Should I seek a second opinion about possible physiological sources of my fatigue, depression, and anxiety before contacting a psychiatrist?
February 23, 2012 9:08 AM   Subscribe

Should I seek a second opinion about possible physiological sources of my fatigue, depression, and anxiety before contacting a psychiatrist?

I recently saw a general internist regarding three separate concerns that I thought might have a shared physical source. The doctor advised me to contact a psychiatrist to obtain psychopharmacological medication. I intend to follow his advice, but I also wonder whether I should seek a second opinion. (Relevant details (?): I am a 29 year old male, employed full-time in a challenging but not overly stressful job.)

1) For the past six or seven months, and on a daily basis, I have felt fatigued to the point of being unable to perform my normal daily tasks. This seems largely independent of the amount of sleep I get (sometimes I sleep for 8-10 hours, and I still wake up feeling as though I’ve only slept two). However, more often than not, I am having trouble falling asleep or staying asleep for more than 5 or 6 hours. In the past, I’ve functioned without noticeable fatigue on 5-7 hours of sleep a night. Lately, however, I’m OK until about noon, after which point my day is an agonizing struggle to focus on or pay attention to anything. I am so tired that the thought of walking to the subway, making dinner, or even talking to friends seems impossible. I can’t remember ever feeling this kind of sustained fatigue. I am also shocked to discover deep dark circles under my eyes whenever I see myself in the mirror.

2) About four months ago, I discovered a small lump on my neck, just to the left of my adam’s apple. The lump is about the size of a pea. It has never gone away, but it seems to shrink or swell slightly from time to time. There is no pain associated with it, and I can move it with my finger. I have assumed it was a swollen gland, but I am concerned that it hasn’t gone away. A friend suggested that it may be thyroid-related.

3) I have been dealing with pretty severe social anxiety and less severe depression for about the past year. I feel like I have forgotten how to talk to people; in even the most casual social situations, I get so flustered that I literally can’t think of anything to say, and remain silent until I can figure out a way to excuse myself and hide. I don’t speak to anyone at work and I hide from my roommates. I see friends maybe twice a month, and, apart from that, I spend almost every day by myself—waking up, coming into work, and heading home, all the while speaking to no one. The fatigue has aggravated this anxiety: it takes such effort for me to remember how to interact with people, that the prospect seems downright impossible when I feel as tired as I do. I’ve been in talk therapy for about six months, but do intend to contact a psychiatrist and look at medication.

The internist felt my neck and told me that the lump was small, and he was not worried about it (he did not share any guess as to what it might be). He surmised that my fatigue was entirely the result of the depression and anxiety. Then he advised me to contact a psychiatrist. He did a general check-up, but no bloodwork or more extensive tests were performed.

No one here is my doctor or therapist, and I am not looking for a diagnosis. But I wonder whether I should seek a second opinion about a possible physiological basis for my fatigue/depression/anxiety. I am particularly intrigued by the idea that this might be thyroid-related. I am worried that if I go straight to the psychiatrist, I will end up treating the symptoms without identifying the (possible) root physiological problem.

Thank you all so much. Anyone who wants to contact me outside askme may use the dummy email address:
posted by anonymous to Health & Fitness (16 answers total) 6 users marked this as a favorite
you should seek as many opinions as you need until you feel that your concerns have been adequately addressed. From what you describe, I would at least like a second opinion (or a better explanation) about the neck lump, so you might as well get one for the other things as well.
posted by dpx.mfx at 9:19 AM on February 23, 2012

Yes. Seek another opinion. Start tracking your diet as well.

I had the same lump on my thyroid, and same excessive tiredness & anxiety, and nasty cystic acne to boot. I had some depression, too, but that wasn't fixed by this part of what was wrong with me. My problem was due to eating high in MSG & soy meat substitutes. Once I stopped eating those I felt so much better. Apparently, I have a food sensitivity to MSG. I was also told to cut down on my soy intake, because the thyroid issue may be aggravated by it.
posted by kellyblah at 9:22 AM on February 23, 2012 [1 favorite]

Honestly, I would go see another doctor, but leave out the part about depression and anxiety so they don't jump to conclusions and focus on your physical symptoms instead. You might mention that you feel mentally foggy. The alternative would be to see a doctor and make it clear that you're getting treatment for depression, but that you want to rule out any physical causes.
posted by yarly at 9:25 AM on February 23, 2012 [3 favorites]

Yes, you should seek a second opinion with a doctor who will run a complete thyroid panel. I have Hashimoto's (autoimmune hypothyroidism) with multiple nodules and my pre-diagnosis symptoms were very similar to what you are describing.

Medical professionals are sometimes dismissive of men presenting with possible thyroid issues and I hope you find someone who will take your concerns seriously.
posted by last night a dj saved my life at 9:41 AM on February 23, 2012 [4 favorites]

I would suspect thyroid as well. Your thyroid levels can read "normal" (there is a lot of debate of what's normal) and you can have classic thyroid symptoms - which you described. Get blood tests for TSH, T3 & T4 and antibodies. They will likely say they won't test antibodies unless your TSH is not normal. This is your first clue this person knows nothing about thyroid tests (!).

Thyroid symptoms can seem very similar to psychiatric disorders. There is also lots of info on thyroid diets - foods that can trigger thyroid symptoms.

With thyroid nodules, first step is usually an ultrasound and maybe a needle biopsy of the nodule (to test for cancer). They may then ask for a thyroid scan - to read whether the nodule(s) is hot or cold.

Read Mary Shomon's site at She is probably the most patient driven expert on the web. Lots of info and current forums where you may find other's with similar symptoms.

Here's a video of a man who woke up to discover a lump in his throat (it's a little slow - but informative).
posted by what's her name at 9:45 AM on February 23, 2012

Have you thought about getting a sleep study done? It's possible that you are having some sleep issues that are interfering with your ability to get enough rest. Lack of sleep could be causing all of the symptoms that you are listing above.
posted by Leezie at 9:45 AM on February 23, 2012 [2 favorites]

The internist felt my neck and told me that the lump was small, and he was not worried about it (he did not share any guess as to what it might be).

What. The. Fuck?

Second opinion, third opinion, fourth opinion. This sounds like classic thyroid, but even if it isn't, doctors aren't supposed to just IGNORE lumps.
posted by 2soxy4mypuppet at 9:49 AM on February 23, 2012 [4 favorites]

Definitely see a doctor who's willing to do blood work. I agree with others that this could be your thyroid. I was hypothyroid for years, and my problems included fogginess, fatigue, and anxiety. Once I was put on the right medication, I perked up and life became easier.

You might also look at your diet. When I shifted to a focus on protein instead of carbohydrates, I got sharper and more energetic.
posted by ceiba at 9:52 AM on February 23, 2012

Yep, thyroid panel and ultrasound. You want to make sure the lump isn't calcified. Also, for me, same symptoms minus the lump---found out I had significant D3 deficiency. I take 5,000 IUs of vitamin D3 and I can now do cartwheels.

Ok maybe not cartwheels, but I'm not falling asleep. :)

Thyroid controls a LOT of things so go that route before seeing a psyc.

For docs ignoring lumps----always get a second opinion. Mom had "lumps" for years in her breast, doc said fibroids, she wound up with stage IV metastatic breast cancer.

Yes, some docs are asses. Always try to get other opinions. Good luck and feel better.
posted by stormpooper at 9:56 AM on February 23, 2012 [1 favorite]

Strange lumps require further follow up. Another vote for a second opinion here.
posted by bunderful at 10:35 AM on February 23, 2012

Years and years ago I developed a lump on my thyroid, one which was actually visible on my neck. It turned out I had Hashimoto's (it runs in my family) and that was a goiter (ew). I was also feeling terribly run-down, fatigued, couldn't concentrate, my skin was dry as a lizard's and itched terribly... 50 mg of Synthroid cleared everything up nicely.

Go to your doctor and talk about the physical symptoms only (as a poster upthread suggested) because you don't want them focusing on psychological problems. You're tired, run-down, have a lump in your neck...that's what you want to investigate.
posted by Rosie M. Banks at 10:42 AM on February 23, 2012 [1 favorite]

Yes. Change doctors. You want lab tests, and a real conversation with the doctor.

I'm currently a walking example of "probably has Hashimoto's Thyroiditis but maybe has something else!" If you want someone to take your concerns seriously, you need to have a list of them. What has changed? So take note of your bowel movements for a few weeks. Constipated? Straining? Are you feeling cold? Night sweats? Any puffiness in your face? Has your voice become hoarse? Joint tenderness? The DO I saw this week touched my throat in a way that immediately made me recoil. She explained that my not liking my neck being touched since adolescence indicates that this may have been a brewing problem for years. She also checked my deep tendon reflexes, which were pretty much non-existent, and commented on my slow heart rate and low BP. You want a doctor who is going to take all of these things (and more!) into account with your lab work.

I got a full thyroid panel (for the antibodies and everything, since Hashimoto's runs in my family, including a sister) and because that, unsurprisingly looked normal, (I still have some of my outer eyebrows, I've only gained 15 pounds in a year, I can manage to keep my skin soft if I use lotion, I am not a total slug unable to get out of bed on time for work, etc) this week the doctor added a bunch of tests to look at anemia, so if I am anemic they can see what from. Also, complete blood count and complete metabolic panel, to see if my liver, kidneys, etc are affected, or are maybe the cause of all my fabulous symptoms.
posted by tulip-socks at 11:21 AM on February 23, 2012

The first thing a shrink would do is order a thyroid panel, and possibly blood work to check vitamin D levels. Go ahead and see the shrink, he/she will order all the physical tests required before writing you a prescription. This is in the shrink's best interest, he/she will not want to medicate the wrong thing.
posted by crazycanuck at 12:39 PM on February 23, 2012

did they at least take some blood to test you for thyroid issues, anemia, common shit like that? if not, ask for that. cause seriously.

but depression is amazingly fatiguing. crushingly. and you don't even realize it until you don't feel quite so bad anymore. when i am in the deepest pits, going across the street to get pizza is too hard. filling the brita pitcher is too hard. changing the sheets or doing the dishes? so out of the range of possibility as to be laughable.

but, you could be hypothyroid or anemic or something.
posted by misanthropicsarah at 2:08 PM on February 23, 2012

someone I know was experiencing unexplained fatigue and his MD did a series of tests including thyroid hormone, some basic blood tests to get things like iron levels and so on; fatigue is one of those tricky things that can be the result of many things. in my friend's case it was rheumatoid arthritis.

if you are already working on the therapy angle, find a way to get yourself to ask your MD for some blood work. if it helps to write it down, go ahead and do that and bring your note in (or have it with you when you make a phone call).

good luck and I hope the reason for your tiredness is easily fixable.
posted by sciencegeek at 2:45 PM on February 23, 2012

I would get a second opinion on the lump.

The fatigue may be a manifestation of worsening depression, or it may have to do with the lump. I think that's kind of a chicken-and-egg question until you get the lump sorted out.

The lump could very well be a swollen gland, but four months is a long time for that to last, so it's worth investigating why.

Be aware that you may not get a satisfactory answer: I have one in my armpit that has come and gone for more than a decade and nobody knows why. (I'm otherwise healthy.) But get it checked out, and get some bloodwork done, for peace of mind.
posted by elizeh at 8:17 PM on February 23, 2012

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