Was a patient using methamphetamine to self medicate?

A young woman was admitted to the forensic mental health unit, where I provided medical coverage. She had been charged with dealing methamphetamines. The county jail in which she was awaiting trial had concerns about her mental health, so she had been transferred to my unit for further evaluation.

The mental health diagnosis was tentatively set at depression. She had dropped out of high school. She seemed very withdrawn, and was a bit chubby despite her admitted methamphetamine habit. She didn't seem very open to discussing her health problems with me, but allowed the routine physical exam and blood draw to be completed.
 
The next day, the lab report showed that her thyrotropin (THS) was 132! Could it be that this single fact could explain much about her current status?

I worked to quickly normalize her TSH, since it was never clear when the patient might be returned to the outside facility. As her TSH returned to normal, she lost about 30 lbs. without much effort. She began taking high school completion classes. Her energy level improved and she also started to take an aerobics classes. Her grooming improved, and she became a very attractive and vivacious young woman.

She told me several times that she couldn't remember ever feeling better. Needless to say, she never did need antidepressants, and the depression diagnosis resolved.

I have often wondered whether her use of methamphetamine represented self-treatment of her profound hypothyroidism. I hope that levothyroxine will keep her away from her old drug habit.

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