Can Anxiety Cause Fluctuations In TSH Levels?

Posted on Fri, 18 Dec 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 18 Dec 2015 Answered on

Mon, 11 Jan 2016 Last reviewed on

Question : Hi, this question is for my daughter. She is 19 years old. She was prescribed Lexapro (10mg daily), to treat symptoms of depression and anxiety one year ago. Her symptoms exasperated 6 mths later, following a significant life event (3 yr relationship break up), and she had extreme outbursts of anger/rage. We noticed a pattern emerging, whereby this occurred during her menstrual cycle, and also included self harm. Recently she has had some blood testing. Her thyroid TSH came back at 5.1. Her Dr was concerned, advised she had an under active thyroid, and may be unnecessarily be taking antidepressants. She ordered further and full testing on thyroid and hormones. This was carried out 4 weeks after the 1st tests. 4 weeks later, her TSH was 1.0. What does this mean? Why such a large fluctuation in such a short period of time? My daughter is also asking if her antidepressant could be affecting her thyroid? She would like to obtain a correct diagnosis and treatment. Are her issues Mental Health or Thyroid related?

Answered by Dr. Binu Parameswaran Pillai (2 hours later)

Brief Answer:
Depression and thyroid

Detailed Answer:
Good day,
Noted your concern. TSH is a a pulsatile hormone secreted by pituitary gland. Secretion of TSH is influenced by varipus external and internal factors. Stress/anxiety/depression/acute illness/certain drugs are known to cause fluctuations in TSH levels. Hence i am not surprised about this fluctuation of TSH.

Please get a Free T4 and TSH and an Anti TPO ( antibody) after few days. Does she have an enlargement of thyroid?

Yes, anti depressants may influence the secretion of TSH. Hypothyroidism can cause depression. How ever, her TSH levels doesnt seem to be high to cause mental health issues.
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (3 hours later)

Hi, no her thyroid does not appear to be inflamed. Could there be any other medical reason why she displays rage/self harming behaviours consistently over the past 6 months, when she has her menstrual cycle? It happens at the beginning of her cycle.

Answered by Dr. Binu Parameswaran Pillai (6 hours later)

Brief Answer:
Screening for cushing's syndrome

Detailed Answer:
Thank you for the reply. Cushing's syndrome is another hormonal disorder which can cause depresssion and other such behaviours. High estrogen levels just before her periods can worsen her symptoms. May i suggest you to wait for a month or so and please repeat TSH and Free T4 when she is stable. You may also suggest your doctor to screen for cushing's syndrome if clinical examination warrants such screening.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (1 hour later)

Thank you so much for your information. We will do further testing and get a referral to see an endocrinologist. Could you also explain her serum hormone results? They are:
FSH - 9
LH - 17
OEST - 190
PROG - 2

Thank you

Answered by Dr. Binu Parameswaran Pillai (14 hours later)

Brief Answer:
Timings important

Detailed Answer:
LH is little on higher side. But again depends on the time of collection. How many days after the firts day of period was this bloods taken?
Does she have excess acne, excess hair over face /body ?
Irregular periods ?
Other hormones seems to be okay. I would appreciate if you could attach the report copy

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (19 hours later)

Thank you for your information. I have attached the report. I have also found out the following as well;

* she took the morning after pill approx 3-5 days prior to the blood test
* she started bleeding approx 12 hrs prior to the blood test
* her actual period was due one week after the bleeding and blood test
* she has experienced acne and excess body hair for many years, however her father is very hairy and her cultural background is the same (Bangladesh)

Kind regards

Answered by Dr. Binu Parameswaran Pillai (17 hours later)

Brief Answer:
Thank you

Detailed Answer:
Thank you for posting the report and details. LH is high. The best time to check LH is on 3rd day of periods in fasting state. High LH is known in hairy girls and those with poly cystic ovary syndrome.
I recommend to recheck LH on third day of period again . Similarly TSH should be re checked when she is well.

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