My 66-year-old mother has Hashimoto's and was diagnosed about 12 years ago. She takes Levothyroxine for it.
However, she is also on an SSRI. Fluoxetine at the moment, but she has been on others previously. She also takes olanzapine. Both medications are known to affect the thyroid.
Is there a way to find out if these medications have caused the Hashimoto's? If she came off the medication and her thyroid levels remained normal would that confirm it was drug-induced?
Any advice is appreciated.
Written by
amco40
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Hashimoto's is an autoimmune thyroid disorder which would remain even if the hypothyroidism were drug induced.
Hashimoto's is not usually thought to be curable - just manageable. But, if the thyroid has been sufficiently damaged that it cannot produce sufficient thyroid hormone, then taking some form of thyroid hormone medication is seen as necessary.
Other medicines might affect the amount of thyroid hormone required.
The causes of Hashimoto's are not well understood.
No , While it is true that these drugs may cause lower thyroid hormone levels in people with normally functioning thyroids, they do not cause autoimmune hypothyroidism .
If she has hashimoto's (autoimmune hypothyroidism with positive TPOab ) then it is not drug induced and her thyroid has / is being damaged by her own immune system so stopping levo would therefore be a bad idea.
there are some associations , in both direction s here . and it's not really the sort of situation where you could ever be sure what caused what , or separate them out .
But one thing you can be pretty sure of .. if she has tested positive for TPOab 's (Thyroid peroxidase antibodies ) and she had hypothyroid symptoms and 'hypothyroid' blood tests , then she does have 'autoimmune' hypothyroidism ., not 'drug induced'.
some drugs used in psychiatry are based on lithium which does have a the known possibility of causing 'drug induced' hypothyroidism .. but this would not cause raised TPOab .
Some people with undiagnosed hypothyroidism do suffer serious mental problems, and undiagnosed hypothyroidism can be misdiagnosed as a psychiatric problem this is true , and there is also an 'associated' encephalitis (Hashimoto's Encephalopathy or S.R.E.A.T ~Steroid Responsive Encephalopathy associated with Autoimmune Thyroiditis) which can happen with or without being hypothyroid , but with raised TPOab .
So the questions to ask are :
~ Does she have positive TPOab tests. (or TGab ) to confirm 'autoimmune' hypothyroidism.
~ Was she ever given blood tests to check for hypothyroidism ( TSH /fT4 /fT3 ) before she was given her psychiatric diagnosis .. what were the results ?
~ Has she had any thyroid blood tests during the period that she has been treated for psychiatric condition .. what were the results ?
if she was tested for TSH /fT4 /fT3 / TPOab at the time of the psychiatric diagnosis or afterwards and the result were not showing hypothyroidism at that point. then you can be sure the hypothyroidism developed later and was not implicated in the psychiatric diagnosis.
To get this information SHE would have to get access to her medical records to find the blood tests that had been done at various points...... but you should think very carefully before going down that route when basically you can't change the outcome , because the medical records of people who have had a psychiatric history will be pretty distressing for them to see..... and if you can't change the outcome, which you can't ., and since she is being treated for hypothyroidism now, which is needed ........ then it's possible that by trying to prove "which came first , and are they related at all" , you could do her feelings about herself more harm than good.
So , so give it some thought before acting .. perhaps you might help her better by making sure the treatment she gets for her hypothyroidism NOW and going forwards is 'optimal' rather than unravelling the history of how she got where she is .
If she want's to post her latest thyroid blood tests on the forum , people here can help you and her make sure her hypothyroidism is now being treated effectively.
I've often wondered why TSH, fT4, FT3 and B12 levels are not measured at the start of the diagnostic process when a mental health issue is being considered as a diagnosis.
It seems obvious that those tests should be included before someone gets labelled with a lifelong mental health condition and prescribed serious medication.
Sorry meant to add it’s worth reading the late Professor John Studd blogs on bipolar versus hormonal imbalances and reproductive depressions which start at pmt then post b no stall depressions then perimenopausalhe speaks of phschiatrist ignorances that refuse to accept the hormonal side
& me. This recent helpful hrt & menopause outcry and celebrities leading the way Davina & Carol vaudaman v Lorraine, she thought she was going mad too, I was offered antidepressents with a post natal depression but didn’t take as hated how I felt with side effects & got better naturally but do remember being asked if athlete as pulse so low which was undiagnosed hypo im sure. All came back at menopause but nobody told me what it was which seems bizarre
Tatty B is so right to consider if a rd to go along but understand you looking at bigger picture of understanding to maybe even include no mood drugsAs she similar aged I wondered if it’s the reproduction cycle that Prof Studd explains
So bit by bit and with old bloods it may form a full picture of it all, my feeling is why would you suddenly develop a mental illness label if been healthy & well, what changed
Iv tried hrt patch it’s wonderful difference but had to stop short term due to iminent hip op, Sadly the bone deteriation came without the extra ostregens
When I saw Prof Studd he was going to retest my bones after 2 yrs of hrt but sadly passed away as covid intervened
and amco40 it's probably likely she would of had the thyroid tested at some point - I remember being told I'd had thyroid checked at the start to rule that out (When I had a bipolar episode)
They do normally test the thyroid - especially before prescribing certain meds too!
In terms of psyc meds they themselves can have side effects, and post natal psychosis is actually a high risk from pregnancy in bipolar. 40 years is a long time to be on meds they would have been reviewed, but if it has been a very long time since a review she needs to ask for one!! It is unlikely for them to get a diagnosis wrong, but diagnosis can change / more added in and like you say it was many years ago and every pdoc has their own approach and opinions but generally overall there would have been evidence for a diagnosis and to be on meds 40 years.
My mother went into early menopause in her late 30s. They just put it down to the medication she was on for her mental health as the cause. It was 20 years later that she was diagnosed with Hashimoto's. She was very briefly on HRT, but this was the 90s and there was a cancer scare with HRT then so she didn't continue with it.
Yes same for me. the scare finished in 2015 and was with the tablet form as far as im aware, not the gels & patchesShe will know if she was well before pregnancy
Yes...she WAS well before pregnancy. Everything seemed to begin after she had her 2 children. She had one at 20 and the other at 23. She experienced a psychotic episode when her 2nd child was a baby.
So is it hormones at root then🤔 ostregen progest totesterone all in play and altering thyroid connection maybe as I lost loads of weight suddenly and friends had this too, I think I had a Hashi swing as I’ve read about here, when move over to hyper from hypo -
My hypo symptoms were at pregnancy too
Had carpal tunnel too which I think is relevant , my feeling is it’s the mix , but just my feeling of what happened to me
It helps me to understand what happened to Mei had one post natal depression when I went into fear & anxious and unmotivated
Went into another after birth thing after pre eclampsia a bit similar but then SPRUNG into action with boundless energy which I believe was a Hashi swing. What else could it be🤔
Some of us are predisposed to hormone sensitivity. My sisters didn’t have this but they didn’t have autoimmune like psirosis which I inherited from dads side
Mainly to remember I had three lovely babies! And lived to tell the tale although it was hit & miss with the pre eclampsia episode 😊. After these years of nhsblet down im not letting it define who I am or il get very angry
This isn’t the rd to go down though as waste of precious life x
Thank you for that extremely helpful information. I will give it some thought.The main concern is that she is still on psychiatric medications that cause side effects and could reduce life expectancy. If the issues she experienced in the past were caused by undiagnosed Hashimotos then the psychiatric meds are unnecessary.
I’m convinced there is connection with thyroid & sex hormones together - they are all hormones afterall ( As said i can see I had Hypo symptoms around childbirth times, very low pulse esp but no dots were drawn sadly )
And things naturally settled down in time but not then at perimenopause as the hormones diminished and I got awful cognitive symptoms. I thought I was going mad as Lorraine Kelly writes.
And no hrt available at that time so offered SSRI which I couldn’t take. Nobody told me it was menopause. Prof Studd wrote to my gp to put it on my notes. He was worth every penny as not so exspensive his two colleagues remain at his clinic m
-?I have had thyroid antibodies and have had autoimmune as I had psirosis vitiligo and pre eclampsia’s. (All the baby waters go back into body. )
But I’m fortunate as they not highly overange and since being gluten free and following help from intricate food intolerance testings my antibodies have been in range again
We each tick differently too , I feel we become a walking blood number at times
The brain has the most receptors for T3 - the ACTIVE thyroid hormone. The Levo/T4 your Mum is taking is inactive and needs to convert into T3. It is low T3 that can be the cause of many symptoms including mental issues. Full testing privately would be my next step.
Agree completely, one of the most noticeable symptoms I had with low T3 was the most horrific nightmares, they all involved something terrible happening to a family member, they were so vivid I actually struggled on a number of occasions to discern whether they were true, causing a great deal of distress.Low T3 also triggers visual migraines in me which is a brain associated issue.
My mother was also diagnosed with Rheumatoid athritis about 2 years after the Hashimoto's diagnosis. I wonder if she really has it or if it is another Hashimoto's symptom. How do we know that the Hashimoto"s is being treated properly? They only test TSH on an annual basis.
She is on sulfasalazine for the RA but continues to get joint pain and swollen hands. Usually one hand swells, but sometimes it's two hands. Additionally she was diagnosed with ovarian cancer in 2020, but had a great response to chemo and surgery and is currently in remission. After chemo she developed the skin condition psoriasis.
She currently takes a parp inhibitor called Niriparib which appears to affect her mental health condition and means she needs regular breaks from it. I don't think there are any studies on whether Niriparib affects Hashimotos so that's a big unknown.
It's all so confusing as the various medications she takes can also cause joint pain. So I am questioning everything - even the RA diagnosis.
I recently had to reduce my t3 when I was running out, all my joints started to hurt within a week of taking a reduced dose, along with the symptoms I have mentioned above in my reply to Marz, so I guess anything is possible.
As I mentioned in my Reply above I would carry out a Private Test so you have the results for TSH FT4 & FT3. You can then judge the conversion of T4 into T3.
Monitor my Health is an inexpensive on-line lab attached to the Royal Devon & Exeter hospital. Used by many here.
Sulfasalazine is poison and I blame this drug on my ovarian cancer diagnosis when I was in my early 30s and I blame Stelara for my thyroid cancer 5 years ago I believe in my heart all these drugs are helpful with a sinister downside.
That's interesting Batty1. My mother was also diagnosed with Ovarian cancer in 2020 after about 7 years on Sulfasalazine. The oncologist who treated her wanted her off the medication and told her she hoped she never went back on it again. Flash forward 2 years and this is all the rhuematologist has to offer her! Even her new oncologist has approved it.
I might add she had gum disease in her 20s and had to have all her teeth removed. It was put down to her either not brushing her teeth regularly and (or) the psychiatric medications causing it. However, we now know Hashimotos can cause this.
Exactly! I had dental problems for most of my life, until I got off gluten and got my hypothyroidism properly treated with T3+T4. My dental health is now an order of magnitude better.
I would think if her hands swell with the RA , then that diagnosis is probably correct. And i think they have a specific blood test for diagnosing RA (specific antibodies ? . not 100% sure about that though , don't know that much about RA).. but if you have one autoimmune disease it is very common to get others , and RA is an autoimmune disease.
The fact that her issues started after a 2nd pregnancy is interesting... this can point to thyroid problems ,they are often triggered by pregnancy/birth ,sometimes temporary swings of hyper /hypo /euthyroid , but sometimes becoming permanent hypothyroidism.....but it is also well known that pregnancy / birth can trigger psychiatric conditions that are not thyroid related eg . Post Partum Psychosis ,which is not specifically related to hypothyroidism. ( i think this is usually treated pretty effectively and doesn't continue for decades afterwards)
One thing i would say though .. if she was seriously hypothyroid after this pregnancy, and if it went untreated for the next 20 odd years... you would expect that over that time she would have developed other more specific signs/symptoms of hypothyroidism, as well as the psychiatric problem. ie feeling too cold, slow heart rate, dry skin ,unexplained weight gain etc etc .
And the other thing to bear in mind is that there are so many other 'nonspecific' symptoms and associations of hypothyroidism, and that so many of these can also be related her treatment for psychiatric problem , and /or her other autoimmune disease .. that it would be very easy to make her pattern of health problems 'fit' untreated hypothyroidism ... to be honest you can make virtually anything fit hypothyroidism. eg tooth decay . yes there is an association with hypo.. but if you already know there is an association with the drugs she was taking for psychiatric problem that she did have , and she didn't have hypothyroid symptoms ,, then the psychiatric drugs are way more likely to be the cause than undiagnosed hypothyroidism .
If you want to know how well her hypothyroidism is being treated , then you need her recent annual thyroid blood tests, TSH and hopefully fT4 ...
Has her TSH been kept in range , (preferably in the lower half of the range for most people) ?
If they have only ever tested TSH, it would be a good idea to get a private test done so you can see where fT4 and fT3 are now ,
also Vit b12/ Vit D/ Folate / Ferritin tests will let you know if anything needs to be improved .
and if not done already ,then TPOab /TGab can confirm an autoimmune cause for her hypothyroidism. (But if negative they don't rule it out)
My Grannie was committed to an asylum for 5 yrs shortly after the birth of a second child after they found her trying to gas herself and the baby .. (this was in the 1930's), she was given electric shock treatment, and was then sort of ok for decades afterwards ~ did a degree and worked as headmistress in a village school (but was always a bit 'delicate' i think, they tried to keep her from getting too stressed, i think she had some sort of manic episodes occasionally and she couldn't handle having us stay for more than an odd day as kids) but she didn't need to be 'treated' again until old age( 80 ish )when she went 'wrong' again and was found burning her clothes inside the house .. she never had a clear diagnosis , my mum used to say she had 'something a bit like bi -polar , but not bi-poler'
As far as we know she didn't have a thyroid problem , she certainly didn't look hypothyroid, she was thin, with a very full head of hair, and good skin , and very bright/ on the ball .... but i have always wondered if 'thyroid' may have been connected to her history somehow .. her daughter developed Graves Hyperthyroid after a pregnancy , and i developed autoimmune Hypo after my 2nd pregnancy , so we obviously have a family tendency towards 'thyroid going wrong after pregnancy' .
So i can see why you are wondering if your mum have thyroid issues all along .... i 've always wondered abut my grannie, and indeed her other daughter~ my mum , but i don't know if either of them were ever tested for it or not .
You do wonder if GP's /Psychiatrists always check thyroid as a possibility when they should do .. even nowadays... it took 4 years before anyone thought to do a thyroid blood test after i became unwell during / after a pregnancy, because i didn't put weight on so 'i didn't look hypothyroid' .. and that was as recently as 2001.
My mum and my grannie certainly didn't 'look hypothyroid'..... but then neither did i.
How do you know her Hashi's is not due to an intolerance to something in her diet? Has she ever been tested for subtle food allergies or excessive levels of toxins like heavy metals? For example: in my case, consumption of gluten caused destruction of my thyroid, and that destroyed my mental health. So ignorant docs put me on various prescription medicines for panic and depression, but the results were crap. Didn't get well until my gut healed and my T3+T4 levels were brought up into the normal ranges. One of the (apparently suppressed by allopathic medicine) treatments for depression, when conventional prescription meds like SSRIs and benzos have failed, is administration of T3 (liothyronine).
Before I was diagnosed as having thyroid problems I seemed to go on a two year cycle of being over and underactive and thought I must be manic depressive. My doctor was happily going to refer me to a therapist as I said if there was nothing wrong with me I must be crazy. Just a simple blood test would have given the answer.
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