# T4 Dosing and Severe Anxiety



## iamhypo (Jul 2, 2013)

Hello everyone,

This is my first post and I look forward to reading some sound advice.
Here are my lab results for reference. These are recent tests that do not include my titration up to high t4 doses. 
----------------------------------------------------(mcg dose is for levothyroxine)
Date-------Test--------------Result----------Reference Range------------Notes
6/8/13-----TSH-------------5.47-----------0.1-5.5------------100mcg 3 months
4/5/13-----TSH-------------2.57-------------0.1-5.5---112mcg but started 100mcg
4/5/13-----Free t4---------1.4---------------0.8-1.7-------------dose? 100 or 112 
6/29/12----TSH------------3.35--------------0.1-5.5------------dose? 100 or 112 
6/29/12----Free t4--------1.6----------------0.8-1.7-----------dose? 100 or 112 
5/2/12-----TSH------------4.43----------------0.1-5.5------------dose? 100 or 112 
5/2/12-----Free t4--------1.4----------------0.8-1.7------------dose? 100 or 112 
3/15/12----TSH-----------17.44--------------0.1-5.5------------off med completely
3/15/12----Free t4--------1.0----------------0.8-1.7------------off med completely
1/31/12----TSH----------0.04----------------0.1-5.5--------125mcg-then quit med
1/31/12----Free t4--------1.8----------------0.8-1.7--------125mcg-then quit med
Thyroperoxidase Antibody and Thyroglobulin Panel normal or in range
I'm a 23 year old male, eat healthy, and exercise 4 days a week (if that helps).

The short story.
I'm currently on 100mcg levothyroxine and feel tired for most of the day and am sad for no reason. Being on 112mcg caused unbearable physical/mental anxiety that my doctor says is not related to my thyroid. Judging by the thyroid tests, its as if my body likes the 112mcg dose better but my mind can't stand the associated anxiety that accompanies it. Please share your advice or ideas. Thanks so much! For important details read below.

The long story. 
I was diagnosed hypothyroid with a slightly out of range tsh a few years ago and have titrated up from 25mcg to my current dose of 100mcg synthroid. My issue is that I have decent and in range thyroid levels at the 112mcg dose but experience unbearable anxiety(that is new to me within the past year). And at 100mcg I am tired and depressed. Since my thyroid levels are normal on the 112mcg dose, my doctor said that anxiety is not due to my thyroid. From the severity of the anxiety and insomnia I suspected that I could have developed bipolar but the psychiatrist I saw does not think so. Also, this severe anxiety is nearly eliminated on the lower 100mcg dose. What's interesting is that I occasionally feel the same sensation that would cause the unbearable anxiety on the 112mcg dose but its not unbearable and only distracting when on 100mcg. Aspects contributing to general anxiety are stress from college and isolation due to few friendships. The anxiety on the 112mcg dose does not have a noticeable trigger. If the anxiety is analogous to noise, its as if at the 100mcg dose its occasionally noticeable and at 112mcg unbearable. I am not sure exactly when I first felt this anxiety but definitely within the last 12 months. Since coming down from the 125mcg dose I spent several months switching between the 112mcg and 100mcg doses. This resulted in an unstable mood for quit some time. I would be on the 112mcg dose for 3-6 weeks, experience unbearable anxiety/insomnia, then skip a few days on it and start the 100mcg dose. About 2 to 3 weeks later I would feel tired and depressed and start back up again 112mcg. I could not take the anxiety anymore and have been on 100mcg for roughly the last 3 months. My last tsh is nearly out of range so I should probably be on 112mcg. Secondly, I read online that the t4 dose should be 1.6-1.8mcg/kg which suggests I should be on a thyroid hormone dose of 103-115mcg. One option is to alternate 100/112mcg doses creating a 106mcg dose. However, my doctor suggested that the body has a buffering system and the 6mcg dose difference would not be noticed. Also, I quit caffeine and upon trying it again without a tolerance it caused some anxiety but not the severe anxiety I'm describing, so I will stay off it. For the anxiety I have tried magnesium and prescription antihistamines which do not target it at all. Xanax seems work on an as needed basis and seeing a therapist helped personal development but not anxiety. The doctor suggested an SSRI to treat the anxiety as well but I'm hesitant and read they don't necessarily treat severe anxiety well. Seeing as I'm napping all day on 100mcg and scared out of my mind on 112mcg, I know something needs an adjustment. There is that periond of about week 2-4 when titrating from the 100mcg dose to 112mcg that everything feels good. As days pass anxiety slowly creeps in and then insomnia and it just gets worse. If anyone has experience with this and/or advice please share. Thanks so much for reading this!


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## Lovlkn (Dec 20, 2009)

First and foremost - TSH is NOT for dosing thyroid replacement - it is diagnostic to determine the function of the thyroid.

You need to insist your dose of replacement be made by Free T-4 and if possible Free T-3.

I noticed your Free T-4 was at top of range. I also experience anxiety when my FT-4 gets much above 1/2 range and definitely at the top end of range.

Ask your doctor to test your FT-4 and FT-3 then begin your 100mcg dose again - you may also consider alternating your dose 112mcg 3x a week m-w-f and 100mcg 4 days a week and retest with the FT-4 and FT-3.

You need to look at both to determine if you are converting properly.

Have you tested your Vit D, Iron, Testerone, B-12?


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## Andros (Aug 26, 2009)

iamhypo said:


> Hello everyone,
> 
> This is my first post and I look forward to reading some sound advice.
> Here are my lab results for reference. These are recent tests that do not include my titration up to high t4 doses.
> ...


Geez; I don't think you are converting and your doc does not have a clue.

It is very very important for you to get a FREE T3 test.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

And you might want to check ferritin and testosterone for both are usually in the basement w/thyroid disease.

Here is info on Ferritin which if low could account for anxiety and tiredness.

Have you had any thyroid antibodies' tests and/or an ultra-sound of your thyroid? Both would be an excellent idea.

The 2 tests you had leave a question in my mind as you should not have any of those antibodies.

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/


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## Gwen1 (Sep 3, 2011)

Looks like you've been off and on the medication plus going between the two different doses. You need to keep things steady and stabilize on one dose before carefully increasing it. A good 6-8 months to stabilize and then try an adjustment.
Thyroid medication does not work instantly. It would be so much easier for us if it did, but it doesn't work that way. And it can mess us up if we are changing it frequently.


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## iamhypo (Jul 2, 2013)

Thanks for your responses and the great information. Im going to speak with my doctor about some of the things you guys mentioned. I'll make sure to include free t3 and t4 in my future thyroid tests. As of now I'm going to alternate 100 and 112 mcg levothyroxine daily and see how that goes. Its great to have a community of people who have been down that road and have awesome insight to share about the condition.


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## Andros (Aug 26, 2009)

iamhypo said:


> Hello everyone,
> 
> This is my first post and I look forward to reading some sound advice.
> Here are my lab results for reference. These are recent tests that do not include my titration up to high t4 doses.
> ...


You may not be converting. If the FT4 is high, that can cause anxiety and nervousness. Mainly because it might be converting to rT3 (reverse) instead of FREE T3.

Here is some info to arm yourself with.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

rT3
http://thyroid-rt3.com/whatis.htm

Also consider getting and ultra-sound of the thyroid for if there is cancer, that could caused raised anxiety when trying to dose higher.

Has your doctor ever run any antibodies' tests?

Also, low ferritin can cause anxiety when trying to increase thyroxine dose.


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