Thyroid UK
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Need help for anxiety

My husband has terrible anxiety, fear and depression. He was diagnosed with hashimotos in June when we found he had high TPO antibodies of 100, his TSh was about 4 and was on 30mg of NP throid until December. The functional dr we are seeing in the US increased it to 60mg of Armor. His fear and anxiety is worse since mid January but was a little better before that from Dec 30 til January 20. its complicated but hes been on Citalopram for years for a little anxiety. Last Feb his anxiety got worse and they kept switching meds and telling him it was all his anxiety and then we found out about the high TPO antibodies. So I am thinking he needs to get off the citalopram, but need to know if anyone else experienced this. His cortisol levels are high in the evening, and his ferritin in low at 40. His B12 was fine. He's taking other vitamins like selenium, D, and methyfolate. Nothing helps. Then he had heart surgery couple weeks ago for a bad mitral valve. Now his anxiety is so bad he cant do anything !

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Hi, How is your husband's potassium level? It can drop post operatively following open heart surgery. In the states many heart Surgeons work with a nurse who has specialized in cardiac matters. You can & should use them as a sounding board. Does he have a follow up appointment with his surgeon soon? I'd give the doctor's office a call & update the surgeon given he is so fresh post-op.

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Dont know what his potassium level is - they didn;t check that. He will go to cardiac rehab and he saw the cardiologist yesterday who said he looked fine. He is also on warfarin now for a blood thinner if that makes a difference.

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Hi, It sounds like your husband may have a mechanical valve as he is on Coumadin. I thought of potassium because once upon a time (when patients stayed in hospitals much longer than they do today) I worked briefly on a surgical floor (before going into blood collection). Cardiac patients were always on potassium sliding scales & given daily potassium based on labs. It left a firm impression on me how some patients required much more potassium than others. Hopefully a progressive exercise program will help your husband get back into the swing of things & reduced anxiety. Always trust your gut feelings on how you feel things are going along, & continue to keep the surgeon in the loop. I am new to this site so I encourage you to take my advice with a grain of salt!

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As he has Hashimoto's is he on strictly gluten free diet?

If not this may help

Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

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His B12 levels will have also dropped post op. And his TSH will probably have risen, his FT3 dropped. Not surprising he is reacting badly. He needs time to recover, but taking some B12 might help.

What you need to know is if he was adequately medicated before his op. Do you have any blood test results to post, so we can have a look?

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New tests were taken about a week and half ago: His TSH is 1.51 ,

T4 is .69 , with recommended range of .76 to 1.46; and T3 is 2.10 with a range of 2.2 -4.0 .

His iron was 40 and got that up to 68 now, TPO antibodies are down to 58.

Yes, he is gluten free, diary free, and mostly sugar free except for a little Turb sugar in coconut bliss ice cream made from Coconut milk.

He was taking 60 gr of the Armor before surgery and I think that was too much cause his TSH after surgery was .7 but they didnt check that T3 or T4. We lowered the armor a little by cutting the edge off a tablet. His D levels were low when tested last may.

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TSH is totally irrelevant when taking Armour, it's bound to be low - or even suppressed. You should not dose by the TSH. It's the FT3 that is important. 60 gm is a very small dose. I doubt he was adequately medicated. And his FT3 is now much too low.

His iron is still low. What are you doing about his D levels? Has he had his B12 tested? That is so very important. :)

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Be aware that there is a difference between Total T4 and Free T4. There is also a difference between Total T3 and Free T3.

The tests you want done are Free T4 and Free T3 (often referred to as just FT4 and FT3). The Total T4 and Total T3 are not useful.

It isn't clear from the results you gave above, but I'm assuming the levels you give above are Total T4 and Total T3.

When you give results it is vital to give the units of measurement and the reference ranges. Europe and the US use different units and it makes a big difference to the optimal levels you should be aiming for.

This might be helpful : stopthethyroidmadness.com/r...

Note that people in the US (which I'm guessing is where you live) can order their own labs to be done privately without involving a doctor or an insurance company. Links to companies that will deal directly with patients are given on that page. You might find it useful.

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Just about anything that goes wrong in connection with the thyroid can cause or contribute to anxiety :

The wrong levels of Free T3 (and to a lesser extent Free T4).

The wrong levels of serum iron, ferritin, transferrin saturation, TIBC.

Low levels of other nutrients e.g. vitamin D3, vitamin b12, folate, other B vitamins, low minerals.

All the above put strain on the body, causing more stress, and the release of more stress hormones - cortisol and adrenaline (epinephrine). Eventually the body might be unable to keep producing stress hormones in huge quantities, and levels end up dropping to become too low. Levels that are too low and too high can cause anxiety. It is impossible to be sure which problem someone has (too low or too high), and saliva testing is the only way of telling which one is the problem.

The direct cause of anxiety is having the wrong levels of stress hormones. Lowering the stress on the body by fixing the other problems will help enormously, but if stress hormone levels are too high or too low direct treatment is usually needed too.

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His B12 was fine.

People on this forum have come to hate the phrase "X is fine" or "X is normal". We don't believe it until we see it, and we need to know the reference range too!

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