Archive for the ‘Thyroid’ Category

How can I prevent recurrence of depression and what do I do if the depression does come back?

Depression runs in my family and I’ve been on the same medicine for a while with no episodes of depression.  About two weeks ago I woke up feeling not myself and contributed it to getting my period on top of coming down with a respiratory infection.  Still not feeling well after two weeks I think it might be depression because I feel tired, confused thinking, can’t focus, etc.  I’ve called my doctor and he told me to up my medicine 100mgs.  My question:  

Since I have not had an episode of depression in quite some time could it have been brought on by me not feeling well?

 


 

Dr. Jones’ reply:

I’m not sure what antidepressant you are on – but it was possibly Zoloft or Luvox since they can be increased by 100mg increments, but not SNRI’s (Effexor, Cymbalta) or other SSRI’s (Prozac, Celexa, Lexapro, Paxil).

Women with a family history and or prior history of depression who respond to an SSRI or SNRI can have return of symptoms if their serotonin level is reduced (as it is premenstrually, post partum, or during perimenopause).  Being ill can also contribute to relapse by disrupting sleep or normal thyroid function.

Previous studies have shown that:  "the dose that gets you well keeps you well", but even then the relapse rates are:  20% of patients have recurrence within 3 years,  50% relapse if the dose is lowered, or 80% relapse if medication is stopped.

Recurrent depression not only causes distress and possible short term impairment, it can also increase your vulnerability to future episodes and decrease your responsiveness to treatment.

There are several things that can help prevent recurrence:

  1. Good sleep – 7-8 hours every night (Lunesta, Ambien provide normal sleep)
  2. Physical activity – daily vigorous activity for at least 30 minutes (a 2 mile walk or equivalent)
  3. Omega 3 fatty acids – take twice daily.  (I trust Cooper brand the most)
  4. Bright light daily 
  5. Thyroid – make sure thyroid levels are good  test.askdrjones.com/ 
  6. Cognitive behavioral therapy – if needed
  7. Other medications – other medications may help such as alprazolam, atypicals, stimulants
  8.  L Methylfolate – (Deplin,  Cerefolin, or Cerefolin NAC)  – these contain a form of folic acid that gets into the brain cells.  Deplin was recently approved by the FDA as an add-on treatment for depression.  Cerefolin also contains B12 and Cerefolin NAC has a third ingredient that increases glutathione (a powerful brain cell antioxidant).  These medications not only can improve mood, but improve cognition and energy.  Caution:  taking Deplin if your B12 level is low can be harmful.  It is safer to either check your B12 levels or take Cerefolin. 
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Say Goodbye To The Pill Ladies

I am now completely against birth control pills. I’m also against hormone replacement with oral estradiol. Estradiol (in every birth control pill) taken by mouth goes through the liver and causes problems with thyroid, testosterone, and the most effective form of estrogen.

In anyone with a history of depression and/or stress reactivity, this can be a major contributing factor to their functioning and quality of life.

For premenopausal women the NuvaRing seems to be the best option. This is because the hormone blood levels are about 1/3 of what they are with the weakest birth control pill.

Controversy continues regarding hormone replacement in postmenopausal women. However, for most women, the benefits outweigh the risks – especially for brain function (mood & memory). Using the right types of hormones and the right dose is essential. The best options are Premarin or Cenestin tablets and/or estradiol by patch or gel.

Remember, estrogen x thyroid x brain transmitters = mood in women.

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Synthroid and Weight Gain

Question: I have been on Synthroid for three months, just bumped up to .1 three weeks ago. Since starting the meds, I continue to gain weight–faster than before I started them. My face, hands stomach and feet are always swollen. I exercise every day (60 mins on treadmill) and eat well, drinking lots of water.
So what’s the deal? Is my thyroid in some kind of shock following treatment? Will it ever improve?

— Babs
Answer: I’m assuming your thyroid level was low when you started Synthroid. It builds up slowly over 5 weeks. Initially, it will boost your T4 and usually, secondarily, T3.
But if your initial problem was secondary hypothyroidism (i.e., TSH wasn’t significantly elevated – basically, the rheostat in the hypothalamus is set too low), when you add Synthroid (T4), the hypothalamus starts to suppress your own production of T4 to compensate. At sub-optimal doses of Synthroid, you could actually end up with less than you started with (and subsequently gain weight, develop edema).
Columbia Thyroid Clinic uses body weight in pounds to determine approximate goal dose of Synthroid in micrograms (e.g., If you weigh 150 pounds, you end up on 150 micrograms of Synthroid – same as .15 mg).

Some people do better on a combination of T4 and T3: Synthroid (T4) with either Armour (T4+T3 – available in generic, so a cheaper option) or Cytomel (T3 – more expensive). 1 grain (same as 60 mg) of Armour approximately equals .075 Synthroid; .025 mg Cytomel approximately equals .1 mg Synthroid. The goal dose is a combination of the two. For example, 150 pounds – .075 mg Synthroid + 1 grain (60 mg) Armour. Or, more commonly – 1/4 to 1/2 grain Armour and .125 to .112 of Synthroid.

So in your case, I would assume your dose is too low and you would probably do better with adding Armour and/or increasing Synthroid. If thyroid is too high, you usually have symptoms of being hot, shaky, sweaty and/or having palpitations.
When getting lab work in the morning, don’t take your a.m. thyroid that day until after blood is drawn, and be sure to get free T4 (and free T3 if taking Armour or Cytomel).

For weight loss purposes, people usually do better with their free T4 in the upper part of normal range and usually do better with some T3.

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Thyroid Facts and Myths

I am a bibliophile, or a person who loves books. My friends and family would probably say I am more a hoarder of books, journals, magazines and notes. (More about what causes hoarding later) I love going to book stores and I always see what they have on medicine and neuroscience. I don’t think it’s a coincidence that there are more books on thyroid than any other subject. I believe the reason is low thyroid is an extremely common, fixable problem that may be more frequently mismanaged than any other medical condition. Proper treatment improves fitness and quality of life but most doctors don’t get it. There are two maladies that I have noted in some physicians, PRE EXTRACTION DISORDER and MILK OF MAGNESIA DEFICIENCY. In the first condition they lack important information or don’t understand key principles because their head is somewhere in their sigmoid colon. In milk of magnesia deficiency, they believe things that are sometimes creative or at one time believed, but unfortunately not true – ergo they are full of crap. You may think this point of view is unkind, and you’re right. I believe that as an ADHD person I was put on earth to stir things up and challenge the system, so I won’t apologize for being at times “tacky”.

Why are there so many books about thyroid? I believe when a doctor “gets it” and starts treating low thyroid effectively, they realize how often it is mistreated and how many patients suffer the consequences. I could regale you with case after case of examples, but suffice it to say, I too feel compelled to try and educate the public and my physician peers about the physiology of thyroid hormones.

The thyroid gland in the neck secretes two primary hormones, the more abundant T4 and the more active T3. Most of our T3 is made in other parts of the body by converting T4 to T3. I am working on a thyroid article that will go into detail about all the important nuances, but the key points are:

  • Thyroid regulates the activity of every cell in the body.
  • Many people, for various reasons, are low in T4 and/or T3.
  • Most doctors will order only part of the tests needed for accurate diagnosis (the TSH).
  • Total T4 and T3 uptake and a multiple called T7 or free thyroid index (FTI).

The FTI is preferred by insurance companies because it’s cheap, not because it’s adequate. This test is unreliable according to many reputable texts, so I consider it to be useless. The most important test is the Free T4 and sometimes the Free T3. Even when the Free T4 is within normal range, it may be too low for the individual. It would be analogous to giving you an IQ test in which you scored 90, and I told you this range was normal. The normal average range of IQ is 90-110, but what if you said “my IQ used to be 130”? … Something’s wrong. That may be the case with your thyroid.

One reason that this is missed is that most doctors don’t ask about thyroid symptoms (or a lot of other symptoms for that matter). But if you have fatigue or easy fatigueability you need to review all the possible symptoms:

Dry skin, hair loss, sensitivity to cold, constipation, swelling, decreased memory, depression, or mood sensitivity, weight gain, difficulty losing weight, and infertility.

Even when low thyroid is treated, it usually is undertreated. The main medication used is Synthroid (the generic is especially unreliable). Many patients also need T3, either Cytomel, or in combination Armour or Thyrolar.

In the past 2 years I have attended two lectures by different Endocrinologists who talked about treating low thyroid. They talked about TSH, estimated Free T4 and treatment with Synthroid. No discussion of secondary hypothyroidism (low thyroid) which means due to causes other than an underfunctioning of the thyroid gland. Neither presenter talked about the role of T3 or use of T3 in treatment.
The books on medicine and endocrinology all say that for secondary hypothyroidism the TSH is useless, and yet, that is frequently the only test they get. At the second talk I asked if they believed that the soul was in the pituitary. This is the gland that helps regulate thyroid by monitoring levels and secreting TSH. But the problem is the pituitary (the master gland just outside the brain) is regulated by the hypothalamus in the brain.

Years ago a study found that if post menopausal women not on estrogen were treated with too much thyroid it could worsen osteoporosis. Ever since there is a fear of causing bone loss, and the result has been a lot of undertreatment. The problem is over reliance on the TSH and fear of osteoporosis, “osteophobia.”

In secondary hypothyroidism the thermostat for body temperature and the set point for basal metabolic rate is set too low. I believe a common cause is “hibernation”. Many of us are mostly indoors and some are mostly sedentary. But we adapted over 1000’s of years to being outside all day and physically active. Our energy and sleep were regulated by the bright outside light. Even on a cloudy day it is 10x’s brighter outside than inside. If our brain thinks we are hibernating, and especially if we have cultural heritage from the northern countries, then we compensate by reducing our metabolism until the weather permits productive outside activity. By reducing our temperature and metabolism we conserve energy (stored as fat). This is also why it’s very difficult to lose weight.

If our hypothalamus is set too low the pituitary will read our level as too high when we take an adequate healthy amount of thyroid medicine. The TSH will then be below the normal range – this is fine. But most doctors overreact and lower the thyroid medicine. Now the patient feels terrible, but their TSH comes up and the doctor is happy – pre-extraction disorder. Most doctors are conscientious. They want to do what’s best for their patients, but in the case of thyroid, they mostly don’t get it.

Low thyroid can cause or worsen depression. In women it is:

Thyroid

x

Estrogen

x

Brain transmitters

(norepinephrine, serotonin, dopamine)

=

MOOD

It’s like for your car you have to have gas, oil, and water. You can’t compensate for no gas with more water. You can’t compensate for low thyroid with an SSRI (antidepressant such as Lexapro). In men testosterone is more important than estrogen. The brain converts testosterone to estrogen in men and women. Older men have more brain estrogen than older women (who are not taking estrogen). Older men have half as much Alzheimers – the only common cause of premature death more common in women.

In bipolar disorder Synthroid or T4 needs to be in the upper part of normal range to help stabilize mood. T3 is more of an antidepressant but obsession by “osteophobic” physicians results in inadequate treatment doses to help with mood. “The operation was a success (we kept the TSH up) but the patient died.”

I will cover osteoporosis n detail later but just a note – adequate estrogen/testosterone/DHEA, weight bearing exercise, and adequate calcium is the prevention/treatment.

Other than that I have no opinions.

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Thyroid Facts and Myths

I am a bibliophile, a person who loves books. My friends and family would probably say I am more a hoarder of books, journals, magazines and notes. (More about what causes hoarding later.) I love going to book stores and I always see what they have on medicine and neuroscience. I don’t think it’s a coincidence that there are more books on thyroid than any other subject. I believe the reason is low thyroid is an extremely common, fixable problem that may be more frequently mismanaged than any other medical condition. Proper treatment improves fitness and quality of life but most doctors don’t get it.

There are two maladies that I have noted in some physicians, PRE EXTRACTION DISORDER and MILK OF MAGNESIA DEFICIENCY. In the first condition they lack important information or don’t understand key principles because their head is somewhere in their sigmoid colon. In milk of magnesia deficiency, they believe things that are sometimes creative or at one time believed, but unfortunately not true – ergo they are full of crap. You may think this point of view is unkind, and you’re right. I believe that as an ADHD person I was put on earth to stir things up and challenge the system, so I won’t apologize for being at times "tacky".

Why are there so many books about thyroid? I believe when a doctor "gets it" and starts treating low thyroid effectively, they realize how often it is mistreated and how many patients suffer the consequences. I could regale you with case after case of examples, but suffice it to say, I too feel compelled to try and educate the public and my physician peers about the physiology of thyroid hormones.

The thyroid gland in the neck secretes two primary hormones, the more abundant T4 and the more active T3. Most of our T3 is made in other parts of the body by converting T4 to T3. I am working on a thyroid article that will go into detail about all the important nuances, but the key points are:

  • Thyroid regulates the activity of every cell in the body.
  • Many people, for various reasons, are low in T4 and/or T3.
  • Most doctors will order only part of the tests needed for accurate diagnosis (the TSH).
  • Total T4 and T3 uptake and a multiple called T7 or free thyroid index (FTI).

The FTI is preferred by insurance companies because it’s cheap, not because it’s adequate. This test is unreliable according to many reputable texts, so I consider it to be useless. The most important test is the Free T4 and sometimes the Free T3. Even when the Free T4 is within normal range, it may be too low for the individual. It would be analogous to giving you an IQ test in which you scored 90, and I told you this range was normal. The normal average range of IQ is 90-110, but what if you said "my IQ used to be 130"? … Something’s wrong. That may be the case with your thyroid.

One reason that this is missed is that most doctors don’t ask about thyroid symptoms (or a lot of other symptoms for that matter). But if you have fatigue or easy fatigueability you need to review all the possible symptoms: Dry skin, hair loss, sensitivity to cold, constipation, swelling, decreased memory, depression, or mood sensitivity, weight gain, difficulty losing weight, and infertility.

Even when low thyroid is treated, it usually is undertreated. The main medication used is Synthroid (the generic is especially unreliable). Many patients also need T3, either Cytomel, or in combination Armour or Thyrolar.

In the past 2 years I have attended two lectures by different Endocrinologists who talked about treating low thyroid. They talked about TSH, estimated Free T4 and treatment with Synthroid. No discussion of secondary hypothyroidism (low thyroid) which means due to causes other than an underfunctioning of the thyroid gland. Neither presenter talked about the role of T3 or use of T3 in treatment.

The books on medicine and endocrinology all say that for secondary hypothyroidism the TSH is useless, and yet, that is frequently the only test they get. At the second talk I asked if they believed that the soul was in the pituitary. This is the gland that helps regulate thyroid by monitoring levels and secreting TSH. But the problem is the pituitary (the master gland just outside the brain) is regulated by the hypothalamus in the brain.

Years ago a study found that if post menopausal women not on estrogen were treated with too much thyroid it could worsen osteoporosis. Ever since there is a fear of causing bone loss, and the result has been a lot of undertreatment. The problem is over reliance on the TSH and fear of osteoporosis, "osteophobia."

In secondary hypothyroidism the thermostat for body temperature and the set point for basal metabolic rate is set too low. I believe a common cause is "hibernation."  Many of us are mostly indoors and some are mostly sedentary. But we adapted over 1000’s of years to being outside all day and physically active. Our energy and sleep were regulated by the bright outside light. Even on a cloudy day it is 10x’s brighter outside than inside. If our brain thinks we are hibernating, and especially if we have cultural heritage from the northern countries, then we compensate by reducing our metabolism until the weather permits productive outside activity. By reducing our temperature and metabolism we conserve energy (stored as fat). This is also why it’s very difficult to lose weight.

If our hypothalamus is set too low the pituitary will read our level as too high when we take an adequate healthy amount of thyroid medicine. The TSH will then be below the normal range – this is fine. But most doctors overreact and lower the thyroid medicine. Now the patient feels terrible, but their TSH comes up and the doctor is happy – pre-extraction disorder. Most doctors are conscientious. They want to do what’s best for their patients, but in the case of thyroid, they mostly don’t get it.

Low thyroid can cause or worsen depression. In women it is:

Thyroid x Estrogen x Brain transmitters (norepinephrine, serotonin, dopamine) = MOOD

It’s like for your car you have to have gas, oil, and water. You can’t compensate for no gas with more water. You can’t compensate for low thyroid with an SSRI (antidepressant such as Lexapro). In men testosterone is more important than estrogen. The brain converts testosterone to estrogen in men and women. Older men have more brain estrogen than older women (who are not taking estrogen). Older men have half as much Alzheimers – the only common cause of premature death more common in women.

In bipolar disorder Synthroid or T4 needs to be in the upper part of normal range to help stabilize mood. T3 is more of an antidepressant but obsession by "osteophobic" physicians results in inadequate treatment doses to help with mood. "The operation was a success (we kept the TSH up) but the patient died."

I will cover osteoporosis in detail later but just a note – adequate estrogen/testosterone/DHEA, weight bearing exercise, and adequate calcium is the prevention/treatment.

Other than that I have no opinions.

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