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 tell you, I am singing the Hallelujah Chorus from being validated! Kalina has a LOT wrong, but most seems fixable. 1) Magnesium was SO extrememely low she had to have an IV treatment of one bag of magnesium and one bag of B vitamin. It was low enough that she was in danger of a seizure! She also needs to get 2 more IV treatments in the next week. 2) Ferritin is very low, and B12 and D3 are suboptimal; 3) Thyroid tissue is still present. TSH is 0.14 (0.34-5.60), Free T4 is 0.6 (0.6- 1.2), FreeT3 is 5.6 (2.5-3.9). Keep in mind that these levels were taken on 6/3 after Kalina had been on .180 Armour thyroid (taken all at once first thing in the morning) for 2 days. New thyroid doc says pattern fits Hashimoto 's, but will confirm with 1 more blood test & explain more at appt. next week. 4) Adrenals will be tested via blood test in the next couple of days. Not as precise as the saliva test but should show some ratios.
I think she's trying to process all this. My goal is to get a vitamin and mineral supplement called Fatigue to Fantastic that this doc OK'd ASAP and get Kalina on it.
Have a great weekend, everybody!
- Debbie
I think she's trying to process all this. My goal is to get a vitamin and mineral supplement called Fatigue to Fantastic that this doc OK'd ASAP and get Kalina on it.
Have a great weekend, everybody!
- Debbie
Not too much to repport. Kalina still craves stillness and quiet, just her and her laptop. Her new endo doc wrote a script for more blood tests: the antibody test(s) for Hashimoto's that was inadvertantly left off the previous script, test to look at the ratios for the adrenals (not as accurate at the saliva test, but we can't afford that right now), and test of her female hormones. The doc also OK'd a vitamin/mineral supplement formula that we can order. Once the blood test is completed (it needs to be drawn on the 19th day of Kalina's cycle), then the new doc wants to see Kalina to go over all of the lab and scan tests with her. At least progress is being made!!!
I'm giving a status report, but I don't think we really know anything more definite than last week. As I said earlier, Kalina was extremely lethargic all weekend. We just simply let her rest as she seemed to need it. Yesterday (Monday) she rode the bus to see her regular counselor (no connection to the local psychiatric hospital) and ended up relaxing the rest of the day at Barnes and Noble. Although I wasn't home for much of the evening, when I did pop in I saw she had cooked dinner and was VERY energenic and playing an animated improv game with her dad and sister. Later she apparently stayed up late (maybe the whole night, like she did last Thursday), and she was too tired to join us for breakfast. I DID bring her meds to her so she at least could get them at the same time of day.
We are still waiting to hear from the new thyroid doctor. I know I am only looking at a week's time, but Kalina's pattern for the last few days is 2 days of exhaustion, 1 day of unusual energy and insomnia, then back to 2-3 days of lethargy with a day of increased activity. It almost seems like her period of high energy is so intoxicating that she can't resist staying up. I could certainly speculate on the causes for this uneven pattern, but I'd like to find out the actual lab test and scan results from her doctor.
We are still waiting to hear from the new thyroid doctor. I know I am only looking at a week's time, but Kalina's pattern for the last few days is 2 days of exhaustion, 1 day of unusual energy and insomnia, then back to 2-3 days of lethargy with a day of increased activity. It almost seems like her period of high energy is so intoxicating that she can't resist staying up. I could certainly speculate on the causes for this uneven pattern, but I'd like to find out the actual lab test and scan results from her doctor.
Bumping up as its TUESDAY in Oz lol
Bumping this up as its MONDAY in Australia ...hehehehe
You guys are 16 hrs behind me lol.
Let us know how all goes today Debbie.
You guys are 16 hrs behind me lol.
Let us know how all goes today Debbie.
You're on the right track Debbie - Don't question it. It sure beats the other options you were given at Rogers.....
This takes time as we talked about and Sally says... One step at a time - especially with multiple gland issues.
This takes time as we talked about and Sally says... One step at a time - especially with multiple gland issues.
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.