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Suggest Remedy For Severe Anxiety And Depression
Question: Since mid summer I have been gaining weight steadily, despite watching what I eat and exercising regularly. I have been having mood "issues" that are very unlike me, such as depression and anxiety and unusual anger and frustration. I am exhausted all the time. My skin and hair are so dry that my hands have started peeling in places and I have developed calluses on my fingers. The joints in my hands are so painful by mid day that I have trouble using my mouse at work. My menstrual cycle has become, for the first te in my entire life, completely unpredictable.
I had my annual checkup with my doctor in July. Symptoms hadn't really started to become noticeable yet so I didn't mention them. Blood work was done as a matter of course - TSH was 0.424 and T4 was 1.79, both within normal limits. In September I returned to my doctor and told him about my symptoms. He gave me an antidepressant (such a cliche) and did more blood work. This time TSH was 0.602 and T4 was 1.46. Again, within normal limits though higher and lower, respectively, than 2 months prior. On 12/18 I ended up in the ER for a problem with my throat. Blood work was done again and my TSH was 0.95, T4 was 1.16. Within normal limits again and again, higher/lower. Looking at it from this perspective, there definitely appears to be something happening but I cannot seem to find a doctor who can hear me speaking or one who will listen and look at the whole picture.
I've now come to the point where I am asking a random stranger on the internet, that I hope is an actual doctor, because I know I'm not nuts and that something is going on. Is it normal for TSH and T4 to change this much over 5 months? And for it to not so much fluctuate as make a continuous turn up (TSH) and down (T4)?
I had my annual checkup with my doctor in July. Symptoms hadn't really started to become noticeable yet so I didn't mention them. Blood work was done as a matter of course - TSH was 0.424 and T4 was 1.79, both within normal limits. In September I returned to my doctor and told him about my symptoms. He gave me an antidepressant (such a cliche) and did more blood work. This time TSH was 0.602 and T4 was 1.46. Again, within normal limits though higher and lower, respectively, than 2 months prior. On 12/18 I ended up in the ER for a problem with my throat. Blood work was done again and my TSH was 0.95, T4 was 1.16. Within normal limits again and again, higher/lower. Looking at it from this perspective, there definitely appears to be something happening but I cannot seem to find a doctor who can hear me speaking or one who will listen and look at the whole picture.
I've now come to the point where I am asking a random stranger on the internet, that I hope is an actual doctor, because I know I'm not nuts and that something is going on. Is it normal for TSH and T4 to change this much over 5 months? And for it to not so much fluctuate as make a continuous turn up (TSH) and down (T4)?
Brief Answer:
Thyroid
Detailed Answer:
Sorry to note your troublesome symptoms.
I have reviewed your TSH and T4 values over the course of the year. This can very well be normal.
It has varied somewhat from 0.424 to 0.602 and then most recently to 0.95 but this is considered normal. It is not as large a fluctuation as it seems to you.
The T4 has also essentially remained within normal range all this while.
It is extremely unlikely that there is a problem with the way your thyroid is functioning.
There are several scientific reasons for the TSH and T4 to appear like this on your blood report. They can be complex to understand.
I will give one example to illustrate. The TSH test is quite reliable and accurate but yet imperfect as in , it has a 20% 'Co efficient of Variation'. This means that if I gave my blood sample for TSH now and the result came back as 1, it is very much likely that if the exact same blood sample was tested 5 minutes later in the same laboratory the result could be 20% on either side of the actual reading ie between 0.8 to 1.2
Furthermore, if the same blood sample drawn from my bod was sent to two different laboratories at the same time, even then there is a strong possibility of the TSH result being roughly in the same range of 0.8 to 1.2
So these are all correct values reflecting your body's TSH , as long they remain consistently within the normal range.
Your tests were done months apart. Here too, the time of the day can cause some variations.
Such factors affect the TSH result but they are not significant enough to analyse as long as the TSH falls in the range of normal, especially with T4 being well within the range of normal
Thyroid
Detailed Answer:
Sorry to note your troublesome symptoms.
I have reviewed your TSH and T4 values over the course of the year. This can very well be normal.
It has varied somewhat from 0.424 to 0.602 and then most recently to 0.95 but this is considered normal. It is not as large a fluctuation as it seems to you.
The T4 has also essentially remained within normal range all this while.
It is extremely unlikely that there is a problem with the way your thyroid is functioning.
There are several scientific reasons for the TSH and T4 to appear like this on your blood report. They can be complex to understand.
I will give one example to illustrate. The TSH test is quite reliable and accurate but yet imperfect as in , it has a 20% 'Co efficient of Variation'. This means that if I gave my blood sample for TSH now and the result came back as 1, it is very much likely that if the exact same blood sample was tested 5 minutes later in the same laboratory the result could be 20% on either side of the actual reading ie between 0.8 to 1.2
Furthermore, if the same blood sample drawn from my bod was sent to two different laboratories at the same time, even then there is a strong possibility of the TSH result being roughly in the same range of 0.8 to 1.2
So these are all correct values reflecting your body's TSH , as long they remain consistently within the normal range.
Your tests were done months apart. Here too, the time of the day can cause some variations.
Such factors affect the TSH result but they are not significant enough to analyse as long as the TSH falls in the range of normal, especially with T4 being well within the range of normal
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Topiwala. I understand what you're saying. You noted your brief answer as "Thyroid" though, in your detailed answer, you expressed that my thyroid function results are normal. Are you saying that you think my thyroid is possibly the cause of my symptoms despite the normal results or am I misunderstanding? If so, how? If not, what should I do next? I should have also told you that my A1C was checked in Sept - 4.2
My LH and FSH levels were checked to rule out pre menopause and those results were WNL also.
My LH and FSH levels were checked to rule out pre menopause and those results were WNL also.
Brief Answer:
Follow up
Detailed Answer:
I see.
I am saying it is extremely unlikely for the thyroid to be the cause of your bothersome symptoms.
So you must pursue other reasons.
I have noted your normal A1c , FSH and LH.
When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination:
CBC
Electrolytes
Calcium
Liver function tests
Kidney function tests
25 hydroxy Vitamin D
Follow up
Detailed Answer:
I see.
I am saying it is extremely unlikely for the thyroid to be the cause of your bothersome symptoms.
So you must pursue other reasons.
I have noted your normal A1c , FSH and LH.
When I see someone like you in my practice, I typically order the following tests in addition to a detailed physical examination:
CBC
Electrolytes
Calcium
Liver function tests
Kidney function tests
25 hydroxy Vitamin D
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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