Thyroid UK
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Could I be hypo if no symptoms aside from lethargy and depression?

Dear all

I am new to this forum. I have been doing a lot of reading on hypothyroidism and am wondering if I may be a sufferer.

I have been depressed for a good five years. Not seriously, luckily, like in bed all day every day. I mean I do have the occasional good day. But in general my mood is low to rock bottom. I am tearful at least once or twice a week. My mood can go from 2/10 in the morning to 8 or 9/10 in the evening. So it's not a persistent low mood; rather a lot of swinging, with a general preponderance for low mood and negative thinking. I also have anxiety. And I feel tired often. I have no energy much of the time, and feel like afternoon naps. These are the only symptoms I have. I am desperate to find out why I am like this. My depression has cost me a 19-year relationship, as well as thousands of pounds on therapy and supplements (multivitamins, EPA, SAM-E, 5-HTP, St John's, you name it, I've tried it and been bitterly disappointed every time).

Three months ago I had TSH 4.25 and T4 13.1 No other tests were done. I went back two weeks ago for another round of tests, this time including antibodies. TSH was now 2.6, T4 unchanged, antibodies negative.

I went to the GP and told him I thought these results warranted further tests. TSH may be in the 'normal' range but it's certainly not optimum. (In the US they treat you for hypothyroidism if TSF is above 2.5 and you're symptomatic.) And T4 is at the low end of normal. I asked him to do tests for FT3 and rT3 and he refused point blank. I pointed out that I may have an inability to convert T4 to T3, and that an FT3 test would answer this, and still he refused. Worse, he tells me that if I have the tests done privately and the FT3 is low or rT3 is elevated, he still won't give me T3 medication.

So, some questions. I hope somebody can help.

1. Given that depression and lethargy and lack of energy are my only symptoms, could I have hypothyroidism? Or am I barking up the wrong tree?

2. Is it worth paying for the T3 tests myself?

3. Is it worth looking for a new GP, or will s/he likely be just as reluctant to investigate my depression?

Thanks for reading.

17 Replies

Welcome to our forum Margalick

I am sorry you've been troubled for years with depression and you could be hypothyroid. The problem is that doctors have been directed only to diagnose us by the blood test results and do not know or ignore clinical symptoms, of which one is depression. There are about 300 clinical symptoms roughly in hypothyroidism.

Unfortunately in the UK the guidelines tell doctors to wait until the TSH reaches 10 - and some never reach that number. Some do prescribe in TSH is over 5 with clinical symptoms. I shall give you a couple of links:

When you put your results it is helpful if you can put the ranges too as labs differ throughout the country and it makes it easier to comment.

Ask GP to test your Vitamin B12, Vit D, iron, ferritin and folate as we can be deficient which can also cause problems.

Levothyroxine (also called T4) is a synthetic thyroid hormone which once swallowed should convert to liothyronine (T3). This is the active hormone required in all of our receptor cells and our brain contains the most so I think that's why some are diagnosed as depressed because the doctor hasn't done a FT3 test but doctors are told FT3 isn't necessary but you will see from thyroiduk's blood tests above the para relating to FT3.

You can get a test yourself for FT3 and in the above site there is a list of labs and if you put a Code No. you get a small discount.

For the next thyroid hormone blood test have the earliest possible and fast (you can drink water). If taking thyroid hormones, leave about 24 hours before the blood test and take afterwards.

Some members source their own thyroid hormones but you would have to put up a new post asking for a Private Message as it is against the Guidelines to post on the open forum.

Levothyroxine is the usual thyroid hormone prescribed and many do fine on it and have no problems converting but others do and the addition of T3 to T4 might be helpful. Others, of course, may have to take a natural dessicated thyroid hormone or T3.


Thanks for your message.


What care has your doctor given for your depression? Have you been referred to a psychiatrist?

Hypothyroidism can cause depression. More to then point depression can down regulate the pituitary so that you produce less TSH and hence less T3, T4. Additionally antidepressants sometimes do not work until a little liothyronine is prescribed. really this is beyond a GP and requires a specialist.


Hi. All the doctor has ever done from day one was stick me on his favourite antidepressant. I've tried several. They seem to have some impact but symptoms always return when I come off them, usually after around a year. Currently starting on sertraline yet again, 100mg. Two weeks so far. Doctor never suggested a psychiatrist or even mentioned my thyroid. I had to bring it up.


Magarlick, TSH >2.0 does indicate your thyroid is struggling and FT4 13 is usually low in range which in turn can cause low FT3 but NHS won't make a diagnosis of hypothyroidism until TSH is over range, or FT4 below range. FT3 isn't commonly tested unless TSH is suppressed <0.03 and I don't think rT3 is tested on the NHS but as you aren't taking Levothyroxine it is highly unlikely you will have high rT3.

Time of testing is crucial. TSH is highest early in the morning and lowest in the afternoon. Future testing should be early in the morning and you should fast, water only, as TSH drops post-prandially.

You can order private thyroid tests but it is unlikely your FT3 will be below range when FT4 is 13. Poor conversion is indicated by low TSH, high FT4 and low FT3 of patients taking Levothyroxine.

Supplementing 200mcg selenium and Nutri-Thyroid may improve thyroid 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.


Thank you so much for that. How sad that no solution will be forthcoming unless I shell out for private care. I currently take a multivitamin which includes 100% RDA of iodine and selenium. Have been for years. 200mcg of selenium is 400%. Is it really worth giving that a go?


Magarlick, you're unlkely to find a private endo who will diagnose hypothyroidism until TSH is >3.0 either. Multi-vits are fine for healthy people supplementing diet but they don't contain enough of anything to help people who are unwell or with deficiencies. What do you have to lose by trying 200mcg selenium for a few months? Even a small improvement in thyroid function should improve wellbeing.

You might ask your GP to test ferritin, vitamin D, B12 and folate. Low levels can cause musculokeletal pain, fatigue and low mood similar to hypothyroid symptoms.


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.


Thank you, I am much obliged.


A TSH of 4.5 and your low t4 are indicative of hypothyroid and yes your symptoms do scream hypothyroid but will be exacerbated by low levels of




Vit d3

all of them must be HALFWAY in their ranges

These and the depression etc can start years before any doctor will admit you are hypothyroid

Without antibodies the BTA and RCP have decreed that you cant have treatment till your TSH is over 10 yet with antibodies the cut off is 5.0

Your only option will be to get above tested and correct the levels and then self treat with NDT


Thanks so much for your reply. What's NDT? Can I still test low for D3 and B12 given that I take a multivitamin with 100% RDA B12 in it, as well as a huge dose of D3?


Yes you can. The deficiencies originate from hypothyroid slowing the body down, including the digestion. So you may not be absorbing well from what you eat.

Generally, a multivitamin is in no way a magic bullet. It's a low dose tablet intended for people who are eating a healthy diet and are basically healthy, just to maintain and keep things balanced. It won't help you at all if you have a deficiency in any of these nutrients. Many deficiencies will take months or years to correct even on a very high dose treatment, often taken via a more effective route than straight into the stomach.


Do you take an antidepressant? I would find a good psychiatrist if not as well as a new GP who will listen to you. Could very well be hypothyroid. Do you have a weight problem/difficulty losing weight? That could be a symptom of either depression or hypo as well.



You said your symptoms always come back after stopping your antidepressant. If it was working, why did you stop it? Sometimes people are on it for life. Also every time you stop it and then start it again it is harder to get the same relief you had. If one works, stay on it.


That's certainly the case with me. Violent mood swings with horribly depressed phases in between, so a yummy combination of buproprion and lithuim for me. I think of it in the same way as I think of taking my thyroid meds: I need to take them because something has gone wrong with my brain chemistry; I need to take them because something has gone wrong with my thyroid function.


Hose1975 and Dexter 1: thank you both.

I did find that the antidepressants helped, but came off them after I'd felt better for six months (as is often suggested). The depression always comes back a year or so after stopping. Hose1975, my girlfriend has said the same thing: if they work, just keep taking them and accept that you need to be on them because of a brain chemistry issue.

Thanks again to you both and everybody else who has replied. I am humbled and heartened.


I know this is a complete sideswipe, but have you tried testing for food allergies? Food intolerances can cause the most invidious problems, and can exacerbate any and all underlying conditions as well as cause illnesses in their own right. the subject of allergies and intolerances is treated with a kind of patronising dismissal often, but on reading your post it is obvious you are suffering from depression (classical signs). The thing is, treating the depression symptoms themselves hasn't helped in the long term.

A holistic approach would be your best bet, I'm thinking. You are working on the thyroid issue, which is good, and will get massive amounts of advice here. But the rest of you could do with support. You mentioned therapy - I reckon most therapists are not up to much. By the way, a psychiatrist diagnoses and treats mental illness. You don't sound mentally ill - the mentally ill don't exactly know they are. I mean, they don't question that they are depressed or pessimistic or low. They just are. And a psychiatrist will treat with medication, especially on the NHS. You know what meds help you. Psychiatrists are useful if the patient is very ill. But a really good therapist would help you track what's going on for you, differentiate between emotionally causative and physically causative issues as well as enable you to find which fronts to fight on. AND help you find ways of tackling/easing the depression whilst researching the different causative factors.

And that's really important. To know which fronts to fight on as well as give yourself permission to feel crap whilst working through this. Antidepressants are an aid to recovery; they can curb the worst symptoms, leaving your brain able to think more clearly to find the causes. But they are mostly a temporary measure - months, rather than years and years.

So if you're working on the thyroid issues, then recognise this is a slow haul and you need other support for you. If you want to check for food intolerances without going the whole hog (no pun intended) of a total elimination diet, then I can tell you that the worst antagonist to health today seems to be both gluten (of wheat in particular) and sugar. Cut out wheat for 2 weeks and lower sugar to a minimum. You'll quickly see if you are intolerant. You'll feel better in the amount that it is noticeable, even if not miraculous. If you were able to pay for investigation then a qualified, registered nutritionist would be useful too, if a bit fundamentalist in approach.

Lastly, if my GP EVER showed signs of compassion fatigue, let alone not wanting to investigate depression of five years standing, I'd get rid. They get paid too much money to not listen to me when I'm fighting to get well.

There is a lot to think about and it's easy to get swamped. Take your time, pick your battles and try to be patient with yourself.


Thank you so much.

Oddly enough, yes, I have tried cutting out fructose. I have always had a very sweet tooth. I love cakes, biscuits, chocolates and sweets, sugary cereals, cereal bars. I have done lots of reading on this, and fructose seems to be one to avoid. So I have done just that for about 6 weeks. I eat high-fibre fruits (sparingly), a good portion of nuts, but avoid dried fruits, juices, sugary cereals and cereals bars, and of course confectionery. I still feel the same. It could be because of withdrawal but only time will tell. I don't have a weight issue; in fact I have a good body and find it hard to put weight on. Since cutting fructose I did lose 2 kg or so but that has been the only benefit. Still, I'll keep at it.

Gluten, I'll be honest, I am one of those who rolls their eyes at gluten-free, lactose-intolerant, etc. But I am seeing a nutritionist soon, so I shall see.

Thanks again.


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