Sertraline and Thyroid

[Gallstonegirl]

Hi all,So I managed to use my private health cover to see an endocrinologist about my hormones.

I had a period of acute low mood and anxiety that came on quickly and resolved almost overnight after a couple of weeks. Spoke to an online GP who was able to do the referral to endo.

He re ran all the blood tests and I've just been for the 'verdict'.

He says there's nothing in the bloods to explain my symptoms and suggests I come off Sertraline (which I have taken for 20 odd years) to see if I feel better.

I couldn't get exact ranges for any tests from him but did manage to extract that my T4 was on the bottom of the range 11.9 (11.9-??) and my tsh was 4.0 in a range that ended with 4.2.

He says these levels are not high enough to explain my symptoms and that my T3 is ok so he's not worried about T4.

I have heart palpitations - he says this only happens with overactive.

Cortisol was 245, he says normally they like it to be 300 but it's not low enough to cause symptoms.

I have just finished having a little cry and am now trying to think of a way forward.

Does anyone know if Sertraline could be causing my issues of intense fatigue, dizzy spells, hair loss, constipation, palpitations, unequal pupil sizes and more. Is it worth a try?

[Jazzw]

Not high enough to cause symptoms…

Not low enough to cause symptoms…

Well, I’m not sure the private endo is smart enough to be a endo. Slightly terrifying actually. Trust me, if they were his results, he’d be taking this way more seriously.

Please tell me he wasn’t suggesting you came off sertraline cold turkey? Cos that wouldn’t be a good idea.

First things first, your TSH, while not above range, is much higher than it should be. And given your thyroid stimulating hormone is signalling violently for your thyroid to make more thyroid hormones, a low in range FT4 suggests there’s a problem. And given your cortisol is also lower than it ought to be, the problem might be a pituitary issue.

At the very least, you need some more tests.

Do you know if you’ve previously had any thyroid function tests? Just so we can compare?

(Have edited this cos I realised you were talking about what the private endo said, rather than your GP.)

[Gallstonegirl in reply to Jazzw]

Thank you for replying. He didn't mention how to come off Sertraline, just that it might be worth a try.

He looked up the side effects of Sertraline and said it might be causing my issues. When I had the period of v. low mood my GP said maybe my Sertraline wasn't working anymore and I should try Citalopram, endo sort of seized on this and said, well if thats what the gp is saying maybe you should try it, all while looking at my husband. It felt a bit like he was looking for the man to back him up that I was just a bit bonkers.

[Jazzw in reply to Gallstonegirl]

Oh no. I’ve just lost all confidence in him (to be fair I already had) at the words, “he looked up the side effects.”

Sertraline is such a commonly used medication (and very similar to all the other SSRIs) that he probably shouldn’t have needed to look up the side effects.

Can’t believe he looked to your husband. I’m so very very sorry. This is not how things are supposed to be. 😢

[Jazzw]

Have also now flicked through previous posts of yours. You have Hashimoto’s - you have positive TPO antibodies. And have struggled to raise ferritin and folate levels.

Probably because your thyroid isn’t capable of pumping out enough thyroid hormone to keep your gut functioning well.

[Gallstonegirl in reply to Jazzw]

He said half the population will have tpo antibodies and they don't matter. Honestly, didn't know what to say! All the while, my husband, who thinks all my symptoms are down to anxiety, is just nodding along as if he's been proved right.

[Jazzw in reply to Gallstonegirl]

If it was anxiety, your blood test results would be normal. They ain’t normal. You have persistently raised TSH which is failing to raise your T4 levels.

I’m just having a think about what to suggest next. When you do your blood tests, do you do them early in the morning before breakfast?

[FallingInReverse in reply to Gallstonegirl]

I’m only scanning this post… but this caught my eye.

What a load of absolute garbage.

How unfortunate your husband now thinks he’s right, too.

Just piping in with some support for you. I will try to read more carefully later and see if I have any better ideas.

But for now - big hugs, you are not crazy and you’re not wrong. So frustrating.

[Jazzw]

OK. When in doubt, it’s sometimes good to go to the parent website for this forum (Thyroid UK is a charity).

Have a read through this: thyroiduk.org/if-you-are-un...

You might have tried lots of these things—but it’s probably worth seeing if there are any you’ve missed.

[Gallstonegirl in reply to Jazzw]

Thank you for your help and kindness. I will certainly have a look at the link.

[Jazzw in reply to Gallstonegirl]

Wish I could do more—it’s really hard when family and friends don’t understand how rubbish you’re feeling. xx

[RuthieRuth]

I'm sorry to hear you are feeling this way - I have all those symptoms when I am nearing needing a dose increase in levo (its a slow old process this getting to the right dose etc). Sounds like the first thing you might want to do is check your levo/t3 and do what you can to raise those levels? If you are medicated most people feel better on more like a TSH of 1 or so according to what I've read.

And the heart palpitations may be from adreneline trying to make up for the lack of thyroid hormones.

I am perhaps misremembering some of what I've read on this but I am sure someone more knowledgable than me will come along soon enough and correct me!

[humanbean]

I found that my mood was massively improved when I raised my ferritin (iron stores) to optimal (which I consider to be 90 - 110 mcg/L, and I aim to keep it around 100). I don't absorb it well so it took me a very long time. I was taking a full therapeutic dose of ferrous fumarate 210mg (one of the iron salts that doctors prescribe, although I was buying my own) for nearly two years then I took a much lower maintenance dose for five years. After that I stopped the iron when my serum iron got close to optimal for the first time.

If I had my time over again, knowing what I know now, I would try and speed up the process of improving my iron by trying haem/heme iron supplements. And if they were very slow to improve my levels as well I'd try getting a private iron infusion if I could afford it. But before I took any iron supplements I would have an iron panel done then decide what I wanted to try.

Improving my iron and ferritin improved my mood enormously, reduced my episodes of tachycardia (fast heart rate) and non-cardiac chest pain. I'd been diagnosed with angina but it went away when I improved my iron and ferritin. More iron also reduced my episodes of cramp and muscle twitching.

...

I also have problems with low folate. If I stop supplementing methylfolate regularly, my levels drop to bottom of the range or lower. (I never supplement folic acid to improve my folate levels because it seems to sit in my bloodstream not doing anything.)

...

[Gallstonegirl in reply to humanbean]

Thank you for the reply. Apparently my ferritin is at 40 at the moment, which is the highest it has ever been. I have been taking 1 x Ferrous Sulphate every other day for around a year. Any thoughts on stopping the Sertraline being worth a try? Or in your experience could my symptoms be caused by the thyroid/iron at the levels they're at?

Letter

[radd]

Gallstonegirl,

I think the reason your GP & endo suggest you withdraw from Sertraline is because it can lower T4 levels, and yours are very low.

Adequate thyroid hormones play an important role in the release of neurotransmitters, and in fact T3 is considered both a hormone and a neurotransmitter as found in largest amounts in the limbic system of the brain (which regulates emotions with serotonin, GABA, noradrenaline, etc.)

However, before making any decisions I think it a good idea to firstly get up do date private thyroid hormone tests so you know exactly where your levels lie in range. And check iron and nutrients as these are essential for the enzymatic conversions required to maintain good neural health.

Speak to your GP/endo about a slow withdrawal plan from Sertraline if this what you decide, or look at alternative meds.

******************************************

Re heart issues, I previously had terrible heart bangs on both low and high levels of FT4.

Re cortisol of 245, that is pretty low. Low cortisol can instigate terrible anxiety. Have you ever done a cortisol & DHEA saliva test?

Gallbladder- un/mismanaged hypothyroidism has been shown to impair bile flow and slow gallbladder motility, promoting gallstone formation.

Remember there’s always a way forward, it’s just finding it by educating yourself. I found a book called ‘Why Isn’t My Brain Working?’ by Datis Kharrizian to be extremely helpful.

[Gallstonegirl in reply to radd]

Thank you for your reply. That's really interesting re the Sertraline and I'm thinking I will give it a go. Although, I'm not sure the endo knew about this link, he said he didn't really know much about Sertraline!It all seems such a tangled mess it's so difficult to see the way forward and tempting to just give up trying to work it out.

My latest results from medichecks in August were

Tsh 5.63 (0.27-4.2)

Free thyroxine 12.1 (12-22)

I haven't had nutrients and ferritin etc done since April but they were all quite low but coming up from where they had been a year ago. The ft3 from this test was

FT3 4.0 (3.1-6.8)

I did a cortisol saliva test with Medichecks a year or so ago and it was normal.