What steps should one take for managing hypothyroidism and anxiety?

Question

Hello doctor,

I experienced my first panic attack five months back and was diagnosed with hypothyroidism, with a TSH level of 8.6. I have been prescribed 50 mcg of Thyronorm to manage my thyroid condition. Initially, I was prescribed tablets Amitone 10 mg (Amitriptyline) and Zapiz 0.25 mg (Clonazepam) as needed for my anxiety symptoms. While I felt some improvement initially, I had a negative experience after consulting a neurologist who prescribed tablets Flunil 20 mg (Fluoxetine) and D Venizap (Venlafaxine). These medications caused severe side effects such as heaviness of the head, extreme fatigue, and more.

Seeking further help, I consulted a psychiatrist who initially prescribed tablets Pari 12.5 mg (Paroxetine) and Clonasig 0.25 mg (Clonazepam). After a month, the psychiatrist switched me to tablets Clobazam 5 mg and Pari 12.5 mg. Unfortunately, I have not noticed any improvement, and my psychiatrist recently increased the dosage of tablet Clobazam to 10 mg in the morning and 10 mg at night, along with tablet Paradise XR 25 mg (Quetiapine extended-release). However, I still experience restlessness, laziness, sleepiness, and an overall feeling of not being normal. I take Clonasig when I feel panicky and restless.

I would greatly appreciate your guidance on what steps to take next. Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query.

I suggest discussing with your treating psychiatrist regarding tapering off the dosage of the tablet Clobazam (generic name). If there has been no improvement with the tablet Pari CR (Paroxetine), then it can be substituted with Sertraline. These medications usually take two to three weeks to start exerting their effects, and it is important to ensure that proper dosage is prescribed. The previous dose prescribed by the neurologist may have been suboptimal, which is why consultation with a specialist, in this case, a psychiatrist, is recommended. Additionally, it would be helpful if you check your thyroid status and adjust the dosage of tablet Thyroxine sodium (Thyronorm) if the TSH (thyroid-stimulating hormone) levels are still high. Along with medication adjustments, practicing breath restructuring during panic episodes and daily meditation for at least half an hour in the morning can also be beneficial.

I hope I have addressed your concerns. Feel free to reach out if you have any further questions.

Thank you.