Hello.
My 17 year old daughter is in remission for Graves' disease. Numbers are good except TSI is slightly elevated after a year of remission.
She's been having a lot of anxiety the past few months and was just prescribed Prozac (ssri) by a psychiatrist. Our endocrinologist had mentioned that if she were to take anything cymbalta (Snri) would be better since she has had thyroid problems.
Should we try Prozac or should I push for cymbalta. Any advice would be welcomed.
Ssri medication affects levels of serotonin. Serotonin levels in turn affect gut function. This may affect absorption of thyroid hormones if you're daughter was on any. I was on SSRI, citalopram, for years so it is not necessarily to be avoided.
I would add that my anxiety, panic attacks and need for SSRI went once I was on an appropriate dose of levothyroxine. The anxiety was a symptom of undermedication and my thyroid hormone levels being too low .
An elevated TSH might indicate that her thyroid hormone levels are too low and be the cause of the anxiety.
Have you recent blood test results to share? Also have you antibody test results to share on here?
The reason for antibody tests is to determine what has is causing the thyroid problem. Autoimmune thyroiditis is hypothyroidism which can start with symptoms which mimic graves disease. After the initial hyper phase the person then enters into hypothyroidism. It is not unknown for folks to be misdiagnosed with graves because of this. Only way to know for sure is by looking at the antibodies.
An SNRI is slightly different to an SSRI . I found this is a good site for understanding the different forms of antidepressant treatment . mind.org.uk/information-sup...
SSRIs prevent the reuptake of serotonin.
SNRIs prevent the reuptake of serotonin and norepinephrine.
What are her actual most recent thyroid and vitamin results
Anxiety is common hypothyroid symptom
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, with Graves or Hashimoto’s
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
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
When were vitamin D, folate, ferritin and B12 last tested
What vitamin supplements is she currently taking
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Blue Horizon will test under 18’s
Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
Gluten intolerance is often a hidden issue too. Request coeliac blood test BEFORE considering trial on strictly gluten free diet
Link about thyroid blood tests
Hello again :
Which numbers are said to be " good " ?
Do you have current T3 and T4 readings and ranges there ?
What about her vitamins and minerals, especially those of ferritin, folate, B12 and vitamin D ?
As mentioned before Graves is known to be an anxiety and stress driven auto immune disease and it must be so difficult seeing your child go through all this.
I was put on Citalopram after RAI thyroid ablation for Graves, but now I self medicate and buy my own full spectrum thyroid hormones, and monitor myself I have no need for this crutch.
Just for further reference from my previous reply :
Hi Christina,I have used a lot of meds similar to your Daughter and I honestly feel my best outcome was achieved by using Cymbalta 60 and 30 mg.
The one issue withdrawl from Cymbalta after prolonged use is quiet tricky and must be done very carefully.
Very best wishes 🙏
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