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Thyroid Disorders Community
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Avatar universal

New HYPO, depression/fatigue - when will Synthroid take effect, etc??

FINALLY! Just diagnosed Hypothyroid (TSH was 6 at highest, usually between 4.5-6.0) I've been suffering for YEARS with all symptoms (chronic Depression, always cold, irregular period spotting, irritability, fatigue, no sex drive..) but doctors never blinked an eye or did anything.

i hear that "Optimal level" for TSH is 1-2.0, so would TSH of 4.5-6.0 be MILD case of Hypothyroid? I am new to all of this. How high is considered clinically "Serious" or "Dangerous" if you are close to the top range TSH 4.5 ? I've heard they only recently lowered the top of TSH reference range from 10 to 3.0. What about in pregnancy? (trying to conceive)?

My free T3 & T4 ( I think) are in range...
Free T4 is 16 pmol/l (ref is 10.0-28.0)
Free T3 is 5.2 pmol/l (ref 3.0-9.5)
No antibodies indicating Hashi's

My doctor just started me on Levothyroxine at night - how soon will I feel any effects and know that it is helping if at all? I also have High Prolactin which could be causing my symptoms - I am desperate to get to the bottom of what is making me feel unwell.

I am 40-year old, healthy/normal weight, female (never pregnant) otherwise, and not on any medications this past year. 20 years of chronic Depression with no help from antidepressants has led me to thinking it is all due to Low Thyroid! Will see an endocrinologist soon for the first time, hoping to get answers.

11 Responses
Avatar universal
First off all you are not hypothyroid and only sub clinically hypothyroid so no need of treatment. Treating sub clinical hypothyroidism when TSH less than 10 is of no use and can actually make your symptoms get worse especially if the dose is high. With such a moderately low TSH starting dose should be 12.5 or 25 mcg going beyond this can cause palpitations, insomnia, tremors and other hyperthyroid symptoms.

Doctors actually not care the quality of patient so you should close monitor your condition. If its getting worse need to stop taking synthyroid. Also there is chance of osteoporosis so can result in bone loss resulting in back pain all.

Also another thing is your symptoms are not caused by thyroid as your T4 and T3 levels are under normal range.

If you are experiencing fatigue its worth to do complete blood count to see if your mildly anemic which is common with subclinical hypothyroid people.
1756321 tn?1547095325
I had severe hypothyroid symptoms with a TSH of 6 and free T4 of 13. That isn't normal but in my case it was Hashi's combined with cellular thyroid issues.  I would agree to start off low with those lab results.

I also have high prolactin when tested but I've been dopamine deficient since forever - bane of my existence. Dopamine has the dominant influence over prolactin secretion. There are other causes of high prolactin though like a prolactin secreting tumour.  Despite correcting a long list of reasons that cause dopamine deficiency and exercising I'm still low but a bit better.  There are more symptoms and causes of dopamine deficiency than listed below but it gives you an idea.

***

Pretty In Primal - Dopamine Deficiency (or, I'm Not Lazy After All!)...

"Here is a list of symptoms of dopamine deficiency (with my emphasis added on symptoms I identify with):

1. Physically fatigued easily (Sometimes.)
2. Sleep too much and trouble getting out of bed (Yes on trouble getting out of bed!)
3. Reduced ability to feel pleasure
4. Flat, bored, apathetic (Yes on feeling flat)
5. Low drive, motivation & enthusiasm (Yes, and yes.)
6. Depressed
7. Difficulty getting through a task even when interesting to me (HELL yes!)
8. Procrastinator/little urgency (Mmmm-hmmm!)
9. Shy/introvert (Yes.)
10. Mentally fatigued easily (Yes.)
11.Difficulty paying attention and concentrating (A little bit!)
12.Slow thinker and/or slow to learn new ideas
13.Put on weight easily
14.Crave uppers (e.g. caffeine/sugar/nicotine/diet soft drinks/cocaine/amphetamines)
15.Use these improve energy/motivation/mood
16.Prone to addictions (e.g. alcohol)/addictive personality
17.Light headedness
18.Reduced libido and/or impotence (sometimes on the libido)
19.Family history of depression/alcoholism/ADD

Factors which reduce dopamine levels (with my emphasis added on factors I have):

1. Chronic stress
2. Inadequate sleep (Like, DUH!)
3. Hypothyroidism (Bingo! Hashimoto's!)
4. Lead, arsenic and cadmium exposure
5. Under-methylation (Possibly- I suspect my dad's family under-methylates their B12. They have a strong history of Alzheimer's and dementia.)
6. Tyrosine (precursor) deficiency
7. Magnesium, iron, zinc & vitamins B3/B6/C/D deficiency
8. Excess copper levels (I have melasma and used to be vegetarian, so copper might be a factor.)
9. Genetic dopamine receptor abnormalities
10.Chronic opioid, alcohol & marijuana use
11.Adrenal insufficiency (Definitely!!)
12.Glutathione deficiency
13.Parkinson's Disease
14.Influenza
15.Estrogen deficiency (Yes.)
16.Human growth hormone deficiency"
Avatar universal
Let me first say that the emphasis should be on FT3 and FT4, not TSH.  Hypothyroidism is hypothyroidism, regardless of TSH level.  Hypo is rarely "dangerous".  Just to give you some perspective, my TSH on diagnosis was 60-something, and we periodically have posters here who have TSH in the hundreds.  FT3 and FT4 should be adequate when TTC and pregnant...the fetus depends on your thyroid hormones until his own thyroid develops.

Is there some reason your doctor told you to take your meds at night?  Levo has to be taken on an empty stomach, and you can't eat or drink anything for 0.5-1.0 hour after.  So, it's typically take in the morning before breakfast.  How much are you taking?

It takes 4-6 weeks for levo to reach its full potential in your blood.  

Were antibodies tested?  Which ones?

Your FT3 and FT4 are at the top of the lower third of their ranges.  That's a little low of the midrange recommended for FT4 and upper half of range for FT3.  Your TSH is high, which indicates your pituitary would like your levels higher.  
Avatar universal
Well, my OBGYN just prescribed Levothyroxine .25 mcg because she obviously thinks my TSH level is too high at 6.0 and I have chronic symptoms that are not going away. She said it is better to take on empty stomach to absorb (therefore before bedtime) She says the optimal level is between 1-2, while trying to conceive, regardless of FreeT3 and fT4. The "normal TSH" range I was given is .10-4.0.... and I have just about every Hypothyroid symptom that has not been helped with any antidepressant/psych meds.

Is the consensus that I should NOT be taking this medication and it will NOT help?? I've had other things tested and there is nothing else wrong that could be causing these symptoms (other than high Prolactin) I've had Antibodies tests (nothing came up - I asked her to test for possible "Hashimotos/autoimmune syndrome") and had an MRI (totally normal, no tumors) I am NOT stressed, and healthy otherwise I am not vegetarian and eat balanced diet and exercise.

I have all of the dopamine-deficient symptoms mentioned above, but all my tests (vitamins/minerals/estrogen are normal) I do not drink excessively not do I ever do marijuana/drugs, I think next steps might be to treat the High Prolactin if the Thyroid med does not do anything...

1756321 tn?1547095325
Ican tick all those symptoms (except the lightheadedness) along with family history. Plus other symptoms from not yawning to being very unorganised. I do now yawn on the rare occasion but it's a short incomplete yawn. I don't yawn when I see someone or think about it. My party trick if you will lol.  

I believe in my case damage was done to dopamine receptors due to to inflammatory cytokines.  My father has Parkinson's too actually so maybe something going on there too. I am going to try some dopamine supplements (I've been saying that for ages...I'll get around to it..stupid procrastination lol). If you are well treated for your hypothyroidism you will soon find out if this is the sole cause of your elevated prolactin levels.
Avatar universal
TSH is an indirect measure of thyroid status since TSH is a pituitary hormone.  FT3 and FT4 are direct measures.  TSH is nothing but a messenger hormone from your pituitary to your thyroid to tell it that hormone levels are too low.  FT3 and FT4 are what's important.

Your stomach doesn't get much more empty than before breakfast in the morning.  I'd say 99+% of us take our levo first thing in the morning.  

No, I'm not saying you shouldn't be taking this medication.  Whether it will help or not is yet to be seen.  25 mcg is a low dose; you will have to follow up with more blood work in 4-6 weeks, re-evaluate how you are feeling and adjust meds as necessary.  Our initial dose is seldom the dose we end up on.  It's not unusual to feel slightly worse and have labs get slightly worse upon start meds and until you find the appropriate dose.    

There are two antibodies that are markers for Hashi's, TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies).  Many doctors only test for one, but only one has to be elevated to indicate Hashi's, so both have to be tested to rule it out.  I'd make sure she tested both.

Your doctor's fixation on TSH is just plain wrong.  Her advise to take your meds at night is questionable.  It works for some people, but we're advised to take it in the morning unless that doesn't work for us for some reason.  Adjusting thyroid meds is a bit of an art form, and it demands taking symptoms, FT3, FT4 and TSH into account and in that order.  

I think it's great that she's giving you the opportunity to take a trial dose to see if it helps.  I just hope she's savvy enough to be able to evaluate your labs and adjust as needed.  

Avatar universal
Yes, my doc did test both TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies). Nothing there...

I agree, I've read you cannot simply look at TSH and nothing else. However, I've also read that many people have all of the classic Hypo symptoms with all of the right "numbers" and lab ranges. She is only an Obgyn, so she wants to start a low-dose trial and I will see an Endo/specialist that actually knows about this hormone balancing stuff to adjust/monitor.

I get up at very inconsistent times in the morning & eat breakfast/coffee immediately, so I think this is why she said Bedtime is better in my case. In the morning, you have to wait at least an hour to eat, right??

Red_Star: What herbs or supplements have you heard increase Dopamine? I've read that most do not cross the blood-brain barrier, and are ineffective..
1756321 tn?1547095325
L-dopa crosses the blood brain barrier but dopamine itself cannot. The supplement I've been interested in trying out is Mucuna pruriens which contains L- Dopa. I found a random product online called DopaBoost with this list of ingredients...

"Mucuna pruriens - a botanical which naturally contains L-DOPA, the metabolic precursor to dopamine, which can cross the blood-brain barrier. The Mucuna material in DopaBoost is standardized to contain an extremely potent 60% L-DOPA.

EGCG (from green tea extract) - antioxidant; brain-protecting properties. These polyphenols in green tea offer neuroprotective effects, help to increase availability of dopamine. EGCG has been shown to have a positive effect on the electrical activity of dopaminergic neurons in the substantia nigra, the area of the brain where dopamine is made.

Quercetin - a flavonoid present in many fruits and vegetables, naturally inhibits COMT (catechol-o-methyl transferase) and MAO activities, the key enzymes involved in the metabolism of dopamine. Quercetin works synergistically with Mucuna pruriens and EGCG as it helps to preserve dopamine levels.

N-Acetyl-L-Tyrosine - the acetylated derivative of l-tyrosine, the amino acid from which dopamine is synthesized. Acetylation helps to increase the stability and solubility of tyrosine, making it more efficient and bioavailable, and therefore, the superior choice for raising the body's levels of tyrosine.

Pyridoxal-5-Phosphate - vitamin B6 in its metabolically active form; needed for the decarboxylation of L-DOPA to dopamine. P5P is a coenzyme for dopa decarboxylase, the enzyme responsible for the conversion of L-DOPA to dopamine. Dopa decarboxylase is important in the improvement of Parkinson's disease."

Avatar universal
Yes, it's true that many people have classic hypo symptoms with labs in range.  That's because the reference ranges for thyroid tests are very flawed, which is why we, on this forum, consider anything below the midpoint in the FT3 and FT4 ranges to be potentially hypo.  Doctors have to learn to adjust meds until symptoms go away, not just until the patient pops into the bottom of the range.  Most of us don't feel well low in the range, but once numbers are within range, the doctors backside is covered.  

The rule is to wait half to one hour after meds before eating or drinking anything but water.  So, you're probably right that's why she told you to take it at night.  
Avatar universal
Hi, just wanted to comment in regards to what goolara said. When people have the hypo symptoms and labs are in "normal range", is called Hypothyroidism Type 2 meaning you have resistance to the thyroid hormone and for many reasons it doesn't get to the cells, therefore the symptoms. For some unknown reason to me, there is not much info on this topic. A person can have Hypothyroidism Type 2 and develope Type 1. Mark Starr wrote a book on that, very informative.  I do have the resistance but when I was finally properly diagnosed I was very hypo.(labs really low) After months of trying Armour, Nature Throid I got switched to Synthroid/Cytomel 2 weeks ago and feel much better, feel progress for once. I did ask my doctor about trying Synthroid at night and he said the main reason he would not advise, is because I may not be able to sleep. He told me I can try if I want , but I don't think I want. Some people claim they feel better when they started taking it at night.  At this point my dose is 150mcg Synthroid and 10 mcg Cytomel(generic), I'll have labs in 2 weeks and go from there.  I think the first week is the hardest when trying a thyroid med, or switching for one to another, it also depends how your body responds. If you don't see improvement in 3 weeks you may want to call your doctor and try a different medication, I suffered like that with armour not knowing. I am to call my doctor once a week with my symptoms, whether good or bad.  Good luck to you!
Avatar universal
The reference ranges for FT3 and FT4 are far too broad.  In addition, in establishing ranges, many people with undiagnosed hypo or elevated Hashi's antibodies are included in the "normal" ranges.  This doesn't necessarily mean that T3 can't get into cells.  It simply means that we are not all comfortable across the whole breadth of the ranges.  You may have to be in the upper half to third to feel well, whereas I feel well much lower in the ranges.

Typically, thyroid hormone resistance (THR) is suspected when serum FT3 and FT4 levels are adequate, TSH is low or suppressed, but hypo symptoms persist.  The hypothalamus and pituitary do not evaluate cellular hormone levels, only serum hormone levels.  So, when everything in the blood looks good, but hypo symptoms persist, we have to look to what might not be present in cells that needs to be to metabolize the thyroid hormone properly, e.g. Vitamin D deficiency, ferritin deficiency, etc.

So, while I would agree with you that with FT3 and FT4 results in the upper half of the ranges with hypo symptoms persisting would indicate THR (or type 2, as your author would say), if FT3 and FT4 are in the lower half, there's a good possibility that there's no THR and a simple increase in T3 and/or T4 meds is all that's needed.  FT4 should be about midrange, and FT3 should be in the upper half of the range before THR comes into play.    
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