Is It Your Thyroid or Are You Going Crazy? – With Dr. Izabella Wentz

Introduction: Thyroid and Mental Health 0:00

Are you going crazy or is it just your thyroid? Hi, welcome to the thyroid pharmacist healing conversations podcast. I'm your host, Dr. Isabella Wentz, your Thyroid Pharmacist. As you may know, I am not just a thyroid pharmacy. Lately, I've been reflecting on some of these symptoms of hypothyroidism and Hashimoto's Graves' disease and autoimmunity that just don't really get a lot of attention from conventional medicine and these are mental health symptoms such as anxiety, obsessive-compulsive disorder, depression, I've even seen people with bipolar disorder and schizophrenia diagnoses that actually had Hashimoto's thyroid antibodies and or hypothyroidism as their root cause.

And once the antibodies were brought into a lower range, and once that thyroid function was optimized, sometimes it took doing a few more things there as well. their mental health symptoms significantly improved, in some cases vanished. Right now, I'm expecting a baby girl and I've been really reflecting on what it feels like to be a young woman. And I can tell you that my teenage years were very, very challenging for me where I struggled with my mood. I struggle with depression.I was very tearful all the time as I was going through puberty.

something interesting to note that at that time my mom actually suspected that I had thyroid dysfunction and she took me to an endocrinologist who said her thyroid labs are normal. Now if you are somebody that has been in the thyroid space as a thyroid advocate, thyroid patient, practitioner that works with people with thyroid disorders, you will know that that is something that a lot of times people hear but isn't the truth.

Teen Years, Fatigue, and Misdiagnosis 1:58

This is because most doctors actually test for TSH, the thyroid stimulating hormone, and in many cases that can appear to be normal, or perhaps they're not using the most latest reference ranges, so they are telling you that your thyroid function is normal when your TSh is at a 4, where it probably should be somewhere between 0.5 and 2. The other thing is that in many cases the TSH level might be normal for 5, 10, sometimes 15 years, but you might have an autoimmune attack against your thyroid gland.

This auto immune attack has been tied to all of the various mental health conditions that I mentioned, so feeling depressed, feeling unwell, having obsessive-compulsive disorder. There is a condition known as Hashimoto's Encephalopathy that is pretty much very high thyroid antibodies that start impacting brain function and people have appeared as psychotic, catatonic, schizophrenic, in those situations. Their thyroid function might be normal, but yet the thyroid antibodies do something to the brain where the people end up oftentimes in mental health hospitals, and sometimes they have treatments that can stabilize this, such as immunoglobulins usually done intravenously to get that stabilized, sometimes steroids.

And this is more of an extreme case, But in my experience, I have seen people who have thyroid antibodies and they're not hospitalized for mental health issues, but they are significantly suffering from mental issues such as anxiety. And unfortunately the answer they get is to go to a doctor's office, get a prescription, right from sometimes for an SSRI. Sometimes they're referred to a psychiatrist and a lot of times they are again told all of your labs are normal. All of you labs or normal and it's because the doctors don't do the right kind of lab testing.

It's very commonly that people are misdiagnosed that they are dismissed that there's a lot of gaslighting that occurs and sadly once somebody receives a mental health diagnosis they no longer become trustworthy so you might be somebody that's struggling with extreme fatigue And the doctors might say, oh, well, that's part of your depression. They might not really want to do any further testing with you once you have a mental health diagnosis. Again, I'm pregnant with a little girl and I am really reflecting on my youth and thinking about my early college days.

I remember being so incredibly fatigued, sleeping for 14 hours a night and feeling like I had a hard time making decisions. I went from a really bright-eyed and bushy-tailed honor roll student to somebody that had really hard times with brain fog. And I came home from college that summer and my mom took me to a psychologist. She's like, this is not the same kid that I sent away to college. What happened with you? I was diagnosed with depression, which I kind of like well, I'm not really sad. I guess I am sad that i can't do the things that normally do, but like I really tired and I have a hard time making decisions.

Hashimoto's, Antibodies, and Brain Symptoms 5:18

And i went to therapy for that and again probably the answer was that there was something going on with my thyroid, you know, fatigue is a red flag for thyroid dysfunction and so are the other symptoms. So if you have a teenager that is moody, if a young adult in your life that's mooty, you know, whatever age you are and your mood is off, it's really important to look at your thyroid function and look the full picture. So, we know that hypothyroidism is typically associated with slowing down of the system, so you might be sluggish.

You might have constipation, you're going to have fatigue, and part of that clinical presentation is depression. On the other hand an overactive thyroid you're going to have a sped up metabolism so you might be losing excess weight, you may be having palpitations and you will also experience anxiety. Now this is commonly known by conventional medicine yet when most people present with symptoms like depression and anxiety their thyroid is rarely ever checked. So I do encourage people to really go deeper when you have these symptoms.

The other thing that can be very confusing for people is a person with Hashimoto's, especially in the early stages, might present with symptoms of depression and symptoms anxiety. This is because when have those thyroid antibodies attacking you, you initially will get a bunch of thyroid hormone dumped into the bloodstream which can cause a transient overactive thyroid making you anxious and as that clears out you can start having hypothyroid symptoms including depression and fatigue and this can be kind of like a cyclical situation for many people, very distressing.

I know when I was in my early 20s I started to experience panic attacks and they came out of nowhere. I was offered prescription medications and benzodiazepines for the panic attack and I knew that they were just not normal, I had nothing to really panic about. Yet again this can be a symptom of those elevated thyroid antibodies. By the time I got my thyroid antibody tested they where in the 2000 plus range and getting them lowered is what really helped my anxiety. Not personally relevant for me, but there's a condition known as rapid cycling bipolar disorder where you like jump around from the ups and downs.

So you might be feeling manic, you may be depressed and that tends to switch rather quickly. And there is a very high percentage of people where scientists and researchers have said thyroid antibodies should be a marker used to detect rapid cycling bipolar disorder to diagnose this. So essentially what that means is that people, many people with this actually have thyroid antibodies and you know the traditional approach and psychiatry is very much like mood stabilizers, antidepressants, lithium and therapy and trust me you know I used to work in mental health so I wanted to specialize

Anxiety, Panic, and Bipolar Links 8:27

as a psychiatric pharmacist so i did a lot of rotations in psychiatry and I also worked at a few jobs where I would work with psychiatric patients And so I'm very well versed with pharmacology and I feel like that it has a place and it can be very helpful for certain situations. But at the same time, my eyes were really opened where I started seeing some of my patients, psychiatric patients. One of them had a history of depression throughout her life and a story of doing really well and history being impacted mentally where she was not able to function and take care of herself.

And I had an opportunity to review 20 years of her medical records and I found that at some point she diagnosed with hypothyroidism and at a time when she's really thriving mentally, physically, doing well, independently, She was on thyroid hormones. And then the times when she came to us, she was off of thyroid meds. Somebody took her off her thyroid and she had intractable depression that no antidepressant could help. Now, there are some studies suggesting that for patients, even without thyroid dysfunction, adding some thyroid hormone on board can help intratable depressions if people have been on antidespressants.

For me, it's kind of like, okay, if somebody is depressed, let's figure out why. There's a chance they don't have a Prozac deficiency, right? But there could be a change that they are hypothyroid. Specifically for depression, I would really advocate for looking at your T3 levels. So T-3 hormone is the more active hormone that helps your brain and body function, whereas a person going to an endocrinologist will typically receive a prescription for a T4 containing medication like levothyroxine. On paper levathyroxyne is supposed to convert to just enough T3 but this doesn't always happen sometimes for genetic reasons sometimes because you're stressed sometimes, because, you've got nutrient deficiencies and so a lot of people are really left with Hey, I am taking thyroid medications, but I'm still depressed.

And a big part of that could be just getting on some T3 hormone. You can do this by adding a medication like Cytomel. you can use this. So thyroid hormone conversion support or T4-T3 conversion, support nutrients. such as zinc and selenium can be very, very helpful for improving that conversion of T4 to T3. The other thing to look for if you are depressed is looking at your vitamin D levels. I really like them between 60 and 80 for most people with chronic health conditions. Getting some sunshine can be a really great way to get those levels up.

Sometimes a vitamin or a nutrient can help with that as well. Typically we don't absorb a lot of vitamin d from our sun. thinking about whether it's a seasonal depression, in that case you might benefit from bright spectrum lights or even blue light therapy, and then also considering whether you may have a MTHFR gene mutation. Sometimes people that are depressed can really benefit with methylation support. This can be a really, really big game changer for them. And another big elephant in the room for people who are depressed is actually their iron status.

More specifically some people might not be anemic per se so they might test their hemoglobin, hematocrit, red blood cells and all of those might be within the range and their Iron panel might but they might be low in something called ferritin, which is an iron storage protein,

Treatment Approaches: T3, Nutrients, and Labs 12:24

and when that baby is low, you can actually have a lot of symptoms of depression. You do need ferretin to properly activate T4 to T3, so I think this is a part of it for many thyroid patients, but it's been very fascinating. Some psychiatrists in the know really focus on getting those ferrotin levels up for patients to get them to feel better, people that specialize in nutritional psychiatry. And this has been quite remarkable for, in my experience, for people with Hashimoto's, where we get their ferritin levels optimized and their brain function comes back on board, their mood stabilizes, they're no longer moody people, it just really, really transforms for them.

Obsessive compulsive disorder has also been tied to thyroid antibodies and fluctuations in thyroid hormone levels. There are a few things to consider if you do have obsessive-compulsive-disorder. Top things that I would consider would be looking into myoinositol, blood sugar balance, and N-acetylcysteine. These three things can be really big game changers for a lot of people with obsessively-compulsive disorders. as well as looking into whether you might have a strep infection. In some cases that can be a powerful driver of obsessive compulsive disorder.

Of course optimizing thyroid function is always something that I'm recommending for any kind of mental health issue. So getting that TSH between 0.5 and 2 and then also getting your thyroid antibodies lowered, making sure you are properly converting your T4 to T3. So oftentimes this means T-3 is in the top half of the reference range. Anxiety and panic attacks. This is another common presenting symptom that people with Hashimoto's will have. And this can be tied to an overactive thyroid or an underactive.

In my experience, the two things that help anxiety and panicked attacks the most are going to be selenium, This can be a really, really big game changer. Doses of 83 to 200 micrograms per day have been studied to reduce thyroid antibodies. In my clients, I have seen them work wonders for anxiety levels. Sometimes you can combine myoinositol with selenium for synergistic benefits. Generally speaking, the dose of myonositols is going to be 600 and and 83 micrograms with selenium, you kind of need a lower dose to get that synergy.

Some people are able to their thyroid antibodies in the remission range, other people able optimize their TSH even just using those two synergistic nutrients. Sometimes adding a little bit of vitamin D on board can really help to tie that together and really get into balance. Another critical component of anxiety is going to be blood sugar balance, I am a big advocate for eating plenty of food to stabilize your blood sugar when you have Hashimoto's. Most people with Hashimoto's have some kind of a carb intolerance, insulin sensitivity, and insulin resistance situationship with their food.

And typically what I recommend for people is focusing on eating more protein and more fat than the standard American diet. fewer carbohydrates. For some people that might look like a keto diet, for some that look might like modifying their macros a bit, you do have to work a little bit to find your sweet spot with that. I do find that people's lives change. Their thyroid antibodies reduce, their weight stabilizes, and they're like, oh my gosh, I've never felt so calm when my blood sugar is balanced.

Turns out you were just deficient in protein and fat.

Blood Sugar, Gluten, and Healing Journey 16:12

and your carbohydrates were putting you on a blood sugar roller coaster. I have had people who were misdiagnosed with bipolar disorder, and once they stabilized their blood sugars, they were able to be weaned off of their medications. Of course, this is something you would want to do under supervision with your physician. I will have a couple of more episodes coming out in the next few months. One of them is going to be with Dr. James Greenblatt, and we're going be focusing on depression, how to heal that.

And then we are also going releasing an episode on bipolar disorder. So I hope that these episodes are going incredibly helpful for you on your healing journey. Seek more information if you have gotten a mental health diagnosis. There are things you can do to make yourself feel better such as balancing your thyroid. For some people gluten sensitivity is like the biggest driver of mental issues or celiac disease, the great imitator. I do encourage you to seek answers and seek help. Do things under the supervision of your doctor, but also really educate yourself because there are ways to make yourself feel more calm, feel better, energetic to thrive and be more balanced.

And so I've already summarized a few of the common nutrient deficiencies that you might find. You might that gluten is not your friend, you may find that want to stabilize your blood sugar. These are all potential things to start with. I do have an article on my website, I'm going to link to that in the show notes. That goes into a little bit of deeper knowledge on how to balance your health and anxiety. I will say that my health, and my mental health really transformed with my healing journey. i thought i was somebody that was emotionally unstable.I thought I was anxious and I thought, I wore my heart on my sleeve And it turns out that was mostly Hashimoto's and my hormones.

And once I was able to stabilize things, I became a very, very calm and happy and easygoing person where people that knew me when I younger were like, what happened? And so if you know anybody that's struggling emotionally, if anybody's that struggling with their thyroid, maybe they've tried all the things and they're still having symptoms, please send them to the Thyroid Pharmacists Healing Conversations podcast. I'm here to help you take charge of your own health. I am here share about some of the experiences that I've had, things that learned the hard way so you don't have to.

Um, I really want to narrow the learning curve for you and I realized there's a lot of crazy information on the interwebs these days and sometimes having a nuanced conversation like this really helps. And I also have some amazing colleagues that are going to be coming on board this month and the next month. to share some of these strategies that really work to help you feel better. So thank you so much for joining today. I hope this has been healing on your healing journey.