The call is coming from inside the house, but not from where you think
October 3, 2011 8:39 PM Subscribe
Let's say a patient presents with several symptoms of hypothyroidism and the lab finds evidence TSH that is slightly too high. The patient started taking the Synthroid which returned TSH to the "normal" range (2.74), wouldn't you expect the original symptoms to go away if they were really "better"?
Is there some reason you wouldn't just up the Synthroid dose until the person felt better? Could it have to do with the patient not taking the Synthroid regularly or before food?
Instead of upping the Synthroid, the doctor prescribes an anti-depressant. Is it possible that the patient could have some "other" depression not related to the hypothyroid problem and therefore unaffected by the Synthroid treatment? Or all they nearly always related? (knowing that there are few "always"s when it comes to human mental/physical health.)
Is there some reason you wouldn't just up the Synthroid dose until the person felt better? Could it have to do with the patient not taking the Synthroid regularly or before food?
Instead of upping the Synthroid, the doctor prescribes an anti-depressant. Is it possible that the patient could have some "other" depression not related to the hypothyroid problem and therefore unaffected by the Synthroid treatment? Or all they nearly always related? (knowing that there are few "always"s when it comes to human mental/physical health.)
Oh, forgot to mention: I have hypothyroidism (Hashimoto's Thyroiditis) that is well-controlled--no symptoms at all, normal test results year after year--and chronic depression and SAD that I do my best to manage on my own, since antidepressant medication doesn't do much for me.
posted by WorkingMyWayHome at 8:49 PM on October 3, 2011
posted by WorkingMyWayHome at 8:49 PM on October 3, 2011
The patient might want to get their T4 and T3 levels checked also.
Is there some reason you wouldn't just up the Synthroid dose until the person felt better? Could it have to do with the patient not taking the Synthroid regularly or before food?
I'm not sure what you are referring to by "it". If the patient isn't taking the Synthroid regularly, I suspect the effect would be pretty similar to taking it regularly at a proportionally smaller prescribed dose. (IANA pharmacist, IANA doc, etc.) I suspect that most doctors would not try to fix the problem of their patient not taking their medication regularly by prescribing a higher dose -- if the patient started taking it as directed, they would suddenly be getting more medication than was needed.
There's no reason a person can't have depression as well as one or more other medical conditions. There's not some special mechanism that prevents this.
posted by yohko at 11:07 PM on October 3, 2011
Is there some reason you wouldn't just up the Synthroid dose until the person felt better? Could it have to do with the patient not taking the Synthroid regularly or before food?
I'm not sure what you are referring to by "it". If the patient isn't taking the Synthroid regularly, I suspect the effect would be pretty similar to taking it regularly at a proportionally smaller prescribed dose. (IANA pharmacist, IANA doc, etc.) I suspect that most doctors would not try to fix the problem of their patient not taking their medication regularly by prescribing a higher dose -- if the patient started taking it as directed, they would suddenly be getting more medication than was needed.
There's no reason a person can't have depression as well as one or more other medical conditions. There's not some special mechanism that prevents this.
posted by yohko at 11:07 PM on October 3, 2011
The reason you take it with food and at the start of the day is because of the time-release mechanism. If this isn't done correctly you might have changes over the course of the day, but TSH levels take time to flatten out, and if they have then it's likely not the thyroid's fault anymore. Slightly high levels would likely not produce very strong effects either...
If you take more synthroid/levothyroxin to bring your levels even further down, this will only have a negative effect - effectively simulating hyperthyroidism, I believe.
In short, it's perfectly 'normal' that a person could have some degree of depression regardless of the condition of their thyroid.
posted by MangyCarface at 6:06 AM on October 4, 2011
If you take more synthroid/levothyroxin to bring your levels even further down, this will only have a negative effect - effectively simulating hyperthyroidism, I believe.
In short, it's perfectly 'normal' that a person could have some degree of depression regardless of the condition of their thyroid.
posted by MangyCarface at 6:06 AM on October 4, 2011
The patient might want to get their T4 and T3 levels checked also.
Strongly agreed, but it is FREE T3 and T4 (FT3/FT4) that should be tested -- free, unbound levels of the actual thyroid hormones. Testing the TSH level is pretty meaningless once thyroid hormone replacement has begun.
There is a strong correlation between hypothyroidism and depression, and anti-depressants may not be effective at all if the underlying thyroid issue is not adequately treated. Synthroid is a synthetic T4-only med which, for many patients, is unlikely to resolve all symptoms.
It's well-worth doing some more reading to understand this better. Here's one article to get you started.
Do not settle for less than optimal treatment.
posted by vers at 7:32 AM on October 4, 2011 [1 favorite]
Strongly agreed, but it is FREE T3 and T4 (FT3/FT4) that should be tested -- free, unbound levels of the actual thyroid hormones. Testing the TSH level is pretty meaningless once thyroid hormone replacement has begun.
There is a strong correlation between hypothyroidism and depression, and anti-depressants may not be effective at all if the underlying thyroid issue is not adequately treated. Synthroid is a synthetic T4-only med which, for many patients, is unlikely to resolve all symptoms.
It's well-worth doing some more reading to understand this better. Here's one article to get you started.
Do not settle for less than optimal treatment.
posted by vers at 7:32 AM on October 4, 2011 [1 favorite]
I have had two independent endocrinologists tell me that current standards, during pregnancy anyway, require TSH below 2.
(pregnant with Hashimoto's here.)
posted by kestrel251 at 7:56 AM on October 4, 2011
(pregnant with Hashimoto's here.)
posted by kestrel251 at 7:56 AM on October 4, 2011
Taking too much Synthroid (or any thyroid replacement medication) is hard on the heart, in the sense that you risk swinging the patient over to hyperthyroidism, so most doctors will try to keep the dose as low as they can while getting the patient's numbers/symptoms back into the green zone.
I did finally convince a doctor to try it with me, since my symptoms never seemed to resolve no matter how "normal" my TSH was. We got my TSH down to something like .2 or .5 and...the symptoms were still there. It seems that for me, at least, my symptoms are either affected by things in addition to my thyroid, or just evil and intractable, and pushing my TSH down that low didn't turn out to be worth the racing pulse, etc. that came from the induced hyperthyroidism.
posted by badgermushroomSNAKE at 10:09 AM on October 4, 2011
I did finally convince a doctor to try it with me, since my symptoms never seemed to resolve no matter how "normal" my TSH was. We got my TSH down to something like .2 or .5 and...the symptoms were still there. It seems that for me, at least, my symptoms are either affected by things in addition to my thyroid, or just evil and intractable, and pushing my TSH down that low didn't turn out to be worth the racing pulse, etc. that came from the induced hyperthyroidism.
posted by badgermushroomSNAKE at 10:09 AM on October 4, 2011
A TSH level of 2.74 is not necessarily "normal". Most people with Hashimoto's do better with a TSH around 1.0.
Find a good endocrinologist, and get the levels for free T3 and free T4 back in the middle of the normal range, then see what happens. It takes several months to see the full effects of a particular dosage.
Might want to take the antidepressant, too, while doing that, but don't only take the antidepressant without seeing what six months with a TSH around 1.0 feels like.
posted by artistic verisimilitude at 11:46 AM on October 4, 2011
Find a good endocrinologist, and get the levels for free T3 and free T4 back in the middle of the normal range, then see what happens. It takes several months to see the full effects of a particular dosage.
Might want to take the antidepressant, too, while doing that, but don't only take the antidepressant without seeing what six months with a TSH around 1.0 feels like.
posted by artistic verisimilitude at 11:46 AM on October 4, 2011
Response by poster: Thank you for your answers everyone.
Not being a doctor, it seems logical to me that if lack of chemical X can cause symptoms such as Y, and the patient has symptoms such as Y, you give the patient chemical X and symptoms Y should go away.
Especially since the original TSH results were barely into the abnormal range and the doctor agreed to treat only because the patient was complaining of symptoms. Therefore the patient must have a high sensitivity to the balance of chemicals, right? Therefore perhaps they need more chemical X than other people do.
In addition to depression there are other hypothyroid symptoms still hanging around like sleepiness, sluggishness, weakness, brittle nails, dry skin and sensitivity to cold (and more) but they're all so general it's hard to tell where they really come from. But not being a doctor who am I to say?
Anyway we're going to ask the doctor again armed with this new information. Thanks so much.
posted by bleep at 12:31 PM on October 5, 2011
Not being a doctor, it seems logical to me that if lack of chemical X can cause symptoms such as Y, and the patient has symptoms such as Y, you give the patient chemical X and symptoms Y should go away.
Especially since the original TSH results were barely into the abnormal range and the doctor agreed to treat only because the patient was complaining of symptoms. Therefore the patient must have a high sensitivity to the balance of chemicals, right? Therefore perhaps they need more chemical X than other people do.
In addition to depression there are other hypothyroid symptoms still hanging around like sleepiness, sluggishness, weakness, brittle nails, dry skin and sensitivity to cold (and more) but they're all so general it's hard to tell where they really come from. But not being a doctor who am I to say?
Anyway we're going to ask the doctor again armed with this new information. Thanks so much.
posted by bleep at 12:31 PM on October 5, 2011
More tips:
Stopthethyroidmadness.com , and the author's book are pretty darn thorough about why treating hypothyroidism by just tossing people t4 pills and saying "have a nice day, your TSH bloodwork is in the normal range" is not always going to do the trick.
Also I just discovered this information at 'Real Thyroid' help . By 'real thyroid' I believe the forum people mean, people who take dessicated thyroid (Armour, etc). But even if you don't ever take that stuff, the information there is also a mountain. A lot of people swear by it; I am about to try and find a person who really knows what they're doing with it, because it's often not as simple as 'just take one pill once a day'.
It can be an experiment, that's for sure. The real problem is finding a doctor who is willing to help you experiment until you feel better, whether it's checking all the stuff you can check, or modding/changing your meds so you feel optimal. It may be that you need to take something that isn't strictly thryoid medication, either.
posted by bitterkitten at 6:36 PM on October 6, 2011
Stopthethyroidmadness.com , and the author's book are pretty darn thorough about why treating hypothyroidism by just tossing people t4 pills and saying "have a nice day, your TSH bloodwork is in the normal range" is not always going to do the trick.
Also I just discovered this information at 'Real Thyroid' help . By 'real thyroid' I believe the forum people mean, people who take dessicated thyroid (Armour, etc). But even if you don't ever take that stuff, the information there is also a mountain. A lot of people swear by it; I am about to try and find a person who really knows what they're doing with it, because it's often not as simple as 'just take one pill once a day'.
It can be an experiment, that's for sure. The real problem is finding a doctor who is willing to help you experiment until you feel better, whether it's checking all the stuff you can check, or modding/changing your meds so you feel optimal. It may be that you need to take something that isn't strictly thryoid medication, either.
posted by bitterkitten at 6:36 PM on October 6, 2011
This thread is closed to new comments.
There's no reason why you couldn't have depression and hypothyroidism at the same time.
posted by WorkingMyWayHome at 8:47 PM on October 3, 2011 [1 favorite]