Stay on Lithium and Add Thyroid Med?
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Q:  Stay on Lithium and Add Thyroid Med?

I've been on Lithuim for many years. At my last appointment. We went over my blood tests. My doctor explained that my thyroid was high. That I could stop the Lithium or take more meds with it. I told her I was willing to change the Lithium for something else. But she kept the Lithium and added a med for the thyroid. Could you explain what the thinking might be behind this. I already take 13 meds. I just real don't want to take more if I don't have to. Even if it means changing the lithium.

Thank you,

Dear Kim --

First a little background: Lithium is well-known to sometimes cause "hypothyroidism", meaning that your thyroid gland is not making as much hormone as it is supposed to. This is reflected in a laboratory measure called TSH, the standard way we check thyroid status.  Just to keep things confusing, when your thyroid status is low, such as can be induced by lithium, your TSH goes up.  So that is what your doctor was describing as being "high".  Overall, it means that you are not getting enough thyroid hormone. 

If that was confusing, or if you would like to see more detail on that, read my page about thyroid and bipolar disorder.  It provides a review of these basics, including the laboratory testing. 

Now, why keep lithium and add thyroid instead of just switching lithium for something else?  Fair question.  Your doctor may fear that the alternatives to lithium might not work as well.  Or it could be that you have had a long struggle to get to where you are now, in terms of the effectiveness of medications.  Your doctor may not want you to go through any more suffering while you are trying to find an alternative.   

Remember, there is no guarantee that an alternative can be found.  Sometimes it takes quite a bit of searching.  During that time, symptoms can come back.  And finally, most of our medications have some drawback.  So your doctor may believe that the "downside" of medications to which you might switch are as big or bigger than having to correct a lithium-associated problem with thyroid, using a simple additional pill with no side effects or risks (thyroid hormone, when managed properly, will not cause any trouble at all). 

Having to take so many medications is certainly a burden.  Hopefully, your doctor has figured that issue in to the complex equation as well -- that is, the complex judgment about how much risk to take switching, versus how much trouble it represents to stick with lithium and add thyroid.  Nevertheless, in general it is useful to have a discussion with your doctor about your concerns.  If she/he has the time, which in some settings is not the case, she may be able to explain some of the logic used in keeping lithium, adding thyroid.  For your discussion, you may find it useful to read my little essay about Talking with Doctors.  Good luck with the process. 

Dr. Phelps


Published January, 2009

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