T4 for depression ? Advice please

Hi everyone . I ve posted before with 9 yrs of symptoms that have gone undiagnosed.

Out of desperation I reluctantly sought help from a psychiatrist who is extremely helpful and prescribed venlafaxine. After taking these for almost a year I an still suffering all the same symptoms . Extreme exhaustion and body feeling like lead being the worst.

On review with my psychiatrist last week, he suggested supplementing my anti d s with t3 ( if my GP will prescribe) .

Today I received a copy of the letter he sent to my GP asking to treat me with t3 or t4 but t4 would be the easier route to essentially make me hyperthyroid . I'm very confused as he said t3 in the review. Also I suspect I was hyperthyroid when all my problems started .

Is this a way forward ? Has anyone else been medicated like this ?

Any advice would be greatly appreciated . X

16 Replies

  • Williiamsa, Were thyroid blood tests done to determine your thyroid levels before recommending thyroid replacement? If so, what are the results?

    Psychiatry does sometimes use high dose T4 or T3 to treat depressed euthyroid patients who don't respond to anti-depressants. Endocrinologists abhor this. Overmedicating a patient to make them hyperthyroid can cause heart rhythm disturbances and cause atrial fibrillation. I wonder why your pyschiatrist didn't prescribe T3 or T4 himself if he thinks it will be beneficial.

    Have you had ferritin, vitamin D, B12 and folate tested to rule out deficiencies which can cause fatigue, muscoloskeletal pain and low mood?


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Hi Clutter , thanks for replying.

    My tsh was 2.54 (0.30 -6.0)

    And my t3 and t4 were lower end of range ( can't find my email with results on ) .

    Ferritin 8 and iron 5 , so quite low.

    B12 way over range

    D slightly below mid range

    Folate ok .

    The reason I went to psych in the first place was due to unbearable heart symptoms .

    Constant fast rate lasting all day . Stopping as suddenly as they started on an increasing daily basis.

    Panic attacks from nowhere even though I was not stressed .

    Palps .

    Extreme shortness of breath on very little exertion .

    Last going off my heart went from feeling strong and pounding to feeling very weak

    Also the unrelenting chronic fatigue and weakness.

    I was sent for heart checks and I knew there was nothing wrong with it , but after months of ongoing worsening symptoms I have become weaker and my heart feels weak and fragile to the point I don't do anything too physical , as now I feel it there is a problem with it as it feels so feeble and feels like it trembles rather than beats.

    I have many other symptoms which I can put up with. I just want my body to feel alive with energy and not feel like a weak lead weight is dragging me down leaving me unable to anything. My brain fog doesn't allow me to process or retain any information so I find it difficult to research and move forward.

    Thank you

  • Williamsa, TSH >2 does indicate your thyroid is struggling and low FT4 and FT3 can cause racing heart, palpitations and shortness of breath. 50-75mcg T4 or 20mcg T3 is likely to be sufficient to make a significant improvement in your symptoms, but more might overmedicate you and cause hyperactivity which can also cause racing heart, palpitations and shortness of breath.

    Ferritin and iron are both deficient which can cause significant racing heart, palpitations, shortness of breath, musculoskeletal pain and muscle weakness. Have you been prescribed iron?

    Vitamin D is optimal 75-200, most are comfortable around 75-100.

    Are you supplementing B12 to have high levels?


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Clutter

    I forgot to say my vit d was 45 I think . I seem to get palps when I try to supplement .

    I don't supplement b12 but was way over the upper range but GP said it was fine.

    I am supplenting iron with spatone as I don't tolerate f fumerate . It's a slow process with spatone though I think.

  • Williamsa, VitD 45 is inadequate. Spray, drops and oil capsules are available if tablet cause palpitations. It is worth trying the alternatives but if you are one of the people who don't tolerate D3 supplements you'll have to rely on natural sun April-September to get your levels up.

    There are better iron supplements than Spatone. Bisglycinate or haem may be worth trying as your ferritin is so low. You can also use cast iron cookware or the Cambodian Iron Fish to leach iron into your food.


    There can be underlying health issues to have high B12. If your GP hasn't done so, he ought to check your liver function.



    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Clutter , I definitely need to improve my iron so I ll look those options up and order some . How long can it take for iron to improve ( how long is a piece of string question there I think) . I seem to be getting lower not improving numbers.

    I've tried sprays and oil capsules , same effect with both. I always try to buy natural , preservative , gluten etc free . So looks like I need a nice holiday somewhere sunny to sort my vit d out lol

    Thank you Clutter your help and patience is really appreciated .

  • Williamsa, improving iron can take months/years. The Cambodia iron fish has restored iron to reasonable levels in anaemic patients in 9 months, I guess through use 3 times a day in cooking.

    Wouldn't it be nice to be prescribed 14 days in a sunny clime to boost vitD :-D

  • In some patients who are refractory to antidepressants (meaning they don't work) the addition of a little T3 makes them work. Nobody knows why this is so but it's an established medical fact and acknowledged by psychiatrists. I believe T4 does not have this effect.

    However, we have a chicken and egg problem, or perhaps a vicious circle. Let me explain.

    You previously posted some blood test resultsL-

    TSH - 2.25 range 0.27 - 4.2

    Free t3 - 3.7 range 3.1 - 6.8

    T4 - 93 range 59-154

    Free thyroxine - 12.3 range 12 - 22

    Your fT3 3.7 and fT4 12.3 are both low (within their reference intervals) and the TSH not elevated. Both fT3 and fT4 contribute to suppressing the TSH so with both lowish one would expect a higher TSH. Thus the pituitary is not producing sufficient TSH. This could be a mild pituitary disorder but two other causes are far more likely:-

    1. You could have autoimmune thyroid disease which sometimes causes a period of thyroid overactivity which you may not of noticed. If this persists for some time it can down-regulate the pituitary TSH secretion.

    2. Perhaps the most likely in your case. Depression can reduce the hypothalamic stimulation of the pituitary. The hypothalamus produces TRH which stimulates the pituitary to produce TSH. In depression the hypothalamus produces less TRH and this TRH usually has reduced bioactivity, i.e. it is less effective.

    So, depression can lead to hypothyroidism and hypothyroidism can produce depression. Which came first the chicken or the egg? Also as one becomes hypothyroid less hormone is produced leading for more hypothyroidism - a vicious circle. A further consequence of a TSH that is a bit lower than it should be is that TSH promotes T4 to T3 conversion. So if L-T4 (levothyroxine) is given the fT3 doesn't increase.

    How to progress? It sounds like a prescription of L-T3 (liothyronine) would be the best option. However, I think a good course would be for your GP to prescribe, say, 50 mcg levothyroxine and then do another TSH, fT3, fT4 blood test about six weeks later. They could then assess how you are doing and see if the fT3 has increased, or pehaps fallen. If the fT3 is no higher then it suggests you need some liothyronine also.

    It strikes me that unless there are obvious personal reasons you are depressed your depression is more likely due to hypothyroidism. Some hypothyroids become depressed some don't. In my case I became very irritable and so other people became depressed - cool!

    Be friendly but assertive with your GP, if he feels he can't follow this course of action insist on an endocrinologist referral (say there is evidence of pituitary failure - they are supposed to refer in this case). I don't think an endocrinologist can be of any more help, it just requires a theraputic trial of thyroid hormone. However, if mild pituitary failure was suspected they could do blood tests for other pituitary hormones, although I don't think you have a pituitary problem.

    Please note I am not a doctor, I just spent a decade of so trying to getting to the bottom of my own hypothyroidism.

  • Hi Jimh111

    Thank you for all the info . It's good to see it all laid out clearly, so thank you for that . I will pay for another thyroid panel and see what that brings up and then hopefully my GP will prescribe the Levothyroxine.

    Are you feeling better now ?

    With depression .... after the birth of my last child 9 yrs ago I suddenly became extremely exhausted , struggling to function , even speaking was an effort some days. I lost 2 stone in a couple of weeks despite constantly eating for energy and trying to keep awake . I could have slept for 24 hrs and it felt like I hadn't slept for a minute.

    Prior to this I was an extremely fit gym bunny . Never sat still , always doing something. Never went to the doctors and never worried about my health despite my father dying when I was 25.

    But my doctor who is my mother's neighbour had different ideas . He decided I was just depressed , just had a baby , my age etc etc , despite knowing my history of no medical problems . He has then influenced every doctor/ consultant I have been to see both in the NHS and privately.

    I've wracked my brain with what it could be . My c section , the haemorrhage after . Was I missing a vital "something"

    I have changed surgeries 3 times and they seem very helpful until they receive my notes !

    Like you I too became irritable lol and eventually years later very depressed as I have lost all that time watching my life pass me by with no hope of change.

    People think I'm just "in a rut" , I "don't try hard enough" or I'm "just a weak person" . If only they could spend a week in my body (and a lot of other people's bodies who are struggling with all this too ) .

  • I'm a great deal better now thanks. I agree with Clutter and Shaw in that you probably need T3. However, from a diagnostic point of view it would be useful to try levothyroxine first, to see what effect it has on your fT3 and fT4 (wait a good six weeks before trying a further blood test). Also, because you have heart symptoms it is better to start off on levothyroxine, if only to gently get your body used to more hormone as it appears to have been deprived for a long time.

    I take a different view on not taking hormone for 24 hours before a blood test, I'd go for 8 hours as it will give a more accurate indication of average levels, especially T3. I understand why it is done, doctors are reluctant to prescribe unless the TSH is above 10 which is silly. Waiting 24 hours makes the TSH higher. In your case the problem appears to be that the TSH is too low compared to your fT3, fT4. Taking action to make the TSH assay report a higher figure would be shooting yourself in the foot. In any case I believe you are not on any thyroid medication at the moment so it doesn't apply for now.

    Normally I would say don't bother about another blood test but as it has been five months since the last one it may be useful but you can skip it if finance is a problem. You would only need TSH, fT3, fT4. It's been so long since your condition started any antibodies may have disappeared so there's not much point in trying to measure them.

    Your psychiatrist says he can’t prescribe liothyronine? Liothyronine is used in psychiatry when patients are refractory to antidepressants. It would seem your psychiatrist needs to see a psychiatrist.

  • Wiliamsa, Sheehan's syndrome is a likely culprit mayoclinic.org/diseases-con...

  • I agree with Clutter - why doesn't the psychiatrist prescribe liothyronine for you (T3) as I am sure you'll benefit enormously if you have been diagnosed for ages.

    Most of your clinical symptoms do sound hypothyroid. I myself had my heart jumping etc due to lack of thyroid hormones as I too was undiagnosed. It's not pleasant at all.

    Proper thyroid hormones will make you feel much better.


    T3 is the Active hormone our body needs to function. It is required in every receptor cell. T4 is the inactive hormone and should convert to sufficient T3 but sometimes doesn't and if you were hypo your body doesn't produce sufficient hormone to do so so that might well have contributed to 'depression'.

    When you go for your next blood test for your thyroid gland. Make the appointment as early as possible and fast (you can drink water). If you are on thyroid hormones leave about 24 hours between the last dose and your blood tests. This helps the TSH to be at it's highest as it varies throughout the day and most doctors only take this into account and diagnosis upon it and don't think about FT4 or FT3.

    I hope you feel better soon.

    "I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions"

  • Hi Shaws

    My psychiatrist said he was unable to prescribe ? I asked him if GP won't prescribe can he prescribe privately and he said he couldn't , he could only oversee the use and effect of the drug .

    How are you now ?? Are you back to good health ?

    Yes the heart problems are really horrible . The anti d s seem to mask how much the heart is "upset " , but I don't know what's worse as sometimes I think it could be more serious than it feels .

    Thank you for the link and tips , I ll follow your advice on the next test. I'm sure I didn't fast on my last thyroid test .

    It's so good to have knowledgeable and helpful people to turn to for advice on here .

    Thanks again !

  • Maybe our psychiatrists have been told as well as the Endos not to prescribe T3. It might be due to the fact that the only licenced UK T3 is exhorbitant in price. You can source your own but some don't want to do that.

    Yes, I am well now, thankfully, and am on T3 only now.

    I hope you get better quite quickly. Fasting etc are quite new hints as it appears eating lowers TSH and they diagnose only by the TSH and ignore/don't know clinical symptoms.

  • Is it a Psychiatrist or Psychologist? In the US, Psychiatrists can prescribe, but not the other. I think you need thyroid antibody testing, t3 and no psych. meds..i don't know how helpful this doc is, unless they can get you ordered the right tests. Your symptoms are caused by a physical condition.

  • t3 is used for depression, not t4.

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