Stress, depression and underactive thyroid?

Hello, I am seeking advice concerning my husband's health. Four months ago he began a new job (he's a postdoctoral scientist) which is not going well. For this job we moved home, and he is also homesick. His working environment might be described as 'fraught' and he is incredibly stressed. Firstly, I am concerned that he is suffering from (mild?) depression and anxiety: he seems defeated, and is clearly unhappy. Sometimes he struggles to face the day and he often complains of a tight chest a nausea in the mornings before work. He is sleepy very poorly and has reduced self-esteem and confidence: for eg, he says he feels like an 'imposter' at work, as he isn't progressing with his research. He seems unable to accept that, since his colleagues are also not progressing on this project, it doesn't reflect badly on him. It is IMPOSSIBLE to persuade him to see a doctor, so I am giving him as much support as I can: I do all the work at home (I am also in research and my hours are even longer than his) and try to free up as much time as possible for him to do things which help him relax, like exercise and music. I try not to let him see how hard this is for me in case he feels bad about that as well as everything else. When he wants to, we talk about work and how he feels, and I try to help him find some perspective. I had two courses of CBT a while ago and try to pass on some of the things I learned which helped me to manage my own depression. I would, firstly, welcome any advice on the best way to support someone in his situation. My second question, however, is more practical. I recently read that stress can cause reduced thyroid activity. Is this true? It rang alarm bells for me because my husband is constantly cold (he regularly goes to work in 5 layers) and has very cold hands and feet, is always tired but often cannot sleep, frequently complains of constipation since starting the new job, and, since then also, seems to be losing his hair - but not typical male pattern baldness, rather a uniform thinning, perhaps also at the ends of his eyebrows a little. More worrying he states that he can't concentrate at work. I know these could be symptoms of lowered thyroid activity, but realise that there are other possible causes. I know thyroid supplements are available w/o prescription but we would not trust these. I am concerned that if stress is lowering his thyroid activity, loss of concentration and depression could result from that, making him feel more inadequate and more stressed, with bad results for his mental health. I imagine (please tell me if I'm wrong!) that stress would only reduce thyroid function a little, so I wonder whether he can be helped by any changes in diet? Should we consider vitamin supplements (B12?) or zinc, iodine, selenium, iron? I hope that if a small change like that could give him an energy boost and help his concentration, the depression could ease too. I realise that if his symptoms worsen I will somehow have to drag him to his GP... Finally some background: My husband is 27, male (obv!), fit & healthy - about 5'9 or 10", 9.5 stones (slightly built); runs at least one 10k per week, cycles 40 mins per day, does at least 2x 2hours of fencing per week. He eats a balanced diet, including his 5 a day, and is not vegetarian/vegan or with any restrictions except a peanut allergy. He has been in hospital only 2 times: once, when 7 years old due to a severe rotavirus infection which somehow affected his kidneys (through dehydration i guess?) and then two months ago because he had norovirus badly, could not keep down water, and had to be put on a drip for a while. He does not smoke or take any drugs (hard to persuade him even into an aspirin!) and has no history of mental health issues. He drinks a little: he used to put away 3 or 4 pints once a week but since we moved way from our friends he now only shares a pint of beer with me or a glass of wine - maybe once every 2 weeks. Thank you for any help you may be able to give! *****

Doctor's Response

Date:Jan / 2012

Thank you for your question.

Sorry you are having a tough time with this.

I'll answer the second question about thyroid problems first. There is a lot of material out there on the internet about thyroid disease that simply isn't true, and lots of spurious material, that I have not read any evidence for, about dietary supplements and their effects. In non -westernised countries lack of dietary iodine is a common cause but this is very rare in the UK. However, Hypothyroidism, or an underactive thryoid, can mimic lots of other conditions, including depression.  I'm not sure about low mood or stress causing hypothyroidism, but the reverse is definitely true, having an underactive thyroid can make someone very depressed. Lots of the other symptoms you described (cold all the time, tired all the time, hair loss, constipation, poor concentration ) would fit with hypothyroidism, but this condition is known as the great mimicker! That is why doctors have a very low threshold for checking thyroid function, to exclude it from the list of differential diagnoses. See below, www.patient.co.uk/health/Hypothyroidism-Underactive-Thyroid.htm. I would strongly suggest that you persuade him to see his GP to have his thyroid function checked, as you won't know for sure until he has the blood test done, and it will only deteriorate without treatment if it is that. Treatment couldn't be more simple, and usually people feel better very quickly.

So assuming you've mananged to drag him there for a blood test, and say either he's on treatment or the test was normal, ( which is entirely possible - his symptoms would also fit with a moderate depressive episode) that brings us to the first question. How to support someone in this situation. It's very difficult when he can't see that he needs some help. You are being extremely supportive already taking on household chores etc, and listening which can be very hard over a long period of time. I would consider whether concealing the impact this is having on you is the right thing to do. I would agree with you that he ought to see his doctor to discuss using medication, and / or arranging some CBT for him. If he can't see this yet, perhaps letting him know or see that you are struggling to hold things together for both of you, he may get the message that he can't ignore things any longer. Although this will be hard, it can be done in a supportive way, and ideally you could accompany him to the appointment for moral support, or to talk on his behalf if he finds it hard. Some patients have taken their emails with us to their doctor to read if it's easier than telling the story. Normalising depression and trying to de-stigmatise it may help. 1 in 10 people have an episode at some point, including yourself! It's not a sign of failure seeking help - quite the opposite, ignoring it is the path of least resistance, but gets you nowhere.

If he absolutely refuses to see anyone, there are some online resources for CBT. Having used them myself they are written for the average layperson and will be pretty simplistic for a man like your husband! However, it may be a road in to discussing it more with him. A drip drip drip approach until he sees that he may need some help, and that it's not normal or ok to go on feeling like this.

www.patient.co.uk/health/Depression.htm

moodgym.anu.edu.au/welcome

This website has some good material on low mood depression and stress, and also a self help toolkit.

www.breathingspacescotland.co.uk/bspace/controller

Good luck, I hope you can persuade him to seek help.

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

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