1) Can depression ever be the only symptom of hypothyroidism, at least for a while?

While hypothyroidism is often associated with fatigue and inability to lose weight or weight gain, depression can be the only sign. In fact, the largest study done on the treatment of hypothyroidism with antidepressants found that supplementing with the thyroid hormone T3 worked as well or better than all the antidepressants. This is one of the hundreds of studies that demonstrate that a large percentage of patients with depression are actually low thyroid. Also, studies show that antidepressants are much less effective even if “low-normal,” which is still considered normal and not treated by most doctors.

2) How bad can depression ever get, as a secondary outcome of hypothyroidism? When there is a symptom list for hypothyroidism, it just says “depression” without giving more details, and “depression” is ambiguous.

Not only can low thyroid cause depression but it can make it much worse in the face of depression so every person needs to get their thyroid levels tested. The problem is that the standard blood tests that are typically used by the overwhelming majority of doctors will miss low thyroid levels in depression. What is called a free T3/reverse T3 ratio is currently the best method to detect these low levels in depression.

3) Can symptoms of hypothyroidism come on insidiously at first, and then suddenly escalate? What are some triggers of a sudden escalation?

Yes, that is very common. Often people have low level symptoms for years and are told everything is fine and then it escalates. This can be due to a viral infection or significant physiologic stress, which lowers thyroid levels.

Hypothyroidism symptoms can worsen gradually and then escalate suddenly. Triggers may include illness, major life stress, or hormonal changes. When the thyroid struggles to keep up in these situations, symptoms like fatigue, depression, weight gain, and brain fog can become severe.

4) Can Lean, Physically Active People Get Prediabetes?

Yes, genetics play a significant part so even a lean, active people can have insulin resistance. Interestingly, insulin resistance is associated with reduced tissue thyroid levels (not detected by standard blood tests) and treating with T3 can reverse the insulin resistance.

Interestingly, insulin resistance is associated with reduced tissue thyroid levels (not detected by standard blood tests) and treating with T3 can reverse the insulin resistance.

While genetics do play a role in insulin resistance, maintaining a healthy weight and lifestyle habits can help minimize risks even for those at higher risk. Lean, active individuals with prediabetes should focus on following a balanced diet, exercising regularly, reducing stress, quitting smoking, and limiting alcohol intake. These steps can help control blood sugar, reduce cardiovascular risks, and in some cases even reverse prediabetes. Medications are typically only prescribed if lifestyle changes alone do not improve conditions after 6-12 months.

5) If lean, exercising people with healthy diets indeed can get prediabetes, what could they do for it if they are already eating healthy, already a healthy body weight, and already exercising? Also, what numerical value would truly indicate a pre-diabetic state, versus just a fluke in the testing or a normal variation outside the “normal” range of glucose levels?

We find a little thyroid optimization can dramatically reduce or reverse insulin resistance.

Optimizing thyroid hormone levels and following a low-glycemic diet may help reduce insulin resistance for those already at a healthy weight and exercising regularly. Fasting blood glucose levels between 100 to 125 mg/dL are considered prediabetic. Lifestyle interventions should be the first line of defense, as medications are typically only prescribed if levels remain high after 6-12 months of lifestyle changes.

6) Is a glucose level higher than 99 but lower than 125 (“impaired glucose metabolism”) necessarily something to be concerned about in patients with no risk factors for diabetes (no family history; healthy body weight; good eating habits; good cholesterol profile; exercise)?

Yes, it is an independent cardiovascular risk factor. Often, such patients will also have a leptin resistance, as defined by a leptin level greater than 12, which is also an independent risk factor for cardiovascular disease.

Leptin resistance refers to a condition in which the body produces leptin, a hormone that regulates hunger and feelings of fullness, but does not respond properly to it. When leptin levels rise, the body typically reduces appetite and increases energy expenditure. However, in leptin resistance, the body does not sense the leptin properly and continues to feel hungry while also storing more fat. Leptin resistance is associated with weight gain and obesity, and may increase the risk of health issues like diabetes, heart disease, and other cardiovascular problems.

7) Diabetes, of course, can have serious consequences. Is this only when it’s mis-managed, or can someone who diligently manages their diabetes also suffer serious consequences (amputations, blindness)?

Even well-controlled diabetic is at higher cardiovascular risk than a non-diabetic.

Following a diabetic management plan can significantly reduce health risks, but some risk will always remain compared to those without diabetes. Even with optimal control, people with diabetes face a higher chance of complications like heart disease or kidney problems. However, maintaining a healthy lifestyle and working closely with doctors can minimize risks and lead to the best possible health outcomes for those with diabetes.

8) If diabetes is managed well by the patient, is the patient still at increased risk for the conditions that diabetes is known to increase risk of, such as dementia, stroke, some cancers…or do the increased risks only apply to those who mis-manage diabetes?

Even in the best of cases, the glucose levels cannot be made totally normal so he would be at increased risk even if he does everything “right” and keeps his sugar “normal.”

While managing diabetes well can reduce health risks, some increased risks still remain. Even optimal blood sugar control cannot eliminate the underlying condition, so people with diabetes may face a higher likelihood of stroke, dementia, and certain cancers compared to those without diabetes. However, following a treatment plan and maintaining healthy lifestyle habits can help minimize risks and lead to the best health outcomes possible.

Have questions about your thyroid and metabolic health? Call us today at: (844) 844-2981

squares icon

Stay Up-To-Date

By submitting this form, you consent to receive marketing and promotional emails from Holtorf Medical Group. You may unsubscribe from this list at any time. View Privacy Policy.

squares icon

Our Office

2232 E. Maple Ave. El Segundo, CA 90245

Call Our Office
(310) 375-2705

Book Appointment
(877) 508-1177

Office Hours
Monday – Thursday: 9am-5pm
Friday: 9am-4pm

To top