Is it purely depression or thyroid problem?

Is it purely depression or thyroid problem?

Hi everyone! Im from the Philippines. Im struggling with depression for about a year now. Im always in a low mood, i always easily get irritated, i have anxiety, i have a brittle hair and sometimes i have insomnia. The first thing i did was to go to a psychiatrist since I felt depressed all of a sudden without major problems in my life. The psychiatrist just gave an antidepressant (brintellix 10mg). I took it for 2 months, the first 5 weeks of taking it was scary. I felt more depressed and anxious with suicidal thoughts. After taking the pills for 2 months, i abruptly stopped taking it, for the fear of becoming dependent on it. I never came back to that doctor again. After 5 mos i went to an endocrinologist and have my thyroid ultrasound and ft3,ft4,tsh test. Here are the results:

TSH - .061 uIU/mL (normal range: .25-5.0)

fT3 - 3.72 pmol/L (normal range: 4.0 - 8.3)

fT4 - 14.71 pmol/L (normal range: 10.6 - 19.4)

My ultrasound says that:

"Enlarged thyroid gland with complex hyphoechoic nodules"

My endocrinologist says its all normal but my fT3 is obviously not. The doctor didnt prescribe any meds, she also advised me to stop taking my SAMe, fish oil and folic acid because accdg to her i can get all of those from foods.

What should i do now since there are symptoms i cant ignore? Thanks!

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30 Replies

  • Often we struggle to get an increase in meds if TSH is low and I can't see them starting you on treatment either! All is not lost though and something you can try. Your FT 4 could be higher but you may not be converting the inactive T4 into the active T3 properly. All the cells in our body need T3 so you are struggling as you aren't even in the normal range. To make this conversion happen we need our vitamins to be high and that doesn't always happen naturally so we need a little help.

    The three most important to get checked are Vit D, B12 and Folate. See if your doctor will test those. Many of us take supplements of those to help us. If you look on the ThyroidUK site you will find a lot of good information and also a list of common symptoms. You may like to print it off and tick the ones you have and show that to your doctor as well. Your docto may not recognise that any symptoms can be thyroid related so it's got going to be easy but learn as much as you can and produce as much evidence as you can. You may have to see if there is a different Endocrinologist you can see. Also ask your doctor to explain what the scans mean. If there can't then they may at least realise you need help they cannot give.

  • Thank you silverfox7 for your reply. I appreciate your suggestion. I will ask my next doctor if they can test me with vit d, folate and B12 deficiency, i just dont know if we have that kind of test here in the Philippines.

    Anyway, though i was forbidden by my former endo to take any vitamins or supplements im still currently taking fish oil (1000mg) once a day, folate (5mg) once a day, vitamin b complex once a day, and probiotics every other day. But i feel nothing's happened.

  • The ones I mentioned are the main ones and it takes a month or so before you start to feel any different. My GP said to me to stop taking them but the next time she saw me asked how I was getting on with them! She says she knows nothing re thyroid problems but has a friend who does so I think get friend must have suggested it was a good idea! We have to learn as some doctors know very little or don't realise what a problem it can be.

  • Thanks again! I'll get back to you whatever my 2nd endo will tell me. God bless you!

  • Glad that your ft3 was tested, but the low result is being completely ignored by your doctor, and shockingly, by your endocrinologist too. The low ft3 is a red flag that on a cellular level you are hypothyroid. You certainly should have a good think about supplements that can help with t4 to t3 conversion, because, in my experience they certainly help, but conversion looks like it could be an issue with enzymes (see link) and your ft4 is not exactly overwhelming either.

    Here is a scientific paper from an American website .. it seems that although groundbreaking research is available in respectable medical journals that many endocrinologists just don't have the time or inclination to update and revise their knowledge.

  • N.B. correction - the link above is a commentary - not a scientific paper.

  • Thank you HLAB35 for your time. I will go to another endo next week, hopefully I can be diagnosed and treated well. God bless you!

  • Depression doesn't give you brittle hair.

    There is a report out in the UK that some people actually feel worse when on antidepressants -

    It is left for you to work out whether antidepressants made you feel worse or not but if you start taking them and they immediately do the advice from a doctor is to immediately stop taking them and seek help. Unfortunately some doctors refuse to believe that antidepressants can cause side effects so I don't know where you are suppose to get the help from. However you do need it on your medical notes that the antidepressants cause you issues.

  • Yes anti-depressants can cause more anxiety etc. that's why i stopped it immediately though doctors said it is not proper to just stop. Thank you for your time!

  • Angel,

    Sometimes low thyroid with an enlarged gland can be due to iodine deficiency. However, as you are in the Philippines I assume you eat fish and of course you have been taking fish oil supplements. You are unlikely to be iodine deficient. You should not take iodine supplements or kelp (seaweed) as these contain too much iodine and can make matters worse.

    Low thyroid causes depression in some patients and depression can reduce the amount of TSH produced by the pituitary. Furthermore, the TSH produced can have less bioactivity (is less potent) but still has the same immuno-response to the blood test. An added complication is that the nodules may be harmless or they might cause the thyroid to occasionally flare up, releasing thyroid hormone in spurts. If this is so your mood will likely change and it can cause the pituitary production of TSH to be down-regulated, i.e. you produce less TSH than you should.

    I don’t know anything about SAMe (S-adenosylmethionine) but a quick check suggests it might interfere with thyroid hormones so I would avoid it.

    So, your case is complex. It is fairly obvious that your TSH is too low for your fT3 and fT4. In most people with this low fT3 their TSH would be quite high. There is evidence that patients who are refractory to antidepressants (meaning the antidepressants don’t work) respond when treated with liothyronine (L-T3) in doses of around 40 to 60 mcg daily. I would seek out an endocrinologist who is willing to trial liothyronine. You would gradually build up your dose, taking half in the morning before breakfast and half at night. If antidepressants are needed your psychiatrist should work closely with the endocrinologist to manage your care.

    A possible complication is that if your thyroid occasionally flares up you might need a process called ‘block and replace’. This is where they give you a medicine to shut your thyroid down (it will eventually give in) and replace it with thyroid hormone.

    I would ask for a trial of liothyronine to overcome your hypothyroidism and particularly your depression. If that resolves they can then see if some of the liothyronine can be replaced with levothyroxine which is cheaper and delivers a more even dose over the day.

    HLAB35. The article you referenced on Deiodinases is a commentary not a scientific paper. Unfortunately it has a number of errors. I would ignore this document completely as you will need to have a detailed understanding of deiodinase in order to spot the errors, which rather undermines the purpose of reading it. In general if a document has a disproportionally large number of references it is a good sign that the author has a poor understanding and is throwing in references rather that targeting one or two references to back up a precise concept. Deiodinase is a very advanced subject but if you want to study the subject this website is a good starting point, Tony Bianco is a leading researcher in the field.

    Please note I am a patient not a doctor.

  • Thank you for your time responding to my questions! We live far from the sea coast, we can eat fish once or twice a month. My family has a history of thyroid problems. My mom has a toxic goiter but it was treated with radioactive iodine, my grandma and her sister also have goiter, my aunt also has a goiter. I think it is hereditary. Anyway, whether i got it from my lifestyle or it is hereditary I badly needed help. I will let my doctor know your comments, maybe she/he can get insights. Thanks again

  • I think your situation is called central or secondary hypothyroidism. Your FT3 is low so your pituitary should be telling your thyroid to produce more hormone. It does this by increasing your TSH (Thyroid stimulating hormone). So your TSH should be high, but instead it is low. Do you have any other pituitary problems? I think they test for prolactin.

    I do hope you get sorted soon. You could try taking NDT (Natural Dessicated Thyroid). It is readily available without prescription in Thailand but I don't know what the situation is in the Phillipines.

    I hope you get better soon. Once your FT3 level is normal (at least half way up the range) your depression may well resolve. In the UK T3 used to be prescribed for cases of intractable depression. Possibly it still is.

  • Thank you eeng for your response. I will research on that NDT if it is available here in the Philippines. Regarding on that pituitary issue, i havent been tested for that, and i dont know if we have that kind of test here or if we have i think it is expensive.

  • The second video I posted above talks about prolactin.

  • Hi I would suggest its all down to low vit d. Ask your doc for a H25 test. I was ill for 4 years my thyroid results were low but I never received any treatment or help. I pressume you have darker skin which means you need much more sun exposure to produce vit d. It makes living here without sun exposure difficult for all those with darker skin and without vit d you are open to all sorts of health problems esp as a woman as it controls thyroid function and progesterone production. I suffered from near all hypothyroid symptoms, depression, chronic pain and headaches and my hair was falling out in handfulls. After a few weeks of vitdlux spray, magnesium oil, vit k2, calcium rich food and floravital I am now on road to recovery. My ferittin, vitd, b12 and thyroid were all low. Hope this helps as its often underlying problems that cause thyroid malfunction and this vit and mineral business is all inter related and something docs know nothing about x

  • That's an interesting theory as low vit D links to depression as well..

    I think researching sick euthyroid syndrome is possibly worth doing, if this fails.

  • your results of a low tsh and a low free t4 indicate to me you have pituarity /central/2ndary hypothyroid as opposed to the more usual primary hypothyroid

    you need to challenge the endo on this issue

    do any of your family have other auto immune disease,diabetes, RA,lupus etc

  • Hi reallyfedup123 , you mean i have low ft3? My ft4 is in normal range, as well as my tsh. My ft3 is low. Thanks for your response

  • your TSH is low its range

    your free t3 is low

    this means either you have Central / pituarity hypothyroid or maybe tertiary hypothyroid or you have the DIO2 gene and cannot convert t4 into t3

    every cell in your body needs t3 in order to function

    in any form of hypothyroid levels of many vitamins and minerals are trashed





    vit d3

    vit c


  • Thank you for your clear explanation. I think you better understand my lab results than my endo. I appreciate for sharing your time responding to my questions.

  • I understand it bcos my husband started with Graves Disease nearly 50 yrs ago then had surgury our daughter and 4 grandaughters all have Hashimotos and one is also coeliac

    I was a co ordinator for BTF for a while until they decided that the tests and levothyroxine are perfect and they will not listen to any one who disagrees

  • Hi angelindisguise, Depression is so horrible. My own personal story is that I used to have very low thyroid, I've managed over the years to get it correctly medicated but I was still left with bad depression. I've lately been taking natural serotonine tablets. I got them off the internet. The pack says they are Natural Griffonia Seed. I take two tablets together rather than one twice a day and it's certainly helped me a lot. Best wishes x

  • Thank you marigold22. Im happy to hear that from you. I will reseach on that griffonia seed. God bless you

  • Hi again - I was being a bit dim yesterday and I've looked at my packet of Griffonia Seed. It's 5-HTP you need to look for. The natural version of 5-HTP seems to contain griffonia seed. This converts into serotonine in the brain.

  • I assume you live in the Philippines and so you are less likely to suffer from vit d deficiency, however I would eat more fish as in the long term that will help with both vit d and iodine. If there is a pituitary problem the TSH is usually much lower and the fT4, along with other pituitary hormones. It is much more likely that your depression is lowering your TSH (via low TRH from the hypothalamus) and the low fT3 is from your thyriod which is probably failing. The important point being that if they check your pituitary and it comes out OK it does not mean your TSH is OK. I think the best way forward is with a good endocinogist who is willing to prescribe liothyroine in cooperation with a good psychaitrist. In any event you need liothyronine at least in the near term.

  • Low TSH combined with low FT3 suggests that you do not have primary hypothyroidism. Your pituitary should be putting out more TSH to push your T3 and T4 up, but it isn't. This is not a "normal" situation (in spite of what your endo said).

    Regarding nutritional supplements or anti-depressants, don't listen to what MDs say. Almost all of them are ignorant about both of these. As I learned from personal experience, many ADs have horrible side-effects and they are far inferior to T3. T3 is an excellent anti-depressant.

    Keep taking the key nutrients suggested here (folate, D3, B12, etc.). You need to consult with someone other than an MD endocrinologist. In the US, patients who have problems like this often end up consulting with naturopaths or chiropractors who know about correct treatment as espoused by people like John Lowe or Datis Kharrazian. There are a few MDs who have gone "off the reservation" who also know how to treat, such as Kent Holtorf.

    In the short term, my immediate thought is that you might do well on T3-only therapy for a while, until you can get things sorted out. With in-range FT4 and under-range FT3, you obviously are not converting well. Driving FT3 into the top half of its range will likely lift the depression and clear brain fog. If you have to self-treat, people here can tell you how to purchase T3 off the web.

    In the long-term, you are going to have to see an endo who knows what to do with nodules. You have to make sure you aren't on-track for thyroid cancer. I would search for articles by thyroid advocates like Mary Shomon and Dana Trentini, to see what they say about thyroid nodules and cancer.

  • Thanks Eddie83! You're suggestion is highly appreciated. God bless you!

  • Yes, your FT3 shows you will have low thyroid symptoms. Dr. Clark mentions about 24 different reasons for those symptoms because other hormones become involved. Serotonin and dopamine can also be affected and can alter your mood. High prolactin can also disrupt things.

  • Thank you Heloise for that very informative videos you shared. At least now i know that my depression was caused by my low fT3 and not just bec im a weak person or a mentally impaired person.

  • Your welcome angel, If you go to you tube, you can see the rest of his 24 reasons for low thyroid. I think low progesterone is very prevalent. We get estrogen in many ways and estrogen dominance is a big problem and also may cause cancer. Progesterone is a cancer protecter. Give your body what it needs (not pharmaceuticals) and it will heal.

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