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Are you followed by an Endocrinologist? If not, I would suggest that you do and have labs done to see where you are at since you have adjusted the medications. You not only need a TSH (almost worthless), but a Free T3 and Free T4, as well as other labs which will give the doctor more info if you need Cytomel or not.
If you do come off the anti-depressants, do it under doctor's advise and taper slowly.
I do well on T4 only. Some people don't.
T4-only meds like Synthroid do NOT work, exclaim many patients!...
"And what do uninformed doctors do for the symptoms you might continue to have, or seem to acquire the longer you stay on T4-only meds?
They put you on anti-depressants, statins, pain meds, blood pressure meds, and all sorts of bandaid medications to cover the effects of a poor thyroid treatment, which include chronic depression, anxiety, weight gain, the need to nap, aches and pains, rising cholesterol or blood pressure, heart problems, “Chronic Fatigue Syndrome”, “Fibromyalgia”, bi-polar, anxiety, hair loss, dry skin or dry hair… to name just a few.
When you mention your poor energy levels, they tell you to “exercise more”. When you mention your weight problems, they tell you to “eat less”.
And the worst thing they’ll say when you continue to have, or suddenly find yourself with, symptoms of a thyroid disorder? “It’s not your thyroid. Your TSH is normal, and you’re optimally treated.” :("
Red while I appreciate your comment, i do indeed have depression, i almost blacked out. the thyroid surgery itself did something they could have cut my vegas nerve while in there, whatever happened my seratonin levels remain low, you must understand this, it is not just the thyroid, but i will ask my doc about cytomel or T-3. T-4 actually converts to T-3 but its a long chemical process. I have a masters degree in health care so i've done all my homework, thyroid drug alone does nothing for me, i have depression since the surgery, so my case is a bit different and shows DO NOT get thryoid surgery if you can help it, get the iodine treatment for a nodule removal which is what i had. I had a hot non cancerous nodule
Here is some info if you haven't found it already from Integrative Psychiatry's article on serotonin...
"Once your natural serotonin levels are low enough to cause syptoms it is very difficult to significantly raise serotonin levels enough by food alone. SSRI's or selective serotonin reuptake inhibitors and SNRIs, serotonin and norepinephrine reuptake inhibitors do not actually increase the amount of serotonin molecules in the brain. SSRI’s are thought to block the reabsorption (reuptake) of serotonin by certain nerve cells in the brain. This theoretically leaves more serotonin available in the brain. However if you have low serotonin to begin with these medications either will not work well, or work for a while then "poop out".
Natural serotonin supplements are likely to be the most effective means to raise serotonin levels in the brain while being safe and without the side effects of anti depression medications. Derived from seeds of Griffonia simpicifolia, a native African plant, 5-HTP, or 5-hydroxy tryptophan, is a safe dietary supplement that introduces higher levels of tryptophan into the blood stream which then enter the central nervous system and facilitate the needed synthesis of serotonin.
Lifestyle Changes to increase Serotonin:
Get plenty of exercise (30 minutes at least three times a week)
Eat regularly throughout the day.
Get plenty of natural sunlight
Manage stress and negative emotions
Get 6-8 hours of quality sleep a night
Set time aside for fun and relaxation
Take a multivitamin daily
Prayer and Meditation
Take a serotonin supplement"
Depression is a known symptom of low thyroid. Is it the only cause for depression? certainly not.
But it is AWEFULLY coincidental that when you have half of your thyroid removed and you then become depressed that it would seem at least possible that the depression could be related to insufficient thyroid.
T4 only does not work for everybody. But it is also possible that you simply were under medicated with the T4 only dosage.
the Free T3 hormone is what is actually used at the cellular level which I'm sure you already know. If there is not sufficient T4 or if you body is not properly or efficiently converting the Free T4 in you blood, then there won't be enough Free T3 to do its job.
So whether you get to the proper Free T3 level required for you to feel well by T4 only with good conversion, or the need to add some Cytomel T3 in order to get there doesn't really matter.
Many people here who have been on anti-depressants were able to either reduce or completely wean themselves off of the antidepressant medication. Will that be the case for you remains to be seen.
To best help if you had your free T4 and Free T3 levels labs and could post them along with the reference ranges that would be great.
The reference ranges have been established by statistical mathmatics and do NOT represent optimal ranges. They vary from lab to lab and the ranges ONLY show were 95% of the people tested for the particular test (whether or not they were symptomatic) fall.
Many people have found that a much better target or rule of thumb in order to feel well they need to have BOTH of the following:
1) Free T4 to be 50% of the range or slightly higher
ANd- that means in addition to
2) Free T3 to be in the UPPER 1/3 of the range which is 66.7% of the range.
Every person feels well at different levels, so the best approach is to start low and slowly add dosage and get retested frequently. Also if taking both synthetic T4 and synthetic T3 or any multiple medicine to only change one dosage at a time. Labs and clinical symptom response is all important, using the labs as a guide to see the effects of the dosage changes and how they relate to symptoms.
Also, T3 only protocol is unusual. It is usually only used to counter a Reverse T3 dominance problem and even that is highly controversial.
Do you have other "hypo" symptoms other than depression?
It is common for people to be deficient in Vitamin D3, B-12 and often if fatigue is an issue Iron and Ferritin.
Again the reference ranges are not that accurate. In many countries for example the B-12 range does not even start at the low end until 500 while many places in the USA the low range starts at as low as 200. Many people report that they do not start feeling well until their B-12 is at about 800 or above.
Just my thoughts.
I agree with everything flyingfool said. In addition, if you have any other endocrine disorders (e.g. adrenal insufficiency - either primary or secondary), this would complicate matters worse by having some of the same symptoms, yet one disease couldn't completely be treated until the other one was, but you have to start somewhere.
I always suggest to keep copies of your records and labs and look for trends to see if there are any triggers as well.