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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6937
Experience:  14 years as clinician in the field of Family Practice
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I have anxiety symptoms that have worsened greatly in the last

Customer Question

I have anxiety symptoms that have worsened greatly in the last two years. Trying to decipher if it's pathological or organic in nature. My TSH was 4.2 and free T4 0.9 earlier this year. Last week my TSH was 3.59 and free t4 was 1.3. My psychiatrist said it could be the potent thyroid axis causing the effects and we could try a trial of T3 (Cytomel) or we could just try standard psych medication. I declined everything, but accepted ativan. Probably will see an endocrinologist about this. I am a 28 year old man, very active and fit and healthy. Have tension/high anxiety symptoms even while resting inside my house. Have brain fog, dizziness, lightheadedness and irritation often as well. Could this mild abnormality of my thyroid numbers really be a factor, or simply coincidence?
Submitted: 11 months ago.
Category: Health
Expert:  Anthony Bray, MD replied 11 months ago.

Anthony Bray, MD : Hello!
Anthony Bray, MD : No -- I do not think it is reasonable to blame your anxiety symptoms on your thyroid function ....
Anthony Bray, MD : normal TSH is 0.4 to 4.5 and your numbers fall within range....
Customer: Any other tests you would reccomend before just accepting that it must just be me?
Customer: I never used to be this way and I have no stress inker.
Customer: In life*
Anthony Bray, MD : normal free T4 falls between 0.8 to 1.5 mg/dL ( now some labs may vary a bit with normal brackets due to different measuring techniques..)
Anthony Bray, MD : Adding thyroid medication is sometimes helpful for depression but may tend to make anxiety worse!!
Customer: symptoms are primarily all physical and bizarre. I'm considering testosterone test as well. I don't want to give up yet, as it has ruined my quality of life big time
Anthony Bray, MD : so to me adding thyroid medication does not really make sense as you describe anxiety as your primary symptom....
Customer: The t4 is normal but TSH was abnormal, and for psych patients it's even more narrow apparently. I agree it could make it worse. Once you start thyroid medication, can you stop? Or is it a rumor that you're on it for life?
Anthony Bray, MD : Yes it may be reasonable to check your testosterone levels -- low testosterone can have symptoms of fatigue and more along lines of depression ....
Anthony Bray, MD : reasonable to test ACTH and cortisol as well...
Customer: I've had some brain fog and depression which are very new to me, but my main complaint is angst and anxiety and general feeling something is wrong
Customer: Ok.. Is there any other medical condition that would fit my symptoms that you can think of? Because things have really changed for me lately, but if it's purely psychological I'll accept the but I'd like to be sure before I do that.
Anthony Bray, MD : Well an SSRI class antidepressant may serve you well ( examples are Lexapro, Zoloft, Paxil) these are indicated for treating BOTH anxiety and depression ...
Anthony Bray, MD : keep in mind that if you should TRY one of these medicines or another that it is NOT written in stone !!!
Anthony Bray, MD : many people fear these too much I think!!
Customer: SSRIs have nasty side effect profile and not an option for me but may be down the road if this evokes unbearable. I'm going to try CBT first and stick with the benzodiazepine medications for the moment
Anthony Bray, MD : if you did not feel better on medication ( it does take a few weeks to really know what benefit an antidepressant will have) then can always stop!!
Anthony Bray, MD : That is fine to try therapy first...
Anthony Bray, MD : you might have benefit to try low dose benzodiazepine ... I doubt you would have much in way if adverse side effects with one of those -- especially LOW dose....
Customer: CBT is as effective as SSRIs according to studies I've read, it's just more work. One last question, what is a possible condition that could change cortisol levels (besides stress) that could possibly cause this? This is just bizarre, but
Customer: Maybe it's just me
Anthony Bray, MD : Cushing's disease and Addison's are main organic disease processes that could alter cortisol levels...
Anthony Bray, MD : dysfunction if pituitary gland(ACTH) or adrenal gland( cortisol) may affect...
Customer: Which are thyroid related right? I'll look into those. My mother has autoimmune diseases which I'm concerned could affect my chances of things like hashimotos and other disorders
Anthony Bray, MD : combination of therapy plus medication is actually more effective treatment than either component alone....
Anthony Bray, MD : No -- not exactly --- TSH AND ACTH both from pituitary gland but adrenal axis and thyroid axis are generally separate...
Anthony Bray, MD : pituitary injury could affect both however...
Customer: I'm taking klonopin 0.5mg daily, and some times Ativan as needed. I'm concerned about building tolerance though. Is a low does like this going to result in dependence where I'll experience even more anxiety without them? Or will that require a higher dosage?
Anthony Bray, MD : No you on on very low dose so I think concern here of withdrawal is minimal -- perhaps not zero as I would think you enjoy SOME benefit from treatment ... I do think it wise to resist boosting up dose too much though...
Customer: Thanks. Would you recommend I see an endocrinologist for several more tests and thyroid consult before going the psychiatrist only route?
Anthony Bray, MD : The low dose Klonapin may help take edge off anxiety... I expect helpful for you... Perfectly safe to stop though ... No physical withdrawal symptoms would be expected from this low dose... Higher dose would carry more risk in that regard...
Anthony Bray, MD : I don't think you need worry about the thyroid really... Your numbers looked ok. I that regard ... It would be reasonable to include measures of testosterone, cortisol and ACTH....
Anthony Bray, MD : Endocrinologists or primary care doctors in internal medicine or Fanily Practice could check these for you....
Customer: Ok I'll do that. What's the prognosis for all these buzz are physical symptoms of anxiety? Do these get better or worse with age or is there no data to support either? Last question.
Customer: Bizarre*
Anthony Bray, MD : What physical symptoms are you having! Hopefully the reasons for stress will get better and so will your symptoms...
Anthony Bray, MD : I think that your situation will be main detriment of symptoms and not age -- either way...
Customer: Lightheaded, dizzy, foggy head, feelings of unrealness, medicine head type feeling, clogged ears, tightness in face, woozy feeling all the time, feelings of agitation and angst, cold clammy hands to name a few
Anthony Bray, MD : Sleep quality ok ?? If anxiety causing sleep disturbance then that could play factor --- especially poor concentration, foggy headed, memory difficulty....
Anthony Bray, MD : you may wish to consider an antidepressant trivial to see if you felt better -- Cymbalta works on both serotonin and norepinephrine ... May be more helpful vs depression but sometimes less toward anxiety....
Customer: Sleep is fine, unlike many people with anxiety. My girlfriend notices that I grind teeth in sleep, and on one occasion noticed periods of apnea. My psychiatrist asked about sleep apnea. I have no way of knowing though unless I do some sort of study
Customer: Just not a fan of weight gain, ED etc that come with SSRI. Just can't bring myself to take one yet
Anthony Bray, MD : Right a sleep study if sleep apnea is felt likely --- clues would be snoring- daytime sleepiness- being overweight....
Customer: I don't have any of those but some daytime sleepiness but I really don't think sleep apnea is an issue
Anthony Bray, MD : ok I see--- probably not if you have no red flags....
Anthony Bray, MD : most men do not have ED with SSRI but it commonly delays orgasm... Weight gain not promo ant either -- reported but not majority...
Customer: Well I guess I'll get those blood tests. And then if I come up normal I'll just have to battle it out and try to feel better with CBT and other meds. Thanks a lot for your help
Customer: Ok good to know
Anthony Bray, MD : ok well take care and good luck in battling the anxiety!!
Customer: Thank you, XXXXX XXXXX good day
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6937
Experience: 14 years as clinician in the field of Family Practice
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