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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Phillipa on August 8, 2009, at 0:02:36
Interesting other side of the coin from above thread. Phillipa thyroid or antidepressant as ranges have changed.
How Many of the 27 Million Americans on Antidepressants Actually Have Undiagnosed Thyroid Disease?
Tuesday August 4, 2009
According to news reports out today, the use of antidepressants doubled between 1996 and 2005. Today, 10% of the population is taking antidepressant medication -- that's an estimated 27 million Americans.
The question this raises for me is, how many of these people who have been diagnosed as "depressed" -- usually by primary care and family doctors -- are actually hypothyroid, but haven't been properly tested and diagnosed? How many of the people taking antidepressants may actually be misdiagnosed?It's an important question. Because we know that depression can be a symptom of hypothyroidism. And we also know that there appears be a relationship between autoimmune thyroid disease/thyroid antibodies and depression. And we know that thyroid treatment can sometimes help as an adjunct to treatment for depression.
Consider the scenario. A woman goes to the doctor, complaining that she's feeling more tired than usual lately. She's gained a few pounds. And she feels down in the dumps, a bit blue and moody. Does the doctor think, "Hmm, fatigue, weight gain, depression -- these could be signs of hypothyroidism. Let me run a complete thyroid panel?" Sometimes. But more often, the doctor thinks "fatigue, weight gain, depression -- these are symptoms of depression, so I'll write a prescription for an antidepressant."
Why is this happening?
First, thyroid disease affects women, some eight to ten times more often than men. And women often describe our symptoms to doctors in a more emotional way. It's not uncommon for a woman to say: "Doctor, I feel just awful. I'm so depressed, I feel like a blob, and I'm so tired I can't think straight." And when doctors hear symptoms described like this, the tendency may be to assume a mental health diagnosis, rather than consider the possibility of an underactive thyroid.
Second, the typical family practice doctor or GP doesn't spend enough time in medical school studying thyroid disease or learning its many signs and symptoms. Much more time is spent, for example, on diabetes, which is actually less prevalent than thyroid disease.
Third, everyone who is depressed does not have a thyroid condition. (This is not an excuse to rule out thyroid disease as a cause of the depression, but it seems to be considered as much by some physicians.)
And finally, don't overlook the financial aspect. Sad to say, but there is cost containment going on. No tests are needed, and it costs almost nothing for a doctor in an HMO or managed care environment to write a prescription for an antidepressant and send a patient on her way. But blood tests for thyroid disease, followup, and thyroid treatment -- possibly even a referral to an endocrinologist for evaluation -- all cost time and money.
Unfortunately, even if in our scenario, the doctor was one of the more enlightened physicians who hears "fatigue, weight gain, depression" and immediately thinks thyroid, the majority of those doctors will run only the Thyroid Stimulating Hormone (TSH) test, rather than a complete clinical and laboratory assessment of the thyroid.
And here, we have another challenge. Since late 2002, the endocrinology community has recommended that the normal reference range be changed for the TSH test. They recommended that the range -- which usually runs from about 0.5 to 5.0 -- be narrowed significantly, to 0.3 to 3.0. That debate has raged for more than six years. Today, millions of Americans fall into the limbo of a TSH level between 3.0 and 5.0 -- where some doctors consider them hypothyroid and warranting treatment, and other doctors consider them "normal" and would assume depression to be primarily a mental health issue, and not a symptom of hypothyroidism. So the depressed patient with a TSH between 3.0 and 5.0 -- who has a doctor who isn't up on the latest thinking -- is likely to be dismissed with an antidepressant prescription -- and without thyroid treatment.
An added problem: Because laboratories like Quest and Labcorp are still using the old, outdated range, many doctors are not even aware of the TSH range controversy at all, because levels above 3.0 are not flagged on the lab reports as "high."
I'd like to see all 27 million people on antidepressants have their thyroid levels tested. And no, not just TSH tests, but TSH, Free T4, Free T3 AND thyroid antibodies levels. I'll bet that a significant percentage of the people on antidepressants have a TSH above 3.0, and/or antibodies indicative of autoimmune thyroid disease, or "normal" TSH but low or low-normal Free T4 and Free T3, and have never even been checked.
In my opinion, as a patient advocate, a complete thyroid panel should be required before any doctor prescribes an antidepressant. But, until it is a requirement, if you are experiencing depression, please ask for a complete thyroid evaluation -- and not just a TSH test.
Posted by floatingbridge on August 8, 2009, at 1:58:23
In reply to Does The Patient Need Thyroid Meds Or Antidressant, posted by Phillipa on August 8, 2009, at 0:02:36
Right on!
fb
(who has hashimoto's and feels best w/ tsh around 1-1.5)
Posted by manic666 on August 8, 2009, at 4:30:07
In reply to Does The Patient Need Thyroid Meds Or Antidressant, posted by Phillipa on August 8, 2009, at 0:02:36
in england ,when you see a p doc the 2 things he does before anything else, 1 you have a brain scan , 2 you have a thyriod test to rule out the two main questions , dont they do that in america, there must be many on p meds an all they need is thyriod adjustment,i take thyriod meds im only a small ajustment,but a lot that go to metal hospital thats all they need there thyriod if way out ajusting
Posted by Glydin 00 on August 8, 2009, at 12:30:08
In reply to Does The Patient Need Thyroid Meds Or Antidressant, posted by Phillipa on August 8, 2009, at 0:02:36
or both?
I have always advocated for workups for determining a "cause" or underlying condition. I can't think of a RL situation where this wasn't done - even if someone I knew visited a "Doctor in a box" type clinic. That's just my RL experiences.
If thyroid supplementing treats a person's symptoms of depression and anxiety... great! If a person finds that's not the case... well, maybe comorbidity seeing both conditions as disorders needs to be looked at however contributory one is to another.
I've know folks carefully followed by endocrins who achieved results from supplemental thyroid additions by all parimeters but in the area of symptoms of the mind.... that also falls under my RL experience.
Posted by manic666 on August 8, 2009, at 14:07:47
In reply to Re: Does The Patient Need Thyroid Meds Or Antidressant » Phillipa, posted by Glydin 00 on August 8, 2009, at 12:30:08
i take both, i assumed, sorry i thought you would no that as im on a mental health site,but i think the question is a thyriod test is not always done in all countries, an should be to rule it out first. my thyriod is only a little out but the doc.s put you on meds to keep it stable.or they wont no if the a d will work if not
Posted by Glydin 00 on August 8, 2009, at 19:42:08
In reply to Re: Does The Patient Need Thyroid Meds Or Antidressant, posted by manic666 on August 8, 2009, at 14:07:47
> i take both, i assumed, sorry i thought you would no that as im on a mental health site
~~~ Yes, one would think if someone was on the med board on a mental health site they would be having psych problems and discussing the use of psych meds.
I'm just as you.... no matter what else is going on with my health, my brain has a problem.... Sometimes, I think not everyone has that idea. (Smile)
Posted by Phillipa on August 8, 2009, at 20:15:29
In reply to Re: Does The Patient Need Thyroid Meds Or Antidres » Phillipa, posted by floatingbridge on August 8, 2009, at 1:58:23
Floating Bridge me also but still at 2.5 was down lower too low and then it was hyper. Asked the endo if eventually they the thyroid completely burns out as my neices did and he said yes. I'm thinking of swithing to unithroid neighbor on that loves it. Anyone one this med? Phillipa
Posted by manic666 on August 9, 2009, at 3:11:32
In reply to Re: Does The Patient Need Thyroid Meds Or Antidres » floatingbridge, posted by Phillipa on August 8, 2009, at 20:15:29
phillipa im on 50mm levothyroxine tabs. an my thyriod is only slightly out, what the sh*t does 2.5 do i thought your tyriod was all over the place.
Posted by manic666 on August 9, 2009, at 3:13:35
In reply to phillipa, posted by manic666 on August 9, 2009, at 3:11:32
i mean micro grams 50
Posted by Phillipa on August 9, 2009, at 21:21:40
In reply to phillipa, posted by manic666 on August 9, 2009, at 3:11:32
Manic my current TSH is 2.5 that is high by the new standard 1-2. Phillipa
Posted by Alexanderfromdenmark on August 10, 2009, at 20:41:40
In reply to Re: phillipa » manic666, posted by Phillipa on August 9, 2009, at 21:21:40
> Manic my current TSH is 2.5 that is high by the new standard 1-2. Phillipa
Philippa, you need to educate yourself on thyroid treatment as much as you can. If your mental health problem started with low thyroid function, then I think this is were you should direct your attention.
Learn about
Reverse T3 dominance
Adrenal fatigue
Low ferritin(common in hypothyroidism, meds won't work with too low ferritin).
Blood tests(they are not also reliable to measures of thyroid function. One can have completely suppressed TSH and still be hypothyroid).However most informed patients and doctors would still agree that your TSH at 2.5 is too high. It's need to get under 1 at least and your Free T3 needs to be on top of the range.
Posted by Phillipa on August 10, 2009, at 21:35:30
In reply to Re: phillipa, posted by Alexanderfromdenmark on August 10, 2009, at 20:41:40
Alexander I know I do get the Mary Shoman newsletter on thyroid. Do you have any good links? The endo didn't seem to mind the 2.5 since fluctuate between l.5 and the 2.5. I do think this bioidentical hormones may be contributing but it's cream. Any ideas? Love Phillipa
This is the end of the thread.
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