I am 29, female. Is my high TSH worsening my bipolar symptoms?

Question

Hello doctor,

I am a 29-year-old woman diagnosed with bipolar disorder type II two years ago. Lately, I have been feeling persistently low, with no energy or motivation to complete even basic tasks.

I sleep for more than 10 hours a day but still wake up feeling drained. I have also been struggling with obsessive thoughts about contamination, which have worsened recently. I find myself washing my hands repeatedly. Sometimes more than 20 times a day, even though I know it is excessive.

My psychiatrist recently switched my medication from Lamotrigine to Quetiapine due to worsening depressive symptoms, but now I feel emotionally numb, and my appetite has significantly increased.

My recent laboratory work showed a slightly elevated TSH of 5.2 μIU/mL, and my vitamin D level is 14 ng/mL. Could this thyroid issue be affecting my mood? My psychiatrist mentioned that it might.

I also feel extremely anxious and irritable before my periods. Could this be related to PMDD? Additionally, I have gained about 13.22 pounds over the last three months, and my fasting blood sugar was 104 mg/dL, which concerns me. I want to know how to manage both my OCD symptoms and depression without worsening one or the other.

Are there therapies or medications that can help with both while keeping my mood stable?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I can see you are trying hard to understand what is going on and how to manage it.

So your slightly elevated TSH (thyroid stimulating hormone) and low vitamin D can absolutely contribute to low energy, mood changes, and even worsened depressive symptoms.

Subclinical hypothyroidism, especially if you are symptomatic, needs treatment.

Start low-dose Levothyroxine, especially if you have ongoing mood issues. Low vitamin D is also strongly linked to fatigue, low mood, and even immune dysregulation, so supplementing with vitamin D (usually 2000 to 5000 international units daily under supervision) could help over time.

Regarding the worsening depressive symptoms and obsessive thoughts, it is not uncommon for OCD (obsessive-compulsive disorder) symptoms to flare in the context of bipolar depression. The challenge here is that many first-line OCD treatments, like SSRIs (selective serotonin reuptake inhibitors), can sometimes destabilize mood in people with bipolar disorder.

However, there are still effective strategies. Quetiapine is often used for bipolar depression, but as you have noticed, it can cause side effects like emotional blunting, weight gain, increased appetite, and sometimes elevated blood sugar. These are valid concerns, especially with your fasting glucose trending upward.

One potential option is to consider mood stabilizing strategies that also target OCD symptoms. For example, adding a low-dose SSRI very cautiously (like Fluvoxamine or Sertraline) alongside a mood stabilizer under supervision is sometimes done in treatment-resistant cases.

Alternatively, augmenting Quetiapine with medications like Aripiprazole (which can help with both OCD and mood without as much sedation or weight gain) might be considered.

For the obsessive thoughts and compulsive handwashing, cognitive behavioral therapy (CBT), particularly a form called exposure and response prevention (ERP), is one of the most effective treatments, and crucially, it works well alongside medication. Finding a therapist trained in CBT for OCD really helps you regain control.

As for your mood worsening before your periods, that definitely sounds like premenstrual dysphoric disorder (PMDD), which is common in women with mood disorders. Hormonal fluctuations can significantly worsen both depression and OCD.

Tracking your symptoms throughout your cycle can help confirm this pattern. Some women benefit from SSRIs taken only during the luteal phase (second half of the cycle), hormonal treatments like oral contraceptives, or even lifestyle adjustments like magnesium, calcium, and vitamin B6 supplementation.

Your weight gain and increased appetite could be related to Quetiapine, hypothyroidism, or even emotional eating tied to depression and anxiety. Managing blood sugar through small dietary changes like reducing refined carbs and eating more protein and fiber, plus mild regular activity (even short walks), can help prevent further metabolic changes.

So your symptoms are interconnected, like bipolar depression, OCD, PMDD, thyroid dysfunction, and medication side effects. It is time to revisit your treatment plan with your psychiatrist.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.