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What causes nervousness and anxiety in a thyroid patient?

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Posted on Sat, 7 May 2016
Question: I feel nervousness and anxiety and also causes mood off when my wife when talks to some person(not to known persons) or talks through phone.
Also causes nervousness when she talks to the same person again. I am having Thyroid CA and under gone XXXXXXX and taking 200 Mcg of thyroxine.
But i donot have any problem of doubt and I complete trust her, I feel only anxiety.
i consulted one doctors 1) prescribed nexito 5 mg and Clonotril .25 mg and asked stop clonotril after 2 weeks and continue nexito for 3 months.
And other doctor suggested 1) Amazeo 50 mg and Vilodon 20 Mg for 6 weeks
Please let me know what is my problem and Please suggest which medication above one would be better for me. I am confused to take which medicine. or please suggest medicine which suits me.
doctor
Answered by Dr. Chintan Solanki (2 hours later)
Brief Answer:
need more information

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us. I can understand your concern.

For probable diagnosis and treatment I need more information.

- You wrote, "'hen my wife when talks to some person(not to known persons) or talks through phone.". Please elaborate this complaint. What does it mean? Do you feel that your wife has any relation with someone or she is not faithful to you? if you believe so, is it truth or are you just suspicious? have you told this matter to your wife? (you wrote yourself that,"But i donot have any problem of doubt and I complete trust her, I feel only anxiety." but I have to confirm again, as correct information matters much for your treatment. Please narrate straightforward whatever in your mind without any doubt)

- Since when do you have such problem?

- What is latest/current thyroid level report?

- Did doctor have tell any diagnosis?

- Is your wife aware about this treatment of psychological problem?

- Anxiety remains throughout the day or just when you see her talking on phone?

- Have you taken any of the treatment from above two prescriptions? If yes, how do you feel?

I will be happy to help you further after your response.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (14 hours later)
Hi Doctor,
Thank you for your reply.

I have this problem from past 1.5 months.

I donot suspect her and I complete trust her and I donot want to think like you mentioned above as I have 100 trust.
Probably what I feel is an irritation and results in an anxiety when she talks to some one else and not a problem with Faith.
And this is not with particular person it can come with any person. even my friend or relative.it comes as a fear from inside and I become anxious.

The latest Thyroid I tested contains free T4 and TSH levels
Test Name Method Value Units Ref Range
TSH CLIA 0.05 uiU/ml 0.30-5.5
Free T4 CLIA 4.28 ng/nl 0.70-1.8

Doctor told it could be due to stress and tension of the CA treatment.
My wife knows about and I discuss regarding this with her.
This comes when there is slight anxiety is there. Also anxiety comes when she talks to some body else. This don't come and I am normal when I am really in happy mood. Mostly comes when my mood is down. and also thought about this brings me down.

I have taken Nexito and Clonotril .25 half for initial days and dropped after 5 days because it was giving too much head ache and my anxiety was increasing. After taking clonotril .25 full, it completely gone for one week. But I have fear of taking this medicine.
Now I am trying Amazeo 50 mg past 2 days.I Donot know this will create and negative effect.
Is this medicine is the solution for this? Does this reduce anxiety?

I take Ativan 1 mg in the night when I donot get sleep. After taking Ativan next day is superb for me.
So please help me resolving this issue.
Please donot post this in public forum.
Regards,
XXXX
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
counseling is also needed

Detailed Answer:
Hello Mr. XXXXXXX

Thanks for clear information.

This communication is totally personal and confidential and you even can delete from our record with your request.

Your TSH is slightly lower, it means you have some hyperthyroid and there is need of reduction in dose of eltroxin as hyperthyroid can cause some anxiety. Considering your history it seems that due to past physical problem and thyroid disturbance you have some sort of mood problem and it worsens with anxiety when your wife is talking to someone. In that case SSRI group of drug like nexito will be more useful However if you cannot tolerate you can be given paroxetine or sertraline.
Of course clonotril or ativan like drugs from benzodiazepine group will surely help fast. These medicines can be taken under medical supervision and can be stopped gradually when you improve. There is no need of taking them for lifetime. And there are no serious major side effects of medicines.

I do not think amazeo will help if it is anxiety only, I do not recommend. But it is safe drug, no need to worry. Vilodon is newer anti depressant drug, you can go for it, it may help you.

With thyroid treatment reassessment if I were your treating doctor I would start etizolam in day time to reduce anxiety and couple counseling for CBT (cognitive behaviour therapy). With this approach if no satisfactory improvement in 2-3 weeks I would add SSRI like paroxetine and sertaline after evaluation of detail history.

Feel free to discuss further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (4 hours later)
Some more example to evaluate my issue
1) I felt nervous XXXXXXX when she talks to her cousin brother also. also I ask my wife to stop talking about that person.
2) I felt nervousness when she she talks about some person.

But i never mistrust or doubt only thing but an element of fear is there when she talk to some one. I mean there is a irritation to the guy talking to my wife is there.

When I contacted first doctor for Nexito 5 is increasing my throbbing headache
he increased the dose to 10 mg.
He was telling it could be due to low dose making other cells hyper active.
So increasing the dose would help, he told. So I was scared and stopped that time
taking clonotril .25 mg in Night is advisable? or shall I take it Day time?

From the discussion I feel I should continue with Nexito. Hope it will eliminate my issues.
I will stop Amazeo as it will not help.
Can I stop Betacap tr 40 suddenly or shall I taper down?

Do you think taking 10mg of Nexito will reduce throbbing nervous head pain?
doctor
Answered by Dr. Chintan Solanki (3 hours later)
Brief Answer:
no need to reduce betacap

Detailed Answer:
Hi,

Thanks for asking your doubts.

Your problem is some kind of anxiety. There is need of evaluation of psycho dynamic part through detail long history.

As far as medications are concerned no need to stop betacap it will help in headache as well as in anxiety.

Headache is very common side effect of nexito (escitalopram). If I were your doctor I would stop it and start amitryptiline for headache and for your anxiety problem other medicines as I mentioned in previous answer. I think vilodon is good option. Amazeo is not needed according to my opinion.

Clonazepam (clonotril) in 0.25 mg will work as anti anxiety and you should take it in daytime. If you feel sedation you can make it half and can take half tablet twice a day in daytime. For sleep it can be taken at night in dose of 0.5 or more.

As my opinion differs from your doctor, you can discuss with your doctor in polite manner about your concern and change treatment.

You are welcome if still there is any query.



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

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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What causes nervousness and anxiety in a thyroid patient?

Brief Answer: need more information Detailed Answer: Hello XXXXXXX Thanks for writing to us. I can understand your concern. For probable diagnosis and treatment I need more information. - You wrote, "'hen my wife when talks to some person(not to known persons) or talks through phone.". Please elaborate this complaint. What does it mean? Do you feel that your wife has any relation with someone or she is not faithful to you? if you believe so, is it truth or are you just suspicious? have you told this matter to your wife? (you wrote yourself that,"But i donot have any problem of doubt and I complete trust her, I feel only anxiety." but I have to confirm again, as correct information matters much for your treatment. Please narrate straightforward whatever in your mind without any doubt) - Since when do you have such problem? - What is latest/current thyroid level report? - Did doctor have tell any diagnosis? - Is your wife aware about this treatment of psychological problem? - Anxiety remains throughout the day or just when you see her talking on phone? - Have you taken any of the treatment from above two prescriptions? If yes, how do you feel? I will be happy to help you further after your response. Regards, Dr.Chintan Solanki.