Hypothyroid: Need guidance on Effexor + Synthroid

[susmani]

I am glad that I found this incredible forum. God Bless you all. Below is my story:

Please review and let me know the right course for the treatment, and please also let know if my sexual issues can be fix or not.

Age: 39 , 5'6" , and 160 lbs.

For last six months I started feeling like a 100 year old man in the morning with energy to get out of bed to get ready for work. I thought this is aging and my lack workout so I joined a gym and found myself even miserable after workout unable to recover from the workout fatigues. I started to realized myself that I am suffering from a depression based on my analysis on how I felt in the morning such as confused, dizzy , and felt like an Alzheimer patient …….. I contacted an experienced Psychiatrist and after couple sessions he prescribed me Effexor XR 75 mg once a day. ……..

Please keep in mind all my life I have been very healthy and I didn’t remember when was the last time when I have seen a doctor, but now I became so worried about my health and started investigating myself on health issues during my life that could relate to my suffering……………

In 1995 when I was 25 years old I noticed an change in my genital my penis shrink (atrophy) as well as testicles and beside that I didn’t notice anything else such as low libido (14 years ago). I visited a physician and after few blood tests and examination he told me I am just fine and I am going through some physical change and it is just fine don’t need to be worried. After few days doctor called me since he received one blood test bit late and he told me that I laser thin ‘Hypothyroid’ and there is no need to worry about it as well he didn’t prescribed any medication and told for this low level reading I don’t need to take anything it will get better by itself AND he didn’t related my sexual problems with my low thyroid at all.

My Psychiatrist order some blood test and it came out I am indeed ‘Hypothyroid’. Below is the result:

TSH: 22.67 Ref: (0.400 – 4.610)
T4 Free 0.76 Ref (0.94 – 1.65)

I have been referred to another physician who prescribed me Synthroid 150 mcg once a day. At this point I am taking Effexor 75 mg and Synthroid 150 mg daily for about a month. I am still waiting to see a positive change.

All my life I have been the most talented and intelligent student, worker etc. won lots of prices highly paid because of my intelligence but NOW I am having hard time hold on to it and mostly I feel real dumb. Even at this moment I am having hard time to put my thoughts here in this forum.

I have all of the below symptoms (taken from another site) and for a while I thought It is aging or my gene.


 NO sex drive
• Premature Ejaculation
 Less stamina than others
 Less energy than others
 Long recovery period after any activity
 Arms feeling like dead weights after activity
 Chronic Low Grade Depression
 Often feeling cold
 Cold hands and feet
 Bizarre and Debilitating reaction to exercise
 Hard stools
 Constipation
 Dry Hair
 Hair Loss and dandruff
 Requires naps in the afternoon
 Sleep Apnea (snores a lot )
 Inability to concentrate or read long periods of time
 Forgetfulness
 Foggy thinking
 Inability to function in a relationship with anyone
 Exhaustion in every dimension–physical, mental, spiritual, emotional
 Inability to work full-time
 Complete lack of motivation
 Broken/peeling fingernails
 Major anxiety/worry
 Ringing in ears
 Carpal tunnel symptoms

[rick055]

I can tell you that effexor is a different drug at different doses.

Anything less than 150 mg for me was VERY sedating, 150 - 300 mg was stimulating. Maybe the effexor is contributing to your fatigue.

Your thyroid treatment could take a while to kick in, and you'll find many here who think you should be on armour thyroid, which also contains some T3. Plus, if effexor is sedating you, it could be masking the thyroid results.

You also might ask your doctor to run a 4x cortisol test to see how your adrenals are functioning. Since your TSH was so grossly elevated, they might even want to run a full endocrine work up on you; if you're hypopituitary, you could have more than one endocrine axis not running properly.

JOOC, do you have any history of head trauma?

You should discuss this with your healthcare professional. Remember nobody on the boards can treat you.

But there is knowledge to be discussed with your healthcare professional.

[susmani]

Thank you so much for your response. Actually, this is my condition even before starting medication and I don't see any change. I am not sedative. My energy level is so low and 8 hour work day is so long for me so I start feeling sleepy at around 2 PM, plus the situation I wrote about other symptoms. Is there a complete list of test that you think would be good for me to go through, I 'd really appreciate if you or anyone could post a hyper link where I can find the list of test.

I came to know that Armour Thyroid is from swine and religious belief restrict me for taking it... but I will ask for exception in this case........I would really appreciate if anyone know about a similar product like Armour but extracted from cow, sheep etc...

Thank you,

[susmani]

Never had a head trauma just to let you.

[marianco]

When treating hypothyroidism, no matter what the treatment, good targets to achieve are the following in an adult male, assuming no big problems in the other systems.

1. TSH <= 1.0
2. Total T4 between 8.0 and 12.0
3. Free T3 between 3.3 and 3.9

Total T4 is the most important target. When it is reached but there are still problems, then there are problems in the rest of the system - e.g. adrenal problems, metabolic problems such as insufficient iron or vitamin A or B-vitamins, selenium, zinc, magnesium, excessive immune system activation, etc. etc. for thyroid hormone to work. Thyroid hormone requires adequate nutrition, nervous system and hypothalamic-pituitary-adrenal function to work.

Sometimes higher dose targets are used - particularly in psychiatry.

When the nervous system is not functioning well, TSH can be off. It can be lower than the actual deficit of thyroid hormone present. When a person has a mental illness, this is particularly true. Thus it is important to measure what thyroid hormone is actually there to determine the course of treatment. Endocrinologists and primary care providers swear by TSH. But it makes the huge assumption that the nervous system is working well. They may not realize this.

I generally look for these problems from the start. Often they are simultaneously there. It usually takes multisystem and metabolic problems to occur simultaneously before a mental illness can occur.

Often, when hypothyroid, adrenal fatigue will occur as the sympathetic nervous system and adrenal glands work together to compensate for the loss of thyroid hormone. It is when the adrenal glands become exhausted (as per Hans Selye) does a person develop problems and can no longer compensate for the loss of thyroid hormone. Adrenal fatigue is NOT a recognized diagnosis by endocrinologists or internists. In psychiatry, it is generally recognized that mood disorders generally have problems with the hypothalamic-pituitary-adrenal axis as one of the causes of the mental illness. This is the analog to adrenal fatigue/exhaustion. However, nothing is often done about it directly - much to the detriment of patients. One will have to study about it to help improve response to treatment since few physicians outside of alternative medicine would know how to deal with it.

It is important to obtain follow up labs to help gauge progress in treatment.

T4 (synthroid) needs to be taken on an empty stomach and apart from iron and heavy proteins (such as caseinate proteins from milk) to have the best absorption.

Synthroid can be used just as Armour Thyroid. The key is achieving target dosing then looking for problems in the rest of the system that keep thyroid hormone from doing its job. Some people have difficulty converting T4 to T3 - particularly in the brain - which is a separate compartment from the body (where a person can have normal thyroid levels but low brain levels of T3). In this case, Armour Thyroid or combinations of T3 (cytomel) and T4 may be used.

Cheers.

Dr. M

[BBC3]

I am not on eto critique this one but NICE>...

Originally Posted by marianco

When treating hypothyroidism, no matter what the treatment, good targets to achieve are the following in an adult male, assuming no big problems in the other systems.

1. TSH <= 1.0
2. Total T4 between 8.0 and 12.0
3. Free T3 between 3.3 and 3.9

Total T4 is the most important target. When it is reached but there are still problems, then there are problems in the rest of the system - e.g. adrenal problems, metabolic problems such as insufficient iron or vitamin A or B-vitamins, selenium, zinc, magnesium, excessive immune system activation, etc. etc. for thyroid hormone to work. Thyroid hormone requires adequate nutrition, nervous system and hypothalamic-pituitary-adrenal function to work.

Sometimes higher dose targets are used - particularly in psychiatry.

When the nervous system is not functioning well, TSH can be off. It can be lower than the actual deficit of thyroid hormone present. When a person has a mental illness, this is particularly true. Thus it is important to measure what thyroid hormone is actually there to determine the course of treatment. Endocrinologists and primary care providers swear by TSH. But it makes the huge assumption that the nervous system is working well. They may not realize this.

I generally look for these problems from the start. Often they are simultaneously there. It usually takes multisystem and metabolic problems to occur simultaneously before a mental illness can occur.

Often, when hypothyroid, adrenal fatigue will occur as the sympathetic nervous system and adrenal glands work together to compensate for the loss of thyroid hormone. It is when the adrenal glands become exhausted (as per Hans Selye) does a person develop problems and can no longer compensate for the loss of thyroid hormone. Adrenal fatigue is NOT a recognized diagnosis by endocrinologists or internists. In psychiatry, it is generally recognized that mood disorders generally have problems with the hypothalamic-pituitary-adrenal axis as one of the causes of the mental illness. This is the analog to adrenal fatigue/exhaustion. However, nothing is often done about it directly - much to the detriment of patients. One will have to study about it to help improve response to treatment since few physicians outside of alternative medicine would know how to deal with it.

It is important to obtain follow up labs to help gauge progress in treatment.

T4 (synthroid) needs to be taken on an empty stomach and apart from iron and heavy proteins (such as caseinate proteins from milk) to have the best absorption.

Synthroid can be used just as Armour Thyroid. The key is achieving target dosing then looking for problems in the rest of the system that keep thyroid hormone from doing its job. Some people have difficulty converting T4 to T3 - particularly in the brain - which is a separate compartment from the body (where a person can have normal thyroid levels but low brain levels of T3). In this case, Armour Thyroid or combinations of T3 (cytomel) and T4 may be used.

Cheers.

Dr. M

[susmani]

Dr. M,

Thank you so much for your response and it really increase my knowledge, understanding about the my problems, and I am getting a big boost from your post.

I have gone through lots of postings from you and built a better understanding about SSRI as well.

Earlier I was not taking the Synthroid in empty stomach but from today I started taking in the morning empty stomach and wait for another 30 minutes to eat anything.

I am taking 75 mg of Effexor since 05/04/09 so it is not long and it will be easier for me to get off from them now instead of after few months or year since I am starting to realized that my problem is 'Hypothyroidism' and if it is treated my other symptoms will go away as well and one of them is 'Depression', but at the same time I am thinking may be I need to continue on Effexor which may help the process of recovering from hypothyroidism.

I will appreciate your thoughts on this.

Thank you,

[marianco]

Originally Posted by susmani

Dr. M,

Thank you so much for your response and it really increase my knowledge, understanding about the my problems, and I am getting a big boost from your post.

I have gone through lots of postings from you and built a better understanding about SSRI as well.

Earlier I was not taking the Synthroid in empty stomach but from today I started taking in the morning empty stomach and wait for another 30 minutes to eat anything.

I am taking 75 mg of Effexor since 05/04/09 so it is not long and it will be easier for me to get off from them now instead of after few months or year since I am starting to realized that my problem is 'Hypothyroidism' and if it is treated my other symptoms will go away as well and one of them is 'Depression', but at the same time I am thinking may be I need to continue on Effexor which may help the process of recovering from hypothyroidism.

I will appreciate your thoughts on this.

Thank you,

Note that it takes multiple problems to cause depression. Thus finding hypothyroidism as one problem is just the tip of the iceberg.

I often do complex treatments, since that is what is necessary to address all the problems involved. Treating hypothyroidism related to mental illness is just one piece of the puzzle. An antidepressant/antistress medication such as an SSRI or low dose Effexor may still be necessary. Only once all of the underlying factors are addressed does it become easier to reduce antidepressant treatment. Otherwise, depression is likely to return.

Even then, some patients have a normally high stress nervous system. Such a person may be Type-A, for example. In this case, continuing antidepressant/antistress treatment would be necessary to maintain balance and optimum functioning. Medications such as the antidepressants are designed for lifetime use since a mental illness is a lifetime problem. People often want to get off treatment with them. But only if a substantial proportion if not all of the other underlying problems that caused depression in the first place are addressed would it be possible to get off an antidepressant and not have recurrence of depression.

[susmani]

My Physician called me this morning told me everything is looking great and all the tests are normal. I just got the faxed copy of my results and I think they are not good at all. As a matter of fact I am a borderline 'HYPERTHYROID'. ------- It is time for me to look for a qualified physician for this illness. I have already contacted one of the physician who comes in this forum last week but still waiting to here from anyone from his office. You comments will be greatly appreicated.

Below is my lab work after taking Synthroid 150 mcg for six weeks.

(It is from Quest)

T4, FREE, NON-DIALLYSIS ------------------ 2.2 ng/dL ( 0.9 - 1.8) -????? Not looking good.

TSH -------------------------------------------------- 0.08 mIU/L (0.40 - 4.50) ???? Not looking good

TESTOSTERONE, Total ------------------------- 737 ( 2 - 45.... couldn't read what's afer 5)

TESTOSTERONE, % FREE --------------------- 1.68 % ( 0.5 - 2.00)

TESTOSTERONE, FREE -------------------------- 123.8 pg/ml ( 0.1 -6.4)

Below is my test results before I started my treatment:

TSH: 22.67 Ref: (0.400 – 4.610)
T4 Free 0.76 Ref (0.94 – 1.65)

I will write more about how I feel now in the evening since I am at work.

Thank you,

[AlexanderDenmark]

If you don't feel hyperthyroid, your probably not hyperthyroid. Don't let them reduce your medication.

They also omitted testing total t3, ft3, ft4 to get a wider look at the picture.

Do you feel any better?