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Adjusting to Synthroid  

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  1. 1. Did you need to make any modifications to psychiatric medications when starting Synthroid?

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A few years ago, I found out from my father (who I don't see often) that he was diagnosed late in life with hypothyroidism. Making due diligence, my family doctor started testing my TSH and Free T4.

Tested it once in 2017 where TSH was normal and T4 was just barely low. Tested again in 2018 about 6 months later and TSH was still normal and T4 still lowish. Wasn't until early last year that I started testing high TSH numbers. The initial high was only 4.77uIU/mL, which isn't that high relatively speaking. However, a subsequent test of my TSH and T4 showed the same high TSH but now I had lower T4 than in 2017 or 2018. It was apparent that either something was going on in my body or I just had hypothyroidism that was progressing.

So in November of last year, my general doctor starts me on Synthroid at my request. My father takes 100mcg a day, but there's also a family history of heart issues on both sides of my family where the one side specifically is cardiac arrhythmia. So my gdoc wanted to start at the bottom and work our way up.

Started on 25mcg and tested again this past January. TSH is still high at 4.61 but T4 is now 0.97ng/dL. Whoopee! I'm actually in the normal free T4 range! So we increased to 50mcg because no jitters or cardiac side effects to speak of. Test again in April and TSH is now 7.18 and T4 back down to 0.76ng/dL. :wtf:

So at this stage my gdoc recommends I see an endocrinologist. Got one. She has me take an additional 50mcg on Sundays (100mcg total) which seems to start making a real difference. Latest TSH is 5.90 and T4 is 1.01ng/dL. Looks like we're headed somewhere.

Now, all that to tell you this: My current psych meds are:

Trintellix 5mg AM

Rexulti 1mg AM

Vyvanse 40mg AM

Depakote ER 1250mg

This combo has worked well for me since 2017 when my pdoc and I pieced it together. My bipolar disorder follows a seasonal pattern. So we typically adjust meds as the seasons progress. Usually just the antidepressant, but sometimes the Rexulti as well. Standard dose on Trintellix for me is usually 10mg but in the Summer I need to back down to 5mg for a few months because it can cause me to go a little hypomanic. On the flip-side in the Fall and Winter, I typically require Trintellix at 15mg and 20mg respectively.

The problem though is that since introducing Synthroid, my normal seasonal rhythm feels like it's been thrown off. I find myself feeling over-stimulated on a semi-regular basis. Sometimes a little anxious. The weirdest thing for me though is that caffeine usually goes right through me (I'm a CYP1A2 rapid metabolizer, hence I remove caffeine from the body faster than most), yet recently I'm finding that after 1 MAYBE 2 coffees, I'm finding I'm a little too stimulated when I usually need like a whole pot of coffee to get by.

I started on Vyvanse because I was having issues with focus and concentration but also motivation/fatigue. My pdoc and I weren't 100% sure what I was experiencing was ADHD and not some unrelated problem rooted in anhedonia or anxious inattention. However from where I'm standing now, it would seem that all I really needed was some Synthroid and that the Vyvanse was just a bandaid covering up the real problem. I tried going off Vyvanse for a month before I had started Synthroid or knew there was a thyroid problem. Mixed success. My mood was less stable, but I found myself in good moods more often. Couldn't focus on anything for the life of me, and I was DOG tired.

As a side note, the endocrinologist did some further blood tests and we did determine that I do have Hashimoto's disease, which is why my thyroid is under-performing. My immune system is attacking it. So I did some research on Hashimoto's disease and psychiatric impact and come to find that there are plenty of people with similar stories. Psychiatric diagnoses (bipolar and major depressive especially) were super common in these people, who would then go on to start thyroid hormones that resolve a significant portion of their psychiatric issues.

I'm not saying that Synthroid is my answer and that I or anyone should throw out their psych meds when they get a Hashimoto's diagnosis. What I want to know is who here has been treated for some sort of affective/mood disorder, then been diagnosed with some sort of thyroid problem, start taking thyroid hormones, only to find that it really did change the psych med merry-go-round for you?

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It changed my psych meds a little bit, because lithium works so well for me, but has major thyroid side effects, so people don't want to put me on more than the lowest dose of lithium that I don't lose it on.  It improved my depression a little bit otherwise, but wasn't enough improvement to change meds for me.  If I get hyperthyroid, I eat a ton of benzos, though.  

Edited by Banana Smurf
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2 minutes ago, Banana Smurf said:

It changed my psych meds a little bit, because lithium works so well for me, but has major thyroid side effects, so people don't want to put me on more than the lowest dose of lithium that I don't lose it on.  

Do you experience thyroid issues because of the lithium (i.e. did the thyroid issues start after you started lithium) or was the thyroid issue pre-existing?

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It's really unclear.  I was also tested as having Hashimoto's, but I read that can also be stimulated to begin on lithium.  I had an abnormal reading near the time I started, and I've never been told it caused it, but I don't know.

Edited by Banana Smurf
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9 minutes ago, Banana Smurf said:

If I get hyperthyroid, I eat a ton of benzos, though.  

This is more how I've been feeling. Like I need to start taking clonazepam again because my irritability and anxiety have both been on the uptick

2 minutes ago, Banana Smurf said:

It's really unclear.  I was also tested as having Hashimoto's, but I read that can also be stimulated to begin on lithium.  I had an abnormal reading near the time I started, and I've never been told it caused it, but I don't know.

Yeah so I can't figure out for myself if starting valproate played any role. You hear about lithium causing hypothyroidism all the time but not so much from valproate. It can happen but.......I'm also considering that my father has hypothyroidism and has never even taken psych meds so I don't read into this too much.

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