Comment by mendelsd | Hacker News Reader

Comment by mendelsd | Hacker News Reader

Decades-long anxiety sufferer here, basically cured with thyroid hormone replacement...

Thyroid underactivity is a very common condition (thyroid hormone is the third-most prescribed medication in the UK), and some of you anxiety sufferers out there may have a thyroid problem (either under- or over-activity).

The most common problem is an underactive thyroid, which 90% of the time is caused by auto-immunity.

Detection is complicated by an ongoing controversy over reference ranges [1][2]. I recommend you seek the advice of the most careful practitioners. If you suspect a problem but your doctor won't treat, keep testing. The results will fluctuate, and even more so if you have a problem.

Beware TSH measurements consistently above 2.0. That may put you at risk of chronically elevated cortisol [3], which has been shown to cause anxiety in mice [4].

[1] https://www.ncbi.nlm.nih.gov/pubmed/16148345

[2] https://www.ncbi.nlm.nih.gov/pubmed/16148346

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819/

[4] http://www.apa.org/news/press/releases/2006/04/stress-mood.a...

I got tested for hypothyroidism after my hair started falling out one day. I had a TSH level of 64.0.

My body was effectively screaming for more thyroid hormone.

I've also had high levels of anxiety and cortisol, I wasn't aware of the relation though. Unfortunately hypothyroidism is so common place that my doctor's don't really give me the info. I'll read through your links to find out more about this.

EDIT: After reading the chronic exposure article I think I'm going to avoid adrenalin releasing activities for a while. Coffee and intense video games :)

While we're at it, we should also add sleep apnea to the list of disorders to screen for. Sleep apnea causes anxiety. Estimates of prevalence range from about 1-2% at the low end to 30% for certain demographics. And increasing with time due to changes in the facial skeleton. Diagnosis rates remain low because the symptoms can be difficult to trace back to it and there's low awareness among doctors still.

Thyroid test is the first thing psychiatrist look at when dealing with mood disorder. Wouldn't this kind of problem be diagnose and treated immediately? Or are the "standard" tests not accurate enough? What kind of "non-standard" tests should one be asking for?

I'd hope that was the case everywhere, but there's still a big grey area. The British Thyroid Association says:

"There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L. Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis" [1]

So what might happen to you if your TSH is, say 3.5, for at least a decade (hey hey, I know the answer to this one...)? Well, you're at risk of elevated cortisol with resulting mental illness, to which my previously posted links will attest. Doctors, if they're not especially attentive, will just prescribe the usual anti-depressants (perhaps a low dosage as an anxiolytic) which are band-aids and don't get to the root of the problem.

Note that I never mentioned non-standard tests - "keep testing" means "keep getting the standard tests". The problem is that interpretation of the standard tests varies - some test results may or may not indicate disease, and this is not always carefully followed up on. There are of course many more people in this grey area than there are people with overt disease. I'd say if you're in the grey area and you have chronic mental health symptoms the risk/reward ratio is overwhelmingly in favour of treatment with thyroid hormone (carefully monitored of course).

[1] http://www.british-thyroid-association.org/info-for-patients...

But then why not just look at the t4 and t3 levels?

"Currently, measurement of the serum TSH concentration is the most reliable indicator of thyroid status at the tissue level. Studies of mild (subclinical) thyroid hormone excess or deficiency (abnormal TSH/normal range FT4 and FT3) find abnormalities in markers of thyroid hormone action in a variety of tissues (heart, brain, bone, liver and kidney). These abnormalities typically reverse when treatment to normalize serum TSH is initiated" [1]

The reference has loads more detail...

[1] https://www.aacc.org/-/media/Practice-Guidelines/Thyroid-Dis...

I wasn't arguing that, I was suggesting that if it wasn't clear why the tsh level is high or low, to add on a t4 level check. Which is what is currently done, at least in the US.

Well, there's a common condition called subclinical hypothyroidism which may be asymptomatic and harmless, or it may indicate thyroid disease and be accompanied by various non-specific symptoms. It's defined by slightly elevated TSH but normal T4 test results. Anybody with that condition would not be helped by what you are proposing.

In general, it seems to me that you will get some false negatives when using a less sensitive test result to qualify a more sensitive test result.

The link seems to be 404, was this the document you intended to link?

http://www.acb.org.uk/docs/default-source/guidelines/TFTguid...

Yes indeed, thank you.

I have many friends being treated by psychiatrists, and none have checked thyroids. Psychiatrists behave like pill dispensers, not like actual physicians.

The primary healthcare providers that referred your friends to psychiatrists may well have checked thyroid levels but, as I've pointed out elsewhere in this thread, tests do not always lead to appropriate detection and diagnosis.

Not preaching just curious did you try any diet changes?

I made major dietary changes before I went on meds. My overall health improved a lot, but mental health improvements were insufficient.

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