Today is very special, perhaps it is a historical day.

I started today a (medically supervised) life changing venture and in these coming days I will tell you about as it unfolds.

Let me put you up to speed first.

 I was diagnosed with bipolar disorder back in 2017. I documented my long and raw journey of fighting this illness here in Happilydepressed.blog. Despite repeated hospitalizations and endless cocktails of psychotropics, I was getting worse. Luckily, in 2019, my husband stumbled across a new approach to treating bipolar, a mix of rTMS sessions (repetitive transcranial magnetic stimulation), and life long high-dose Levothyroxine. It figures that bipolar patients suffer from a lack of Thyroid hormone due to a gene mutation which can be compensated by high-dose thyroxine. Slowly but surely, and thanks to this treatment, I was able to regain my life back. For more information on this treatment approach and to better understand the link between thyroid and mood disorders, you can refer to this research article published in 2021 by my treating psychiatrist Dr Andy Zamar. 

The treatment I am following is quite simple. I supplement with high-dose levothyroxine (700 mcg daily) to bridge the gap between my body’s production and its effective use of this hormone. Because of gene variants in my DNA (DIO1 and DIO2), I do produce thyroid hormone like everyone else, but it does not get converted efficiently into its active form in my brain. This conversion gap manifests as symptoms of bipolar disorder.

For about a year now—and increasingly so—I’ve been exhibiting what I learned to be signs of excess thyroxine in the body, which could mean my genes could have switched off. In other words, perhaps I no longer need as much levothyroxine to function like a normal person.

Today is the first day I embark on lowering this six-year long dose. I have no idea if I will be able to survive, let thrive on a lower dose. But I have to say: trying is a victory in itself!

---

To reach the stability I have enjoyed for about six years, I had to go through slow, incremental dose increases. Simply put, I started at 50 mcg levothyroxine, and the dose went up until I had no more symptoms of bipolar disorder. But if I had developed side effects, my dose would have been readjusted. This goes on until a balance is reached – no more mood swings and no side effects.

My treatment is supposedly a lifelong treatment. Nothing else worked, and nothing else will given that no one is addressing the real cause behind bipolar disorder – which, as I have experienced it, is an endocrine problem manifesting as a psychiatric one. I always knew my treatment with high dose levothyroxine was absolutely necessary for my mental stability – and that without it I would simply not survive.

Still, I have been noticing subtle changes in my body throughout the last couple of years, that are perhaps indicating that my treatment dose needs to be readjusted. To be honest with you, I tried lowering my dose alone without any medical supervision. It was a mistake, and I relapsed rather quickly. This was a big mistake.

In 2023, I began paying more attention to my body when I discovered that I was in early perimenopause, likely triggered by the chronic stress prior to treatment.

First thing I paid attention to was my heart, which would beat faster than normal at times without any explanation. This had also been the case in the very beginning of the treatment, but back then it normalized. I also noticed that my muscle mass had been declining, mostly in my arms – something my psychiatrist also noted. Another change was shortness of breath while speaking, though I brushed it off. A dermatologist once told me I had lost facial muscle, and I thought she was just trying to sell me fillers—until my psychiatrist later made the same comment. A new symptom was my hair: it began falling like never before, to the point that I dread brushing or washing it for fear of the shed.

I tried tackling these issues as best as I could. I consulted my cardiologist, who ordered cardiovascular tests, all of which came back fine. He prescribed Ivabradine to stabilize and lower my heart rate, and it worked. I experimented with facial fillers, but soon decided not to continue, as they could cause more problems in the future.

A year ago, I also began taking supplements to reduce the toll of perimenopause symptoms – especially hot flushes. With Maca and high quality Royal Jelly all the symptoms disappeared.

I am also following up with a bio-identical hormone replacement therapy (BHRT) doctor- who is also a psychiatrist and nutritionist – to balance my hormones without ever harming my mental well being. I have been on BHRT for three months now and my labs are improving. I had a few sessions of EMS for my muscles, but I honestly got discouraged: either because results were slow or because it simply was not effective. For my hair, I tried nearly everything expect minoxidil: topical peptides, peptide injections, and PRP, but unfortunately none of them worked.

My most recent labs confirmed that my creatinine remains low, with a new finding of an Estimated Glomerular Filtration Rate (eGFR) well above range — indicating that my kidneys are filtering blood at a higher than average rate. The results also show a mild but progressively increasing trend in red blood cell count and overall red cell mass, suggesting ongoing long-term red blood cell production driven by thyroid hormone stimulation.

As expected, my TSH remains suppressed, which is completely normal given my thyroid hormone dose. What is new however, is that both Free T3 and Free T4 values, which have always been high, are now showing a steady upward trend across this year.

All this led me to contact my doctor, who explained that I am exhibiting signs of excess thyroxine and that it is perhaps time to lower my dose.

I also learned that some patients on this same treatment—though at different doses—eventually show signs of excess. Some were able to stop taking levothyroxine altogether without relapsing into bipolar disorder, while others significantly reduced their stable dose.

I also learned that some patients on this same treatment- though at different doses – eventually show signs of excess. Some were able to stop taking levothyroxine altogether without relapsing into bipolar disorder; while others significantly reduced the dose they were previously stable on.

Today is my first day in this experiment. As per my doctor’s order, I will quit taking levothyroxine for 5 days, then I go to a new lower dose: which is going to be 600 mcg if all goes well.

I am not worried at all about today, as I have skipped a dose before simply because sometimes I forget to take my medicine.

What worries me are the next days.

Will I survive?

Will I glide into depression? Will I get dark thoughts?

I do not have any answers to these questions. Only time will tell – and you will be the first to know.

To be continued