Could the cocktail of drugs that I have built up over the years be affecting my Thyroid? If so, could my Thyroid be worsening my anxiety and depression as a result?
Any others views/ opinions welcome.
Thank you.
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PillJunkie
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1. The NHS ranges are different to the ones I get when I do a private test. My last test was NHS. The ranges were:
TSH upper 4.94; lower 0.35; result <0.01
FT3 upper 6.00; lower 2.94; result 4.2
FT4 upper 19.1; loweer 9.0; result 9.8
Monitor My Health, the company I use between NHS tests, use the following ranges: TSH 0.27 - 4.2; FT3 3.1 - 6.8; FT4 12.0 - 22.0. But then the results are higher in FT3 & 4. It's very confusing.
2. I'm taking Thyroid S. This is natural extract, but I thought it is different from NDT. Anyway, no, I take the whole dose first thing in the morning.
3. No, the test was in the afternoon. I didn't take my dose that morning, but ate and drank normally beforehand.
4. Last test was 11th March.
5. Noted
6. One year ago. Vit D was 81 mmol/L (50.0 - 200.0); Folate 11.8 ug/L (3.0 - 20.5); Ferritin 213 ug/L (30 - 300); B12 846 ng/L (200 - 900)
7. No
8. I have no idea. I've decided to see an endocrinologist who, hopefully, will answer that question. Is there a way I can tell if my hypothyroidism is autoimmune?
One other concern I have is that I'm uncertain, sometimes, whether I'm hypo or hyper. I struggle with anxiety and get waves of depression. I am easily fatigued and have muscle weakness, but then, on occasions, I feel quite "wired" about things I need to do. I've put on weight that I can't shed despite exercise and a strict diet. I often wonder if I'm wanting to be hypo and look for signs to justify that wish.
I'm thinking of posting on the Depression/ Anxiety Group because my symptoms are so much worse when I wake up. But could this be down to Thyroid issues too?
My one simple answer to you, although there are lots of facets to us each individually, your Free Ts are very low in range, and for myself and many of us here that CAUSES the SYMPTOM of anxiety and depression where none existed before and that gets better as your thyroid hormone replacement optimized. Which by your numbers you are nowhere near.
Now, depression/anxiety can indeed be caused by other things. But my guess is your low thyroid hormones are contributing.
To confirm autoimmune cause you need antibody tests. There are four to be comprehensive between either autoimmune HYPER (graves) vs autoimmune HYPO (Hashimotos):.
1) TRab
2) TSI
3) TPOab
4) TGab
One more important detail: iron should be taken 4 hours away from your thyroid hormone replacement, as iron will block its absorption.
As long as the Thyroid S you are talking about is a version of NDT - which I think it is but others will correct me if I’m mistaken - then yes, it WILL increase your FT4.*
But keep in mind that there are many things (including some foods, other medications, some vitamins/minerals, supplements etc) that will block the absorption of your Thyroid S if taken too close together.
To address your question, if you have auto immune thyroid issues, then that is the main culprit in a worsening level of thyroid health and hormone levels.
Addressing the impact of your “cocktail” of meds is more complex as there are so many. I’m personally not sure if there is build up so to speak, they might have overall impact I’m not sure, but it’s possible also that some may be interfering with the effective of your thyroid hormone replacement.
Lastly, it would be your low FT4/FT3 that would be causing/worsening your anxiety and depression. But also unclear if there was anxiety/depression independent of thyroid issues.
* Edit: I mis-spoke above, as although NDT has both T4 and higher T3, as Slowdragon notes, it can result in lower FT4 blood test results. The trick is to get optimal levels of both, while balancing other key vitamins and minerals. There is a learning curve for everyone and even for the best of us it is a slow process. So after reading SD’s replies, don’t hesitate to ask any other questions you have. We are all here to help wherever we can.
8. I have no idea. I've decided to see an endocrinologist who, hopefully, will answer that question. Is there a way I can tell if my hypothyroidism is autoimmune?
How to diagnose autoimmune
How long ago were you diagnosed as hypothyroid
Presumably not had Thyroidectomy or RAI for autoimmune Graves’ disease?
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
You need BOTH TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin) and NHS currently only test TG antibodies if TPO are high
One other concern I have is that I'm uncertain, sometimes, whether I'm hypo or hyper. I struggle with anxiety and get waves of depression. I am easily fatigued and have muscle weakness, but then, on occasions, I feel quite "wired" about things I need to do. I've put on weight that I can't shed despite exercise and a strict diet. I often wonder if I'm wanting to be hypo and look for signs to justify that wish.
Well your currently taking all your NDT in one go…..probably too much making you feel hyper ……then by end of day running out and start to feel hypo
This high/low dipping is quite likely upsetting cortisol levels
Anxiety and depression common hypothyroid symptoms
NDT doesn’t suit everyone
many people find once on ADEQUATE and fine tuned dose levothyroxine, plus all four vitamins at optimal levels, they can manage fine on just levothyroxine
Did you ever take just levothyroxine
But having fine tuned Levo and vitamins, if Ft3 remains low, once Ft4 is towards top of range …….then SLOWLY adding SMALL doses of T3 through the day. Either initially 2.5mcg or 5mcg twice day ……..waiting 6-8 weeks and retest before considering if need to increase T3
Thank you, SlowDragon, for your time and expertise. There is so much for me to take in there, but I will cherry-pick a few points, if I may?
1. My usual pattern of symptoms is that I wake up highly anxious/ depressed (unclear exactly), but my brain is so fogged up that I find it difficult to open my eyes (certainly hypo). After my meds kick in then my day starts to normalise. This can vary from 2 - 3 hours to 9 - 10 hours. My symptoms tend to be muscle weakness and easily fatigued at this time.
However, if I look back at the last two days, I've woken feeling agitated, "wired", tense and physically stiff. No problem coming round. My last two days my anxiety hangs around all day, fluctuating from mild to uncomfortable. I'm constantly hungry, making me light-headed. I feel fatigued later in the day because I've been battling the anxiety.
2. Yes, I took Levothyroxine, prescribed by my GP, for about four months. My T4 improved from 8.8 to 10.8 and my TSH moved from 0.61 to 0.35. I still felt very fatigued so took matters into my own hands and dropped the Levo and started on Thyroid S (Thyroid extract), building up slowly to 3.5 grains.
3. I took a Cortisol test in March. This showed me as being within the normal range during the morning, then spiking above the range during the afternoon, then back within range in the evening. I don't understand this as the afternoons are usually my best times.
4. I took a TPO test last May. The result was "Negative (9 IU/mL)". My other results were: TSH 1.9; T4 10.7; T3 3.3. It appears from these that I am not autoimmune.
5. I was first diagnosed as hypo 7 months ago. I've had no tests for Graves or Hashimotos.
6. I always leave at least 24 hours between testing and my last dose of Thyroid S. I'm a little confused by your subsequent advice to take my last dose at 8pm before testing at 8am the following day. Can you clarify please?
7. Thank you for all your other advice and all the helpful links. I'll start working on those.
I always leave at least 24 hours between testing and my last dose of Thyroid S. I'm a little confused by your subsequent advice to take my last dose at 8pm before testing at 8am the following day. Can you clarify please?
you may need to split your dose NDT everyday
Try 6-8 weeks split as 2 doses per day
Then try 6-8 weeks as 3 doses per day
Day before test last dose should be maximum of 12 hours before
If, after these experiments, you prefer / go back to taking all as single dose in morning …..on day before test ALWAYS split NdT ….with last dose 8-12 hours before test
Possibly as result of concoction of other medications you’re on
Dosing should be by Ft4 and Ft3 levels……not by TSH
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
TSH should be under 2 as an absolute maximum when on levothyroxine
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
Thank you, SlowDragon. That's very helpful. As you suggest, I booked to see an endocrinologist. You've taught me a lot and given me a lot of material to discuss with him.
Hmm. It's a bit chicken and egg. If I can get my TSH, T3 & T4 at optimum levels, and my anxiety and depression ease as a result, then I can come off Quetiapine. I've tried reducing my Quetiapine levels, but with bad consequences.
TSH level significantly reduced and T4 level significantly increased in the reboxetine group, however TSH level significantly increased and T4 level significantly reduced in the sertraline group. Percent changes of TSH (p=0.007) and T4 (p=0.001) were significantly different between the reboxetine and sertraline groups.
……We observed that various antidepressants had different effects on thyroid hormone levels and this could be attributed to the different mechanisms of actions of these antidepressants.
So Sertraline increased the TSH levels. Well that was certainly the case before I started Levo, and then Thyroid S. Same old chicken and egg, but at least in this case I can manipulate my levels with those drugs.
Several studies have evaluated the association between TSH and ADHD. It has been shown that TSH levels, although within normal limits, were significantly lower in methylphenidate-treated boys with ADHD than in the drug-naive and control groups
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