# HypO with Hashi's and Depression.....



## Jya1124 (Oct 1, 2011)

I'm so exhausted I can barely type this. Supposedly my thyroid is regulated and in the "normal realm" but I have had crying spells, anxiety and irritability a lot lately along with being tired. I Was searching medical journals and came accross this one but im new to everything I Was only diagnosed a month ago....can someone explain what they are talking about in this article???

Hypothyroidism and depression: a therapeutic challenge
SK Rack and EH Makela
Abstract

OBJECTIVE: To describe a patient with longstanding depression and hypothyroidism who had marked mood improvement only after triiodothyronine (T3) was added to her thyroxine (T4) replacement therapy. CASE SUMMARY: A 50-year-old white woman had a long history of depression and documented hypothyroidism since 1991. Despite treatment with T4 with dosages up to 0.3 mg/d, she continued to be depressed, have symptoms of hypothyroidism, and have a persistently elevated thyroid-stimulating hormone concentration. Addition of a low dose of T3 to her regimen resulted in significant mood improvement. DISCUSSION: The relationship between hypothyroidism and depression is well known. It is possible that this patient's long history of depression may have been a consequence of inadequately treated hypothyroidism, due either to poor patient compliance or resistance to T4. Nevertheless, her depression responded to addition of a low dose of T3 to her regimen. This case emphasizes the importance of screening depressed patients for hypothyroidism. Her clinical course also suggests that depression related to hypothyroidism may be more responsive to a regimen that includes T3 rather than to replacement with T4 alone. This is consistent with the observation that T3 is superior to T4 as adjuvant therapy in the treatment of unipolar depression. CONCLUSIONS: Depressed patients should be screened for hypothyroidism. In hypothyroid patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone. Therefore, inclusion of T3 in the treatment regimen may be warranted after adequate trial with T4 alone.

http://www.theannals.com/content/34/10/1142.short

Thanks for the help! This is awful! I feel so hormonal (


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## northernlite (Oct 28, 2010)

Please get your last bloodtest results from your doctor and post them here. We can help. A lot of us battle the "your blood results are normal" with our doctor even though we do not feel well yet. The normal range for TSH should be 0.3-3.0, many labs are still using a range with a higher max and doctors are calling those ranges "normal". I am significantly symptomatic when my TSH =2.0 which is "normal" by even the new range. By symptomatic, I mean fatigue and mood issues. I have to get my TSH closer to 1.0 for those to be symptom free.

Standard hypothyroid treatment is levothyoxine which is T4. There are some people that take a T3 medication with their T4, a few take T3 alone and there are quite a few people that take a combo medication that includes T3 and T4. If your body doesn't adequately convert T4 to T3, a T3 medication is beneficial to you. The person in this study benefited from the addition of the T3 to her medications.

Share your test results with us. If you were only diagnosed a month ago, I highly doubt you have found your optimal dose of T4 or that your body has had the time to heal and regulate itself. It takes a long time and a lot of attention to get it right. I have been at this for 11 months and know where my optimal level is but am not quite there at this point.


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## Jya1124 (Oct 1, 2011)

My FT4 on august 31 was .36 normal being (.59-1.17) NG/DL

TSH 8/31 was 25.70 normal being (.34-4.82) UIU/ML

Thyroglobul AB was 309.9 normal being equal to or less than 60

Thyroid pero AB was 149.2 normal being equal to or less than 60

All I got back for my second labs so far is that as of sept 27 my tsh sensitive is now 2.41.

They did more test to test for graves with hashis so I'm waiting for those to come back now. I'm on 75mg of synthroid 1x day right now.

Thanks for helping!!!!


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## northernlite (Oct 28, 2010)

Wow you started with a high TSH and a FT4 out of range!

It takes 6-8 weeks for the T4 levels to level out in your body. Your TSH might not be as low as it is going to go yet on 75 mcg. In addition, my personal experience was that I often experience improvements in my symptoms another 3-4 weeks after that.

My situation was the same as your that I just got a letter after my first blood draw that my numbers were now normal. I called and got a copy of them sent to me. My TSH was in the low 2's and I was still quite symptomatic. I made another appointment went to see my doctor and sat there and explained it to her until she let me try an increase. I dropped to a TSH of 0.8 and was symptom free.

Right now I am at TSH of 1.85 and am fighting a little fatigue, I am changing doctors because I am tired of battling with mine for the increases I need.

Try to get your doctor to run a Free T3 (FT3) test also next time. That is the test that tells you if your body converts T4 to T3 well enough and gives an indication of whether or not you might need to add a T3 medication in the future.

It sounds like a TSH of 2.41 although "normal" in even the new ranges and particularly in your labs ranges, is not low enough for you. If you still feel the way you do in another2-3 weeks. I would make another appointment and tell them you still feel you are undermedicated. It is a hard sell with a lot of doctors, mine included.

Your body has a lot of recovery to do from that high TSH and antibodies, try to just take care of yourself, limit your activities as you can, rest a lot and try to be patient. Give the T4 a chance to work for you and really study your FT3 response before you try to jump to a combo medication or adding a T3.


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## Andros (Aug 26, 2009)

Jya1124 said:


> I'm so exhausted I can barely type this. Supposedly my thyroid is regulated and in the "normal realm" but I have had crying spells, anxiety and irritability a lot lately along with being tired. I Was searching medical journals and came accross this one but im new to everything I Was only diagnosed a month ago....can someone explain what they are talking about in this article???
> 
> Hypothyroidism and depression: a therapeutic challenge
> SK Rack and EH Makela
> ...


Welcome, welcome!









Absolutely! And I like that link; I bookmarked it.

Have you had these tests?

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.
http://www.drlam.com/articles/hypothyroidism.asp?page=3

Okay; I found your other post w/labs but the FREE T3 is a must.


```
Thyroglobul AB was 309.9 normal being equal to or less than 60

Thyroid pero AB was 149.2 normal being equal to or less than 60
```
I strongly advise you to get a sonogram or ultra-sound. Your high titers of both antibodies are strongly suggestive of cancer.

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419

Try taking Selenium, 200 mcg. per day. (note mcg; not mg) This helps to convert T4 to T3. This should help w/depression.

http://www.thyrophoenix.com/selenium.htm


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## Jya1124 (Oct 1, 2011)

I am meeting with endocrinologist on october 27, so I am sure he will do the free testing and the ultrasounds. They think I may also have graves disease with Hashimoto's so they are testing for that too. As far as someone saying that it sounds like I have cancer wouldn't they be able to tell from regular labs that they are running? I read that abstract but im not understanding why you would say that. That really worries me.


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## Octavia (Aug 1, 2011)

Jya1124 said:


> As far as someone saying that it sounds like I have cancer wouldn't they be able to tell from regular labs that they are running?


Welcome to the forum!

Regarding your question...Not necessarily. For many of us post-cancer people, our thyroid lab results were "normal." Mine were. What prompted me to get tested was a visible lump in the front of my neck. When my labs were normal, my doc sent me for an ultrasound, which, not surprisingly, showed a large-ish thyroid nodule. Next step was a fine-needle biopsy (FNA - Fine-needle Aspiration), which was suspicious/inconclusive, leading to the need for surgery, which then showed the cancer. Often, they can't tell whether you have cancer until you get half of your thyroid out and the pathologist takes a thorough look at the tissue.


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## Andros (Aug 26, 2009)

Jya1124 said:


> I am meeting with endocrinologist on october 27, so I am sure he will do the free testing and the ultrasounds. They think I may also have graves disease with Hashimoto's so they are testing for that too. As far as someone saying that it sounds like I have cancer wouldn't they be able to tell from regular labs that they are running? I read that abstract but im not understanding why you would say that. That really worries me.


I like to cover all the bases. If I withheld from you or anyone something that I know should be looked into, that would make me a not very nice person.

No stone should be left unturned and I absolutely do not want you or anyone to have cancer. But, we "all" need to know. Better safe than sorry.

I said it because you should not have any Thyroglobulin Ab and if you do, it raises suspicion.

Also, Graves' and Hashi's increases the chances.

Graves' and Hashi's cancer
http://www.thyroidmanager.org/Chapter18/18-cancothr.htm

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)


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## joplin1975 (Jul 21, 2011)

Octavia said:


> Welcome to the forum!
> 
> Regarding your question...Not necessarily. For many of us post-cancer people, our thyroid lab results were "normal." Mine were. What prompted me to get tested was a visible lump in the front of my neck. When my labs were normal, my doc sent me for an ultrasound, which, not surprisingly, showed a large-ish thyroid nodule. Next step was a fine-needle biopsy (FNA - Fine-needle Aspiration), which was suspicious/inconclusive, leading to the need for surgery, which then showed the cancer. Often, they can't tell whether you have cancer until you get half of your thyroid out and the pathologist takes a thorough look at the tissue.


Just underscoring what Octavia said...

My labs, too, were mostly normal (subclinical hypo based on TSH alone -- t3 and t4 were normal)...my GYN found a lump in my neck...ultrasound found three nodules on the left lobe...none on the right...RAIU more or less showed the left side of the thyroid as non-functioning...FNA was conclusive for papillary cancer...but the interesting thing was that post TT path showed I had nodules on the right side that were also cancerous, in addition to three lymph nodes that were cancerous.

All these tests can indicate cancer, but nothing is conclusive until they have the cells to examine (which might via a FNA or via a partial or total removal). Your labs are certainly suspicious and I think what we are all saying is eliminate the possibility of cancer first, then go from there.

Good luck!


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## Jya1124 (Oct 1, 2011)

Thank you all. I don't have graves my doctor called to let me know that today. She did say that there was no test they had run that would show cancer so I'm hoping my endo will do those tests. Is that the normal procedure or do I have to request it?


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## joplin1975 (Jul 21, 2011)

Outside of surgery during which a full path of your gland can be done, the only other test that would have the most likelihood of determining cancer (I say it in this way because some people get inconclusive results) is a fine needle aspiration (FNA aka a biopsy). They also need to do that to formally dx you with hashi's. Your endo may do it or s/he may send you to a surgeon.


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