Hypothyroidism

I am 48 years of age, I have been diagnosed with Borderline Personality Disorder from my psychologist.  He also informs me that I have Obsessive Compulsive tendencies and mood swings which resembles Bipolar.  I am currently taking Doxepin 100 mg with Trazodone 100 mg in which I take at bedtime for anxiety/depression issues in which I have had problems sleeping so my psychiatrist put me on.  Most of the day today I have felt like a 'zombie' walking around feeling very fatigue and 'wired' feelings of anxiety, shakey (shaky) (shaky) at times...also have noticed of having fatigue headaches...wondering if my medicine needs to be changed.  I also have been medically diagnosed as having 'hypothyroidism along with 'borderline' diabetes.  I am currently taking Synthroid 50 mcg for my hypothyroidism but just watching my diet for the diabetes.  My prim dr tells me the anxiety is NOT caused by hypothyroidism but other people say it maybe a factor.  What do you think?

[flyingfool]

All the Dr's keep telling you that all of your symptoms are a "tick" or essentially in your head.

Your latest symptom fits perfectly with an enlarged Thyroid.  Many people feel pressure or feeling of being choked.  Maybe it represents itself in you as the feeling of the need to clear your throat.

Until you have completely exhausted the whole Thyroid thing.  I would NOT let them convince you that this is all in your head and some how mental or psychiatric.

It could be psychiatric. But I would rule out Thyroid first.

[blsdnsvd]

I think that your doctor has not a clue. I am also hypothyroid due to not having TT and i have anxiety/depression, "borderline" diabetes and other ailments. My levels are not where they should be, therefore I will continue to have these other issues. Most of my ailments occured after the TT.

[gimel]

Please post you thyroid test results and reference ranges shown on the lab report so that members can assess the adequacy of testing and treatment.

[Red_Star]

Mental health conditions caused by hypothyroidism include (but are not limited to):

Depression
Anxiety
Bipolar spectrum syndrome
Borderline personality disorder
Psychotic disorder (typically, paranoid schizophrenia)
Obsessive Compulsive Disorder  
Inattentive ADHD  

These symptoms can be due to low free T3 (active thyroid hormone), and/or adrenal insufficiency. This is found to be especially common for patients treated with T4 medications such as synthroid or levothyroxine.  Other thyroid treatments include a combination of synthetic T4 and T3 (cytomel/tertroxin) or natural desiccated thyroid hormone which contains T4, T3, T2, T1, and calcitonin.

Studies have shown that 90% with type 2 diabetes have low levels of free intracellular RBC (red blood cell) magnesium.  The body depends on magnesium to help the pancreas produce insulin, the hormone that removes excess glucose from the bloodstream.  Magnesium deficiency causes insulin resistance, which in turn causes hyperinsulinemia, resulting in hypertension, diabetes, and hyperlipidemia.

Foods rich in magnesium include cocoa, leafy green vegetables, nuts and seeds, legumes (beans, split peas, lentils), whole grains (brown rice, oats, quinoa, millet, whole wheat breads, pastas, and crackers), bran, seaweed, plus meats and fish.  Do not take magnesium supplements if you have kidney or heart problems.

[Red_Star]

To add, patients with hypothyroidism often have low magnesium levels.

[flyingfool]

There is little doubt that low thyroid has an effect on depression symptoms.

Many, not all, but person after person who WAS treated with anti-depressants were able to stop taking those antidepressants AFTER they got their Thyroid levels correct in their body.

Again depression is a serious condition.  But do NOT rule out that it could be related, or worsened by your low thyroid condition.

[connie753]

Here are my latest lab results done in July 2011:

Hemoglobin A1C           6.5  High  (4.0-6.0 Ref. Range)
Est. Average Glucose  139.9 High  (68.0-126.0 Ref. Range)
T4, Free                       1.31          (0.80-1.80 Ref. Range)
TSH-Ultrasensitive         8.66 High   (0.35-5.50 Ref. Range)

My prim dr has me on Synthroid 50 mcg and will be rechecking me in 3 months.  I still feel that this has alot to do with my anxiety problems that I am having constantly.  My psychiatrist just added me to Haldol 0.5 mg (antipsychotic) for my anxiety as my other anti-depressants were not enough.  I am the type of person that can't take alot of meds, hoping that this new med will not put me under....

[connie753]

to add--my TSH in april 2011 was 6.74 from april to july it went up to 8.66.... my T3 and T4 Free, are normal tho.

[danie17075rm]

I can provide you with some peer reviewed studies telling your doctor otherwise.  There IS a direct connection between hypo and mental health (this is my major).  I just had my thyroid removed so I'm a little wacky still, but if you'd like some let me know and I can try to get them too you as soon as I can.

[gimel]

You are missing the lab test that reveals the most about your thyroid status, Free T3.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have also shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH correlated very poorly.  Doctors frequently tend to not test for Free T3 on the assumption that if they know Ft4, then they can adequately estimate Free T3.  This is frequently wrong because many hypo patients do not convert T4 to T3 adequately.   In view of its importance, why not just test and be sure.  

So I suggest that you should call and ask to be tested for Free T3 now, so that you can monitor the progress of both Free T4 and free T3 over the next couple of months.  If you have not been tested for the thyroid antibodies, TPO ab and TG ab, then that should be done as well.  Those tests will determine if the cause is Hashimoto's Thyroiditis, which is the most common cause of being hypo.  If you are successful with getting those tests done,  that then you might as well go for it all and ask to be tested for Vitamin A, D, B12, zinc, ietn/ferritin, selenium, and RBC magnesium.  

I think you would be well advised to also read about clinical treatment in this link.  

http://hormonerestoration.com/files/ThyroidPMD.pdf

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  Many of our members report that symptom relief for them required that Free T3 was adjusted into the upper part of its range and Free T4 adjusted to around the midpoint of its range.  

It might be a good idea to discuss with your doctor is he is going to be wiling to treat you clinically and also if he is willing to prescribe meds with T3 in them.  If no to either, then you may as well start looking for a good thyroid doctor that will do so.

[connie753]

Yes send me some peer reviewed studies.  So what you are telling me is that hypo and mental health is included with each other?  What is your background in this?

[connie753]

So my T3, Free back in April I had it checked and it was at 2.9 would that considered low?  

These labs were done in July 2011:
Hemoglobin A1C           6.5  High  (4.0-6.0 Ref. Range)
Est. Average Glucose  139.9 High  (68.0-126.0 Ref. Range)
T4, Free                       1.31          (0.80-1.80 Ref. Range)
TSH-Ultrasensitive         8.66 High   (0.35-5.50 Ref. Range)

[gimel]

What was the reference range shown on the lab report, for that Free T3 test result?  If it is similar to the range I see often, 2.3 - 4.2 Pg/ml, then your FT3 would be in the lower third of the range.  Results in that part of the range are frequently associated with hypo symptoms.  The range is far too broad, since it has never been corrected as was done for TSH 8 years ago.  

Many members report that symptom relief for them required that FT3 was adjusted into the upper part of  its range and FT4 adjusted to around midpoint of its range.  Having a Free T3 test result in the low end of the range would not be such a problem if the doctors would use the range as a guideline within which to adjust as necessary to relieve symptoms.  Instead they use the entire range as a pass/fail decision, and the patient suffers.

[danie17075rm]

I worked a year into my master's in counseling, and realized I've always felt better in psychology so I'm working on my master's in health psychology.  All of my research has been on mental health and hypothyroidism (since I experienced it first hand, it is near and dear to my heart).  I cannot say for certain your mental health is related to your thyroid, or which came first the chicken or the egg (not enough research on it, but I intend to work on this with my phd).  There is a direct connection though.  Some researchers believe that you had to have had a predisposition for the mental health problems first, and the thyroid just aggravated them.  I however have written many papers on studies that demonstrate this is not true.  I personally developed like a panic disorder AFTER becoming hyperthyroid.  Now they would say I already had this and it was just made worse.  This however was not the case, and when my thyroid would normalize, everything else would go away.  During my bad thyroid times, I have TONS of issues.  I have studied this from a behavioral, physiological and cognitive aspect.  When I have my thyroid "panic attacks" (I call them panic attacks loosely because I believe they are purely physical), it started with my body and not my mind. I had a hard time explaining this to doctors.  Normal mental side effects came from this.  Since I was having panic attacks, I started to have trouble with stores and developed a mild agoraphobia.  However, I had no issues when my thyroid was normal.  

I recommend ANYONE who has a mental health issue to get everything straightened out with their thyroid (I know this takes a long time).  As the others have told you, they can help with your results.  Once you are normalized, give it a few months and see what kind of changes you undergo mentally.  I will add, that once you develop a mental illness (even if the cause is organic) you might suffer residual effects.  For example, if you have a panic attack, you have opened kind of a pandora's box.  It's similar to Pavlov's experiments on salivating dogs.  Your body gets conditioned to responses, even though they might have been caused from issues with your body.  You will STILL need treatment to get past these conditioned responses, BUT it should be a lot easier because your body is level.  Here is a good starting article to read.  I hope this helps.

http://www.drrichardhall.com/anxiety.htm

[danie17075rm]

By the way, I sent you this study because it includes endocrine disorders, so diabetes is also in there.  

[flyingfool]

It is appears possible that you have a problem converting T4 to T3.

With your FT4 just about exactly mid range, and your FT3 that appears low in the range would be evidence of this fact.

You could increase the T4 med and test again to see what kind of response there was to the FT3 levels.  This could potentially verify that you have a conversion problem if there is little to no increase in FT3.  If that is the case, you will need to add a T3 medication to directly raise your FT3 level as it won't really matter how much you raise your FT4 level if it won't convert.  Finding a Dr willing to prescribe this is the trick.

Also do not be surprised if your TSH is suppressed. (very low) and your Dr freak out and want to REDUCE your meds.  This will likely result in disaster for you as you will slam back down into Hypo land and feel like crap.

Understand also that if you do get a T3 med, they will or should lower the amount of T4 med you are taking.  The rule of thumb is lower the T4 by 20 to 25 mcg for each 5 mcg of T3 med that is added.

Please post your FT3 along with the reference range.

[connie753]

My T3 Free was 2.9   Standard Range 2.3-4.2

This was done in April 2011.

[flyingfool]

Exactly.

When the Free T3 is lower than the Free T4 in the range it suggests a conversion problem.

Many people obtain symptom relief when the FT4 is about mid range (which yours is!) and the FT3 is in the UPPER 1/3 of the range.

The fact that you are still having hypo symptoms, AND the FT3 is near the BOTTOM of the range and not in the upper half or better yet 1/3 explains this fact.

Now, getting a Dr to believe this to be the case is another story all together.  Having your TSH still being high offers you some hope that a Dr will be willing to increase your medication dosage.  

You may want to mention to your Dr to look into conversion problem issue.  However you do have some room to increase your dosage of T4.  But you should put him on notice that you must have both Free tests done and pay particular attention to the amount of increase that the FT3 results from the increase.  if your FT4's get to the upper part of the range but the FT3 remain below mid range, you will not feel good until you get FT3 up and the only way to do that is to add a T3 medication.  Or change to natural dissected Thyroid which has both T3 and T4.

[connie753]

So you say my T3 is lower than Free T4 in the range?

T3 Free    2.9   Standard Range 2.3-4.2
T4 Free    1.27 Standard Range 0.80-1.80    

So are you saying that my anxiety/depression problems are DUE to the fact of my thyroid?

I just saw my psychiatrist yesterday and she put me on add'l meds besides what I am already taken for my anxiety/depression.  She actually put me on a antipsychotic type of med to control my anxiety....

I also did contact my fam dr to request T3 Free T4 Free along with thryoid antibodies, TPO ab and TG ab, Vit A, D, B12, Zinc, Ferritin, selenium and RBC magnesum ...that 'gimel' suggested that was said earlier in my posts.  I am still waiting to hear back from my fam dr about those tests to see if she will agree or not...

[flyingfool]

Well.

Symptom relief for many occurs when the FT4 is mid range and you are about exactly there.  AND the FT3 are in the upper 1/3 of the range.

For you the upper 1/3 for FT3 would be above 3.56   And you are testing at 2.9 so you are a little low.  In fact you are not even mid range which would be 3.25.

I think, that when everything in the conversion process is working fine, when your FT4 was mid range you'd expect to get a result of your FT3 being above mid range to the upper 1/3.  Since that is not the case for you, you may have a conversion problem and may benefit from the addition of a T3 med.

Depression and anxiety ARE associated with being Hypo. SOME people can get off of antidepressants once their Thyroid is controlled.  But not everyone.

I'm just saying that trying to get your FT3 up a bit more may help alleviate the anxiety/depression.  But there are no guarantees.  

[connie753]

Well, I know when I tell my family dr. that am feeling that the anxiety could be from my hypo, she keeps telling me that it is NOT related, that the only way it would affect anxiety if I was hyperthryoidism and not hypothyroidism....she says that my anxiety is separate than from hypo...
Do you know if there is a blood test for 'hormonal inbalance' since I am reaching 'menapause' stage, could my anxiety be coming from hormonal besides the hypo....?

[danie17075rm]

The hyperthyroid being the only cause of anxiety is a myth.  There have been many studies done that showed the same incidences of anxiety in both hyper and hypothyroidism.  Most doctors are not read up on the latest research unfortunately.

[connie753]

I just got a message from my primary dr that she has ordered thyroid tests, Vit D, Vit B12.  But she says the others are not considered first line tests.   Hoping by having these tests done it will show more info.

[danie17075rm]

Good Luck! I hope you can find the information you need.

[flyingfool]

When you are having a problem.  You NEED to go BEYOND "first line tests".

That is the point!  You utilize 1st line tests as a BEGINNING into the investigation.  Now that you are beyond the beginning and recognize a real problem, you need FURTHER and additional testing.

I just don't get the complete LACK of common sense logic Dr's use.  For arguably very smart people Dr's sure seem to have their head up their backsides a whole lot of the time it seems. And it is rampant all over the country and the world.  Just makes me shake  my head in amazement.

If a car is not running.  Do you stop looking for the problem when you do a first line investigation and find that the gas tank is not empty?  What if there is water in the gas you wouldn't know it if you didn't do some further investigation.

Gee Whiz!

[danie17075rm]

Flying- Good analogy.  I may have to use that for my inept doctors.  It's funny, other medical professionals are always asking me if I have this or that, but how would I know?  My docs never test me or investigate.  They guess.  In my case they see the car running and leave it at that even though it stalls all of the time.  As long as it is running, they are fine.

[connie753]

So HOW do I tell my doctor that this needs to be done?  How do I explain that we should do more testing when she says it DOESN'T need to be done----as she says that these are 'first' line tests......does anyone feel that maybe I should be seen by a specialist regarding this---GOSH--not sure if my doctor  would even approve for me to go see one or not...she probably feels like she is HANDLING the situation....huh?

[flyingfool]

Connie.

I'm struggling with that very thing myself. It is my wife with the Thyroid problem and we are dealing with Dr's as well.  And we can't seem to get referred to another Dr.  And we are trying to wear the current Dr. down.  Right now my wife is so Hypo that the Dr. is increasing the dosage although WAY, WAY to small an amount.  But at least we're going in the right direction as we keep trying to be the squeaky wheel.

I guess we have to appeal to them that getting additional Thyroid testing for a known Thyroid problem is at least reasonable.  It is not like you are going in to the lab to have blood drawn and you are requesting to have your right knee X-rayed.  Something totally unrelated.

Also it is almost like the Dr themselves are paying for the tests out of their own pocket or something. Maybe if you get them to understand that it is you and your insurance company that is paying for it, not coming out of their own pocket here.

You may have to start going to some links and printing off some of the information.  Hopefully some that are written by Dr's etc so that you can provide that to the Dr and say this is what XYZ Dr's are saying and finding with Thyroid patients etc.  Maybe then it will hold some credibility with your Dr.  

As Dr's are so busy they do not have time to read all the latest and greatest info on EVERY disease and area in the medical field.  yet you who are ONLY interested in one particular issue, can dig into it with full abandon. Thus with the internet etc it is actually now far more likely that the patient themselves could know nearly as much if not more than the Dr. on any one particular disease or condition.

You see unlike maybe what many Dr's think.  Dr's are only human. They are not any better, smarter or whatever than any other of us.  They just happen to take years to train and gain some expertise in the medical field.  The smartest Dr. in the world may be totally inept on how to fix his car or do plumbing.  So who is really smarter the Dr. or the plumber?  Well it depends on what problem you happen to have at the moment.  

I think in particular that you should take Danie up on her offer related to the association of depression/anxiety related to Hypothyroidism.    I know she has done extensive research and study in this area.  If your Dr. wants more info, you may be able to get a hold of this info to provide to your Dr.

[connie753]

Yes!  Thanks for your input, I plan to show my dr a copy of the article that Danie had sent me.  Hopefully that will help me to get to the bottom of this problem that I have!

[connie753]

I also have another symptom and wondering if anyone else has had the same problem----

I keep clearing my throat as it feels like something is there and everytime I clear it thinking it is gone, it comes right back.  I sometimes think it is just phealm, I cough to try to get rid of it, and is just stays there....feels like a big 'lump' in my throat.  Am wondering if this is another sign of my 'hypothyroidism', my psychiatrist could hear it what I was doing, she informs me it is a 'tick' that I keep doing continouslly every few seconds.  

[flyingfool]

All the Dr's keep telling you that all of your symptoms are a "tick" or essentially in your head.

Your latest symptom fits perfectly with an enlarged Thyroid.  Many people feel pressure or feeling of being choked.  Maybe it represents itself in you as the feeling of the need to clear your throat.

Until you have completely exhausted the whole Thyroid thing.  I would NOT let them convince you that this is all in your head and some how mental or psychiatric.

It could be psychiatric. But I would rule out Thyroid first.

[connie753]

Thanks for you input!!

[danie17075rm]

One of the big things I experienced along with choking was the "lump" in my throat.  In fact I had went to the doctors complaining something was in my throat.   They told me it was my thyroid and I needed to get it out.  I was hyper though.  It's harder to shrink a goiter when you are hyper.  When you are hypo, you can take thyroid meds and a lot of the time, it will relieve a lot of that inflammation.  Also, you could try taking IBuprofren and see if it doesn't help take away a little of the inflammation during your flare.

[connie753]

I just went and got my blood drawn this morning, and was able to contact the lab to get the results and here they are:

TSH                 1.85        (Norm 0.35-5.50)            8.6   done in July
T3 FREE           3.0         (Norm  2.3-4.2)               2.9  done in April
T4 FREE           1.29       (Norm 0.8-1.8)                1.31 done in July
Vit B12              947        HIGH     (Norm 211-911)                

The VIT D and anti microsomal antibodies are not back yet.  But do you know why my
VIT B12 would be so HIGH?  Now that really scares me on why that would be high!

[gimel]

If you look through this listing of typical hypo symptoms, how many of the 26 would you say that you have to some degree?

http://sz0102.ev.mail.comcast.net/zimbra/mail?app=mail#2

[connie753]

I could not access this site

http://sz0102.ev.mail.comcast.net/zimbra/mail?app=mail#2

[Emmy4337]

Maybe danie17075rm  can see if these look like good information and are relevant/accurate.  

2 things I found with a quick internet search of "T3 medicine for depression"

http://thyroid.about.com/cs/thyroiddrugs/l/blt3depression.htm

http://www.psycheducation.org/thyroid/studies.htm

2 things I found with a quick internet search of "bi polar hypothyroidism"
http://www.psycheducation.org/thyroid/introduction.htm

http://www.psycheducation.org/thyroid/combostory.htm

I know when my thyroid medicine is off (like it has for the past year) that I feel like I am bi polar with massive mood swings and a great deal of depression, in addition to all the regular hypo symptoms (my husband thinks so too!).   I hope you are able to find some information that will help you.

[connie753]

I just went and got my blood drawn this morning, and was able to contact the lab to get the results and here they are:

TSH                 1.85        (Norm 0.35-5.50)            8.6   done in July
T3 FREE           3.0         (Norm  2.3-4.2)               2.9  done in April
T4 FREE           1.29       (Norm 0.8-1.8)                1.31 done in July
Vit B12              947        HIGH     (Norm 211-911)                

The VIT D and anti microsomal antibodies are not back yet.  But do you know why my
VIT B12 would be so HIGH?  Now that really scares me on why that would be high!

[flyingfool]

You are only 36 "points" high. With a range of 700 that is only high by about 5%.  So it really isn't that terribly high.

I have not heard of any side effects of too high of B-12.

Remember that many people have symptom relief when the FT3 are in the upper 1/3 of the range and the FT4 midrange.  The upper 1/3 of the range of FT3 would be 3.56.  So you are slightly below that.  Your FT4 is just about exactly mid range.

If you still have symptoms.  You still have some room to increase your T4 a bit.  Or you can add a T3 med and you may find relief.  Both to help get your FT3 levels up a bit more.  You may have trouble talking your Dr. into doing that if they believe in TSH only.  But I would try your best to do that.

[gimel]

Let me try again with that link on symptoms.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

Do you have any of the 26 symptoms listed?

[connie753]

I have fatigue, sometimes fullness in my throat, mild BP, some depression, but mostly I feel very agitated and have anxiety.......which anxiety is not listed.  So that is why my fam dr keeps telling me anxiety is not due to my hypo........but am wondering why would I be elevated on my Vit B12?

[clarebear931]

Hi Connie - one of my worst symptoms of hypoT is panic attacks and anxiety.  Please see this link for a list of symptoms on the Thyroid UK website that includes both of these plus other mental health issues:

http://www.thyroiduk.org.uk/tuk/pages/conditions/thyroid/hyposymptoms.html

[Red_Star]

Causes of high blood levels of vitamin B12 include:

Vitamin B12 supplementation/injection
High dietary intake of vitamin B12
Liver disease (such as cirrhosis, hepatitis)
Myeloproliferative disorders (such as polycythemia vera and chronic myelocytic leukemia)
Hypereosinophilic syndromes (a group of diseases that are characterised by an excessive amount of eosinophils - a type of white blood cell)
Chloral hydrate (sedative used before surgery)

A bit belated lol, but free T3 range should be at least 3.2 and free T4 should be at least 1.2.

.

[connie753]

Hi,

Well besides my TSH, T3Free and T4Free and Vit B12 in which I told you about that in a earlier post.

My antimicrosomal antibiody is     <10      the norm 0-35    

25-Hydroxy D2 (Vit D)              <5.0                              ng/mL
25-Hydroxy D3                          44.3                              ng/mL
25-Hydroxy D Total                  44.3        25.0 - 80.0              ng/mL

Interpretation
80 ng/mL (Toxicity Possible)
80 ng/mL is the lowest reported level associated with
toxicity in patients without primary hyperparathyroidism
who have normal renal function. Most patients with
toxicity have levels >150 ng/mL. Patients with renal
failure can have very high 25-OH-VitD levels without
any signs of toxicity, as renal conversion to the active
hormone 1,25-OH-VitD is impaired or absent.

What do you think about these results?

[flyingfool]

I don't know enough about these other labs to offer a comment.