Hi can anyone tell me if a consultant psychiatrist can prescribe T3 on the NHS in UK in the case of treatment resistant depression which has not responded to numerous antidepressant trials. I have an underlying thyroid issue where my T4 doesn't convert well to the active T3. I also have physical symptoms too long to list here but I find the the depression and anxiety to be the most debilitating symptoms.I have researched Use of T3 in treatment resistant depression in combination with an antidepressant and apparently it can be effective when standard treatments have failed. I am currently taking a low dose of levothyroxine. I am due to see my psychiatrist again in a few weeks and would like to discuss this with her but I'm not sure as a psychiatrist she can prescribe it ? I'm not under treatment from an endo.I'm aware there are issues in UK prescribing T3 and costs.
Any help would be much appreciated
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Hollybushroad
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i'm not sure how current that is . they used to be able to , but some CCG / ICB areas currently have restrictions on their formuluary which mean a psychiatrist would no longer be able to prescribe T3 for 'treatment resistant depression'.
(whether they would accept a psychiatrist trying to prescribe it for 'symptoms of hypothyroidism' is not clear )
eg, my area (Lancs and South Cumbria) it's definitely 'Black' (not allowed) for Treatment Resitant Depression lancsmmg.nhs.uk/medicines-l...
and they reviewed their codes last year to allow T3 for 'new' patients (to treat symptoms of hypothyroidism). .. but despite that , it's use for depression has remained Black.
Hi I think you may have misunderstood my question. I'm not going to book an appointment with a psychiatrist just to get Liothyronine prescribed for TRD...I have been under psychiatrist care for a few years and it was her suggestion to prescribe it alongside an antidepressant as she has seen good results with it when all else has failed. I do have underlying hashimotos. However I'm not sure if she's aware of its restricted use now due to cost implications..that's something I researched myself but wanted clarity on this forum or see if anyone else had experience of it. I have since contacted MHRA on the issue and am awaiting a response.
Hi sorry I'm just getting round to replying.Haven't been feeling too great. I recently got private thyroid bloods through medichecks and would really appreciate if you could shed any light on my results:
TSH 2.68 (0.27-4.2)
FT4 18.7 (12-22)
FT3 3.7. (3.1-6.8)
TP0 antibodies 489 ( less than 35)
Im aware TPO antibodies indicate hashimotos.
I have been on levothyroxine 25mcg for several years.
I know my FT4 is in upper range .
My question is about the FT3. It's in range but I've learned from reading this forum that it's far from optimal???
Would increasing my levothyroxine help increase my FT3 . I know that T4 converts to T3 but if my dose was increased would it not send my FT4 above range??? Could this indicate a conversation issue? Would add on T3 help?
I'm really confused about all this and desperate for some help as I've been becoming increasingly unwell for past 6 months. I'm due to see my consultant next week and just want to be prepared.
Do you test early morning and last dose levothyroxine 24 hours before test
25mcg is only half the standard starter dose of levothyroxine
Levothyroxine doesn’t “top up” failing thyroid…..it replaces it
Almost every one, once started on levothyroxine needs dose increases up over (typically) 6-18months …..until on full replacement dose
Your TSH is too high.
On levothyroxine TSH should be around or under 1
You need next increase in levothyroxine as FIRST step
As you have (incorrectly) been left far too long on just 25mcg …..suggest you initially increase to 37.5mcg per day (cutting 25mcg in half )
Retest after 6-8 weeks
Then increase to 50mcg
Retest again in another 6-8 weeks
guidelines on dose levothyroxine by weight
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Can see on your profile you ticked quit smoking (well done)
Was this recently
Underlying Autoimmune thyroid disease can become apparent/get worse after quitting
guidelines on dose levothyroxine by weight
Even if we frequently start on low dose levothyroxine (usually 50mcg or 75mcg) most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Thank you for links. I am no 37.5 levothyroxine soon to go up to 50. Haematology are only giving me a telephone call. The useless doctor who didn’t refer me said they said it is nothing to worry about. It is because I am not having protein. Have you heard of P.K.U. It is a condition where you have to have low protein. I tried protein powder and it was recommended by Dr Isabella Weintz and I had exactly the same reaction. It makes me feel like I am going mad for days. I told the doctor and he is sending me to an endocrinologist in September because they are the ones that test for it.
Meerkat , was your PKU (phenylketonuria) diagnosed at birth ?
i remember being taught about that when i did Nursery Nurse training .
It's one of the things tested for in the heel prick test on newborns ~it's a inherited disorder which means they are unable to break down and get rid of excess phenylalanine (which is a by -product of the digestion of proteins), and if they are not put on a very low protein diet very early on , the build up of phenylalanine leads to brain damage in childhood.
Hi tattybogle. Thanks for replying. I am 65 and would not have had that test done as it came in the 1960s. I also have got Autism and ADHD. I have never been able to eat a high protein diet. It is very rare but I asked my doctor and who do I see about it and he said a metabolic endocrinologist which I am seeing in September. It mentions it on the National Celiac Society to which I belong. Mine is a complex picture so I do not know what is going on. There was a study done on 100 kids with Autism and 75% were born with an underactive thyroid. Protein has always given me terrible pain always. I didn’t eat meat just the vegetables when I was little. I couldn’t eat cheese eggs or drink the milk at infant school. When cooking for my husband and two kids I would just eat the vegetables. My father could hardly eat anything and my mum had rheumatic fever at eight which is an autoimmune disease and then couldn’t get pregnant with me and had to take medication. I would not pick these parents 😂. My sister has all sorts of digestive issues too. This is not a happy gene pool. I really appreciate the reply. 😊
as far as i know it does not mean people with PKU have any difficulty DIGESTING protein ... they CAN digest it .. but what it means is that the by product (phenylalanine) cannot be eliminated properly by their body , and it is this by product which affects the brain function if levels build up too much (hence the need for a low protein diet, to keep their phenylalanine levels under control)
as far as i know eating protein doesn't cause them any pain or 'digestive' issues, as such.
hi tattybogle. I am going to talk to the doctor about it because I have a developmental delay and if PKU is left untreated this is what it leads to. If I eat protein it makes me go numb and affects my brain causing meltdowns. Without the Special Needs together with not being able to having a lifelong problem with protein I wouldn’t consider it. If you put into Google about not being able to eat protein PKU comes up. It is very rare so I probably haven’t got it but it is worth checking out. My doctor wants me to eat gluten again and be tested for celiac disease. I wish I could and have the test but I have been off that since 2013 and gluten makes me very unwell but he is not happy. Again people with Autism and ADHD have trouble with gluten dairy and soya. Thanks for your very kind reply. I am sure you made a lovely nursery nurse. 😊
My doctor wants me to eat gluten again and be tested for celiac disease. I wish I could and have the test but I have been off that since 2013 and gluten makes me very unwell
Then refuse to go back on gluten just to do a test
There’s no point
You’re obviously gluten intolerant.
It’s irrelevant to know if it’s coeliac or “just” gluten intolerance…..the result is the same either way …..essential to be strictly gluten free
Morning SlowDragon. I have told the doctors and gastroenterologists that I can’t eat gluten. I just wonder if the gluten that I ate all my life till 2013 has damaged my insides and sometimes this doesn’t heal and this is called refractory celiac disease. Ataxia and numbness can also be a part of it and I a bedridden and can’t walk and lose my balance.I know that gluten damages the thyroid too. Thank you very much for sending the links of PKU and Autism and PKU to me. I appreciate that.Hope you are well. Thank you for replying.
Thank you SlowDragon. Have a good day. I appreciate your help. I couldn’t eat a crumb of gluten. A Consultant Gastroenterologist said he thought I had non celiac sensitivity which is serious as you know. I have accidentally been glutened and it was a very painful experience. Would it help me if I has FT3 added to my levothyroxine? My son is getting married next winter and I will have to go in a wheelchair. I missed his engagement party as I was not well enough to go. I missed my husbands 70th birthday party too. I feel like life is passing by without me and I am so depressed. I have been unwell since 1994 but it got really bad when my mother suddenly died in 2002. I knew I was very unwell but as you know being virtually bedridden is horrendous when nobody understands. Sorry to go on and on but I am very depressed and anxious.
Hi tattybogle.Just wanted to say thank you for taking the time and sending me the links for PKU. I didn’t see them when I posted to you last, That was very kind of you. Have a good day.😊
But before considering adding T3 first steps are always to get levothyroxine dose increased slowly upwards and all four vitamins tested and improved to optimal levels
If you have autoimmune thyroid disease (hashimoto’s) trying strictly gluten free diet too
Thanks for your replyI'm new to this forum. I live in northern Ireland.
My psychiatrist reckons T3 Is more effective than T4 when added to an antidepressant in cases of treatment resistant depression even when there is no obvious thyroid abnormalities on blood testing especially in post menopausal women. My own research seems to confirm this.I really have tried a full range of psychotropic meds over recent years. I have hashimotos and have been on Levothyroxine 25mcgs since 2014.
Psych has asked to get TFTs done in preparation for my next review with her. I have chosen to get bloods done privately as I know my GP will probably only check TSH and if I'm lucky T4.
My private lab results have come back :
TSH 2.68mu/l. (Range 0.27-4.2mu/ l
FT4. 18.7pmol/L (12-22pmol/l)
FT3. 3.7pmol/L. (3.1-6.8pmol/l
TPO antibodies 490 iu/ml ( Range less than 35)
I am also getting blood and 4 point saliva test done to check cortisol levels.
Also vit d b12 and folate and ferritin done and awaiting test kit arrival. These test were advised by a very knowledgeable man who has written books on thyroid dysfunction and had his own personal journey with thyroid problems. (I'm not sure if I can put his name on this forum so I won't just in case.)
I'm a bit confused regarding my thyroid blood results as I'm aware they are in range (apart from TPO antibodies of course) but I'm also aware they talk about having to be in optimal range in hashimotos.
Is my T3 too low or what should optimal level be??
Is there a particular calculation/ratio for T4/T3 in hashimotos?
As mentioned I'm concerned if my psychiatrist does advise a trial of Liothyronine that I will not be able to get it on NHS prescription due to cost implications.
I'm not sure how up to date articles are on various sites I've read but know there has been recent problems with the prescribing ofLiothyronine for cost reasons.
I would be really keen to try it as I mentioned research shows it is more effective than levothyroxine in cases of treatment resistant depression.
Any advice on my T3 results would be much appreciated
increasing levo dose should certainly increase your fT3 level a bit .. but obviously it's easier to address the low fT3 by adding some T3 if you can get it prescribed.
Running a high in range / or over range fT4 level to get barely enough fT3 out of it is not ideal ... plenty of us do it and have done for years without any apparent problem , because it's less hassle than trying to get T3 prescribed
but T4 (whether from the thyroid ,or from levo) has recently been associated with the 'proliferation' of some sorts of cancer cells .. higher T4 level/ more association.
So adding a bit of T3 to your levo is certainly not a bad idea if you can get it prescribed .
oh .. i meant to ask ... how many hours did you leave between taking last dose kevo and that blood test ?
if you test fT4 up to approx 6 hrs after taking levo , there is a sharp peak in fT4 level... so testing should ideally be done 24 hrs after last dose which shows a stable base level and misses measuring this 'peak' .
Thank you so much for your advice. I had not taken my levothyroxine for 24 hard prior to testing. I used the calculator that you suggested. I see T3 is 16.22% . What should optimal level of T3 be in percent?I just sent more bloods to medicheck this morning ie vit D, vit b12 ferritin and blood cortisol. Have ordered a 4 point saliva test also.
I'm really new to all this and I'm not very tech savey so I'm not sure when I press reply if I'm just replying to tattybogle or to all on forum participants.
Im getting msgs from others but not sure if my reply to your msg goes to everyone.
Could you clarify this.
Feel so stupid but as I said I'm just not up to speed with technology . Many thanks for your help. Much appreciated
Don't worry ~ i'm a luddite too seasidesusie had to teach me how to do 'copy and paste' cos when i got here i could only do 'point and click'
So .. how it works:
if you use the reply box DIRECTLY underneath someone's comment on a post , then that person gets an 'alert' ( and the person who wrote the original post gets one too) .
but if you use the reply box at the very bottom of the page , or at the top right underneath the post , then only the person who wrote the original Post gets an 'alert',
Re. optimal fT3 levels .. there isn't 'a number' as such , it's very individual , but healthy people (no thyroid problems and not taking thyroid hormone) tend to have fT4 / fT3 levels at a fairly similar %... eg. you wouldn't find a healthy person with fT4 at 95% and fT3 at 15%.
Taking Levo monotherapy distorts this ratio, so most Levo patients will end up with relatively higher fT4 and relatively lower fT3 .
See the 10 healthy people below with results expressed as % through range ... all very different ...... some have T4/T3 high in rage , some have T4/T3 low in range , some have T4 a little bit higher than T3, some have T3 a little bit higher than T4 .. but all are healthy, feel well and these are their 'usual' levels of T4/T3 ,(and their TSH is low in range suggesting their body is satisfied with those levels of T4/T3) .. so there is nothing inherently 'wrong' with fT 3 at any particular %..... you have to look at T4 /T3 /TSH together as a set, not in isolation .
But having very high in range T4 relative to very low in range T3 is not the way a healthy body does things .
Hope that makes some sense .. i'm past my best at this time of night. lol .
p.s .. yes, all replies are visible to everyone ~ what you see here , everyone can see ,, but they are not alerted to a reply unless you used the reply box underneath one of their comments.
You can also give an 'alert' to someone like this :
write @ and start typing thier name (no space after the @ )
eg:
@Hollybu ..... once i get that far and a pop up appears beneath it with some names on .. if i click on your name then when i post the reply your name will have gone blue ,
Hollybushroad
and you will get an alert to say i've mentioned you.
Ok tattybogle I think I get it now. Hopefully I will get used to all this . I'm finding information from all of you very helpful. More so than my doctor. I think I should advise her to join this forum to get properly educated on Thyroid issues 😂
Do you know if it's possible to go hyper before going hypo? Reason I'm asking is in 2017 I had a hypomanic episode for first time in my life ( I'm 56,) Psychiatrist diagnosed me bipolar which I've never agreed with. I recently requested my notes for past 10 yrs from my GP surgery. I noted from my blood tests that during my hypomanic period in 2017 ( which lasted approx 2 weeks) that my bloods showed hyperthyroid results TSH 0.02 and FT4 32. This was never flagged up to me. I think it's too much of a coincidence that the hypomanic episode coincided with my hyper blood results. All other thyroid bloods before or after episode never indicated hyper so I'm convinced my hypomanic was due to hyperthyroid .Following the episode I have been persistently depressed and no psych meds are helping.
So I suppose in summary what I'm asking is can you become hyperthyroid before hypothyroid. Can that be a symptom of onset of real thyroid damage?
my blood tests that during my hypomanic period in 2017 ( which lasted approx 2 weeks) that my bloods showed hyperthyroid results TSH 0.02 and FT4 32. This was never flagged up to me. I think it's too much of a coincidence that the hypomanic episode coincided with my hyper blood results.
Yes…..extremely common for autoimmune thyroid disease (hashimoto’s) to start with transient hyperthyroid type symptoms and results.
This is not true hyperthyroidism …..but due to excess thyroid hormones being released as cells in thyroid start to break down under autoimmune attack because of Hashimoto’s
After each attack, thyroid becomes a bit more damaged and you become increasingly hypothyroid
To reduce the occurrence of these swings from high to low, taking high enough dose levothyroxine to reduce TSH down around or below 1 should help
Similarly strictly gluten free and/or dairy free diet can help
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Almost everyone with Hashimoto’s has some initial increase in levels…..for some …it might not be extreme enough to go to GP …..
We get small but steady stream of Hashimoto’s patients arrive on the forum who have initially been misdiagnosed as hyperthyroid (Graves disease)
Before diagnosing Graves’ disease medics should always test TSI and Trab antibodies. If negative, it’s more likely patient has early stage Hashimoto’s
Hi Hollybush Rd, I could have written your post myself. I too am suffering from treatment resistant depression. I take a TCA but it's not really helping that much. I too researched T3 add on and have written to my psychiatrist to explain the problems with my thyroid and to request help. So far I've not had a reply. Whereabouts are you based, I am in Wales. I have an appointment lined up with an intergrative doctor based in Kent recommended by thyroid Uk. to prescribe if the psychiatrist can't.
Hi Sooty sorry to hear you are going through such a tough time. Depression really is such a debilitating condition and wreaks havoc in all aspects of our lives.My psychiatrist initially said she would consider add on T3 but at my last appointment she said she wanted an endo opinion on my thyroid before she would prescrbe it. She was going to refer me through NHS (could be waiting yrs for appt) but I asked her to do a referral for a private endo appt so as I could do my own research and be able to pick who I think would be helpful and would be understanding regarding depression.( so many horror stories on this forum about awful endos).
I settled on one who gets good reviews and apparently treats patients and their symptoms rather than lab results which sounds encouraging but will see how it goes. I see him in a couple of weeks.
I'm not sure if my psychiatrist is aware of the strict guidelines re prescribing T3 and I didn't make her any the wiser 😂
As per advice on this forum as I'm sure u have read yourself. I've been getting all the vitamin tests done ( through medichecks)and I seem to have low b12 and folate but awaiting further testing so I'm sure if I was truly deficient it certainly wouldn't be helping my mental health. I have had alot of memory and concentration problems esp over past couple of months to the point it really scares me and also some neurological issues which are suggestive of B12 deficiency but will see when I get further tests done. I want to get as much testing and info gathering done before endo appt so I get as much as possible out of my first appt.
He may very well suggest increasing my levo before even considering T3 but will have to just wait and see.
I have been on so many antidepressants I've lost count also lithium ( which I believe should be avoided in anyone in Pts with suspected Thyroid problems) also anti-anxiety meds mood stabilizers and antipsychotics. Sometimes I think is it all the use of different meds over the years have completely frazzled.y brain....scares me.
I'm sure your story is similar to mine re all the medication trials.
I really wish you well with functional medical appt. I would be interested to hear how it went.
Thanks for reply, let me know how it goes for you. I was placed on diazepam for too long and had to come off that aswell, so withdrawal issues too. I stopped taking it in March after a long taper., But lately I have realized that it and and the TCA I'm on are affecting the thyroid. Unfortunately my psychiatrist doesn't want to know. Good luck to you. Shame we don't live closer to each other. There is a Hollybushroad in Cardiff. X
According to my antibodies test I don't ut it sure feels like it. Mood swings are awful. No I'm not on any thyroid meds. I've started taking thyroidinum a homeopathic remedy (though I've always been sceptical about it). Yesterday was very tearful, so I will leave it today and then give it another try. All trial and error with me.
Hi Sooty Ive just read your previous posts on forum.....I truly can sympathize with you.Regarding antibodies they really can fluctuate( alot) so may be worth doing another test in a few months. Mine were 490 in May and I previously tested in February and they were 987 so you can't completely rule out hashimotos. In some ways it would nearly be better if you did have positive TPO antibodies as drs may take more notice of your symptoms.
Do you have any other autoimmune diseases? Often when you have one autoimmune disease there's a good chance you could have another one.
I also have sjogrens syndrome and GP now checking me for PA just to add to the mix. It's a minefield all this stuff.
Do you mind me asking if you suffered from depression prior to menopause?
Hi, I don't have any diagnosed autoimmune diseases but I suspect a few. I was tested for Lupus a couple of years back and I suspect Sjorgrens because of dry eye , but my saliva is ok. The doctors just think I'm a hypochondriac and I get palmed off with mental health. Yes I have suffered from depression before notibly post natal, twice. Why do you ask? I think I've had thyroid problems all my life.
Yes that's exactly why I'm asking because I feel I've had a very low grade depression since my early twenties ( I'm 56) nothing major just a feeling In the background that something wasnt quite right but got on with life and was happy enough....as I said just had this niggling feeling in the background but never mentioned it to anyone as I couldn't quite explain it or make sense of it myself.It's only been since 2017 that things got really bad and that's when I went down the psychiatry route. Hope you don't mind me asking
No I don't mind you asking at all, I feel the same. I think I have had something all my life, never as happy as others. Clinically happy, if there is such a thing 😀. I'm having some quite nasty mood swings at the moment, don't know if I'm coming or going. Not nice.
When you say you have mood swings do you mean like swings within a day hour to hour or do you mean like longer periods?Do you feel like a sense of being internally "reved up" all the time?
Reason I'm asking is I'm trying to guage if you are going from hypo to hyper....this isn't hyperthyroidism in the true sense but can happen in Hashimotos when there is further damage happening to Thyroid when cells release excessive amounts of Thyroid hormones for transient periods before you become increasingly hypothyroid over the years. But as you said in previous post your bloods didn't show TPO antibodies so hard to know.
Have you ever had recent menopause bloods to see exactly what your oestrogen and progesterone are at? I got a private panel done in preparation for my endo appt in a couple of weeks....all these tests costing me a fortune but just want to cover all bases!!
My mood swings are daily, one day ok next day awful.Yesterday was good, today awful. I know, it's a difficult one. I know the Clomiprimine is affecting my thyroid but I have to stay on it for awhile. I tried to sleep a little today but kept getting small surges ( not sure if adrenaline or TSH trying to get my thyroid to produce more.) So confusing. I want my life back! Thanks for your support . Much appreciated . I haven't had recent menopause bloods done as they need to fluctuate so much I don't think it's worth doing. Though I'm 62yrs I still bleed monthly. I've had scans etc, no cancer I think it's as a result of the withdrawal from diazepam which affects the HPA axis. Good luck with your Endo appointment 🤞
Yea Ur probably right bout the menopause bloods being no help. I don't know alot bout female hormone levels. Suppose I never really seen it a cause for my symptoms as depression was there before perimenopause set in.You might find a YouTube video from Dr Ken Waltorf interesting. He reckons T3 better than any antidepressant. Sorry but I don't know how to send the link to your post. I'm just using my mobile so hopefully you will be able to find it by googling his name.
I get the impression he thinks alot of people who are resistant to standard psychotropic meds have actually got an undiagnosed Thyroid issue. He Talks about hypothyroidism at cellular level where there isn't enough T3 actually getting into the tissue cells but it won't show up on standard TSH FT4 blood tests as they will look" normal".
He talks about depression and brain functioning being affected by this.
Just thought you mind find it interesting.
Sorry I do tend to waffle alot. I'm not very good at condensing my words.
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seasidesusie had to teach me how to do 'copy and paste' cos when i got here i could only do 'point and click' 
T3 depression and crying 
T3 feeling depressed
Im really sick, crying and depressed. when to take t3?
Lithium for Depression
