Hypothyroidism symptoms can suddenly blow in like an unexpected storm, escalating for no apparent reason. The patient may have already been experiencing hypothyroid symptoms for a number of months, in a subtle way that really didn’t attract any attention, or maybe a little attention, but certainly not to the point where any alarm bells went off.
And then suddenly, the person with underactive thyroid, who’s been quite functional all this time, rapidly deteriorates over a matter of days. I asked Dr. Kent Holtorf if it’s common for the symptoms of hypothyroidism to escalate after a period of existing just below the radar.
“Yes, that is very common,” says Dr. Holtorf, thyroidologist and founder of Holtorf Medical Group, with practices in California and about to open centers in multiple states throughout the country. “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.
Depression can be caused by hypothyroidism. For several months, my mother seemed a bit moody, but nobody thought anything of it, especially since it coincided with knee pain resulting from a fall at a bowling center. Earlier that year she had endured the mental stress of my father’s total knee replacement. Not long after he was just about independently functioning, my mother slipped at the bowling center.
For the next number of weeks the knee pain came and went, while physical therapy didn’t work. We went on vacation and a few times my mother had panic attacks where she was crying, thought she was dying, and reported severe pain throughout her body. After vacation she kept saying that the mysterious pain throughout her body was “connected” to the knee injury. She began losing her appetite, but was still fully functioning.
Finally, she had an MRI, which had been delayed because her physician (whom she eventually dumped) kept insisting she didn’t need an MRI. The meniscus was torn and she scheduled arthroscopic knee surgery. As the days approached she grew increasingly edgy and disgruntled, which was out of character because she had had two shoulder surgeries years prior with no preceding mood changes.
The morning of the knee surgery, all hell broke loose: My mother was sobbing and inconsolable, trembling, could barely walk (due to whole-body weakness; she had always been able to walk decently with the knee problem), and kept fearing she’d die in surgery. Immediately following the surgery I knew something was wrong. This wasn’t my mother.
Within 48 hours following the surgery, my mother sunk into a deep, dark hell of clinical depression, and for the next six weeks, was disabled, exhibiting classic signs of severe depression: wanting to die, complete loss of appetite, multiple crying episodes a day, refusal to leave her bed, irrational thinking, and a “bonus” symptom: multiple panic attacks daily, where instead of wanting to die, she thought she was dying.
Cymbalta resurrected her, but other problems began appearing (such as severe constipation and excessive sleepiness, which we thought might be latent side effects from Cymbalta!), which ultimately led to a blood test that revealed the true culprit: hypothyroidism!
Suddenly, it hit me: In the months preceding the knee surgery, my mother often complained it was cold, even though the house temperature was 74 degrees. I had noticed her hair loss, but attributed it to older age. Everything now made sense.
Her hypothyroidism had been there all along, but escalated due to the knee arthroscopy. I asked Dr. Holtorf if this non-invasive surgery was sufficient to escalate a low-lying hypothyroidism. He said, “Yes, it is significant physiologic stress and can trigger.” In other words, stress to the physical body can cause a pre-existing, and even clinically undetectable, hypothyroidism to escalate like mad.
The escalation with my mother’s hypothyroidism also included memory lapses, confusion and irrational thinking, which can all result from underactive thyroid.
Hypothyroidism isn’t just weight gain and fatigue (my mother lost weight due to loss of appetite from depression). Hypothyroidism can cause a whole slew of symptoms, and they can lie virtually dormant (subtle, seemingly trite, such as tingling in the fingertips), and then escalate and masquerade as another medical condition, such as major depression. However, major depression can have physical causes, and hypothyroidism is definitely one of them.
