Dr. Mohammed Abdul Nasir
Pain Medicine
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Patient's Query
Hello doctor,
I was tested for hypothyroidism before few years. My TSH was 5.6, and put on 50 mg of Levothyroxine and not explained anything about it to me. I took medicine for the past 12 years with lots of side effects. I got rashes, dry skin, frizzy hair, hair loss on legs and arms, and hair started growing on my chin. I never had any symptoms of hypothyroidism, just side effects from the drug.
I also have bipolar, and I am on Zyprexa 2.5 mg, Effexor 150 mg, Klonopin 2 mg twice a day, and Metoprolol for heart palpitations Zyprexa, and LDN (low dose naltrexone) for fibromyalgia. I have severe osteoarthritis and need a knee replacement. I am a 58-year-old female. I weigh about 275 lbs right now. I used to weigh 120 lbs, but Zyprexa made me gain all that weight. I weaned myself off Levothyroxine before four months to see if the rashes would go away.
I got a TSH blood test last Thursday that showed TSH of 4.01 and FT4 of 1.12. They both are in range according to the lab values range. My family doctor wants me to take 25 mg of Levothyroxine because the TSH is on the higher end of normal. If the test is within the normal range, why should I take medicine? I never had hypothyroidism before, and none of my family members ever had it. I have read my psychotropic medications can cause a rise in TSH values without actually having hypothyroidism. What is your opinion? Do I need 25 mg of Levothyroxine?
Hello,
Welcome to icliniq.com.
I have gone through your problem and can understand that it must have been quite difficult to take some medication for 12 years.
Now there are somethings about thyroid and hypothyroidism that you should know. Usually, a thyroid profile is done when a doctor suspects either hyperthyroidism or hypothyroidism in some patient. It can also be done as a routine investigation.
Increased TSH, as you already know, shows hypothyroidism, but high TSH should always be read in the context of the value of T3 and T4.
Now hypothyroidism can also be of two types. One is subclinical hypothyroidism in which the patient does not show any symptoms, and the other is hypothyroidism in with the patient shows clinical signs and symptoms. There are a few conditions in which even subclinical hypothyroidism have to be treated with thyroxine supplementation like pregnancy, old age, etc.
The TSH cut-off for treatment of subclinical hypothyroidism is 5. Since now, your value of TSH is less than 5. In my opinion, you do not need thyroxine supplementation as of now.
This TSH value should be repeated in the next three months to see if there is any change, and then treatment can be decided according to that value. This is because you have already stopped Thyroxine and your measured TSH level after some time of stopping. If you had not stopped Thyroxine, in that case, you would have advised reducing the dose of Thyroxine.
I would advise you to stop Thyroxine for the time being and repeat TSH in three months or so. Then we can always restart Thyroxine if required.
I hope this helps.
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Pain Medicine
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