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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 am going to type this posting and I hope and pray that you are not offended by it but can see it from both sides. Please dont take this as an attack as thats not what it is but please see it as advice.
I am an outsider in regards to all this but there are a few things that I have picked up on.
I say it as I see it Debbie.......that is ME and this is my thoughts on it.
If I offend you, I deeply apologise xxx
I have gone through my life bringing up 3 children alone.....2 Daughters and a Son.
I too , like many other parents only wants what is best for my children, to protect them, to shield them from harm and to love them unconditionally.
But there comes a time in our kids lives when there is only so much we can do. As the child grows, they take their own road in life and may do things and say things that as parents , we disagree with.
A classic example is the last few weeks with me.....
For the last 9 months, my youngest daughter has been on her own (partner gone) and has been struggling with an uncontrollable 5 year old who is abusive, aggressive, vilent and just DOES NOT sleep.
With the passing of my best friend and also my Father this year...my so called strength dwindled a little,,,thyroid levels went haywire and I was constantly trying to take on my daughters problems.
I would babysit Joshua (grandson) whenever my daughter needed it and would be pulling my hair out an hour after she left , having extreme anxiety from trying to handle a 5 year old who puts holes in walls etc. My daughter would sob that she wasnt getting sleep etc and I was there to support her through this.
Then one day something happened....she turned round and said to me..."Mum, let ME deal with this!"
Unbeknown to me, I was actually taking ALL control off my daughter of her own life, her own desisions etc and didnt even realise it.
She would hit out at me with abuse...yelling to let HER do it.
I was only trying to support her and all along thought I was doing good when in actual fact, I was SMOTHERING her.
To cut a long story short...I promised my daughter I would BACK off and let her make the desisions.
I couldnt see that I was doing more harm than good. I was doing what any MUM does for their kids...love and support.
My partner Rob then said to me...wait until she falls Deb then be there to catch her ...as she will fall
I did just that.
I withdrew all support,,, kept in touch, let her whinge and moan about no sleep then bang! she came to me one day in tears asking for MY help.
I then got Josh into a paediatric specialist who deals with ADHD only, got him assessed, sorted out her paperwork, bills etc and Josh WAS diagnosed as having ADHD (his fathers brother has it too).
I now have a daughter who loves me to death for pulling her out of the rut she was in....a grandson I can babysit who doesnt destroy my place and a daughter who turned around and said to me only last week...Thanks Mum...thanks for all yr support when I needed it."
This is all in a matter of 3 weeks.
It is hard for a Parent to sit back and watch our kids go through he// but sometimes we HAVE to let go a fraction and let them decide which path or road to take and be there for them , should they take the wrong path.
Debbie...I know you are not going to like me saying this but it is TIME to let Kalina choose her road/path.
She is 20 years old ...3 years younger than my daughter and you have to let her manage her thyroid issues. You have to let her be an Adult who can make her own desisions.
As much as your family loves her....by making the desisons for her, you are suffocating her , making her feel worthless without even realising it.
Kalina HAS to be active in her medical management.....she has to say yes or no to desisions.....you cant do that for her anymore.
All you can do is be there for her.
Regardless of what desisions she makes or doesnt make..this is her ballgame now.
All I can advise is that you be there if and when she falls.
Dont try to live her life or she will resent you (like my daughter did for a while).
Be there for her but let her make her OWN choices.
It is the HARDEST thing to do...to take a step back and let HER decide whats best for her but I am telling you that if you dont step back a fraction, she will resent you and retaliate against you ...which is what I think she is doing now.
Kalina is hitting out at you for not allowing her to CONTROL her own mind and desisions.
Let Kalina make the desisions but step in with regards to the ECT but other than that...let her fall...let her feel pain...let her know that you are there when she needs you.
If you dont do this....your daughter will resent you very much and hit out at you with extreme irrational behaviour.
Kalina is not a baby anymore, she is a young woman and does have a mind of her own.
I know this posting will hit hard but as an outsider who has been through it with 3 children....take some of my advice...please.
And once again, I apologise deeply if I have offended you or hurt you .
Debs xxxx
P.S
I now have a happy loving daughter, a beautiful controllable grandson and support that my daughter needed from outsiders and also myself....all in the space of 3 weeks.
We as Parents can only guide our children and hope they take the right path in life...if they stray away from that path...then we try to get them back on the right path but we cannot control our children when they get to be an Adult or their way of thinking.
I am an outsider in regards to all this but there are a few things that I have picked up on.
I say it as I see it Debbie.......that is ME and this is my thoughts on it.
If I offend you, I deeply apologise xxx
I have gone through my life bringing up 3 children alone.....2 Daughters and a Son.
I too , like many other parents only wants what is best for my children, to protect them, to shield them from harm and to love them unconditionally.
But there comes a time in our kids lives when there is only so much we can do. As the child grows, they take their own road in life and may do things and say things that as parents , we disagree with.
A classic example is the last few weeks with me.....
For the last 9 months, my youngest daughter has been on her own (partner gone) and has been struggling with an uncontrollable 5 year old who is abusive, aggressive, vilent and just DOES NOT sleep.
With the passing of my best friend and also my Father this year...my so called strength dwindled a little,,,thyroid levels went haywire and I was constantly trying to take on my daughters problems.
I would babysit Joshua (grandson) whenever my daughter needed it and would be pulling my hair out an hour after she left , having extreme anxiety from trying to handle a 5 year old who puts holes in walls etc. My daughter would sob that she wasnt getting sleep etc and I was there to support her through this.
Then one day something happened....she turned round and said to me..."Mum, let ME deal with this!"
Unbeknown to me, I was actually taking ALL control off my daughter of her own life, her own desisions etc and didnt even realise it.
She would hit out at me with abuse...yelling to let HER do it.
I was only trying to support her and all along thought I was doing good when in actual fact, I was SMOTHERING her.
To cut a long story short...I promised my daughter I would BACK off and let her make the desisions.
I couldnt see that I was doing more harm than good. I was doing what any MUM does for their kids...love and support.
My partner Rob then said to me...wait until she falls Deb then be there to catch her ...as she will fall
I did just that.
I withdrew all support,,, kept in touch, let her whinge and moan about no sleep then bang! she came to me one day in tears asking for MY help.
I then got Josh into a paediatric specialist who deals with ADHD only, got him assessed, sorted out her paperwork, bills etc and Josh WAS diagnosed as having ADHD (his fathers brother has it too).
I now have a daughter who loves me to death for pulling her out of the rut she was in....a grandson I can babysit who doesnt destroy my place and a daughter who turned around and said to me only last week...Thanks Mum...thanks for all yr support when I needed it."
This is all in a matter of 3 weeks.
It is hard for a Parent to sit back and watch our kids go through he// but sometimes we HAVE to let go a fraction and let them decide which path or road to take and be there for them , should they take the wrong path.
Debbie...I know you are not going to like me saying this but it is TIME to let Kalina choose her road/path.
She is 20 years old ...3 years younger than my daughter and you have to let her manage her thyroid issues. You have to let her be an Adult who can make her own desisions.
As much as your family loves her....by making the desisons for her, you are suffocating her , making her feel worthless without even realising it.
Kalina HAS to be active in her medical management.....she has to say yes or no to desisions.....you cant do that for her anymore.
All you can do is be there for her.
Regardless of what desisions she makes or doesnt make..this is her ballgame now.
All I can advise is that you be there if and when she falls.
Dont try to live her life or she will resent you (like my daughter did for a while).
Be there for her but let her make her OWN choices.
It is the HARDEST thing to do...to take a step back and let HER decide whats best for her but I am telling you that if you dont step back a fraction, she will resent you and retaliate against you ...which is what I think she is doing now.
Kalina is hitting out at you for not allowing her to CONTROL her own mind and desisions.
Let Kalina make the desisions but step in with regards to the ECT but other than that...let her fall...let her feel pain...let her know that you are there when she needs you.
If you dont do this....your daughter will resent you very much and hit out at you with extreme irrational behaviour.
Kalina is not a baby anymore, she is a young woman and does have a mind of her own.
I know this posting will hit hard but as an outsider who has been through it with 3 children....take some of my advice...please.
And once again, I apologise deeply if I have offended you or hurt you .
Debs xxxx
P.S
I now have a happy loving daughter, a beautiful controllable grandson and support that my daughter needed from outsiders and also myself....all in the space of 3 weeks.
We as Parents can only guide our children and hope they take the right path in life...if they stray away from that path...then we try to get them back on the right path but we cannot control our children when they get to be an Adult or their way of thinking.
Well, I haven't spoken to my daughter yet, but I called a couple of hours after her ER admission and found she has chosen to go back to the same psychiatric hospital as before. Yes, THIS IS THE ONE THAT RECOMMENDED THE ELECTROCONVULSIVE THERAPY!
My husband and I need to proceed firmly but carefully in this. I don't know yet if our daughter will allow us access to her medical docs and information. She explained to me that she did not allow me in the room at her discharge simply because it was too much stimulation for her to have more than 1 person in the room (which is consistent with the effects of extremely low magnesium and possibly cortisol imbalance). I am going to do everything in my power to get the hospital staff to consult with Kalina's thyroid specialty doctor. Please pray that we can retain our daughter's trust and help her get the best care possible.
My husband and I need to proceed firmly but carefully in this. I don't know yet if our daughter will allow us access to her medical docs and information. She explained to me that she did not allow me in the room at her discharge simply because it was too much stimulation for her to have more than 1 person in the room (which is consistent with the effects of extremely low magnesium and possibly cortisol imbalance). I am going to do everything in my power to get the hospital staff to consult with Kalina's thyroid specialty doctor. Please pray that we can retain our daughter's trust and help her get the best care possible.
I see this as a cry for help.......in all honesty..if your daughterKalina wanted 'out' then she wouldnt have told her Father she had taken them as by taking this many anti-depressants, she would be pretty drowsy, dizzy and low blood pressure within 15-30 mins of taking these pills.
Debbie, you are NOT superwoman...you cant control other peoples actions and as much as you wish that you had taken Kalina to another hospital..you did what you thought best at the time it happened.
You know my prayers are with you Debbie...that you can be sure of.....but all you can do for the moment, is try and get some rest as this would be pretty mentally draining on you and your family.
You was right to take Kalina to the nearest hospital and not delaying as if the tablets had got into Debbies bloodstream , it wouldve been a lot more serious that it is.
These medications cause the blood pressure to drop pretty low and eventually can cause her to become comatose so that that is why I say that Kalina wouldnt have taken them long before she told her Father.
A cry for help is what it looks like to me.
Try and get some sleep...our prayers are with you xxxxxxxx
Debbie, you are NOT superwoman...you cant control other peoples actions and as much as you wish that you had taken Kalina to another hospital..you did what you thought best at the time it happened.
You know my prayers are with you Debbie...that you can be sure of.....but all you can do for the moment, is try and get some rest as this would be pretty mentally draining on you and your family.
You was right to take Kalina to the nearest hospital and not delaying as if the tablets had got into Debbies bloodstream , it wouldve been a lot more serious that it is.
These medications cause the blood pressure to drop pretty low and eventually can cause her to become comatose so that that is why I say that Kalina wouldnt have taken them long before she told her Father.
A cry for help is what it looks like to me.
Try and get some sleep...our prayers are with you xxxxxxxx
I don't know what to say. After my husband and I had gone to sleep, our daughter came up to talk to him and told him she had taken about 20 Mirtaxapine (Remeron) 30 mg. pills. I think she just wants to get well, so this may have been a way to get the psychiatric treatment she feels she needs. Needless to say, I took her to the nearest emergency room...The nurse told me that she was physically OK after they gave her something to absorb all of the medicine in her stomach.
I was able to give this sympathetic nurse a pretty detailed recent history of the thyroid, low magnesium, and possible adrenal problems. She said she would relay all of this history to the doctor. I hope they at least will administer IV magnesium if her level is still critically low.
I requested that Kalina get to make a choice in which psychiatric facility they take her to. I can call in a few hours (if I'm awake) or else in the morning to see where they take her. I am kicking myself a bit that I didn't take her a few miles further away to a hospital that makes sure they check physical issues pretty thoroughly before sending a person to the psychiatric section. I was worried that it might take too long and Kalina would suffer needless ill effects during the ride there.
Your thoughts and prayers are much appreciated.
I was able to give this sympathetic nurse a pretty detailed recent history of the thyroid, low magnesium, and possible adrenal problems. She said she would relay all of this history to the doctor. I hope they at least will administer IV magnesium if her level is still critically low.
I requested that Kalina get to make a choice in which psychiatric facility they take her to. I can call in a few hours (if I'm awake) or else in the morning to see where they take her. I am kicking myself a bit that I didn't take her a few miles further away to a hospital that makes sure they check physical issues pretty thoroughly before sending a person to the psychiatric section. I was worried that it might take too long and Kalina would suffer needless ill effects during the ride there.
Your thoughts and prayers are much appreciated.
I just posted a photo of my daughter at 17 with a painting she had created that won a silver key award with the Scholastic Art contest. I share this photo not to brag about my daughter but to point out (and remind myself) how resilient she is. She painted this picture of herself in December of 2006 when her Grave's disease was raging but as yet undiagnosed. She forced herself to attend school so she could complete this painting and submit it for the contest. Her old high school later asked her to donate an art piece, and this was the one she chose. Her painting is framed and up on the wall by the auditorium in her old high school next to the paintings by a handful of other former high school artists.
You can go to my page and see the painting there. My daughter is at a hard place now because she is resistent to advice from her doctor, her counselor, and us (her parents). She is still following some of the health recommendations, but I would appreciate your thoughts and prayers as we seek to persuade her to complete 2 more magneseum IV treatments and another visit or 2 to her thyroid doctor. Thanks again for all of your comments and encouragement--it means a lot!
You can go to my page and see the painting there. My daughter is at a hard place now because she is resistent to advice from her doctor, her counselor, and us (her parents). She is still following some of the health recommendations, but I would appreciate your thoughts and prayers as we seek to persuade her to complete 2 more magneseum IV treatments and another visit or 2 to her thyroid doctor. Thanks again for all of your comments and encouragement--it means a lot!
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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.