6:30 pm - 06/29/2018

Thyroid testing

Hey all,
I’ve been dealing with some depression issues for about 12 years. Been working closely with a great therapist for 2 years. We’ve hit a point where therapy is doing all it can. But I’m still having a LOT of motivation and exhaustion issues. She will refer me to a psychiatrist for antidepressants but mentioned that they will want me to get my thyroid checked first since apparently depression can be a symptom of hypothyroidism.
This was news. My own research uncovered several other symptoms that all started 12 years ago and have been getting progressively worse: weight gain (used to be underweight with an awful diet and no exercise, now I’m at the top end of average with a great diet and a lot of exercise), dry skin, brittle nails, sensitivity to cold, low body temperature, heavy and irregular periods (now with spotting in between), week long PMS when I used to have none, trouble concentrating and remembering things, depression, fatigue...
Appointment is booked with a new to me primary care physician in 2 weeks. Doctor knowledge trumps dr google and strangers on a forum BUT some doctors are great listeners and some not so much. I don’t know this one at all and have no idea how this appointment will go. I know there are some experienced malfunctioning thyroid people on here and am just trying to gather what info I can so IF I need to advocate for myself I have some kind of idea what to advocate for. Full panel over TSH only yes? Numbers in the optimal range rather than just normal? What’s a reliable source on those numbers/what should they be?
Not going to lie, hypothyroidism seems a lot more straightforward to treat than depression and would explain a lot. Fingers are crossed that’s what it really is.
archangelbeth 30th-Jun-2018 05:23 am (UTC)
I would say that the key things to get are:
TSH
Free T3 (not just "T3" -- FREE T3)
and Free T4 wouldn't be bad.

You can get antibody tests if you want, but unless you're concerned it's like a tumor messing with your pituitary/hypothalamus or whatever, the sudden onset means it's probably Hashimoto's. And even if it wasn't, they'd still treat it the same. Talk to your doctor about that one, but I've only gotten an endocrinologist palpating my thyroid and saying it had the spongy characteristics of Hashimoto's. Everything else is just TSH tests, and one Free T3 to make sure that FT3 was tracking TSH well.

If you don't respond well to levothyroxine (the generic of Unithroid/Synthroid, and the difference in pricing is such that I have to recommend the generic and keeping an eye on if the pharmacy gets a different formulation...), then get Free T3 and Free T4 and see if you have lots of T4 available but not much T3 available; some people don't convert synthetic T4 (levothyroxine) into T3 very well, and either need synthetic T3 as well, or to use... I think it's Armour, which is made from biological sources and contains some T3 as well.

I also recommend ferritin testing, because the fatigue is very similar and it can mess with hair and fingernails as well. It's kind of pre-anemia and is not caught by standard anemia tests.

TSH should be between .4 and 4, and ideally no higher than 2-ish. If I get to TSH 3, it frotzes me up with fatigue. If you didn't have symptoms, up to TSH 4-5 would probably be fine, but you have some very hypothyroid-flag symptoms!

(Also note that if you want to have kids, hypothyroidism is apparently considered a risk flag for pre-eclampsia. Keep TSH managed (this would require extra blood tests) and go to all prenatal appointments. This is a thing I would have liked to have known, but my hypothyroidism was undiagnosed until after I'd had a kid... 2 months early.)

TSH:
https://medlineplus.gov/labtests/tshthyroidstimulatinghormonetest.html
https://medlineplus.gov/ency/article/003684.htm -- this one has the range in it, and is the one I'd print out if necessary.

Ferritin:
https://medlineplus.gov/ency/article/003490.htm
Note that it says: The lower the ferritin level, even within the "normal" range, the more likely it is that the person does not have enough iron. Basically, "normal" apparently means "probably not going to die of anemia." I'd print this one out as well.

I'm not good at getting alerts for Livejournal stuff, so if you have any further questions, please feel free to hop over to my account, and then to my Dreamwidth one, and post on whatever my post-of-the-day is!

Good luck!
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