Hi there, I have been suffering from depression including lack of interest in activities, difficulty concentrating, difficulty doing math and problems with working memory pretty much all my life. I think it may be due to some sort of hypothyroidism.
My TSH when last checked was 3.1 mIU/L, free thyroxine was 15.2 pmol/l, vitamin D was 121 nmol/L. The thyroid numbers fall within normal ranges.
I visited an endocrinologist who said that I was fine and that the depression was not due to the thyroid and that I needed to see a psychiatrist. I have seen many psychiatrists and tried many antidepressants and they don't really help. I tried iodine and selenium recently and it gave me a bit of a boost which leads me to believe that there may be a deficiency in thyroid hormone. Also, when I was on sertraline, my thyroid numbers were out of range for a while and I was given levothyroxine to reduce them. I eventually stopped both sertraline and levothyroxine two months before the above results.
Does anyone happen to know GPs or endocrinologists in the London or Greater London area who work towards optimal numbers and are open to prescribing T3 and natural dessicated thyroid and listen to how the patient feels rather than just looking at bloods? Please shoot me some messages.
Also, please comment if you have had similar symptoms and if thyroid issues were the cause.
Finally, what is suggested course of treatment for me? What should I try (levothyroxine, t3, NDT) in what order and for how long in order to gauge its effectiveness?
Thank you so much!
Written by
Sg14
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Sg14
For anyone to make any useful comment, we need full results with reference ranges please. For a full picture we need
TSH
FT4
FT3
Thyroid Peroxidase antibodies
Thyroglobulin antibodies
Vit D
B12
Folate
Ferritin
What we can tell from the results you've given above, is that your TSH is a bit high for a normal healthy person (one would expect to see that no higher than 2) and a TSH of 3 would give a diagnosis of hypothyroidism in another country. Also, your Vit D is perfect at 121nmol/L as the Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends 100-150nmol/L.
However, we can't assess your FT4 without the reference range. Ranges vary from lab to lab.
Also, thyroid tests should also be booked for the very first appointment of the morning and we should fast overnight (water allowed), this means have your evening meal/supper the night before then delay breakfast until after the blood draw, drink only water, no coffee, tea, etc, before the test.
This gives the highest possible TSH which is needed when looking for a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It can also lower after eating and coffee also affects TSH. [Also, once diagnosed and prescribed Levo, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test.] These are patient to patient tips which we don't discuss with doctors or phlebotomists.
Did you test iodine before supplementing? Most important, and if found to be deficiency it should only be supplemented under the guidance of an experienced practioner. Iodine can give an initial boost then it all goes downhill from then on. Iodine used to be used as a treatment for overactive thyroid.
If you haven't had all those tests listed above carried out, you could ask your GP but they wont all be done by the NHS. You could do a private test with one of our recommended labs which does them all in one test bundle.
Welcome to our forum and I am sorry you have been struggling.
I really don't know why the majority on this forum know more than most doctors. The professionals seem to be poorly trained and seem to just take the TSH into account but hypothyroidism is so common and I doubt the professionals know one clinical symptom and you can tick off the ones you have below:-
We have to read, learn and ask questions in order to recover and we are probably prescribed anti-d's, or pain relief or for anything else we complain of to doctors who state our results are 'normal' when they are anything but normal and neither are we who remain unwell and don't know where to go to for some support.
We can recover but we have to read, ask questions and its no wonder that the majority on the forum know more than most doctors/endocrinologists.
SeasideSusie has given her excellent advice and I'm sure you will soon have a better knowledge through members' helpful comments and support.
SeasideSusie if I were to go in to get my blood drawn say around 9am, what is the latest you recommend having dinner the previous evening? Thank you and Happy New year
So just to recap, I have been suffering from depression including lack of interest in activities, difficulty concentrating, difficulty doing math and problems with working memory pretty much all my life. I have also had issues with terrible social anxiety and generalized anxiety.
Your TSH is over range and in another country once it reaches 3 you would be diagnosed with hypothyroidism. Your FT4 is low in range. Unfortunately, in the UK we have to wait until it reaches 10. However, a TSH above range but below 10 with a normal FT4 is classed as Subclinical Hypothyroidism and some doctors will give a trial in these circumstances but other doctors will just repeat tests to keep an eye on TSH.
Many people with SCH do not need treatment, but if a decision is made to treat, prescribe levothyroxine (LT4).
◦Do not prescribe combination therapy (LT4 and LT3) in primary care.
◦Aim (in most people) to reach a stable TSH level in the lower half of the reference range (0.4–2.5 mU/L).
If TSH is between 4 and 10 mU/L and FT4 is within the normal range
◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.
I would ask your GP for a trial as suggested by the NICE Clinical Knowledge Summary quoted above.
Your thyroid antibodies aren't raised so don't suggest autoimmune thyroid disease (Hashimoto's) with this test.
Active B12 84.200 pmol/L (37.50 - 188.00)
This is within range and will classed as fine. I would want mine higher than that.
Folate (Serum) 16.24 mcg/L (3.89 - 26.8)
Folate is good.
25 OH Vitamin D 99.9 nmol/L (50.00 - 200.00)
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level between 100-150nmol/L. Yours is almost there and it's up to you whether you want to nudge it up to the recommended level.
CRP - High Sensitivity 0.23 mg/L (0.00 - 5.00)
This is fine.
Ferritin 31.1 mcg/L (13.00 - 150.00)
This is low and for thyroid hormone to work (that's our own as well as replacement hormone) it's said that ferritin needs to be at least 70, preferably half way through range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...
You could ask your GP for an iron panel and full blood count as it is low, but as it is within range your GP may not agree and will say it's fine.
Sg, I would just add vitamin D with K2 to your plan. Vitamin D is a prohormone and they have found that cancer patients usually have a low count. It also prevents infections and activates all the other hormones. It would be good to raise your level to 150 and in the winter getting out in the sun is very difficult.
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and Happy New year 
T3 & sympathetic doctor in London
Sympathetic Endos in London?
London doctor prescribing T3
