyroiduk.org.uk who put me on the right path to recovering my health.

[kittyelen]

Citalipram itself can have side effects like feeling tired and weak, like a lot of meds for mental health have side effects. It is best to also have the med for mental health reviewed.

Ive just had a quick research and evidence that in some cases citalipram has caused hair loss, so best to speak to your GP and review this too. I used to be on sodium valporate years ago that gave me hair loss but they switched to another med and it grew back. First point of call I would say is investigate if related to the med you started this year