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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by HMK on April 8, 2002, at 9:17:27
Does anyone know if people who are hypothyroid can even take lithium? I thought there might be some kind of dangerous interaction effect.
Posted by mat on April 8, 2002, at 13:04:36
In reply to Lithium and thyroid disorders, posted by HMK on April 8, 2002, at 9:17:27
> Does anyone know if people who are hypothyroid can even take lithium? I thought there might be some kind of dangerous interaction effect.
hi!
i found the following in a pharmacology textbook (goodman&gilmans):
"a small number of patients treated with lithium develop a benign, diffuse, nontender thyroid enlargement suggestive of compromised thyroid function......lithium appears to interfere with the iodination of tyrosine and therefore with the synthesis of thyroxine. however, patients usually remain euthyroid, and obvious hypothyroidism is rare"
from another german textbook of pharmacology: "approximately 10% of the patients treated with lithium develop a euthyroid struma (enlargement of thyroid) that is treated with l-thyroxin.and i just looked up the contraindications for one of the lithium-containing drugs here in austria (quilonorm):
and-it is not allowed to prescribe this drug in case of an untreated hypothyroid disease (other contraindications in this list are: severe renal insufficiency, several cardiovascular diseases, m.addison, diet with reduced sodium-intake and disorders associated with dehydration)hope this helps
mat
Posted by BarbaraCat on April 9, 2002, at 2:10:03
In reply to Lithium and thyroid disorders, posted by HMK on April 8, 2002, at 9:17:27
I am hypothyroid since forever and have been on lithium since February. I increased my thyroid by 1/4 when I started Li and my recent blood work looked great. Read your previous post. I'm BPII in that my depressions are deep and dreadful and ADs poop out. My hypomanias are the rapid cycling anxiety type that plunge me right back on down into depression and on and on. Lithium saved my life pure and simple. I do not believe there is any known contraindication with thyroid medication. Because I now have a life I'm exercising once again and my metabolism is revved up and better toned than it has been in years.
I resisted lithium for years because of it's so called stigma and especially the thyroid thing. I would give anything to have those years back again. I wish you the best whatever you decide upon. BTW, I hope you're including the active T3 form with your thyroid medication. - Barbara
Posted by HMK on April 9, 2002, at 8:55:11
In reply to Re: Lithium and thyroid disorders » HMK, posted by BarbaraCat on April 9, 2002, at 2:10:03
A quick question about thyroid treatment- all my doctor has me taking is Levoxyl. Is there something I should add to this? I was just diagnosed hypothyroid a few months ago, so I'm very new to all of this. Thanks for your imput!
Posted by BarbaraCat on April 9, 2002, at 20:20:34
In reply to Re: Lithium and thyroid disorders » BarbaraCat, posted by HMK on April 9, 2002, at 8:55:11
Definitely. Do a search on this site for thyroid and depression or look at the posts from a few weeks back particularly from Dr. Ivan Goldberg. Most doctors will prescribe levoxyl or synthroid or some other form of T4. The old line theory is that the body converts T4 into T3 which is the active form that is used by cells, but that ain't necessarily true. There have been a number of respected studies recently that show that depressives respond significantly better when T3 is present. A very good web site is http://thyroid.about.com. Full of fascinating info. Sometimes it's hard to convince an unenlightentened primary care doc otherwise (the T4 thing has been like bible verse), but many are seeing the light. - Barbara
,> A quick question about thyroid treatment- all my doctor has me taking is Levoxyl. Is there something I should add to this? I was just diagnosed hypothyroid a few months ago, so I'm very new to all of this. Thanks for your imput!
Posted by noa on April 10, 2002, at 15:16:23
In reply to Re: Lithium and thyroid disorders, posted by BarbaraCat on April 9, 2002, at 20:20:34
My endocrinologist told me that I could take lithium despite the thyroid problems (which worsened while I was on lithium) but I'd have to increase the thyroid hormone dose accordingly.
Posted by BarbaraCat on April 10, 2002, at 16:57:36
In reply to Re: Lithium and thyroid disorders, posted by noa on April 10, 2002, at 15:16:23
Hi Noa,
Did you actually feel like your thyroid was getting worse or was it just your levels that were looking worse? And by about how much over what period of time? I'm hypo, taking lithium so have an interest in this.> My endocrinologist told me that I could take lithium despite the thyroid problems (which worsened while I was on lithium) but I'd have to increase the thyroid hormone dose accordingly.
Posted by noa on April 11, 2002, at 16:29:57
In reply to Re: Lithium and thyroid disorders, posted by BarbaraCat on April 10, 2002, at 16:57:36
I was on lithium for about 2 months or so. I was struggling with refractory depression and couldn't tolerate high levels of the ADs, and my pdoc hypothesised that I might have a cycling pattern to my depression and could have a depression in the bipolar spectrum, and that lithium might be effective.
After about 1.5 weeks on litium, my depression started to improve. But at about 6 weeks, I started to feel worse and worse--depressed, crying, totally foggy-headed, completely fatigued, etc. And, I developed edema. At that point--when the edema showed up-- I had my TSH checked and it was up to about 3.5, having been about 2.2 or 2.3, I think, prior to the lithium.
I began reading about thyroid problems--this coincided almost exactly with the release of Mary Shomon's book, Living Well with Hypothyroidism. I decided to discontinue the lithium, even though I understood I could stay on it and increase the thyroid hormone doses to adjust, because I felt that it was more likely the thyroid problem that was making my depression so hard to treat than having a bipolar spectrum depression and needing a mood stabilizer. I wanted to test out the thyroid hypothesis first. When I went to Mary Shomon's web site, I saw that there was a doctor recommendation page--rec's from other readers. I went to see one doc in my area and he was great. He confirmed I could have stayed on the lithium, but he also said my hypothyroidism was very undertreated and probably contibuting a lot to the depression. He had me increase my dose of synthroid as long as the increases led to improvement in symptoms, and then stop when the improvement leveled off. He anticipated that I would need a level where my TSH was 1 or less. The improvements leveled off when my TSH was 0.3.
BTW, he also had me split my cytomel dose--telling me it has a shorter half life than the synthroid and would be more effective in split doses.
Finally getting the thyroid properly treated was a major breakthrough in getting my depression under control. I continued to feel better over the course of many months.
I continue to feel pretty good. The only other change I needed to make was to add the light box in the fall and winter this year, which also made a big difference for me.
Posted by BarbaraCat on April 11, 2002, at 20:26:01
In reply to Re: Lithium and thyroid disorders » BarbaraCat, posted by noa on April 11, 2002, at 16:29:57
Thanks Noa for your very clear and informative post. It sounds so much like my own history and symptoms. I think I'm going through some of the symptoms of lithium/thyroid stuff and will start taking a tiny pinch more of the Armour thyroid just to see if it makes a difference. I'd like to get my TSH under 1.0 but not so low that it precipitates any anxiety. I also divide my dose twice a day and find that helps to counteract the T3 surge/drop effect.
I'm curious why lithium adversely affects thyroid - perhaps it displaces the iodine molecule? I haven't read anything on this. BTW, I love Mary Shomon's site and am grateful I stumbled across it 3-4 years ago. There is a such a wealth of information! I found the articles there on the correlation between flouride and hypothyroidism and well as certain pesticides very fascinating. Good luck to you. - Barbara
Posted by HMK on April 12, 2002, at 8:05:11
In reply to Re: Lithium and thyroid disorders » noa, posted by BarbaraCat on April 11, 2002, at 20:26:01
Thanks to everyone for their informative posts! I had no idea that I was being so poorly treated by my family doctor. Just want to double check with all of you what I should request from my family doctor since I can't get into an endocrinologist until the end of June. Right now I only take Levoxyl and have TSH of 3.98. I should add active T3 and aim for a TSH of under 2? Why didn't my doctor know this??
The worst part of dealing with mental illness and disorders as complex as hypothyroidism is having to be your own doctor and finding your own information. Don't we pay THEM to do this work for us??
Sorry to vent- just a little frustrated.
Best wishes,
Heather
Posted by Ritch on April 12, 2002, at 12:47:02
In reply to Re: Lithium and thyroid disorders » BarbaraCat, posted by HMK on April 12, 2002, at 8:05:11
> Thanks to everyone for their informative posts! I had no idea that I was being so poorly treated by my family doctor. Just want to double check with all of you what I should request from my family doctor since I can't get into an endocrinologist until the end of June. Right now I only take Levoxyl and have TSH of 3.98. I should add active T3 and aim for a TSH of under 2? Why didn't my doctor know this??
>
> The worst part of dealing with mental illness and disorders as complex as hypothyroidism is having to be your own doctor and finding your own information. Don't we pay THEM to do this work for us??
>
> Sorry to vent- just a little frustrated.
>
> Best wishes,
> Heather
Heather and others,I found this link which is interesting:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8927676&dopt=Abstract
Posted by BarbaraCat on April 12, 2002, at 13:10:24
In reply to Re: Lithium and thyroid disorders » BarbaraCat, posted by HMK on April 12, 2002, at 8:05:11
A TSH of 3.98 is CRIMINAL. There are plenty of M.D.s, unfortunately, who will let many patients get by with that range saying that it's 'borderline'. This is pure crap, especially when that patient has a history of a mood disorder. Optimal TSH values should be right around 1.0, NOT 2.0. In-between 1 and 2 is OK, but some say that .9 is even better. You should be taking some T3 along with T4. This could be in either the synthetic form (levoxyl=T4, Cytomel=T3) or a natural form (Armour thyroid or some other animal thyroid product). Whichever form you take, the T3 dose should be split into a twice a day dosing because T3 enters the bloodstream rapidly, causes a spike and can cause some hyper feelings if not spread out.
If you have not gone to the http://thyroid.about.com website, by all means do so. Be prepared for a fight about the T3 (you'll get a patronizing little smile and a lecture about how T4 converts to T3 anyhow, silly). If your doctor is letting you out the door with that TSH level I doubt very much he's read any of the newer research or would be willing to consider T3 augmentation. Grrrrrrrr - makes me so pissed off. You may need to print out some articles which is why the thyroid web site is so valuable. Better yet, consider seeing a good naturopathic doctor. They are far superior at this kind of thing than most MDs (especially endo's - believe me on this one!).
- BarbaraThanks to everyone for their informative posts! I had no idea that I was being so poorly treated by my family doctor. Just want to double check with all of you what I should request from my family doctor since I can't get into an endocrinologist until the end of June. Right now I only take Levoxyl and have TSH of 3.98. I should add active T3 and aim for a TSH of under 2? Why didn't my doctor know this??
>
> The worst part of dealing with mental illness and disorders as complex as hypothyroidism is having to be your own doctor and finding your own information. Don't we pay THEM to do this work for us??
>
> Sorry to vent- just a little frustrated.
>
> Best wishes,
> Heather
Posted by noa on April 12, 2002, at 15:34:58
In reply to Re: Lithium and thyroid disorders » HMK, posted by BarbaraCat on April 12, 2002, at 13:10:24
HMK,maybe a psychiatrist might be more savvy about this than your PCP? At least while you're waiting to get in to see an endo.
Posted by HMK on April 15, 2002, at 11:55:50
In reply to Re: Lithium and thyroid disorders » HMK, posted by BarbaraCat on April 12, 2002, at 13:10:24
Good news, everyone- I convinced my doctor to prescribe a higher level of Synthroid. She agreed that our goal should be to get my TSH between 1-2. Turns out, my nurse just had the old fashioned information (that TSH is normal if under 6) and not my doctor. Hooray for educated family practitioners! Am really hoping that things will turn around for me once I get on the right level of thyroid medication. Right now all I do is work and sleep. And sleep.
On a manic upswing today so I'm pretty hyper. I hate this disorder!!! Neurontin just isn't keeping my moods under control!
Best wishes,
Heather
Posted by BarbaraCat on April 15, 2002, at 15:01:37
In reply to Re: Lithium and thyroid disorders » BarbaraCat, posted by HMK on April 15, 2002, at 11:55:50
Well, great news. Hopefully the nurse will go for some higher ed credits cause that's just awful. Forgive me for taking this personally but I had a similar incident where my lab results were 'borderline low' (read 4.0) and I dragged my weary butt around for a year before finally finding a doctor who said 'WHAT!' and treated me.
If you're still not feeling more zippy and clear-headed after adding the extra Synthroid, I urge you to talk to your Dr. about his/her thoughts on T3 (Cytomel is the med name). If it's something that's going to work for you, it'll work like gangbusters, and is especially indicated for people with depression. If it's not gonna work, then you'll know cause you'll feel kind of hyper. Anyhow, I know that for myself and many others of us hypothyroids, taking T3 has been a pretty important piece of the antidepressant puzzle. - Barbara
> Good news, everyone- I convinced my doctor to prescribe a higher level of Synthroid. She agreed that our goal should be to get my TSH between 1-2. Turns out, my nurse just had the old fashioned information (that TSH is normal if under 6) and not my doctor. Hooray for educated family practitioners! Am really hoping that things will turn around for me once I get on the right level of thyroid medication. Right now all I do is work and sleep. And sleep.
>
> On a manic upswing today so I'm pretty hyper. I hate this disorder!!! Neurontin just isn't keeping my moods under control!
>
> Best wishes,
> Heather
Posted by noa on April 16, 2002, at 16:23:44
In reply to Re: Lithium and thyroid disorders, posted by BarbaraCat on April 15, 2002, at 15:01:37
Great news, HMK!
This is the end of the thread.
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