On Lithium, have hypothyroidism,no longer responding to T4 and less to T3. Starting low iodine diet.

[RosannaA]

I have just started a low Iodine diet as set out by a recent book advocating this to reset the thyroid for Hypothyroidism patients. I have been on Lithium by Bipolar for 15 years. 7 years ago I developed Hypothyroidism. Initially I partially responded to T4 but after 3-4 years I completely slowed down, losing my memory and developing severe Hypothyroidism symptoms. I had to give up my job as a GP. For a year I sought an endocrine opinion and after a year of arguing my case was started on T3. I responded really well for 6 months and my symptoms completely reversed including losing 10kg in weight. I managed to restart work. However slowly my Hypothyroidism symptoms have crept back. I am now on 30mcg T3 , twice my original amount and on 75mcg T4 and my levels are in range. I have read many scientific papers regarding Lithium therapy. It seems Lithium concentrates Iodine to high levels in the thyroid gland and this causes damage. Out of desperation I am trying a low Iodine diet to see if this helps. Has anyone tried a low Iodine diet or is also struggling with Lithium therapy and Hypothyroidism? Many thanks

[SlowDragon Administrator]

Welcome to the forum

Other posts that mention lithium

healthunlocked.com/search/p...

Do you have recent thyroid and vitamin results and ranges to add

Were tests done as recommended

Test early morning, ideally just before 9am, only drinking water between waking and test, last dose levothyroxine 24 hours before test

Day before test always split T3 as 3 smaller doses spread through the day with last dose Approx 8-12 hours before test

What vitamin supplements are you taking

Important to test vitamin D, folate, ferritin and B12 at least annually

Have you had BOTH TPO and TG thyroid antibodies tested for autoimmune thyroid disease (hashimoto’s or Ord’s)

[RosannaA in reply to SlowDragon]

I have had all of these tests and taking T4/T3 accordingly ( in range and no thyroid antibodies) nutrients in range. I will try and supply results. Many thanks.

[Hidden]

RosannaA

I’m afraid that Lithium is the kiss of death to thyroid. It affects the functioning of normal thyroids and the effectiveness of exogenous thyroid hormones

I’m sorry that your doctor hasn’t made you aware of this.

There have been several people on forum who have had serious interactions between lithium and thyroid meds

There is a lot of info out there on the internet. Suggest that you discuss some of this with your doctor

Wishing you well

[RosannaA in reply to Hidden]

Unfortunately Lithium is the only bipolar med that works for me so I have been told by Psych and Endocrine to accept this and take the T3 at higher doses to counterbalance. I am reducing my Lithium but if I completely come off it I get mentally quite unwell. Thanks

[greygoose]

Hi RosannaA, welcome to the forum.

Have you never considered that you've probably been hypo for a lot longer than 7 years, and that your bi-polar was a symptom of it? Hypothyroidism doesn't develop over-night. It creeps up on you slowly, then the adrenals take up the strain, so by the time your symptoms drive you to consult a doctor you've been hypo for quite some time.

Are you still taking the lithium?

[RosannaA in reply to greygoose]

I am still taking Lithium but at a lower dose and under Psych am going to reduce it a bit further. I have had thyroid tests since starting Lithium as was always euthyroid till 7 years ago. I had no hypothyroidism symptoms till then either. The hypothyroidism was picked on my routine 6 monthly TFTs which I have as part of Lithium monitoring. I have had bipolar since 16 and am now 43 so I don't think the bipolar has been driven by hypothyroidism especially as I was mainly manic when unwell. Thanks

[Hidden in reply to RosannaA]

It’s not unusual to hear of people who’ve been affected by Lithium when they’ve previously been euthyroid.

I hope you manage to get a balance that works for you

[greygoose in reply to RosannaA]

Yes, that's what I thought you were going to say. However, it does depend on your definition of 'euthyroid', doesn't it. The rest ranges are unrealistically wide, and you can be hypo whilst still in range. As for symptoms, there are over 300 known symptoms of hypothyroidism, and not all of them would be readily recognised as being caused by low thyroid. But, of course, the test would be to see if you still have bi-polar once you're off lithium, and adequately medicated for hypo.

[Hidden]

RosannaA,

I was on lithium for 3 years, it also destabilized my thyroid but I had long standing Hashimoto’s too. Do you have thyroid disease independent of damage by lithium? Thyroid disease has been found to have links to bipolar disorder, but as you might already be aware hypothyroidism is so poorly researched and the connections are not entirely clear.

Is there any way you might be able to speak to your psychiatrist / managing doctor to switch to something different that keeps you stable? I’m aware that long term lithium use is supposed to be avoided due to liver and kidney damage. But I fully respect the need to take it if this is the only thing that works for you. I’m also aware of ketogenic diets being used therapeutically for bipolar disorder - personally I would only ever do that if your hypothyroidism is from lithium use only because ketosis and hashi’s don’t go well together in my experience.

I ended up on low dose antipsychotics & anti depressants, this worked just as well for me personally and I found the combo to be very stabilizing, the antidepressant had to be an SNRI tho, SSRIs were like smarties. Quetiapine interferes the least with metabolism by comparison to say Olanzapine. It could be worth exploring.

I’ve seen one lady in particular on here discuss a low iodine diet actually putting her hashi’s into remission to the point that she is medication free, but that’s the extent of my understanding. And I’m not sure if you have hashi’s or not. In any case, I don’t think low iodine diet will harm you in the short term.

[RosannaA in reply to Hidden]

Hi

I have no thyroid antibodies ( no Hashimotos) so Endocrine feel I am hypothyroid due to the direct toxic effects of Lithium. I am reducing my dose and am on a low dose antipsychotic too. However on no Lithium I get very unwell and alternative mood stabilisers are even worse ( severely sedating and mind numbing). I wanted to see if a low Iodine diet would counteract the Iodine concentrating effects of Lithium.

[Hidden in reply to RosannaA]

Hi RosannaA,

Yes - I actually quite liked the mind numbing-ness of the antipsychotics, but I understand the need to stay on the meds that work for you.

Have you ever researched LDN? I believe it has some potential benefit for mood disorders & bipolar disorder. Might be worth discussing with your doctor. I also spent some time on lithium orotate while weaning, might be if interest. Ofc getting your thyroid labs optimal should help too.

[RosannaA in reply to RosannaA]

I have tried antidepressants and quetiapine plus Lamotrigine and Valproate and all caused major problems. I am currently on 5mg Aripiprazole and 500mg Lithium ( it was 800mg before). I hope to reduce my Lithium to 400mg under Psychiatrist supervision.

[Hidden in reply to RosannaA]

Lamotrigine was the one I was going to say to try, shame that’s a no go for you.

500mg of lithium is good going! I used to take 1200mg. Maybe look into the lithium orotate, I think it made my weaning less bumpy.

[RosannaA in reply to Hidden]

I will definitely look at Lithium orotate it sounds promising. 👌 thank you

[Hidden in reply to RosannaA]

You’re welcome. Good luck x

[RosannaA in reply to Hidden]

I will also discuss LDN with my specialist, thank for all your advice x

[Hidden in reply to RosannaA]

Anytime! Here is a link you and your specialist might find useful: ldnresearchtrust.org/what-i...

[radd]

RosannaA,

I definitely wouldn’t advocate a low iodine diet as hypthothyrodism is much more common than hyperthyroidism in lithium induced thyroid conditions, and for lithium to be concentrated in the thyroid gland rather than lithium to induce iodine concentration in the thyroid gland (they can compete).

Lithium treated bipolar can be both a cause and effect of thyroid disorders as negatively influences the deiodinases (thyroid activating/deactivating enzymes), hence the development of goitres. We’ve had other members medicating lithium who have gone on to develop hypothyroidism or had hypothyroidism previous to lithium treatment.

Lithium effects the HPT axis on multiple levels, most importantly reducing T3 that can be thought of as a neurotransmitter itself and exerts enormous influence on mood, focus and motivation.

Lithium also increases risk of autoimmunity if you are already predisposed by increasing lymphocyte activity whilst reducing suppressor T cells. Hashimotos is the most common cause of hypothyroidism through infiltration of lymphocytes in the thyroid gland, and most are TH-1 dominant whilst attacks are prevalent. If you still have an intact gland lithium can alters thyroglobulins structure so making coupling difficulties with its components.

You have learnt we can have great thyroid hormone labs but still feel hypothyroid on a cellular level so its about ensuring adequate levels of essential cofactors such as iodine, iron and nutrients such as B vits, zinc and magnesium to encourage the deiodinases to behave positively and allow thyroid hormones best chance of working well.

I'm pleased you are medicating T3 as you need to keep levels up. Great advice and encouragement from DFTC.