Thyroid Disorders Community
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Information on hypothyroidism and depression

Several members have asked questions about depression recently. This article from the NIH gives a good explanation of the relationship between hypothyroidism and depression. It also lays out a pretty good explanation of the various types of hypothyroidism in general. The section on testing is somewhat obsolete, especially in regards to T3 testing. FREE T3 is the test that is found to be most accurate. But it does state that combined T4-T3 therapy is helpful for some people. I hope members will find it helpful.

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Avatar universal
Free T3 is the biologically active thyroid hormone that largely regulates metabolism and many other body functions.  Scientific studies have shown Free T3 to correlate best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

Your Free T3 is below the midpoint of the range, which is frequently associated with having hypothyroid symptoms.  The range is far too broad since it was erroneously established.   Sources refer to the upper half of the current range as being the actual functional range.  Many of our members, myself included say that symptom relief for them required that Free T3 was adjusted into the upper  third of its range and Free T4 adjusted to around the middle of its range.  

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, and especially not just TSH results.  

You can gain some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with from a distance after an initial evaluation and tests.  The letter is sent to the PCP of the patient to help guide treatment.  


In the letter please note the statement, "the ultimate criterion for dose adjustment must always be the clinical response of the patient."  Also note that the doctor frequently prescribes T4/T3 type meds because  many patients do not adequately convert T4 meds to T3. He uses whichever type of med works to relieve symptoms for the patient.

So with your hypo symptoms, I suggest that you need to increase your Free T3 level.  Since you seem to be converting T4 to T3 adequately so far, increasing your meds should work to accomplish that.  With Hashimoto's, while thyroid function continues to be destroyed, you may well need to gradually increase your meds to maintain levels that will relieve symptoms.

If you haven't been tested for Vitamin A,D, B12 and ferritin, I suggest that you should do those as well.  Hypo patients often find they are too low in the ranges for those tests as well.  

Avatar universal
I posted this for everybody but especially for you
200220 tn?1361955154
I tried to bring up this web site and it wouldn't go through.  Have you tried it lately?  I just can't seem to get my hashimoto under control.  My endo has increased my tirosent from 50 mg to adding an extra one once a week.  I actually seem to feel worse.  I am really tired, I think from stress and it seems that I am having issues with depression.  Also my hair was falling out - not a lot but as I walked it would just fall on my shoulders.  I am so discouraged that I have been fighting this for over 5 years and it still doesn't seem to get resolved.  Is this something I will never get straight or is it possible to get hashimoto stable?  
1671473 tn?1450596037
Yes I've been hypothyroid since 4yrs , @ 4yrs taking my medication well  a lot of changes  especially the symptoms. Sometimes got strange symptoms I always worried is this hypo symptoms or a side effect.
My strength/ stamina, become low unlike when I was not hypothyroid.
Depression @ my depression are always there but not too much as long I can handle I fair is always there.
One thing I want to know and trying find my self  is about my symptoms goes up & down. Normal the other day not good I feel weak.
The important as long I have my maintenance pills @ & I can move all the time, my mind are clear that wil be great.
1671473 tn?1450596037
@____# Thanks to this site I learn more,
Sometimes when my depression attacking or I feel nervous / all my joint are painful especially if I am constipated and a blurry / cloudy vision  so tendency I'm gonna panic, & depress again,
I always read all post here.
For now I feel a lot of strange symptoms because it's been 7months not checking my blood works I only take my medication daily, I have no  health benefits yet here in VA. I'm trying to figure it out to find a public health but seems Im only 6months staying here in US  there's some requirements needed.
Avatar universal
Yes, the link works fine for me. You typed it into your browser ? Links do not connect directly on this site, you have to type the information in. If it still doesn't work for you, this is the title and source of the article, perhaps you can Google it:

"Hypothyroidism Presenting As Psychosis: Myxedema Madness Revisited."
Thomas W. Heinrich M.D. and Garth Graham MD
published in The Primary Care Companion to The Journal of Clinical Psychiatry, 2003,5(6) 260-266

Have you posted your latest lab tests along with their ranges ? Depression is primarily responsive to T3. The article will explain to you how that works. Tirosint is a T4 medication. It sounds like you might need T3 as well, but it is not possible to say without seeing your labs for FREE T4 and FREE T3.
I can tell you that while I don't have Hashimoto's antibodies, my sister has Hashimoto's and other than an occasional flare up, she has been stable on her meds for a long time and feels well. Before she was properly diagnosed  it was suggested that she might have rheumatoid arthritis or lupus because her joints and muscles were so sore she couldn't get out of bed sometimes and she has 4 KIDS ! He doctor had her go off all sources of gluten for about a year, during which time she did all her own baking and cooking. After a year, she was able to gradually introduce gluten products back into her diet and resume her regular routine. This, along with the proper level of medication, cured the joint and muscle pain.

@Paus. If your symptoms go up and down, have you been tested for Hasimoto's antibodies ? This is an important screening test for thyroid problems for everyone, but for someone whose symptoms fluctuate, I would think it would be crucial. You should also test FREE T4 and FREE T3 when you test your TSH. All the symptoms you describe...EVERY one...are symptoms of under-medication. I hope you can get your health care situation sorted out, it sounds like you need your medication adjusted.

A really good source for information on thyroid that is most current with research science is "The Thyroid Solution" by Dr. Ridya Arem M.D. It has been very helpful to me, and I recommend it.
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