hypothyroid, rheumatoid arthritis and zoloft

[fuzzeykatz]

My mother was dx in the late 90's with hypothyroid and was prescribed levothyroxine.  Her TSH tests were always steady between 3.0 and 4.0.  She weighs only 80 lbs, is 67 years old and has severe rheumatoid arthritis since age 28 with both knee's and hip's replaced, bronchiectasis, and pulmonary fibrosis.  She began to experience depression and was dx with reactive depression in January 2009 and started a low dose of Welbutrin. By June 2009 she experienced severe anxiety.  Dr. stopped Welbutrin and my mom felt somewhat better, but not normal.  In September 2009 her Dr. put her on 25mg Zoloft for the anxiety which seemed to work, but in November the anxiety seemed to be worsening.  Dr. recommended increasing Zoloft to 50mg, but my mother was afraid to up it and tried to just "deal" with it.  Mid February 2010 she had a TSH test and it was 8.0, and her Dr. increased Levo from 100mcg to 125mcg.  She started to experience increased anxiety, depression, fear etc, which led my mom to request another TSH test by her Dr. in May 2010 with the result being 9.45 TSH.  Dr. increased Levo to 150mcg but gave no reason why the levo appears not to be working.  When I asked if the Zoloft could be interferring the doctor said no, she's never heard of it and that my mom needs to see psychiatrist and left it at that.  I know my mom's impairments from the RA and lung problems cause some anxiety but she had always been able to push herself to function, but now she can't and says this is different, she's never had these feelings.  In the meantime she is now suffering from the symptoms mentioned above to the point of non-functioning.  She decided to change doctors.  How soon should she be tested again?  Could the anxiety/depression be caused by the Zoloft or from the hypothyroid?    DESPARATE for any suggestions.  Do you have any suggestions for doctors in the Geauga County, Ohio area, (about 30 miles northeast of Cleveland)?  I sincerely appreciate any advice you may have.

[Mark Lupo, M.D.]

This is a complicated case given her multiple medical issues.
Zoloft can increase hepatic (liver) clearance of levothyroxine -- this is likely causing the higher TSH.  If Zoloft not helping psychiatric components, may consider change to another psych med to eliminate this increased clearance.

150mcg is generally a high dose for a person weighing 80 lbs - so if the zolof is stopped, would carefully follow thyroid levels.  Zoloft can cause akisthesia (anxious like feeling).

Would consider Cleveland Clinic evaluation in their endocrine department and if appropriate second opinions in the rheumatology and pulmonary departments to cover the other illnesses.

[fuzzeykatz]

Dr. Lupo,

Thanks so much for your advice!