Suggest Treatment For Depression After Total Thyroidectomy

Posted on Fri, 26 Sep 2014

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

Fri, 26 Sep 2014 Answered on

Mon, 13 Oct 2014 Last reviewed on

Question : One year ago I had a total thyroidectomy. Since that time I have begun to feel worse and worse. I am 62. Always very active. Now, I have to force myself to get out of bed. I am able to walk for very short distances. I have developed a life changing pain in my lower back and sometimes am short of breathe. I take meds. Liothyronine 3 times a day along withLevothyroxine 112mg once a day. I feel worse almost weekly. My quality of life has drastically changed.

I forgot to mention an incredible depression has set in. This is really unusual.

Answered by Dr. Binu Parameswaran Pillai (8 hours later)

Brief Answer:
Few possible causes

Detailed Answer:
Good day,
Noted your concern and i feel sorry about your symptoms.There could be few reasons for your symptoms.

1) Inadequately controlled hypothyroidism: After thyroidectomy, you need sufficient levothyroxine to keep your TSH in normal range. 112 mcg is a good dose. Now a days, levothyroxine alone is recommended and a combination of levothyroxine ( T4) and Liothyronine ( T3) is not recommended except in special situations. What is your latest Free T4 and TSH results?

2)Hypocalcemia: Hypocalcemia may develop occasionally after thyroidectomy which can cause some of your symptoms. It is worth checking your calcium levels.

3) Vitamin D deficiency: This is a common condition which can cause musce cramps and muscle pain/weakness. This is easy to treat as well.

4) Depression: Post surgery, many people tend to develop depression. This alone may explain many of your symptoms. Usually, people start to beome better affter few weeks/months. IIn your case, since it is one year since surgery. You may need some medications/counselling and you will start to feel normal again.

May i suggest few tests.
a) Free T4, TSH
b) CBC, ESR
c) Serum calcium ( fasting), albumin, Alkaline phosphatase
d) FAsting blood glucose
e) LFT, Serum creatinine
f) Vitamin D ( total).

Please get these tests done so that we can assess your situation further. If all of them are normal, then, you may need to visit a good clinical psychologist and a psychiatrisy who can assess you further.

Regards

Binu

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