Question posted by mmmousemaid on 25 Sep 2021
Last updated on 27 September 2021
... years as no longer tolerated as well), and I wonder if the Synthroid dose has to be adjusted.
I would like to distinguish possible hypomania from hyperthyroidism, in the reduction phase.
Thank you for any information you have. I have not been able to get a reply from general physicians
I wonder if I should take more clonazepam during these excitabilty states and wait to see if I can recover to a stable state. I often wonder if the diagnosis of bipolar disorder was correct in the first place, it was so long ago.
Added 27 Sep 2021:more details?
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An excerpt from the Journal of Psychopharmacology a study first published 31 Oct, 2019:
"In most patients lithium-associated hypothyroidism seems reversible once lithium has been discontinued. Therefore, in such cases, TRT discontinuation could be attempted much more often than is currently done. It seems prudent to allow some weeks for the thyroid gland to recover before stopping TRT. Based on the limited evidence of our study, we can expect hypothyroidism to recur early after TRT discontinuation, if at all. Thus, it is advisable to monitor thyroid function for 3 to 6 months. TRT reinsertion should then only be reconsidered if there are unambiguous signs of hypothyroidism, such as persistently high TSH and low fT4."
Hope this may be help.
Thank you for the reference WildcatVet. I did some research myself, and found that yes it may be reversible (according to how damaged the thyroid is and what the level of malfunction is) once lithium is discontinued:
e.g. "Lithium associated hypothyroidism and potential for reversibility after lithium discontinuation: Findings from the LiSIE retrospective cohort study", Psychopharmachol. 2020 Mar; 34(3) doi: 10.1177/0269882858.
Ingrid Liebrid, Michael Ott, Louise Ohlund, Robert Lundqvist, Mats Eliasson, Mikael Sandlund, Urusula Werneke.
PMID: 31670617
I am interested in this question, because I have noticed the repetitive incidence of progressive agitation after discontinuing lithium, after about 30 days. I cannot distinguish if this is hyperthyroidism resulting from reversibility of some level of thyroid malfunction or the onset of hypomania. I would discontinue lithium (a favoured, very much liked drug taken for approximately 40 yrs.) if it were not for recent symptoms of tremor, tingling, and heart and head intolerance. I have asked general physicians and they do not know. Possibly, my retired dr. who prescribed it, does know, the level of thyroid affected by so many years of lithium treatment.
So, basically, I am in a limbo, in trying to make a decision to discontinue because of the adverse effects lasting about 2-3 hrs until stability, and the necessity to take it upon a type of agitation or hyperexcitability, insomnia, excess energy, etc., typical of hyperthyroidism but also typical of hypomania, usually after 30 days of discontinuation.
synthroid, hyperthyroidism, mania, lithium, dosage
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