Anxiety symptoms overlapping with hypothyroidism medication side-effects?

January 3, 2013 7:43 PM

Anxiety symptoms overlapping with hypothyroid medication side effects?

Hi guys-

I live with my girlfriend- we're both in college, and we're about to get her started on Levothyroxine, a medication for her hypothyroidism. Her TSH is at 5.2 and her doctor has prescribed a 50mcg daily dose.

Thing is, she is a very anxious individual- and I often help her feel better about the things that happen to her, including headaches, random pains, etc. Most of these things we can ignore and a lot of them come from the stress of schoolwork mixed with her tendency to anxiety.

Naturally she looked up the possible side-effects of Levothyroxine- it's the usual,
headaches,
sleep problems (insomnia);
feeling nervous or irritable;
fever, hot flashes, sweating;
pounding heartbeats or fluttering in your chest;
changes in your menstrual periods; or
appetite changes, weight changes.

This is problematic because once she starts taking this medication I'm not sure whether she may be experiencing a legitimate side effect that needs addressing, or whether it is simply an expression of her anxiety. It's worsened because she especially fears taking medication- for this reason, side-effects are sometimes a self-fulfilling prophecy. Her anxiety of the side-effects of Levothyroxine may lead to the exact side-effects she fears due to the anxiety.


Has anyone here ever dealt with this kind of situation? It's a bit of a Catch-22...

And of course, any info and advice regarding hypothyroidism you guys have to give would be mightily appreciated! I don't think hers is too severe, a milder case.

We're just about to start the spring semester back up in a few days.

Thanks so much guys.

posted by drd to Health & Fitness (10 answers total)

I assume she has had symptoms of hypothyroidism, such as (for example), weight gain, lack of energy, dry skin, cold intolerance, etc? With treatment, eventually those symptoms will resolve and she will feel better physically. For some, levothyroxine can cause any of the symptoms it says on the bottle, but really they will only be evident when you're on too high of a dose (or treated unnecessarily). 50 mcg is pretty low, and a good starting dose for the general population. It's possible she may need a higher dose later, but it will take some regular TSH measurements to get the dose properly adjusted. It's probably not going to exacerbate her anxiety at that dose, but it should start to help her feel better.

I remember being started on levothyroxine and feeling better almost instantly (within days), though I have a friend who ended up needing a bit of a higher dose than I did and she said it took a couple weeks before she felt better. I have anxiety issues too, and fwiw, they were not affected at all by my levothyroxine therapy. (They were however affected -for the better- by some CBT, which I recommend to almost everyone.)
posted by eldiem at 8:02 PM on January 3, 2013 [1 favorite]

I have a lot of anxiety, and I don't remember getting any of those side-effects. Like eldiem, I just felt so much better b/c my undiagnosed hypothyroidism had made me depressed and lethargic, cold and given me awful dry skin. I was started at 75 mcg which is also considered a fairly low dose, so at 50 she should just start to feel some of the hypothyroid symptoms go away. It took a couple of weeks to start to get more energy (so I didn't immediately fall asleep for a couple of hours after getting home from work) and just generally feel better.
posted by la petite marie at 8:17 PM on January 3, 2013 [1 favorite]

That dose is really low. If she experiences side effects like the ones on your list in the first two or three days after taking it, I would be astonished to learn they came from the medication and not the anxiety. You're not supposed to get to the full effects of any particular dose for four to six weeks.

My hypothyroid is quite mild (milder than your girlfriend's) and I'm finally up to 100 mcg of Synthroid (they have ridiculous dosages available - like 88 mcg.) We'll basically stop going up when we hit a TSH of .8 or I start showing side effects of Synthroid (depression, etc., have meant that my symptoms haven't resolved to my doctor's satisfaction.) I haven't had any lasting side effects from Synthroid, and I'm quite certain the early ones were entirely self-fulfilling prophecy stuff. If I had a husband I'd probably have him learn the side effects and keep them secret from me - I cause myself fake symptoms all the time.

I don't know if this is something that doctors recommend, exactly, but I've found in the past that my Ativan (for anxiety) does not fix legitimate side effects. The anti-hypertensive medication I was on, on the other hand, just plain knocked me out - I have no idea whether it did anything for side effects; honestly, I had to stop taking it due to the "knocked me out" bit. Anyway, if Ativan works for what I'm dealing with, I know I've hypochondriac-ized myself into being ill, and that's usually enough to make the symptoms go away.

Also, when meds make me jittery/sweaty/etc., it happens all throughout the day, and doesn't respond to things like mindfulness and meditation and deep breathing. I can't be distracted out of what Strattera did to me any more than loud banging on a drum would fix the sedation problem I had with Geodon.

I find that taking my Synthroid before I get into the shower in the morning almost always means I've waited the 30 minutes before eating.

Ummm... she'll probably find that she doesn't need as much heavy winter clothing, thick blankets, etc., as she once did. That's a really good thing, but it means having to make sure you bring a light sweater with you along with the heavy coat. Her hair/skin/nails should start getting healthier again soon, as well: she might actually have to change conditioners/styling products (my hair has been the most noticeable-to-others "obviously Synthroid" thing.)

Synthroid does not make me more anxious. So far, the only psych medications that I've been on that I remember doing that are Strattera and Lamictal (which yes, is a mood stabilizer - it behaves oddly at lower doses.) Oh, and Abilify, but that made me so sick I might have been anxious because I always get anxious when I'm sick.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 8:21 PM on January 3, 2013 [1 favorite]

Remember that Levothyroxine is a replacement hormone for the hormone (thyroxine) that her thyroid is not making, not a medication in the sense that one usually uses the term. It's much more like taking a vitamin supplement to make up for a vitamin deficiency (no, it's not exactly the same - before anyone jumps in and gets pedantic here...) than like taking an aspirin for a headache or a medication for a condition like asthma. Levothyroxine is nearly identical to the hormone as the body makes it.

There are possible side effects to most things one can consume. The dose she is taking is very small, and my guess - without knowing her at all, of course, but as someone who has taken thyroxine for 25 years - is that any of those symptoms are much more likely to result from the anxiety than from the low dose of medication. It might be worth getting some help for the anxiety, as suggested above.
posted by judith at 8:22 PM on January 3, 2013 [3 favorites]

What judith said; I think the vitamin analogy is a great one.

If it makes your girlfriend feel better: I am on a 75mcg daily dose (my TSH was about 12? when I was first diagnosed) and my quality of life has improved about 30% since I started levothyroxine a year ago. I did not even know how crappy I was feeling, it had happened so gradually; I kind of thought everybody just felt exhausted and cold all the time and was just cowboying it up better than I was. I was super-worried when I started (enough to post an anonymous AskMe about it: am I a Sick Person now? Oh Noes!) and seriously, two thumbs up would take daily meds for the rest of my life again.
posted by charmedimsure at 8:44 PM on January 3, 2013 [2 favorites]

Thyroid medication for when you have your thyroid removed can cause anxiety. (Source, someone I know who had to adjust their medication)

Other (potentially helpful or not) thought- does she drink coffee, can she cut it out, and see if that helps? I found cutting coffee really helpful in reducing my physical symptoms of anxiety.
posted by titanium_geek at 8:46 PM on January 3, 2013

My hypothyroidism was much worse and I'm on a higher dose than she is. I have experienced nothing that I could label a side-effect of the meds. I feel dramatically better now that my thyroid problem is treated, though. Some symptoms resolved quickly; others took months to go away. My anxiety levels have definitely dropped since I got my thyroid properly treated, though, so maybe hers will as well.
posted by gingerbeer at 9:02 PM on January 3, 2013

Mostly +1-ing the above, but I hope the piling on helps :-). Levothyroxine is one of the most common prescription drugs. Do think of it more as a pill that adds what your body is lacking instead of a symptom-fixer like many other drugs. It does not fix things overnight, so do give it a few weeks to work and stabilize. If the diagnosis is correct, it should make her feel better, and, I hope, not make her more anxious about what it's doing to her. I've been taking it since 8th grade, I am a worrywart by nature, and read everything I could about it (mostly on http://thyroid.about.com/) which made me feel better because I understood what was going on better (but if more info makes her more anxious, that might not be a good idea!). Good luck!
posted by girlhacker at 10:19 PM on January 3, 2013

Just joining the chorus to affirm that the side effect list is what happens if you end up on too much and drift over into HYPERthryoidism. Also, I'm one of those, "I didn't know how sick I was until the medication started working" people, and my TSH has always been in the single digits even when very sick.

Some other things: I was vitamin D deficient and needed a real supplement (beyond a daily multivitamin); and synthroid/levothyroxin didn't do it for me, so I ended up on Armour, the dessicated (non synthetic) porcine thyroid formulation. If her doc isn't into that, sometimes adding Cytomel helps.
posted by availablelight at 3:17 AM on January 4, 2013 [1 favorite]

Although I agree with everyone else (I've been taking levothyroxin for 20 years with no problems. The only problems I have is when I stopped taking it.) I'm also going to suggest something else.

Although 50mcg is a small dose, in her particular case I'd bring up with the doctor her anxiety issues. It may be wiser in this case to start her on an even smaller dose - say 25mcg - let that stabilize for a few months, and then re-check her TSH and then consider raising the dose.

My guess though, like many others have said, is that she'll probably feel relief after taking the new medication. That is, many of her current symptoms and sense of feeling unwell, may be because she is not getting enough thyroid hormone.
posted by vacapinta at 3:23 AM on January 4, 2013