Indiana native Jonelle R. Chalmers first learned she had hypothyroidism in the spring of 2011 when the gland in her neck enlarged, making breathing and swallowing difficult.
Doctors removed her thyroid gland, and Chalmers started taking synthetic thyroid hormone medication to replace the hormone that was no longer being produced naturally by her thyroid.
But as the months went on, Chalmers, who had been a happy, well-adjusted person, started thinking something else was wrong.
“I was crying for no reason. I wanted to stay home, just be with my husband and close myself off from the world,” the self-employed attorney recalled. “It became very hard to make simple decisions about what to cook for dinner, whether to do the laundry, and how to select the appropriate cold medicine. Simple choices became impossible, and I’d cry about it.”
Chalmers’ original endocrinologist suggested — incorrectly — that the depression had nothing to do with her hypothyroidism and recommended she see a psychiatrist.
Chalmers doubted the sudden onset of mental illness and felt some relief when her family doctor confirmed that depression is a common side effect of hypothyroidism.
The link is strong enough that guidelines on hypothyroidism treatment published in 2012 in the journal Endocrine Practice stated that people with depression should be evaluated for a thyroid condition and that lithium, which is sometimes prescribed for depression can, in fact, cause hypothyroidism.
Root Causes of Depression
The symptoms of depression caused by hypothyroidism and those resulting from an independent mental illness can be similar, making it difficult to distinguish one from the other, explained Leonard Wartofsky, MD, MPH, chairman of the department of medicine at MedStar Washington Hospital Center in Washington, D.C. It's possible to be misdiagnosed with depression when hypothyroidism is the real problem, he added.
“Essentially you can’t tell the difference,” Dr. Wartofsky said. “It’s just a different cause.” Just like people with true depression, people who are depressed because of hypothyroidism may experience slower brain function, feelings of listlessness and exhaustion, a poor appetite, and tendency to nap a lot. But a simple blood test to check levels of thyroid hormones can provide the answer. If hypothyroidism is the cause, “once you’re treated,” he said, “the depression miraculously goes away.”
According to the American Thyroid Association, most people who have hypothyroidism can be treated effectively with levothyroxine alone, which contains the hormone T4. The body then naturally converts the T4 into another thyroid hormone, known as T3.
However, Chalmers’ body was not making this conversion, so even though she was taking levothyroxine, she remained in a state of hypothyroidism. She took matters into her own hands, switched to a new endocrinologist, researched her disease extensively, and requested a prescription for liothyronine, which provides her body with the T3 hormone she was not making naturally.
It took three or four months of adjusting doses of the two medications before Chalmers’ lab tests in early 2013 showed normal thyroid hormone levels and she started feeling better — back to exercise class three times a week and feeling like her old self.
“It was like a switch flipped in my brain,” she said. “My [thyroid hormone blood] levels optimized, and my depression went away. But I wouldn’t be healthy today if I hadn’t researched and pushed."
Last Updated: 7/30/2013