The People's Perspective on Medicine

Depression or Underactive Thyroid?

Armour brand desiccated thyroid extract

Q. Years ago my symptoms of depression, weight gain, difficulty losing weight, intolerance to cold, cold hands and feet and fatigue led my doctor to test me and diagnose low thyroid function. He put me on Armour Thyroid. I took it for years, felt great and had no depression or any other symptoms.

Since his retirement no other doctor will prescribe it. They do a blood test, say my thyroid’s normal and that’s that.

Over the past ten years I’ve had many depressive episodes. I’m currently taking Prozac and Effexor, but all my old symptoms are back along with new ones: dry skin, brittle nails, dry hair, difficulty focusing and low energy. My once thick eyebrows are very thin now, especially at the outer edges. Where can I find out more about thyroid problems and how results of a blood test should be interpreted?

A. The symptoms you describe are typical of an underactive thyroid gland. Blood tests are essential, but may not tell the whole story. In fact, antidepressants such as Prozac and Effexor can occasionally disrupt normal thyroid function.

You need to consult an endocrinologist who will review your history and symptoms when interpreting your blood tests. Thyroid experts are finding that some patients need T3 as well as T4. Both these thyroid hormones are supplied by the Armour product.

We are sending you our Guide to Thyroid Hormones which has more information and will help you interpret test results.

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
    Thyroid Hormones
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    What symptoms signal thyroid trouble? This extensive guide to Thyroid Hormones has critical info on testing, treatment, and side effects.

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    Try a Holistic Doctor or a DO. I also went to a Naturopath and he put me on the blood type diet and that helped me. He also gave me alpha lipoic acid and other supplements. I was having migraines and the holistic doctor tested all my hormone levels and put me on DHEA 10 mg time release and Pregnenolone and the Dhea took my migraines away in 15 minutes. My energy came back. I also take Armour thyroid 90 mg a day. I’ve had thyroid removed. Take 60 mg in morning and 30 mg at dinner time.

    This is a long story, but if it helps anyone, I will be glad that I wrote it. This is the story of someone with a constellation of symptoms involving their whole body, and all the systems therein: hormonal, digestive, endocrinological, reproductive, and if there are more – well, those too. I have gone through one at a time, taking care of them. Each time, the doctors seem to think I should stop complaining; we’ve fixed the problem and I should feel good now.
    No doctor seems able to contemplate that if the system is out of balance and we don’t balance the system, I won’t feel appreciably better. “Koyaanisqatsi”, to borrow a word. What has gotten me this far is if I have only incremental and slight relief I keep coming at them, and I believe I will, with another tweak or so get the relief I desire. The primary problem I see is that doctors want to treat purely to the test, and disregard symptoms and other diagnostic tools.
    About 19-1/2 years ago, at the tender age of 33, (sometime in the summer of 1988), I first went to the doctor because I felt tired. I had been tired after every semester in school, but I had recovered with a week or so of rest and another couple of weeks off. I had been tired after every busy season in public accounting, but since we got to take off at least 6 weeks every summer, I got recharged. This was different. I couldn’t be energetic again after having some r&r. The doctor took some blood tests and said, “nothing is wrong with you” and I was uneducated enough to take that for an answer.
    Over the next 15 years, I went to doctor after doctor, nutritionist after nutritionist, physical trainer after physical trainer, hypnotists, even psychics and religious healers with fatigue as my primary presenting symptom. I learned a lot and stopped taking “you are fine” as an answer. They had to show me they knew what they were talking about or I never went back.
    For several years, until about 1993, I was tired, but could recover to some extent with lots of sleep, and I was still able to go to the gym several times each week, run 3-miles with a neighbor five mornings a week and walk my dogs a couple of miles every night. People told me exercise was energizing, so I exercised. Regardless of the fact that I was taking in fewer calories than I had and was using many more calories (in theory) I began to gain some weight, but I grew up fat and had lost it and kept off the weight for about 25 years or more. I would lose it again – I wasn’t worried. I would just go on a diet and it would come off. But it didn’t.
    About this point, I also adopted this attitude: if any doctor told me “we are not getting any younger, we all slow down with age”, that would be the last time I saw them. I was getting that answer at 33 and still am getting it at 53. It’s a big-time “go away kid, you bother me” answer. Not only that, but I was paying to have them tell me to go play on the freeway.
    Additionally, I learned that many doctors who do not follow the allopathic model and have what I call “a following”, people who go to them frequently and sort of adore them because of their semi-divine status, have only one tool they are comfortable using. For some it is food sensitivities, for some it is taking everyone off of wheat and dairy, for some it is cleansing and colonics and for others it is a primarily vegetarian diet (or macrobiotic, or brown rice, or WHATEVER) with no caffeine and etc. etc. etc…. I learned to ask several people about the doctor, if I could, to see if they were such one-trick ponies. I applied the old wisdom: “If the only tool you have is a hammer, then all your problems start to look like nails” and fled their influence as though the hounds of hell were on my heels.
    I had one nutritionist (in1999) take a series of tests that I later understood showed I had subclinically low thyroid and clinically low iron. She would not make much money treating those symptoms though, so she didn’t treat them. Instead she put me on a liver-gallbladder cleanse and sold me supplements on which I much later found out she got a big kick-back. I got nothing out of her treatments so, $1800 poorer and 6 months later quit seeing her.
    Then in 2000, I went to an MD off of my insurance panel, so I paid for it myself, because I heard him on the radio and he sounded good. And pretty much, he was. He tested my blood again (yet again). By this time, my thyroid was clinically low. He put me on Armour thyroid. I didn’t notice any difference, but when I went to my regular doctor, the Armour had pushed my TSH up over the bottom of normal, so my doctor said that I was “fine”. I was not fine and I knew it keenly. I could go back to expensive doctor to see if he would push the envelope with more thyroid or I could see if something else helped. I elected to do that for several years. But that is sort of a digression.
    Clinical depression runs in my father’s family. Nature or nurture? This is one family that will not help answer the question definitively. Or perhaps it answers the questions in one word: “Both.” My family has plenty of nurture for depression, but not all extended family members have depression, and some get it only mildly. All four of my siblings and I have it to one extent or another. So, I went to a psychiatrist and a psychologist in 1997. I believe I am telling the truth when I say I have tried just about every anti-depressant on the market, the newer ones as they came along and my doctor got samples. For most of them, I had no change in symptoms or bad reactions, or VERY undesirable side-effects. In 2003, I slipped into a very deep depression stayed there for over eighteen months; hanging on to my life by my fingernails and afraid I would live under a cloud or in the shadows emotionally for the rest of my life.
    Then we tried a drug that was 30 years old and not sampled any more. But my psychologist had another very bright patient 25 years ago who had not been able to shake a deep depression, so she suggested it to the psychiatrist and we tried it. That was Vivactl. The result was miraculous as far as the depression went and after 3 weeks, I had a good day, then a bunch more bad days, then a good day, and then another good day, and another and no more really bad days.
    For a while, I was grateful just for not being depressed. However, after I was no longer depressed for about 3 months, I began to remember that my fatigue had been severe before and was not any better yet. I was still going home many nights and going right to sleep. I couldn’t seem to catch up and get rested. I remembered no dreams whatsoever. In past years I had kept a dream journal, my dreams were so vivid and apparently laden with meaning. I experienced sleep with no duration. In other words, the moment my head hit the pillow at night, my alarm was going off the next morning and I couldn’t believe that I had slept at all. I was MORE tired when I rose from bed than when I lay down.
    Now, we began dealing with female problems. I was 51 and still menstruating heavily and painfully. I don’t think anyone ever asked about the heaviness and painfulness of my periods, so I didn’t tell them. How did I know everyone didn’t have that level of pain? All 3 of my sisters had, my girlfriend had in college. I just thought it was normal. My two older sisters went post-menopausal in their mid to late 50s, and my mother, in her early 60s. My younger sister (2 years my junior) had a hysterectomy the year before after very severe symptoms, but of pain and not necessarily of fatigue. So, I knew I had probably had years to go before I did the same. And I didn’t know that it was significant that I had no problems of this nature before I was about 34 or 35. Apparently that means something, but I don’t remember just now exactly what.
    I went to my doctor and told her I was still fatigued. She ran tests and found that I was severely anemic, and my ferritin, the stored iron profile, was down to 7, with a reading of 10 – 220 considered normal. So, she sent me to the hematologist for an Iron Dextran infusion in March 2005. That helped some for about 6 or 7 months. I was still tired, but I could get up and go to work and get through the day. I could do a little yard work on the weekends. However, I gradually began again to lose the capacity to do anything but sleep and carry out other sedentary activity. At this time, I was seeing a physical trainer, because that was the only way I would do exercise. In October 2005, I reached the point again where I was so tired I could do nothing but go to bed when I got home. Also, my mental capacity was beginning to be diminished.
    I am a CPA, bright and highly intelligent. I began not to be able to write a coherent sentence. I am nothing if not articulate, and I began to articulate only nonsense. I had been having trouble putting my mind on the right word for 2 or 3 years and I had learned to cover by pretending I had a slight stutter. I was now afraid that I was just losing it. Maybe it was early-onset Alzheimer’s. My doctor tried several things that did no good. I don’t remember what they were.
    I don’t remember that period very well at all because there was just not enough of what it takes for the brain to lay down the neural pathways of memory and memory transmission. Finally, I convinced my family doctor to do another iron profile. My ferritin was down to 4 or 5. She sent me for another Iron Dextran infusion in February 2006. This time, the infusion did not relieve the fatigue at all, even for a couple of months. This, although the hematologist was happy with my count. He did not ever take a ferritin, of which I had climbed just to the very bottom of normal. He did CBC and RBC count and size and said he was happy.
    Whoopty-F—ing-Do!! He was happy!! Yeah!! My insurance company had paid him something like $2500 for the infusion, the lab tests and the office visits. I would be happy too. Let me say that the people of this doctor’s practice are good people and well-intentioned, but not very effective if what needs treatment is a constellation of symptoms caused by a system and not by a single organ.
    I went back to the doctor after 4 or 5 months and said I was more tired than before the last infusion and could we try something else. On my own, I tried increasing my thyroid dosage by 50%. After 3 or 4 weeks, I had a day when I woke up and was READY to get out of bed. But I had told myself when I started the experiment that I would only do it for 3 or 4 weeks. So, I got out of bed gladly that week, a little less so the next week and then less so still the next week, until after a month, I was again dragging out of bed at the last moment possible to pull clothes on and go to work. To me, this said that additional thyroid would complete the picture.
    She sent me to an endocrinologist this time and he conducted yet ANOTHER set of blood tests on my adrenal and thyroid function. He did all the thyroid tests, but all he believed in was the TSH. The others he did only because I insisted. So, I was over the bottom of normal for thyroid so he wouldn’t raise my does. He was the expert, and he did not consider the other tests credible. My thyroid was normal. At this point, I have officially been bumping along the bottom line of normal thyroid for 6 or 7 years.
    So, my family doctor tried hormones to regulate my period. I just got worse, which suggested fibroids to her, so she sent me for an ultra-sound. My uterus was the size of a large honeydew and looked to have fibroids. I went to a gynecologist and scheduled surgery after a discussion of my treatment options. By the time she took my uterus out 6 weeks later, it had grown to the size of a basketball. I then began taking iron supplements until my ferritin got up into the 70 – 80 range. A reading of 10 – 220 is considered normal but female athletes are documented to experience Restless Leg Syndrome at 55-65. Since I wanted to return to my walking and running as well as weight workouts, I wanted to get above that symptomological floor. At this point, I am also 100 lbs overweight. I weigh more than I ever have. To add to the story, I had my Hemoglobin A1C tested. I was at 5.9. On the advice of my nutritionist I started testing my blood sugar every day several times. My blood sugar readings were usually between 100 and 120. I reduced my carb intake 8 months ago and now my daily blood counts are between 70 and 90 generally and my A1C is down to 5.4. But I have gained 5 pounds over that time period, even though I started walking and still was exercising.
    I went back to my doctor and said, “I am better, but still fatigued.” So we went to the sleep doctor. Ok, fine. Now I sleep with a CPAP device and am better than I have been since early 2005, but that is hardly saying anything, since at that point I was severely anemic, overweight, snoring and eating carbs. I know I am older, but I know 70 year olds with more energy than I have. At 82, my mom has more energy than I do!!
    And speaking of my mom, she sent me to the People’s Pharmacy web site to look up what the Graedons had to say about thyroid. She had read an article and wanted me to check into it.
    I am going to get their pamphlet and see if my family doctor will look at it. If she won’t, maybe I will go to the expensive doctor I have to pay cash money for or go to an MD my nutritionist recommends and see if SOMEONE will experiment with raising my Armour Thyroid dosage upward and treating my symptoms as well as watching my tests instead of treating solely to the test results. If I could find someone who understood the calculus of the various addresses under the normal range on the bell curve and how you don’t want to live real far out on either tail, well that would sure be great too.
    At this point, I have been overweight again for the last 10 years and can’t lose weight any way I have tried. My bone density is at the middle point for women of childbearing age and I believe, from what I have read, carrying around the extra weight has provided much of bone-density protection provided by load-bearing exercise. In addition, I will continue to exercise to keep that protection.

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