16yr old daughter - huge behavior problems - thyroid related???

[Ladybug4cs]

My 16 year old daughter has been on Lexapro since April '05 due to "anxiety" and feeling depressed.  She has occasional "fits" where she gets so mad at me (or whatever, but it is usually taken out on "me"), throwing things, breaking things, being generally horrible.   I'm a single mom, so there's just us in the house - unfortunately, no dad to call on for help.
She had been a bit better the past few months, with occasional fits.  But she had one again this week, and has gone to stay with a friend of hers for a couple of nights.  The doctor who prescribed the Lexapro never did a complete workup on her for her thyroid levels, etc., so I'm taking her in for a physical, etc., tomorrow (Saturday) morning, 10/15/05.  

I just don't believe that her actions are just "teenager" issues - I've read so much about thyroid problems, and so many of the symptoms sound like it could be due to her thyroid (i.e., wanting to sleep all the time, extremely lazy, poor schoolwork (and she is actually a very smart child), not interested in things she used to be interested in, menstrual issues, bad cramps, muscle cramps (leg), depression, irritability.    

What do ya'll think from this brief description?  Am I doing right to go and get things checked?

[Mark Lupo, M.D.]

Certainly behavioral problems can be thyroid related and this should be checked into -- if the thyroid is normal then it may be wortwhile to see a specialist in adolescent behavior (psychiatrist) who would also evaluate for medical conditions contributing to her symptoms or help sort out non-medical causes for her erratic behavior.

[ArmourGal]

How wise of you to realize it might be thyroid related.  Since I've been diagnosed, I've done a huge amount of research on psychiatric issues related to hypo.  I've been fortunate to have been able to helped some teenagers get a proper diagnosis...after they had been put on psychotropic meds.  This is a sad sad thing going on in our country with so many folks being put on these dangerous medications, often with thyroid function not even checked.  And if they do check it, the TSH often comes in low because of the psychiatric disorder or even the med they might be on.  

So - to determine if this is the reason for the behavior disorder, etc...have FULL thyroid testing to include:
TSH
Free T4
Free T3
Thyroid Antibodies

Do not let a doc talk you out of any of these tests. They are all important.  

Antibodies and low thyroid condition have been associated with just about every psychiatric condition...from borderline personality disorder, bipolar, psychosis, depression and anxiety..everything! I have loads of PubMed studies and other articles about this.

Yes, get her tested!  Just to give you an idea of the info on this, here's a list of some PubMed abstracts on the subject:

Psychiatric presentations of hypothyroidism.
Masked “myxedema madness”.
Psychotic manifestations of hypothyroidism.
Psychiatric symptoms in endocrine diseases.
Psychiatric and cognitive aspects of hypothyroidism.
Psychiatric manifestations as the only clinical sign of hypothyroidism.
A case of ‘hallucination of solioquy’ with hypothyroidism induced Hashimoto disease.
“Symptomless” autoimmune thyroiditis in depression.
Myxedematous madness without myxedema.
Hypothyroidism and depression:  a therapeutic challenge.
Psychotic states associated with disorders of thyroid function.
The diagnostic dilemma of myxedema and madness, axis I and II.
Thyroid function in clinical subtypes of major depression:  an exploratory study
Studies on thyroid therapy and thyroid function in depression patients.
Experiences of fatigue and depression before and after low-dose 1-thyroxine supplementation in
essentially euthyroid individuals.
Thyroid antibodies in depressive disorders.
The presence of antithyroid antibodies in patients with affective and nonaffective psychiatric
disorders.
Antithyroid antibodies in depressed patients.
Brain perfusion abnormalities in patients with euthyroid autoimmune thyroiditis.
Brain metabolism in hypothyroidism studied with 31P magnetic-resonance spectroscopy.Psychoneuroendocinology of mood disorders.  The hypothalamic-pituitary-thyroid axis.

[Ladybug4cs]

Thanks for the info.  I'm printing it out and will take it with me in the morning.  There has just GOT to be something else going on with my daughter, other than just the stereotypical "teenager" syndrome.   What she's been doing is just way above and beyond those types of behaviors and issues.

You've made me feel a lot better.  

Question - how long will it take to get the thyroid test results back?   Immediately - or will it take several days?

Just curious so I'll know what to expect/not expect tomorrow.

[ArmourGal]

thyroid tests take a day or two...I believe the Free T3 takes the longest...but still, just a few days.

I understand the behavior you described.  If you search "oppositional defiant disorder" if may sound familiar to you.  But don't get me wrong, I don't really think it's a disorder at all.  But it seems docs get paid if they have a diagnostic code and so everything is getting labeled these days.  But my daughter fit the description to a tee when she was 15-16.  But we had a lot going on in our lives then, and I think it was just rebellion x 3 plus some losses in her life.  She did not take medication for it, and evidently just grew out of it by age 18.  Usually the kids are extremely bright, and that can also present its own set of problems.   But these kids can NOT be controlled and the more you try, the worse it gets.  There's a book about this that I wish I had read at the time.  It has some helpful strategies.  

So - i just wanted to point this out in case the thyroid labs look normal.

[Ladybug4cs]

What's the name of the book you wish you had read?

[Med Help]

PLEASE NOTE:  

The information posted in the comments area comes from lay people, NOT physicians!! The ONLY answer that comes from a qualified physician is that posted by "Forum-M.D.-ML" and it is preceeded by the letter "A" (for answer).

Please do not mistake "comments" for qualified medical advice and NEVER make any medical decisions based on anything you read on the Internet.  You should ALWAYS check with your own personal doctor before making any medical decisions!

Med Help International

[ArmourGal]

Ladybug,
I am cautious now in posting, as MedHelp has just advised me that my telling you how long thyroid labs to get back, is "medical advice", although I see that as "personal experience".  They also told me I'm posting too much, so I will have to lay low I guess.

The book is "The Defiant Child - A Parent's Guide To Oppositional Defiant Disorder" by D. Douglas A. Riley.  

Best of luck to you on this situation...I know it can be quite stressful.
Cindi

[ancientmariner]

My son was diagnosed with ADD, ODD and depression years ago, but refused to take any of the meds prescribed. He is now almost 19 and still exhibits those behaviors. He also routinely threatens suicide if he can't get his own way, and has been taken to the psych ward by the police a couple of times. After hearing somewhere that thyroid can cause problems liek that, I started researching and I really think he's hypothyroid, but he won't get tested. The farthest I could go was taking his temp every morning when he woke up for about 3 weeks. His temp was always around 96.9, every day, which made me even more sure that he has thyroid problems. But, he won't do anything about it, and now he's considered an adult, so I can't just take him to the doctor and ask for the tests. It makes me so sad, because if it IS his thyroid, he could be so much better once he got treated, but he doesn't even want to know...

[Ladybug4cs]

LOL, Cindi - not meaning to get you into trouble there.....Just wanted to know if it would be an immediate answer or wouldn't know anything till she's 52.   Geez.   I don't consider that "medical advice"...LOL

I'll look for that book at BooksAMillion this weekend...probably tonite while she's staying at a friend's house.  

I appreciate your help more than I can so.   I just love my Cara so much - and want to do anything/everything I can to get her the help she needs.   When she's *normal*, she's an awesome child - the other times, it's just not *her*.  

[LowMac]

Hi, Don't feel bad for trying to help people. I am disappointed with Med Help because they imply people do not have enough sense to distinguish from patient advice and Dr. advice. The fact is, patient advice is sometimes significantly more informative, especially when a Doc does the old "quickie summation", using just enough medical type lingo, to sound good but is so generalized, you still feel like you are waiting for an answer.
I've tried to uplift and show gratitude for Dr. Mark and I have no unkindness whatsoever for him but I've seen more and more of that cold and indifferent attitude that other Dr.s have. I tried so hard not to notice it but finally couldn't keep from it any longer. I believe answering questions on the net, may give a Dr. a sense on "notariety" but hopefully there is at least a hint of actual compassion.
It also bothers me, such as in the case of TNT, when a Dr. changes his opinion, because he hears another Dr. said something else about that patient. Read the archives and you'll see what I'm referring to. People are dying and a Dr. cares about nothing but sounding medical and in defending all of "Doctordom", the bad with the good.
The Dr.s aren't suffering, the patients are.
You want to rebutt this post, go ahead, but I personally will not be back to even see if you have. I don't have unforgiveness, honestly but I am terribly disappointed. Remember when Dr. Mark was on the forum as the M.D., for only two days, then was off for a solid week, with people wondering why questions weren't being answered? (look at the archives). All Med Help/Dr.Mark needed to do, was simply say "Dr. Mark will be on vacation this coming week". Wow, so difficult huh? I truely believe the all encompassing motivation for this site is strictly commercial. The only compassion on here, has been from forum members.
Bless you all and I do mean ALL! Again, I have no unforgivenes but wanted to express my opinion.
Jim

[ArmourGal]

that's okay...i'm a big gal, and I can handle it.  smile.
They also warned me that other statements I made constituted medical advice, however as I responded back, the archives are full of statements just like I made.  And not just on this forum.

Perhaps I am just overly passionate about this particular issue - thyroid dysfunction presenting as psychiatric disorder.  I lost a mother unexpectedly to suicide and her autopsy showed undiagnosed Hashimto's.  So, I tend to make sure when this issue arises, that I give as much info as I can so the diagnosis isn't missed.  Not knowing can be deadly.  My cousin, also, was in and out of psychiatric institutions throughout her life.  But I was a little too late getting all the info to her.  Although I had sent her a letter telling her all the tests she needed to get, her hypo psychosis had progressed too far.  She committed suicide last February and her autopsy too, indicated undiagnosed Hashimoto's.  So I do know from personal experience that the proper thyroid testing is critical...and I do know from personal experience that many do not get it.

I will always do anything in my power to provide valuable infomation to someone about this often unsuspected diagnosis.  It's the way I honor my Mom.
Cindi

[ArmourGal]

they're gonna get mad again at me for posting too much, but i just had to say "thank you" for your comments.  To me, the disclaimer that is prominently posted gives us freedom to not have to always say "the medical literature states..." or "if it were me, I would..." or any similar statements.  

And i know what you mean about the docs answers.  I have read thru several of the health topic forums here, and most of the docs answers are quite "generic" in nature.  And i do understand the need for that when they are not seeing the actual person as a patient.  So the knowledge and advice of the other folks can often be quite helpful imo.  i've learned stuff already here.

As for Dr. Mark, I've also read over a number of his answers in the archives.  So although he seemed quite perturbed with me initially, I can say that for an endo, I was impressed.  Uh, that was meant to be a compliment.  See, on my thyroid forum, we tell folks that endos are the worse docs to go to for hypo because of their labs obsession.  But Dr. Mark has written a lot of stuff that quite honestly, I didn't think endos ever would admit.  Example...using Armour, knowing about the new TSH range.

Anyway, I've used up more than my quota of posts here I think..but your comments helped me tonight.  I had felt sad over the emails I received from MedHelp, but now I'm okay. God bless.
cindi

[doodlebug1]

LowMac, great post!! I hope that Cindy and MedHelp will be patient with me for posting since I have been slapped for posting too much (????)--but I did want to let you know how much I appreciate what you said. It's TRUE. WE HAVE SOMETHING TO OFFER HERE!!! Jim, join the Natural group!!!!

[tina999]

Hi you guys,

First you all should know that patients are far to ignorant to be offering medical advice to one another.   We don't have a medical degree and thus it could be VERY DANGEROUS!!!

I am 50-50 on the endos myself.  The first would have let me die from electrolyte imbalances because i didn't fit her test results. She abandoned me and siad to just keep taking synthroid.  I was so terrified and seriously messed up.  My second is very young-only one week old on my first visit-and basically is honest about having no idea what's wrong with me and is very open to any suggestion I have.  I keep coming up with treatment idesa that are working but it is kind of on my shoulders.

Also-to be on topic-I was diagnosed about four years back with ADHD.  I was so spastic and couldn't focus, would fall asleep while driving, couldn't read anymore, and had bouts of irritability and depression.   I took stimulants for about a year and a half and they did sort of work but when the med dose was wearing off I would feel terrible physically.  Very sick and so I stopped taking them.   Now that I have started the T4 I notice It makes me feel much like the stimulants did-I sleep better, I can think clearly and focus, my mood is so much better.    So i guess I needed a "stimulant" but not ritalin.    It kind of bugs me as they never did a physical or any bloodwork-they might have caught my TSH before it got to around 200.

[doodlebug1]

Tina, one thing I have learned in my life is that knowledge is not simply obtained by getting a "degree" or formal education. For example, my husband has learning diabilities, and barely passed his GED, and I have a Master's Degree with a 4.0 and a thesis. YET, my husband has hard-earned, in-the-trenches knowledge that I could have NEVER gained simply from a degree of higher education. Bless him.

Granted, a doctor has obtained vast amounts of education that we can benefit from. But that doesn't take away from the knowledge that patients have gained through personal experience, observation of others, and research material that is available to us all.

So, it's wonderful to have a forum here where we can learn from the doc's education, but also learn from the opinions and experiences of others, who may have gained in-the-trenches knowledge that a doc hasn't learned himself! In fact, when it comes to thyroid treatment, patients are becoming VERY knowledgeable because of too many years of being told that their problems had nothing to do with their thyroid, or their med, when it fact, they were! :o)

[ancientmariner]

So True! I know that I still call my mom for medical advice before I'll call the doctor, and I trust her more than I would ever trust my doctor. Probably that's because she KNOWS so much more than my doctor who is only 30! Plus, her old home remedies seem to work much better for many ailments than the medical advice and drugs dispensed in 15 minutes by a "real" MD!

[tina999]

sorry you guys, I was being sarcastic.  i guess i am not too good at it!  

I think many of us are more knowledgable than our GPs about the thyroid conditions we have.  Not to fault the GP of course. The Gp has to have too broad a scope to be able to zero in the way we can on one specific illness.   So while I understand thyroids better I still don't understand anything about sprained ankles or evn heart disease really!

I can't explain the endos.  I think maybe 95% of people are really routine cases and I guess the other 5% are the odd ones, so maybe the endos get used to the 90% and don't like dealing with or forget about the leftovers.  However drmark shows there are drs who do care even if long distance.

[Ladybug4cs]

Update:  The doctor did not seem to think that she needed her thyroid tested at this point.  He changed her medication from Lexapro to Zoloft, so we'll see how this works.  

We go back for a follow-up visit in a month to see how/if she seems to be doing better.   Her attitude at home has already improved over the weekend - which I'm sure is partially just "mental" because she's on this medication that she has heard of and is supposed to "work".  But I also think that after staying with her friend for so many nights, that she appreciates her "home" and me as "Mom" a lot more.  Nothing against her friend or anything - but I don't smoke and her friends' parents both smoke - and she wasn't used to being so much smoke all the time.   Plus, their house tends to be on the "messy" side (I couldn't live like that myself)....so I think those few nights helped her to see how good she does have it.  Sometimes we take for granted what we have, ya know?

So, anyway, we'll monitor her and see how things go.   Oh, and she got a sinus infection or runny nose from being all that smoke, so I'm not happy about that.  But he gave her Zyrtec for that.  She went home early yesterday (about 2:00 p.m. from school), and when I got home at 5:00, she was sound asleep.  The doctor said she'd be sleepy from the Zoloft the first few days.  

Thanks for all of your info......

[ArmourGal]

I'm sorry to hear that the doc wouldn't follow recommended procedure before putting someone on psychotrophic meds.  This is why so many teenagers are not getting diagnosed properly I think. And unfortunately, permanent brain damage can occur when hypo goes untreated for an extended period of time.

[Trying not to Worry]

Dear ladybug, I hope you see this comment! My daughter is 16 years old and was diagnosed with Hashimoto's about 9 months ago. I never  suspected anything was physically wrong with her throughout her childhood and I do wonder about this. Occasionally I did think her neck looked swollen, but whenever I'd take her to our doctor he never commented about this. She finally started having many of the symptoms you mentioned. It was getting more and more difficult for her to get out of bed in the morning, her grades took a nose dive (in 2nd grade she was tested and found to be gifted and talented), she was starting to gain weight, and her periods were occasionally heavy. I wish someone had taken me and shaken me and said take her to the doctor and address these specific issues! But  indeed she'd have her good days, weeks even, and these symptoms were so much like a teenager's normal weirdness. You should really make sure her thyroid hormones are checked. I live with a great deal of guilt because I did not catch this disease sooner. I wonder if my child will ever be the same. I dread the future problems she may have. By the way many of these comments on this sight make me shudder and are not offering much comfort at this point. Please, someone give me something to be hopeful about.