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"At last, a nationally known endocrinologist with impeccable credentials discusses vital issues of thyroid disease and treatment never previously addressed in print. Dr. Arem provides solid explanations for symptoms of hypothyroidism in patients with normal blood levels of thyroid hormones and particularly addresses the needs of women who have thyroid and hormonal disorders."
Author of Listening to Your Hormones
and The Link Between Thyroid and Depression
"This book will be of tremendous help to the many people with thyroid disease and residual depressive symptoms. Dr. Arem elegantly addresses the important interplay of thyroidology and psychiatry."
—Lauren Marangell, M.D.
Baylor College of Medicine
When obvious precipitating reasons for depression are present--such as a difficult divorce, a stressful job, or other personal problems--a doctor is unlikely to consider a thyroid dysfunction as a possible cause or a contributing factor to the depression. The patient, family members, and the doctor become convinced that the overwhelming stress and life situations are responsible for the symptoms. Yet, as we'll see in Chapter 2, stress itself can trigger a thyroid imbalance and contribute to depression. Stress generated by the effects of thyroid hormone imbalance can lead to an escalating cycle of stress/illness/stress. Stressful life events may then be blamed for what are really thyroid-related symptoms, allowing these symptoms to linger and intensify. I recommend that everyone who has experienced a major stressful event, such as a difficult divorce or the death of a loved one, and has ongoing anxiety symptoms have his or her thyroid tested.
Doctors are even more likely to miss a thyroid problem and misdiagnose you if you have previously suffered from depression, panic attacks, or any other mood disorder. Symptoms of a thyroid imbalance are then likely to be attributed to the mood disorder, and the physician searches no further. One patient told me, "I learned quickly after I had been in the psychiatric hospital the first time what not to tell doctors, because once they hear that you had a mental condition, they disregard everything else you say."
Depression and anxiety disorders are the most common psychiatric conditions in the general population as well as the most common mental effects of thyroid disease. Therefore, patients with thyroid imbalance may see apsychiatrist rather than a medical practitioner. Because depression and anxiety disorders can cause the same physical symptoms as thyroid imbalance (such as a rapid heartbeat, increased sweating, and lack of sleep), psychiatrists are likely to come up with a psychiatric diagnosis when they see a thyroid patient. Often psychiatrists do not perform physical examinations that could lead them to detect physical causes for mental symptoms. One study showed that when psychiatrists use conventional psychiatric criteria to assess hyperthyroid patients, they diagnose nearly half of the patients as depressed or suffering from an anxiety disorder. Unfortunately, some psychiatrists do not always assess their patients for an underlying thyroid condition that might explain their fatigue, lack of interest in life, and inability to function as before.
The apparently close link between depression and thyroid imbalance has wide-ranging consequences. For a person like Rachel, a young wife and real estate agent I treated recently, uncovering that link was crucial for overall health and happiness. Before her true, thyroid-related condition was identified and treated, Rachel showed many of the signs of clinical depression. "I was always tired," she related.
I couldn't exercise anymore, and that was very frustrating. I would come home and fall asleep. If I wasn't sleeping, I was doing nothing more than watching TV. I didn't cook. I didn't clean. I didn't even let the dog out. I also put on twenty pounds in one month and lost a lot of hair, which was terrible for my looks and my self-esteem. I became cold and was constantly turning up the thermostat. Jimmy, my husband, couldn't believe I was so cold. I just had no willpower. I had to take a broker's license test, which cost my firm $2,000, but I couldn't even get motivated to study for it. I just wanted to go home and put on my nightgown and sit there on the couch. I lost interest in having any social life with my husband. I didn't want to see anyone. We quit going out. Our sexual relationship went to zero, too.
Given Rachel's symptoms, it is not surprising that for a long time she was diagnosed as depressed. Yet many of these same symptoms are associated with an underactive thyroid, and when Rachel was treated for her thyroid imbalance, she began to improve. "I gradually woke up and began to feel good," she said. "I didn't feel groggy or rushed anymore. I started eating right. I was more active and doing moderate exercise, and I lost thirty pounds. My husband and I went dancing, and I reunited with my friends again. They all asked, 'Where were you?'" For Rachel to fully answer that question, she would need to understand more about the interplay of thyroid, mind, and mood. Clearly, an underactive thyroid frequently causes depression, and an overactive thyroid tends to result in an anxiety disorder. Nevertheless, anxiety is also common in hypothyroid patients, and some patients with an overactive thyroid suffer from depression. Although when hyperthyroid patients suffer from depression, the bouts of depression tend to be short-lived, some of these patients may have persistent, lingering depression that fulfills the psychiatric criteria for depression.
Patients aren't totally aware of the full range of their symptoms or don't communicate them to their doctors. Patients themselves sometimes unintentionally hinder a proper diagnosis by failing to volunteer all of their complaints to their doctors. The statement "I'm tired and exhausted" usually reflects only surface symptoms. The symptom of fatigue may hide a multitude of feelings and emotional problems that patients may be reluctant to reveal. Most people have difficulty analyzing and clearly expressing how they feel or how their mind has been affected. Often we are not taught to recognize how our hearts feel, and many of us are taught to ignore or discount our emotions. We frequently lump all discomfort and mental suffering into "I'm tired, I'm exhausted, and I can't function the way I used to." Also, we tend to dismiss any mental or physical dysfunction as temporary.
Many people experiencing fatigue, lack of interest in life, and an inability to function as they once did suffer for years. They adjust to these feelings and are able to work and take care of responsibilities at home. But inside they are hurting. They have to struggle to appear normal to those around them. They live in a state of denial or self-dismissal and may not seek help or treatment for their symptoms.
Some of this self-dismissal stems from the stigma our culture puts on any and all mental conditions. The prevailing view that mental suffering is less serious than physical suffering may cause some persons with a thyroid imbalance to hide their anxiety, depression, or pain and not seek medical help. Others may fear ridicule from friends and relatives if they do seek treatment.
One patient who was suffering from lingering depression due to hypothyroidism told me, "I knew I was depressed and something was inadequate within me. I didn't want my family to know. I didn't want my company to know. I didn't have health insurance coverage for depression treatment, so I couldn't afford proper help." Many patients who seek psychiatric care may encounter significant difficulties in obtaining life and disability insurance. Many people with depression choose not to be diagnosed and treated because they know they will be discriminated against when they change jobs.
A second-year law student whom I evaluated for a possible thyroid disorder had suffered from a severe anxiety disorder for two years. He had correctly diagnosed his anxiety disorder a year earlier but had not reached out for help. "I could not go see a psychiatrist because later on, when I sit for my bar exams, just having a record saying I saw a psychiatrist will affect my entire career." This patient turned out to have an overactive thyroid due to Graves' disease.
I cannot emphasize enough how important it is for you to seek help as soon as possible after the onset of your symptoms rather than accepting them and doing nothing about them.
The wide range of physical symptoms can mask a thyroid imbalance. Another reason why doctors may miss a diagnosis of thyroid disease is that thyroid patients' mental suffering may be buried amid the multiple physical effects of thyroid disease. When physical symptoms of thyroid disease are quite prominent, doctors may treat patients for those specific symptoms and fail to diagnose the thyroid condition that is causing the symptoms. For instance, rapid heartbeat is a common symptom of an overactive thyroid that often leads physicians to consider heart disease. But if the heart evaluation is normal, doctors often dismiss the patient as anxious.
Judy, a forty-one-year-old divorced woman whose mother had died three years previously, was experiencing many symptoms of anxiety and depression. Even more disturbing to her were frequent palpitations and weakness in her arms and legs. Hyperthyroidism may be associated with muscle weakness, which should not be confused with the intermittent general weakness accompanying acute anxiety. In Judy's words:
Posted July 7, 2004
I've been taking thyroid meds for 15 years now and will have to for the rest of my life. I can honestly say it DOES affect you in many ways; from being tired all the time, to having no energy to even get out if bed sometimes. I'm also taking an antidepressant which has helped wonders in my 6 month TSH lab work; it was never stable before, but after 15 years of meds and the antidepressant, I can finally say I feel fine.
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Posted December 18, 2008
I recommend this book to anyone living with thyroid disease, family members, friends, Doctors, students etc... This book was by far the most imformative of them all. It covers everything you could possibly know. I was so disappointed when my endocrinologist failed to explain the symptoms. This book enlightened me on my disease and reassured me that I wasnt crazy or imagining the things that I was feeling/going through.<BR/>It is an easy read, its very interesting, not boring, was very well written! It is a must read!!!
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Posted November 12, 2012
Before I received a thyroid pill which was to change me for the better, I felt better.
Now I feel tired, practically lethargic, have a greater lust for food and I must live around this pill requirements because of the time required before and after eating. How did my grandparents survive who made it close to 90 before this magic pill?
So here I am looking for help and I'm concerned. Will this book save me? Stay tuned....
Posted January 28, 2007
I bought this book a few years ago when I was first diagnosed with Hashimoto's Thyroid Disease. It answered so many questions that I had and helped me to understand what I was going through . . . mood swings, weight gain, irritability, etc . . . YOU ARE NOT CRAZY! I bought this book for my doctor after I read it and asked her to read it too!Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted January 24, 2003
Arem's book offers a great deal of insight into the psychological manifestations of thyroid disease. But although he seems to recognize the mind body connection, he offers no solutions, particularly for hyperthyroidism, that address immune system health and the role of stress, iodine and other common triggers. His eagerness to guide hyperthyroid patients into destroying their thyroid glands shows that little thought was given to the life-long well-being of patients with this condition.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted April 24, 2002
A family history of thyroid imbalance had me checking thyroid from early twenties to cope with infertility, depression, et al. I've watched my thyroid values climb and plummet throughout the past 15 years. When thyroid values 'normal' by establishment I was given antidepressant (TSH value was 3.0+). It didn't change symptoms. At 40 years, my TSH value walked out of 'norm' and I was given thyroid hormone. I hadn't felt so well since I was 25! This book includes many charts and values of tests, how to interpret results of tests, diet for optimum health, etc. His book was a great help in understanding my condition. Depression cleared, memory restored, fatigue gone since on thyroid hormone. Dr. Arem's information enabled me to become a participant in my healthcare--not a sickly compliant. Thank you Dr. Arem!Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.