Euthyroid Sick Syndrome

[Sooty101]

Hi everyone, Just wondering if anyone has been diagnosed with Euthyroid Sick Syndrome or thinks they may have it? I am now beginning to think that my problems are due to this and not Hypothyroidism. Am thinking of getting a reverse T3 test but it's quite expensive.This cannot be treated with meds so feeling a bit down at the moment.

[greygoose]

Can I ask why you think that? Last blood test results I can find for you have low TSH and low Frees, which would point more to Secondary Hypo (pituitary or hypothalamus problem). With Euthyroid Sick Syndrome the TSH would correspond to the Free levels, it wouldn't be low.

Getting an rT3 test would advance you must because it would tell you if your rT3 is high, but it wouldn't tell you why.

[Sooty101 in reply to greygoose]

Hi Greygoose, thanks for the reply. As I understand it in ESS the TSH would be low not high. "While patients with euthyroid sick syndrome may have normal or low thyroid hormone levels, patients with primary hypothyroidism have high serum TSH levels. Patients with the sick-euthyroid syndrome may have normal or low serum TSH levels."

I have recently withdrawn from Diazapam and am still taking Clomiprimine. Both of which can mess with the thyroid. It makes sense to me that my body would take this adaptive measure under these circumstances.

[greygoose in reply to Sooty101]

OK, I see your reasoning - although disagree about the TSH - but have you not considered that the reason you needed the Diazapam in the first place was due to hypothyroidism, Were your thyroid levels tested before it was prescribed?

[Sooty101 in reply to greygoose]

Yes they were tested and within the normal range, but we all know what that means. My body is so sensitive at the moment that I can't take T3 even in a tiny dose 0.05mcg. So really I'm hoping it is ESS and is adaptive (some think it's maladaptive), so it should sort itself out as I get further out in withdrawal.But it's hard to feel so low and not be able to take medication for it

[greygoose in reply to Sooty101]

Well, if it doesn't sort itself out, then the next line to follow is that of Central hypo. Because that would have low TSH and low Frees like yours.

[radd]

Sooty101,

I'm not sure an RT3 test will be useful because AD's reduce thyroid hormone output, not convert it to inactive metabolites. SSRIs affect HPT signalling and tricyclic AD’s reduce biologically active iodine and bind TPO which is necessary for the production of thyroid hormone.

Clomiprimine is tricyclic antidepressant and you will need help from your GP to withdraw. Only then can you assess what your thyroid function is doing and whether there is any genuine form of hypothyroidism that requires replacement medication.

Meanwhile, supporting the adrenals would be beneficial with extra Vit C and ensuring all nutrients are optimal. I'm sorry to hear you are going through all this ☹️

[Sooty101 in reply to radd]

Many thanks for your informative reply Radd. You seem to know a lot about what antidepressants do to thyroid output. Could you let me have some sources so I can show my GP, phychiatrist.As I am on a TCA do you think I should take Iodine. I occasionally take it salt form in water when I am feeling dizzy and it really helps.

I have spoken to my GP about reducing/ stopping the TCA, she is writing to my (totally uninterested) phychiatrist.

I take slow release vitamin C.

Thanks .

[radd in reply to Sooty101]

Sooty101,

"Antidepressants can induce hypothyroidism along multiple points of hormonal synthesis and iodine utilization. Tricyclic antidepressants have been implicated in the development of drug-iodide complexes, thus reducing biologically active iodine. Tricyclic antidepressants also can bind thyroid peroxidase, an enzyme necessary in the production of T4 and T3, altering hormonal production, resulting in a hypothyroid state'.

mdedge.com/psychiatry/artic...

And on the other side of the coin ... Clinical investigators have long recognized the link between thyroid and depression - ncbi.nlm.nih.gov/pmc/articl...

Yes, I think iodinised salt could be useful to you because you are NOT medicating thyroid hormone replacement yet, and the sodium will also be good for burdened adrenals. However, if you are having thyroid hormone levels tested be aware that taking iodinated salt could alter future results.

[Sooty101 in reply to radd]

Many thanks for this information.

[HealthStarDust in reply to radd]

May I ask in what way do “SSRIs affect HPT signalling”?

[radd in reply to HealthStarDust]

HealthStarDust,

The exact science is a bit out of my pay grade but just one example (albeit on poor rats ) ...

'While poorly understood, it has been suggested that thyroid follicular cells respond to the neurotransmitter serotonin (5-hydroxytryptamine (5-HT)) and, hence, may be affected by SSRIs. In vitro studies have found decreased storage and secretion of thyrotropin-releasing hormone (TRH) in cultured fetal rat hypothalamic neurons exposed to SSRIs, thereby having an inhibitory effect on pituitary TSH release'.

ncbi.nlm.nih.gov/pmc/articl...

And back to us humans, SSRI's can cause sedation that in a hypo patient already slowed by a decrease in metabolism can be a cause of further depression .. .. ncbi.nlm.nih.gov/pmc/articl...

Also going off on a bit of a tangent but all related to the need for SSRI's ... 'We also know that even in patients with normal thyroid function but with elevated Anti-TPO antibodies, their presence correlates with a higher risk of anxiety and mood disorders' (same paper).

The more you read, the more you find out, although I'm sure SSRI's have their place for some people but thyroid hormone meds gave me psychosis and anything brain altering scares the absolute **** out of me.

[HealthStarDust in reply to radd]

Oh gosh! How awful! How do you manage without thyroid hormone meds then?

I’ve read that untreated hypothyroidism can lead to psychosis, but not treated.

And, thanks for sharing the paper.

[radd in reply to HealthStarDust]

HSD,

Nope, am fine now on NDT thanks  😀.

[HealthStarDust in reply to radd]

Ah! That makes sense. I keep forgetting there are other ways that Levothyroxine to treat hypothyroidism!

[diogenes Remembering]

A good indication that you may have a nonthyroidal illness rather than a thyroid-linked one, is to get a FT4 and FT3 test done, and then compare the ratios. With thyroidal illness the FT4/FT3 ratio might be as low as 3/1 or less (the thyroid is hanging on re T3 production). In nonthyroida illness the T3 is suppressed, so the ratio will be high - say 5/1. No need for a rT3 test -= it'll say you are ill but not with what.

[Sooty101 in reply to diogenes]

Lalatoot has worked out the ratio from my last tests to be 3.4/1. What do you think about that result?

[diogenes Remembering in reply to Sooty101]

I would lean towards lower thyroid activity, but would need TSH to help

[Sooty101 in reply to diogenes]

These are my latest blood results.TSH it 2.08. Range 0.27- 4.2

T3 3.9. R. 3.1- 6.8

T4. R. 12-22

Folate 13.1. 8.83 - 60.8

[diogenes Remembering in reply to Sooty101]

Increases the notion going towards but not at (yet) hypothyroidism. To be kept at follow-up watch on to see if there's further deterioration in the future. It's possible this may be a transitory episode..

[Sooty101 in reply to diogenes]

Many thanks for taking the time to reply. Much appreciated.

[Lalatoot]

Going by your last results and what Diogenes has written, your ft4/ft3 ratio is 3.4/1.

[Sooty101 in reply to Lalatoot]

Many thanks for working that one out for me Lalatoot.

[Sooty101 in reply to Lalatoot]

So going on that ratio what do you think ?

[Sooty101]

So going on that ratio what do you think ?

[Gingernut44 in reply to Sooty101]

You appear to have replied to yourself! You need to tap the blue reply button underneath the response for that person to be notified. Perhaps resend your question to the person you wish to respond.

[Sooty101 in reply to Gingernut44]

Thank you ginger but, I keep doing that

[Lalatoot in reply to Sooty101]

Well for me it means a thyroid problem

[Sooty101 in reply to Lalatoot]

Thanks for your imput. Well If that is the case all I can do is reduce the Clomiprimine slowly as I'm not able to tolerate the thyroid meds. Also what if the T3 is being turned into reverse T3, then it would just make symptoms worse. It's so confusing 😭

[Lalatoot in reply to Sooty101]

Sooty t3 is not turned into reverse t3. T4 is turned into t3 and reverse t3. This happens for many reasons such as inflammation and illness. It can also happen when ft4 is too high. The body down regulates t4 to t3 conversion when ft4 is too high to stop ft3 getting too high. So more reverse t3 is then created. But your ft4 is not high so this is unlikely.Anyway reverse t3 has its own pathway in the body and receptors in the cells and it gets converted into t2 and t1 and eliminated.

[Sooty101 in reply to Lalatoot]

Thank you for this explanation. Just trying to get my head around it all. Do you have any suggestions for possible treatment. (The benzo withdrawal protocol is to wait out all symptoms till they go, but that is not allowing for the Clomiprimine (which is masking many symptoms but affecting my thyroid).) I do appreciate you taking the time to help.