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
I tried those links from your May 28th post, but most of them didn't work. Could you post them again? I will give these hospital docs a couple of days to get on board with the thyroid facts, and if Kalina's health and safety is at risk, then we can go to the director with these research facts.
The nurse at the hospital promise that the psych. docs WILL consult with the thyroid specialty doc. I will keep tabs on this.
I have promised Kalina that if any of the hospital staff wants to talk with us, I will ask them to do it in Kalina's presence. It is so important for her well being that we protect her trust. This is also the best way to gain the cooperation and respect of the staff if we DO need to intervene for Kalina's safety.
The nurse at the hospital promise that the psych. docs WILL consult with the thyroid specialty doc. I will keep tabs on this.
I have promised Kalina that if any of the hospital staff wants to talk with us, I will ask them to do it in Kalina's presence. It is so important for her well being that we protect her trust. This is also the best way to gain the cooperation and respect of the staff if we DO need to intervene for Kalina's safety.
Debbie - you still have the information I gave you on how wrong ECT is with her condition. I have you solid resources to read. Your daughter may not let you have a say right now on her treatment but the doctors will want to cover themselves if they realize her issues.
Go right to the director of the hospitol and show them the facts about her thyroid condition and it wouldn't hurt to put the bug in their ears that IF - your daughter comes out disabled or worse ... you WILL then have rights for her and you will sue the pants off of them for doing this treatment on her.
Go right to the director of the hospitol and show them the facts about her thyroid condition and it wouldn't hurt to put the bug in their ears that IF - your daughter comes out disabled or worse ... you WILL then have rights for her and you will sue the pants off of them for doing this treatment on her.
Actually, your comments don't offend me at all. I am at a different place right now than I was a few weeks ago. I was just telling my husband in the car today that I think we should back off and ask Kalina what she wants out of her treatment and how we can support her. I do agree with you when it comes to ECT. I will not argue against it, but I will tell her that based on her low thyroid, magnesium, and possible adrenal levels that medically I believe it is too risky for HER.
I also plan on telling Kalina that if any of the psych. hospital docs/staff contact us at all, I want to request that we only exchange info. in Kalina's presence. This hospital has already had contact with Kalina's counselor, so I have no doubt that will continue (and this counselor has a pretty detailed idea of the physical problems that are going on for Kalina). In regards to the thyroid specialty doc who seems to have such a good handle on things, maybe I will just ask Kalina if she wants her involved as a consultant at all. If she doesn't, I guess I will just have to accept that (and I think I'm beginnning to understand what you mean about the tears, because they are coming right now...).
Thanks again...so much!
I also plan on telling Kalina that if any of the psych. hospital docs/staff contact us at all, I want to request that we only exchange info. in Kalina's presence. This hospital has already had contact with Kalina's counselor, so I have no doubt that will continue (and this counselor has a pretty detailed idea of the physical problems that are going on for Kalina). In regards to the thyroid specialty doc who seems to have such a good handle on things, maybe I will just ask Kalina if she wants her involved as a consultant at all. If she doesn't, I guess I will just have to accept that (and I think I'm beginnning to understand what you mean about the tears, because they are coming right now...).
Thanks again...so much!
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.