Aa
Psychiatric complications - thyroid involvement?
My 20 year old daughter was diagnosed and treated by radioiodine ablation for Grave's disease 3 years ago. Within the last 6 weeks she has been in a psychiatric hospital twice, has shown some thyroid fluctuation in blood tests, and has been diagnosed with major depression, eating disorder, and borderline personalilty disorder. The first hospitalization was involuntary in Philadelphia (where she attends college) due to her taking a non-toxic dose of Motrin, but she checked herself into a local psychiatric hospital once she got home here in Milwaukee, WI.
My husband and I agree with the depression and eating disorder labels, but we have doubts about the borderline diagnosis. To make matters more complicated, our daughter reacted a bit when my husband and I expressed some doubts about the borderline finding, and she withdrew her permission for us to be involved with her health information and treatment decisions. Now the docs want to use electroshock therapy on our daughter! I have read that this treatment has had a comeback in the last 25 years, but it still carries some risks. The treatment forces your body into a grand mal seizure and can affect memory, cognitive function, and learning in the short term.
Our daughter has displayed symptoms of both mild hyperthyroid and extreme hypothyroid states over the past several months, sometimes even fluctuating over a few hours or days. This fluctuation has also shown up on thyroid blood tests both in Philadelphia and Milwaukee, but so far she has not had a full thyroid panel done. I wish I had numbers to share, but I did not write them down when we had a meeting because I thought I would be allowed to get copies. When our daughter got a blood test in early April in Philly, her doc commented to her that she was "hyperthyroid again" and lowered her levothyroxine from .150 mg. to .125 mg. I am wondering if this was what triggered her big emotional reaction that landed her in the first psychiatric hospital. The current psychiatric hospital has an endocrine doc on staff who has done SOME thyroid blood tests and is trying to stablize our daughter's correct thyroid dosage, but they have commented that it would be best if an endocrine specialist direct the correct tests (which might mean more than just tests for the thyroid).
Here is my question: does it make good medical sense for us to continue to strongly encourage our daughter to seek a second opinion with an endocrine physician who specializes in thyroid disorders (or better yet, a neuroendocrinologist if we can find one in our area), or should we just go along with the electroshock treatments our daughter's docs are recommending? I am guessing that they are looking at this treatment because the depression symptoms continue to fluctuate in and out, even after about 5 weeks on Celexa. Of course, these symptoms may be fluctuating precisely BECAUSE there is a thyroid imbalance (perhaps hashitoxicosis?)! We DO have the names of a couple of endocrine docs in the area who do a lot of work with thyroid issues. I really appreciate any comments you could give us on this.
My husband and I agree with the depression and eating disorder labels, but we have doubts about the borderline diagnosis. To make matters more complicated, our daughter reacted a bit when my husband and I expressed some doubts about the borderline finding, and she withdrew her permission for us to be involved with her health information and treatment decisions. Now the docs want to use electroshock therapy on our daughter! I have read that this treatment has had a comeback in the last 25 years, but it still carries some risks. The treatment forces your body into a grand mal seizure and can affect memory, cognitive function, and learning in the short term.
Our daughter has displayed symptoms of both mild hyperthyroid and extreme hypothyroid states over the past several months, sometimes even fluctuating over a few hours or days. This fluctuation has also shown up on thyroid blood tests both in Philadelphia and Milwaukee, but so far she has not had a full thyroid panel done. I wish I had numbers to share, but I did not write them down when we had a meeting because I thought I would be allowed to get copies. When our daughter got a blood test in early April in Philly, her doc commented to her that she was "hyperthyroid again" and lowered her levothyroxine from .150 mg. to .125 mg. I am wondering if this was what triggered her big emotional reaction that landed her in the first psychiatric hospital. The current psychiatric hospital has an endocrine doc on staff who has done SOME thyroid blood tests and is trying to stablize our daughter's correct thyroid dosage, but they have commented that it would be best if an endocrine specialist direct the correct tests (which might mean more than just tests for the thyroid).
Here is my question: does it make good medical sense for us to continue to strongly encourage our daughter to seek a second opinion with an endocrine physician who specializes in thyroid disorders (or better yet, a neuroendocrinologist if we can find one in our area), or should we just go along with the electroshock treatments our daughter's docs are recommending? I am guessing that they are looking at this treatment because the depression symptoms continue to fluctuate in and out, even after about 5 weeks on Celexa. Of course, these symptoms may be fluctuating precisely BECAUSE there is a thyroid imbalance (perhaps hashitoxicosis?)! We DO have the names of a couple of endocrine docs in the area who do a lot of work with thyroid issues. I really appreciate any comments you could give us on this.
Best Answer
Here's another step forward: Kalina's thyroid specialty doc just made a referral to a family medicine doc in the area who thinks along the same lines, and I was able to make an appt. for next Tues. June 29th! This doc will be able to bill Kalina's insurance, so hopefully her care will not be disrupted very much.
Another positive sign: this morning when I was talking to the psych. hospital social worker about making this new appt., the guy said something like, "it is very important to discover physical conditions that may be the underlying cause of psychological symtoms." Woo-hoo! Now I only wonder why the other social worker and set of docs at THE SAME HOSPITAL couldn't figure this out the 1st time!!! Gosh, I guess I shouldn't complain. Doesn't everyone go for 3 psychiatric hospitalizations in the span of about 2 1/2 months?
Thanks again for everyone's thoughts, prayers, and information/advice. I think things may be finally coming together so that Kalina can take charge of her health and start to have a life again.
Another positive sign: this morning when I was talking to the psych. hospital social worker about making this new appt., the guy said something like, "it is very important to discover physical conditions that may be the underlying cause of psychological symtoms." Woo-hoo! Now I only wonder why the other social worker and set of docs at THE SAME HOSPITAL couldn't figure this out the 1st time!!! Gosh, I guess I shouldn't complain. Doesn't everyone go for 3 psychiatric hospitalizations in the span of about 2 1/2 months?
Thanks again for everyone's thoughts, prayers, and information/advice. I think things may be finally coming together so that Kalina can take charge of her health and start to have a life again.
I'll resend you the links Debbie if need be. No problem. Here is where the confusion will set in with changing docs. Remember as I said - your "network" of doctors is so important with treatment of this disease. Some doctors only use Synthroid therapy and some are more open to conversion issues and use other meds to help when this situations arise.
I understand the insurance issues but the last thing you want is to have her fall back at this stage of the game when she has made huge strides in starting the healing process.
I feel getting a referral from her doctor now would be best so you can find both cost and treatment easier to manage.
Aussie Deb bring up a great thing Debbie that you may want to see would work. I do feel she needs to see the horror of others and know this can be fixed. You will not read anyone here that did not have their own thyroid nightmare first after they found their health returned. She needs to know others were/are in the same position to convince herself she is not alone.
Brain Fog lifting was huge for me. That was my turning point of regaining strength to fight to get well. You have to really be in it to fully understand but it is the greatest gift to "think" again when that symptom controls you.
I understand the insurance issues but the last thing you want is to have her fall back at this stage of the game when she has made huge strides in starting the healing process.
I feel getting a referral from her doctor now would be best so you can find both cost and treatment easier to manage.
Aussie Deb bring up a great thing Debbie that you may want to see would work. I do feel she needs to see the horror of others and know this can be fixed. You will not read anyone here that did not have their own thyroid nightmare first after they found their health returned. She needs to know others were/are in the same position to convince herself she is not alone.
Brain Fog lifting was huge for me. That was my turning point of regaining strength to fight to get well. You have to really be in it to fully understand but it is the greatest gift to "think" again when that symptom controls you.
Why dont you get her to join MedHelp?
I think it would be great for her as she could read others postings and know shes not alone in this.
I think it would be great for her as she could read others postings and know shes not alone in this.
There were lots of positive signs today. At least for today, Kalina seems to have emerged from her thyroid fog! She was proactive in making plans for doctors to see after she is discharged. In fact, she gave ME a homework assignment: I need to prompt Kalina's thyroid specialty doc to give me a name of another endo who can bill Kalina's insurance by Wednesday (since we simply can't afford to pay out of pocket right now). Kalina was also asking me to explain the different aspects of her condition that she can ask future docs about. I figured all along that Kalina could do this, but so many of her hormone and nutrient levels were so off that she couldn't even begin to put the pieces together. So, today starts a new chapter in Kalina's life--one that she is able to write about!
I agree about the ECT....dont allow it but I also think that you and your Hubby need to work WITH kalina as support. In regards to thyroid issues....Kalina herself HAS to become pro-active in her illness as she has to live with Graves for the rest of her life.
I know shes fragile at present but this message has to be got through to her.
You can do a lot for Kalina ..Debbie but she also has to help herself.
Just keep the Docs on their toes.
I know shes fragile at present but this message has to be got through to her.
You can do a lot for Kalina ..Debbie but she also has to help herself.
Just keep the Docs on their toes.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Here is some keys points you and I discussed to get this doctor the information she needs to do the evaluation if you chose to see her next week.
1. gather up her recent labs she had done and get a hardcopy of the report.
A. - look that over and see if the Free T3 and Free T4 along with TSH was done.
1a. Keep in mind keys things if these frees were done. The Free T3 should be on the high end of the reference guide ( very top) and the Free T4 should be mid high/high(er) there too on that sheet - comparible to the ratios. I bet my house there 2 labs are off.
2a. The TSH (althrough not so important as frees) should be near the .5 or lower but it must be looked at with the frees. If her frees are not optimal - do not pay attention to the TSH.
3a. - check for autoimmune antibody testing and see if they "may " have lloked for Hashitoxicosis. That would require a TPOab and a TgAb test confirming her TSI/ Graves antibodies were still present - along with the tests listed on line 1a. sub paragraph.
2. Out of curiosity, try to also get her reports from when she was dx'd Graves - 3 yrs ago. After we shared more information that she had RAI done with NO UPTAKE ( I am still appauld by that if true) scan and was only based on blood labs - I am sure this doctor would like to review the reports then too - to confirm FOR SURE - Graves was really involved to the degree of recieving RAI for permanent ablation or if other measures should be done. Another reason why looking at that would be the toxicosis theroy. If Graves is/was suppressed and was to some degree then toxicity would not be a dx. BUT - however Hashimoto may be present and only TPOab testing could help here too with proper treatment for that - that is being missed probably.
3. Find out what meds she is on and the quanities used daily. Given the run down of meds you told me you will need to provide this to the doctor and the dosages.
4. Write a brief synopsis of her thyroid/health history with your daughter involved too if possible. It does not need to be in length but key points of her symptoms, mood swings, anything she has described to you since RAI - or at her worst with (Graves?) , should be down on paper and released to this doctor so she can associate quicker with Collena and understand her issues. One thing would be to describe the highs and lows Collena has daily with morning highs and crashes in the afternoon. This specifically points to her adrenals are dragged down and should be written with the other things so this doctor can put that together.
5. Make sure K allows you to be on HIPPA release - or her dad. This will be critical for you - as not sick - be able to help her - as sick - until her mental anquish becomes less. Your family will need to be her advocate at this time and if Kalina allows it - I am proud to step into her corner too.
6. Adrenals testing.... It would be wise for me to give you the saliva test as this doctor suggested for her to test the adrenals through her saliva. I have the test and will give you it. Let me know what you decide but it takes 10 days to look it over and get it back. K will not have true results and thyroid treatment could be difficult - even with correct treatment as you will get - if the adrenals are not resolved to proper health first or with thyroid medication working with too.
7. All those things should be done and handed in to the doctors office for her to review the case prior to your visit - As arranged she will do this free of charge and you will be involved in a short paid visit with this doctor after she reviews the reports to go over real results to get kalina back and away from those butchers ready to shock her. I am horrorified at this whole ordeal!
8. For you Debbie - research the Free T3 hormone and neurologic side effects online. Understand it so you can be there to logically help K with understanding. Also - finally, relax.... it was fate for you to go online today and for me to pick up the post as I did being so close locally. You will get your daughter back emotionally - I promise!
9. For K ( if you show her this Debbie) - Hi :) my name is Nikki and I'd like to talk to you about this horrible disease and condition you have right now. My history of it is very common to yours and I spent years learning how to get myself well. Even though I did not get into as much professional mental issues as you are in being in the hospital - I can tell you certainly - I was very close to losing my life both - health and mind over how bad I was treated after I had RAI for my Graves disease. It sounds easy in the beginning with doctors telling you - but so many of us know - just taking a pill to ablate the thyroid with RAI and go on another pill for thyroid life isn't that easy.
I - as many others- have spent years learning so much and found doctors willing to really help. What you have been asked to do - of you going through shock therapy I think is wrong and could hurt you more. I know its tough and could cause anger to listen to someone who you don't know but at least get the second opinion as I gave your mom on "complete" thyroid help and go with that before any shock treatment.
As God is my witness K, I promise now that your mom and I met - I will try not let you down and you will feel better.
9. Debbie - also read about conversion based off T4 Synthroid drugs into the direct T3 hormone w/ RAI patients.
We've got alot of things to get done this weekend so K gets better. I'll reach out anyway you see fit Debbie.
Sending Hugs.... me.