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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
Hi Debbie,
I've been following your saga with your daughter and the wonderful support and advice from Stella and SmilerDeb.
You are on the right track. Be patient. It is going to take some time for your daughter's recovery.... maybe even quite a bit of time... Give her space and love. You are a wonderful Mum!
I've been following your saga with your daughter and the wonderful support and advice from Stella and SmilerDeb.
You are on the right track. Be patient. It is going to take some time for your daughter's recovery.... maybe even quite a bit of time... Give her space and love. You are a wonderful Mum!
Thanks for your encouragement. Kalina really IS wiped out...except for short periods today where she is on the couch with her laptop, she is just laying in bed. I just keep hoping that we are going the right direction with these health problems. I am thankful that my daughter is at least buying into avoiding any gluten and taking her meds as directed. Monday can't get here soon enough when I can find out more info. about getting an order for a lab test for the adrendals (since we don't have the $ right now to pay up front) so that her insurance can be billed. I also want to ask about specific doses/brands of mineral and vitamin supplements that may help Kalina gain a bit of normal functioning.
Hope your chest cold gets better, SmilerDeb. Stella, enjoy your family celebrations this weekend!
Hope your chest cold gets better, SmilerDeb. Stella, enjoy your family celebrations this weekend!
Debbie...it is noe surprise that your daughter is quiet and not talking much.......this thyroid cr@p (and yes it is cr@p!) really knocks you about a bit until you start to get everything on the right balance.
Also she is probably mentally and both physically tired.
She needs time to recharge her batteries and in my opinion.....just leave her be to spend some 'out' time.
Dont panic if she doesnt feel like conversation ...I went through the same thing before RAI and TT.
Some days I would be so sick of it all...I would just sit in my pj's all day and 'veggie out' so to speak as its so mentally draining and this poor girl has gone through so much more than a lot here.
In regards to contraindications...it is usually a drug companys way of 'covering their butt'.
Like when yr prescribed the contraceptive pill...they say it is 99.9% effective but leave the .1% for accidental pregnancies so you cant sue them lol.
Also word of advice too......I have 2 daughters and do you think MUM is ever right???
NO WAY ! lol.......
Be her friend first and then her Mum....I think this is what she needs from you.
I tried it with my daughters and it worked so much better in communication.
Daughters can be "firey" when 'fragile' so do the 'reverse psychology bit' and let your daughter think SHE is making the desisions (when in fact you are hehehe).
Works a treat everytime.
Suggestions like...'What do you think about doing it this way? "
See what her answer is then say ..."I suppose your right but thought I would suggest it anyway love.
This gives her the feeling that SHE is in CONTROL of her health issues and will help her immensely.
I know you are a beautiful caring loving Mum...but girls can be SO stubborn at times.
I worked that out a LONG time ago lol.
You are a MUM in a Million! xxxx
P.S
Doc may just have to wait...winter here in Australia and because of cold extreme temperatures...I have got a throat and chest infection lol.
But this Doc can wait (hehehehe) ...it all in the memory bank lol !
Also she is probably mentally and both physically tired.
She needs time to recharge her batteries and in my opinion.....just leave her be to spend some 'out' time.
Dont panic if she doesnt feel like conversation ...I went through the same thing before RAI and TT.
Some days I would be so sick of it all...I would just sit in my pj's all day and 'veggie out' so to speak as its so mentally draining and this poor girl has gone through so much more than a lot here.
In regards to contraindications...it is usually a drug companys way of 'covering their butt'.
Like when yr prescribed the contraceptive pill...they say it is 99.9% effective but leave the .1% for accidental pregnancies so you cant sue them lol.
Also word of advice too......I have 2 daughters and do you think MUM is ever right???
NO WAY ! lol.......
Be her friend first and then her Mum....I think this is what she needs from you.
I tried it with my daughters and it worked so much better in communication.
Daughters can be "firey" when 'fragile' so do the 'reverse psychology bit' and let your daughter think SHE is making the desisions (when in fact you are hehehe).
Works a treat everytime.
Suggestions like...'What do you think about doing it this way? "
See what her answer is then say ..."I suppose your right but thought I would suggest it anyway love.
This gives her the feeling that SHE is in CONTROL of her health issues and will help her immensely.
I know you are a beautiful caring loving Mum...but girls can be SO stubborn at times.
I worked that out a LONG time ago lol.
You are a MUM in a Million! xxxx
P.S
Doc may just have to wait...winter here in Australia and because of cold extreme temperatures...I have got a throat and chest infection lol.
But this Doc can wait (hehehehe) ...it all in the memory bank lol !
Thanks Stella for listing all of the things we spoke about as well as the supplement info. Kalina slept all night and slept in quite late (and I did as well, though it was unusual for me to sleep until 11:00!) So far today she seems to be functioning OK but is just basically sitting quietly with her laptop without really talking to me at all. That made a lot of sense about her needing to reduce all environmental stimulation while (we assume) her adrenal gland is pooped out. She discounts any of my advice about breaking the Armour dosing into 2 or more sections, so that approach is going nowhere. She will only listen to her doctor's instructions.
Here is one major thing I want to ask the doctor's office about. The following is from the web version of the contraindications section of the Armour thyroid warnings:
"Thyroid hormone preparations are generally contraindicated in patients with diagnosed but as yet uncorrected adrenal cortical insufficiency, untreated thyrotoxicosis, and apparent hypersensitivity to any of their active or extraneous constituents. There is no well-documented evidence from the literature, however, of true allergic or idiosyncratic reactions to thyroid hormone.
Last updated on RxList: 1/4/2008"
Does anyone have experience or additional knowledge of research that shows why this warning would be on Armour thyroid?
Thanks.
Here is one major thing I want to ask the doctor's office about. The following is from the web version of the contraindications section of the Armour thyroid warnings:
"Thyroid hormone preparations are generally contraindicated in patients with diagnosed but as yet uncorrected adrenal cortical insufficiency, untreated thyrotoxicosis, and apparent hypersensitivity to any of their active or extraneous constituents. There is no well-documented evidence from the literature, however, of true allergic or idiosyncratic reactions to thyroid hormone.
Last updated on RxList: 1/4/2008"
Does anyone have experience or additional knowledge of research that shows why this warning would be on Armour thyroid?
Thanks.
Hi Debbie
I decided to post on our conversation. Here are the major topics we discussed down publically so you can refer to them easily with your doctor.
1. Dosing Armour thyroid all at once right now with her Adrenal issues is not recommended as she was told by her doctor. Consider splitting this total grain dosage at least twice a day for her to stabilize the direct T3 coming in off the desiccated medication. With her adrenal issues it may be even better to consider dosing 3 to 5 times a day with the 3 grains total to give her adrenals less T3 reaction. Speak to doctor more on that Monday.
2. I familiarized this doctor on a supplement package I found years ago specifically designed for adrenal/thyroid disorders. You may want to consider speaking to doctor about this complete supplement package. The product is Fatigue to Fantastic formula designed by Dr Teitelbaum. I found is a good source and easier than taking a whole handful of tablets daily. Adding in adrenal support of Vit C ( I used EmergenC packets) and it was quite pleasant to drink each day. I supplemented 3000mgs of EmergenC with the F and F and found is so helpful managing my thyroid meds and symptoms until I was optimal.
3. If you do not want a complete package the important issues until things heal more would be selenium/magnesium and Vit C and B's
4. Let her lead in activities right now and realize any sudden change could be emotional triggers for her on a negative level. She knows what she can endure and be able to do right now more than anyone. That's one thing both diseases bring to the sufferer. Their limits are clear to them only.
5. Rest. She requires resting alot right now and don't be alarmed if her sleep patterns are off. Its the best thing for her to listen to her body and know when rest is needed.
I decided to post on our conversation. Here are the major topics we discussed down publically so you can refer to them easily with your doctor.
1. Dosing Armour thyroid all at once right now with her Adrenal issues is not recommended as she was told by her doctor. Consider splitting this total grain dosage at least twice a day for her to stabilize the direct T3 coming in off the desiccated medication. With her adrenal issues it may be even better to consider dosing 3 to 5 times a day with the 3 grains total to give her adrenals less T3 reaction. Speak to doctor more on that Monday.
2. I familiarized this doctor on a supplement package I found years ago specifically designed for adrenal/thyroid disorders. You may want to consider speaking to doctor about this complete supplement package. The product is Fatigue to Fantastic formula designed by Dr Teitelbaum. I found is a good source and easier than taking a whole handful of tablets daily. Adding in adrenal support of Vit C ( I used EmergenC packets) and it was quite pleasant to drink each day. I supplemented 3000mgs of EmergenC with the F and F and found is so helpful managing my thyroid meds and symptoms until I was optimal.
3. If you do not want a complete package the important issues until things heal more would be selenium/magnesium and Vit C and B's
4. Let her lead in activities right now and realize any sudden change could be emotional triggers for her on a negative level. She knows what she can endure and be able to do right now more than anyone. That's one thing both diseases bring to the sufferer. Their limits are clear to them only.
5. Rest. She requires resting alot right now and don't be alarmed if her sleep patterns are off. Its the best thing for her to listen to her body and know when rest is needed.
I am newly worried about my daughter. All of a sudden she couldn't sleep last night. She went with me to her scans this morning, but this afternoon and evening she was like a zombie. We ask her questions or ask if she wants to do something, and all she says is "I don't know" or "It doesn't matter."
I am wondering if the Armour thyroid she started on Wednesday is too much for her or if she is having a reaction to it. The doctor said to take 2 pills (30 grains each) and 3 if she needed it, but I think my daughter is taking 3 all at once in the morning. I suggested that she space the pills out a bit and only take 2, but I don't think she is taking my advice.
I'm just not sure who to call. Her thyroid specialty doc's clinic closed at 3:00 today, and the doc doesn't appear to have any kind of on-call status. I just feel a need to skip anything else I was going to do this weekend and just stay with my daughter. The doctor should have the lab results as well as the thyroid and pelvic USs as well as the brain MRI by Monday. I hope she can hold on until then. I will NOT take her back to that psychiatric hospital where they want to try electroconvulsive therapy on her! I'd take her down to the hospital associated with the University of Chicago if I have to...All of this is so confusing.
I am wondering if the Armour thyroid she started on Wednesday is too much for her or if she is having a reaction to it. The doctor said to take 2 pills (30 grains each) and 3 if she needed it, but I think my daughter is taking 3 all at once in the morning. I suggested that she space the pills out a bit and only take 2, but I don't think she is taking my advice.
I'm just not sure who to call. Her thyroid specialty doc's clinic closed at 3:00 today, and the doc doesn't appear to have any kind of on-call status. I just feel a need to skip anything else I was going to do this weekend and just stay with my daughter. The doctor should have the lab results as well as the thyroid and pelvic USs as well as the brain MRI by Monday. I hope she can hold on until then. I will NOT take her back to that psychiatric hospital where they want to try electroconvulsive therapy on her! I'd take her down to the hospital associated with the University of Chicago if I have to...All of this is so confusing.
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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.