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Question
Posted by: Jens | 2009/11/11

Hypothyroidism, T3 and TSH levels

Dear Dr Bets,

I suffer from Hypothyroidism and Bipolar Disorder. I' ve been on Eltroxin (T4) for some years now and the TSH levels have been stable at the lower end of the range, where they belong. When bipolar disorder was diagnosed, I was put on Lithium which is known to impede thyroid function, but my TSH levels remained stable.

Because the medication I' ve been taking for Bipolar Disorder is only moderately successful (it took the better part of two years to get to this point), I did some research and found some scientific articles that proposed T3 supplementation may help. I discussed this with my psychiatrist, and we decided to add 0.02 mg Tertroxin (T3) to my -|- tail. It does appear to have made a difference. I feel more stable, although there is still room for improvement.

Here is the part I don' t understand: After adding the T3, my TSH levels rose significantly while one would expect them to drop, thus necessitating an increase in T4 supplementation. Is there an explanation for this? Since the T3 had a positive effect on my mood without making me hyperthyroid, I' m contemplating asking for an increase in the dosage. Would this further increase my TSH levels or is there a point where things level out?

Thanks.

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Our expert says:
Expert ImageCyberDoc

Hallo Jens
Increasing T4 more may lead to increasing TSH if it happened before. TSH increase with increasing T4 could be due to secondary hypothyroidism where the pituitary gland is insensitive to feedback from T3 and T4 or there is some thyroid hormone resistance. Do you see an endocrinologist for the thyroid treatment?
Dr Bets

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2
Our users say:
Posted by: Jens | 2009/11/12

HI Dr,

Thanks for the information. My TSH levels have responded appropriately to T4 supplementation in the past. It is only now with the T3 supplementation that the TSH went up, but the free T3 count remained normal.

My psychiatrist is currently managing my thyroid treatment. The addition of T3 is in essence a psychiatric experiment with a positive psychiatric outcome. The literature suggests that T4 and particularly T3 supplementation may have a positive effect on mood in bipolar patients even if they don' t have hypothyroidism, reportedly without the adverse effects such as loss of bone density associated with elevated T4 and T3 levels. It is the strange endocrine response that puzzles me. Should I ask my psychiatrist for a referral?

Reply to Jens
Posted by: cyberdoc | 2009/11/11

Hallo Jens
Increasing T4 more may lead to increasing TSH if it happened before. TSH increase with increasing T4 could be due to secondary hypothyroidism where the pituitary gland is insensitive to feedback from T3 and T4 or there is some thyroid hormone resistance. Do you see an endocrinologist for the thyroid treatment?
Dr Bets

Reply to cyberdoc

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