# Suicide attempt--thyroid involvement?



## Debbie from Milwaukee

GD Woman referred my to this forum. I am the mom of a daughter who received radioactive iodine treatment for her Graves Disease when she was 17. After 1 year of adjusting her meds, she was declared to have normal thyroid balance. She chose to attend another school for her senior year of high school (since it was hard for her to face answering all of her friends' questions). The year after high school she underwent a jaw surgery to correct problems that had affected her adenoids and possibly were causing mild sleep apnea. This past year she began college at an art university in Philadelphia.

This brings us to the current situation: Late Friday night I received a call from an official from my daughter's university that she had taken a number of motrin (though not toxic enough to have to pump her stomach) and made superficial cuts above her wrist in an apparent suicide attempt. This was apparently an impulsive act, since our family was texting her earlier and her best friend was talking with her on the phone at length that night and detecting nothing wrong. I have heard 3rd hand that this may have been triggered by a brief conflict with a friend (not sure if it was a friend in Philadelphia or her friend on the phone). I flew out to Philadelphia as quickly as I could. She has been placed in a psychiatric hospital for 5 days. My daughter seems fairly like her normal self to me, and she has seemed fine when we have seen her at home (at Thanksgiving, Christmas, and spring breaks). We also have not been hearing much about any emotional difficulties when we regularly text her or speak to her on the phone.

I am concentrating on being supportive to my daughter and not asking her much of the details of this situation until we can talk to her doctor on Monday. This brings me to why I am suspecting thyroid involvement: My daughter said that she had her blood tested by her primary doctor recently and was told she was now "hyperthyroid" again. Her dosage of Levothyroxine was lowered from .150 mg. to .125 mg. just this past week. Before I heard about this from my daughter, I stated to the emergency room doc that thyroid had been an issue in the past. The emergency room docs apparently did check her TSH, and the chart says her level was in the normal range (I forgot to ask them exactly what the number was, but I can do this).

I have to tread carefully with this inquiry. I have burning questions about this entire situation, but my daughter is 20 and wants me to "chill" and let her take care of her treatment with her doctors. My daughter wants to get back to school, but the university needs to be assured that she is "stable" before they will let her back in her residence housing. I am wondering about some of your thoughts about this whole issue. What are some of the questions I should be encouraging my daughter to ask of which doctors, and do people think an endocrinologist should be involved (at least on a consult, because she is currently an inpatient in this psychiatric hospital through at least Wednesday). Thank you so much in advance!


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## Andros

Debbie from Milwaukee said:


> GD Woman referred my to this forum. I am the mom of a daughter who received radioactive iodine treatment for her Graves Disease when she was 17. After 1 year of adjusting her meds, she was declared to have normal thyroid balance. She chose to attend another school for her senior year of high school (since it was hard for her to face answering all of her friends' questions). The year after high school she underwent a jaw surgery to correct problems that had affected her adenoids and possibly were causing mild sleep apnea. This past year she began college at an art university in Philadelphia.
> 
> This brings us to the current situation: Late Friday night I received a call from an official from my daughter's university that she had taken a number of motrin (though not toxic enough to have to pump her stomach) and made superficial cuts above her wrist in an apparent suicide attempt. This was apparently an impulsive act, since our family was texting her earlier and her best friend was talking with her on the phone at length that night and detecting nothing wrong. I have heard 3rd hand that this may have been triggered by a brief conflict with a friend (not sure if it was a friend in Philadelphia or her friend on the phone). I flew out to Philadelphia as quickly as I could. She has been placed in a psychiatric hospital for 5 days. My daughter seems fairly like her normal self to me, and she has seemed fine when we have seen her at home (at Thanksgiving, Christmas, and spring breaks). We also have not been hearing much about any emotional difficulties when we regularly text her or speak to her on the phone.
> 
> I am concentrating on being supportive to my daughter and not asking her much of the details of this situation until we can talk to her doctor on Monday. This brings me to why I am suspecting thyroid involvement: My daughter said that she had her blood tested by her primary doctor recently and was told she was now "hyperthyroid" again. Her dosage of Levothyroxine was lowered from .150 mg. to .125 mg. just this past week. Before I heard about this from my daughter, I stated to the emergency room doc that thyroid had been an issue in the past. The emergency room docs apparently did check her TSH, and the chart says her level was in the normal range (I forgot to ask them exactly what the number was, but I can do this).
> 
> I have to tread carefully with this inquiry. I have burning questions about this entire situation, but my daughter is 20 and wants me to "chill" and let her take care of her treatment with her doctors. My daughter wants to get back to school, but the university needs to be assured that she is "stable" before they will let her back in her residence housing. I am wondering about some of your thoughts about this whole issue. What are some of the questions I should be encouraging my daughter to ask of which doctors, and do people think an endocrinologist should be involved (at least on a consult, because she is currently an inpatient in this psychiatric hospital through at least Wednesday). Thank you so much in advance!


Aaaaaaaaaaaaaaaaaaaaaaw; I hear a very hurting and worried mom!!

From what I know (and I had to have 3 RAI),the thyroid can and does grow back if not completely killed off. Yes, indeed!

It would be crucial for you to get her most recent labs of TSH, FREE T3 and FREE T4 (not T4 and T3) plus if there is reason to believe the thyroid grew back, TSI (thyroid stimulating immunoglobulin) would only be present if the patient is hyperthyroid and then there is always the "uptake scan."

It is true that if a patient is severely hyperthyroid, the patient can become psychotic and otherwise mentally disturbed. Geeze; the poor kid.

When you saw your daughter, did you observe any outward clinical signs of hyper? Weight loss or gain, dry skin, hair loss, eye involvement, anything? If she was heavily medicated, that may have masked agitation? You think?

And I will comment; "if" you are paying your daughter's way, I think you are very very entitled to be involved in her treatment. That said, I will keep you in my thoughts and prayers; daughter also.

This is going to be complicated for sure.


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## Crockie

Debbie from Milwaukee said:


> GD Woman referred my to this forum. I am the mom of a daughter who received radioactive iodine treatment for her Graves Disease when she was 17. After 1 year of adjusting her meds, she was declared to have normal thyroid balance. She chose to attend another school for her senior year of high school (since it was hard for her to face answering all of her friends' questions). The year after high school she underwent a jaw surgery to correct problems that had affected her adenoids and possibly were causing mild sleep apnea. This past year she began college at an art university in Philadelphia.
> 
> This brings us to the current situation: Late Friday night I received a call from an official from my daughter's university that she had taken a number of motrin (though not toxic enough to have to pump her stomach) and made superficial cuts above her wrist in an apparent suicide attempt. This was apparently an impulsive act, since our family was texting her earlier and her best friend was talking with her on the phone at length that night and detecting nothing wrong. I have heard 3rd hand that this may have been triggered by a brief conflict with a friend (not sure if it was a friend in Philadelphia or her friend on the phone). I flew out to Philadelphia as quickly as I could. She has been placed in a psychiatric hospital for 5 days. My daughter seems fairly like her normal self to me, and she has seemed fine when we have seen her at home (at Thanksgiving, Christmas, and spring breaks). We also have not been hearing much about any emotional difficulties when we regularly text her or speak to her on the phone.
> 
> I am concentrating on being supportive to my daughter and not asking her much of the details of this situation until we can talk to her doctor on Monday. This brings me to why I am suspecting thyroid involvement: My daughter said that she had her blood tested by her primary doctor recently and was told she was now "hyperthyroid" again. Her dosage of Levothyroxine was lowered from .150 mg. to .125 mg. just this past week. Before I heard about this from my daughter, I stated to the emergency room doc that thyroid had been an issue in the past. The emergency room docs apparently did check her TSH, and the chart says her level was in the normal range (I forgot to ask them exactly what the number was, but I can do this).
> 
> I have to tread carefully with this inquiry. I have burning questions about this entire situation, but my daughter is 20 and wants me to "chill" and let her take care of her treatment with her doctors. My daughter wants to get back to school, but the university needs to be assured that she is "stable" before they will let her back in her residence housing. I am wondering about some of your thoughts about this whole issue. What are some of the questions I should be encouraging my daughter to ask of which doctors, and do people think an endocrinologist should be involved (at least on a consult, because she is currently an inpatient in this psychiatric hospital through at least Wednesday). Thank you so much in advance!


Debbie,

I know little to nothing about Graves but I do understand what it is to worry about your child.

My thoughts and prayers are with you and your family.

((((( Hugs )))))

Crockie


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## GD Women

I am glad you found us but sorry about your daughter.

Most definitely your daughter, like most of us RAI Gravers', still have a functioning thyroid. With having some function antibodies can still attack the part of the thyroid that is still functioning and play have with our thyroid levels, body, and mind. Until we reach thyroid medication dosage of 200 or higher (300) we will still have a functioning thyroid and this goes for hypos as well. I suspect in your daughters situation, medication overdose, that is, her TSH was too low. She might not be testing and seeing doctor often enough to catch the situation.

Psychiatric disturbances can accompany hyperthyroidism and hypothyroidism. Thyroid conditioned can exasperate existing mental problems or even mimic mental illness. People with an overactive thyroid may exhibit marked anxiety and tension, emotional lability, impatience and irritability, distractible overactivity, exaggerated sensitivity to noise, and fluctuating depression with sadness and problems with sleep and the appetite. In extreme cases, they may appear schizophrenic, losing touch with reality and becoming delirious or hallucinating. However the most common effect of an overactive thyroid is anxiety.

Emotional changes in Graves' disease are primarily caused by the effects of excess thyroid hormone on thyroid receptors in the brain. Emotional disturbances may also result from nutrient deficiencies and exhaustion. Cognitive changes in GD caused by hormonal imbalances also weaken the ability to cope with stress. Compounding the problem, stress causes endocrine and immune system changes, which exacerbate symptoms in autoimmune thyroid disease. In most patients who present with depression or anxiety associated with hyperthyroidism without other psychiatric history, psychiatric symptoms usually resolve with treatment (correct thyroid levels) of the hyperthyroidism.

I go through most of the above still and if my TSH (and FT-4) goes way out of Labes hyper range it, I, get worse. Very overwhelming!

Also I am on anxiety meds. taken on an as needed bases due to Graves' Rage, inappropriate feelings of anger, frequently followed by an impulsive destructive response to this anger. Almost lost my sister and friends until I got help for it. (Hashi is known as "Myxedema Madness or Myxedema psychosis").

I don't know if the below links will help especially without actually knowing what was or is your daughters motives. The links are to varify that thyroid and thyroid levels not only effects our body but also can effect our minds

Scroll approx. half way down under Endocrine Disorders

http://emedicine.medscape.com/article/294131-overview

Psychiatric symptoms in endocrine diseases. 
http://www.ncbi.nlm.nih.gov/pubmed/3983024?dopt=Abstract

Graves' Rage

http://www.suite101.com/lesson.cfm/19330/2904/6

http://www.ncbi.nlm.nih.gov/pubmed/15650357

Good Luck and let us know your daughters progress.


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## chopper

Hello and welcome,

I am sorry for the situation you are in. Im a Dad too. I can tell you only from my own experience with hyper periods that suicide is usually the furthest from my mind when hyper if for no other reason than that I have anxiety and would be afraid of trying it. I have felt sorry for myself for having thyroid trouble and all the days I've missed with my kids but personally I just wouldn't do it and for me, the "rage" portion is more of an outward agression type of feeling - like you want to punch a fist through a wall - not inward - but that is me. Everyone handles things differently and everyone's situation is unique.

Thankfully I have no experience with suicide. I consider myself a logical person and with that, I would say you need to work very closely with your daughters doctors and keep an open mind. No parent wants to deal with that situation and it is very easy for one to lay blame on the easiest target but at the same time, she is your daughter and you must get to the bottom of it to prevent further problems, even if the news is not something you want to hear.

I am not saying that you grasping for straws but please do not try to find a reason to justify the incident with something that has a slim chance of being the culprit, like the thyroid or you may miss the real reason your daughter did this. Of course the thyroid could be a problem - certainly the little gland regulates a heck of a lot of things inside the body but at the same time, logic dictates that it is unlikely.

My first thoughts, going on pure logic and reason, would be some sort of relationship trouble - best friend, boyfriend/girlfriend, etc. She's at the right age to be contemplating longer term relationships and if it is an "away college", I can attest that the first year or two can make for a very difficult adjustment. I was clueless when I first went away to college. I missed my old friends. I missed my mom's cooking. I missed my everything about being back home. It is a difficult transition for most kids.

My next thought, just going on gut instinct, would be regarding activities you may not necessarily be aware of. I do not know you and do not know your relationship with your daughter. I am merely trying to offer any advice I can so please do not take offense to any of what I am posting. Is it possible that your daughter could be involved with something you might not be aware of, like drugs?

Again, please don't take offense to my post. I really am trying to help in any way I can. You need to speak with your daughter and lay it all on the table - absolutely no secrets and she needs to know she has nothing to hide, even if the news might davastate you she needs to know she can talk to you without prejudice. You should probably speak with her friends. At that age friends know everything. When it comes to saving someone from a suicide, there are no boundaries that cannot be crossed to find the truth so do not worry if your daughter gets ****ed off at you for asking so many questions. In the end it wil only help her resolve her problems and will make you even closer with her than you are now.

Good luck to you and your daughter. I hope she gets the help she needs.


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## hillaryedrn

Hi Debbie, I don't have anything to add to what has already been said, but being a mother, I completely feel your pain. I just wanted to let you know that I am praying for you and your family.


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## Debbie from Milwaukee

I wrote something longer last night, but I got squeezed off the Internet from 
too many users before I could post.

First, thanks to everyone for your empathy, caring, and mostly helpful info. I am convinced more than ever that a relapse of Graves needs to either ruled out or diagnosed if it is the primary culprit here.

The emergency room ran a tox. screen because of the intake of Motrin, and there was no mention of drugs. Also, I had a good chance to talk to my daughter's roommates yesterday. They are *extremely* supportive of my daughter. They reported that they have noticed some bouts of sadness in her, but only over the past couple of months. I have heard that a conflict with a friend was the event that propelled my daughter into taking some pills, but I don't think that is the whole story. Put this together with little clues--like my daughter feeling really bad after running, alternating bursts of energy with exhaustion, me seeing her the other day when I observed her feeling hot and dry, was noticably irritable, her mood will swing between anger and sadness, and the comment from her primary doc that she is "hyperthyroid again"--and I think there is reason enough for her current docs to investigate thyroid involvement.

Nasdaqphil, I tried to send you a private message, but you do not accept them. Your reason and logic may be impecable, but please pair your intellect with some information and experience with thyroid issues, which is the primary reason for this forum. I am not stupid--I fully realize that my daughter may well have a primary diagnosis of major depression or perhaps be bipolar. *BUT*, if she has a full blown or even emerging Graves relapse that can come on stronger in the next few months, she could literally die from a heart attack or another suicide attempt without proper treatment to balance her thyroid levels.

I have a call in to the social worker about how I can have access to my daugher's doc(s) RE: this. I will be very cooperative and respectful of them and their expertise, but if they refuse to explore the thryoid possibilities, I'm going to have to force the issue. I made the mistake of going along with a psychiatrist who neglected to look at *any past physical history when my daughter was 17, and I've vowed never to go down that road again.

I'll report to the forum what happens over the next few days. I sense that many of you have found the need to advocate for yourself or a loved one RE: thyroid issues. I really do appreciate you folks keeping us in your thoughts and prayers...*


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## Andros

nasdaqphil said:


> Hello and welcome,
> 
> I am sorry for the situation you are in. Im a Dad too. I can tell you only from my own experience with hyper periods that suicide is usually the furthest from my mind when hyper if for no other reason than that I have anxiety and would be afraid of trying it. I have felt sorry for myself for having thyroid trouble and all the days I've missed with my kids but personally I just wouldn't do it and for me, the "rage" portion is more of an outward agression type of feeling - like you want to punch a fist through a wall - not inward - but that is me. Everyone handles things differently and everyone's situation is unique.
> 
> Thankfully I have no experience with suicide. I consider myself a logical person and with that, I would say you need to work very closely with your daughters doctors and keep an open mind. No parent wants to deal with that situation and it is very easy for one to lay blame on the easiest target but at the same time, she is your daughter and you must get to the bottom of it to prevent further problems, even if the news is not something you want to hear.
> 
> I am not saying that you grasping for straws but please do not try to find a reason to justify the incident with something that has a slim chance of being the culprit, like the thyroid or you may miss the real reason your daughter did this. Of course the thyroid could be a problem - certainly the little gland regulates a heck of a lot of things inside the body but at the same time, logic dictates that it is unlikely.
> 
> My first thoughts, going on pure logic and reason, would be some sort of relationship trouble - best friend, boyfriend/girlfriend, etc. She's at the right age to be contemplating longer term relationships and if it is an "away college", I can attest that the first year or two can make for a very difficult adjustment. I was clueless when I first went away to college. I missed my old friends. I missed my mom's cooking. I missed my everything about being back home. It is a difficult transition for most kids.
> 
> My next thought, just going on gut instinct, would be regarding activities you may not necessarily be aware of. I do not know you and do not know your relationship with your daughter. I am merely trying to offer any advice I can so please do not take offense to any of what I am posting. Is it possible that your daughter could be involved with something you might not be aware of, like drugs?
> 
> Again, please don't take offense to my post. I really am trying to help in any way I can. You need to speak with your daughter and lay it all on the table - absolutely no secrets and she needs to know she has nothing to hide, even if the news might davastate you she needs to know she can talk to you without prejudice. You should probably speak with her friends. At that age friends know everything. When it comes to saving someone from a suicide, there are no boundaries that cannot be crossed to find the truth so do not worry if your daughter gets ****ed off at you for asking so many questions. In the end it wil only help her resolve her problems and will make you even closer with her than you are now.
> 
> Good luck to you and your daughter. I hope she gets the help she needs.


TSI would be definitive that she has relapsed to hyper.

It has also been reported that TSI measurement can be used to predict relapse or remission when methimazole 2 or radioiodine 3,4 is used to treat Graves' Disease.

Reference..... http://www.gluetext.com/content/t/Thyroid/Thyroid_stimulating_immunoglobulin.html


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## Debbie from Milwaukee

Well, I spoke to my daughter's doctor this morning. The doctor seems to think my daughter will be able to pursue her normal activities in college in a few days, which is good. This doctor refuses to pursue any more thyroid testing, however. She states that "the TSH is in the normal range, and that vitals taken everyday do not reveal an abnormal heart rate or respiration." I at least got the doc to agree to consult with my daughter's primary doctor, who detected abnormal TSH levels only very recently (Hello!--and why didn't the psych. doc think of that in the first place???).

As most of you can tell, I am a *bit* agitated over all this. Well, the situation is what it is, and I can be thankful that my daughter is doing well and her docs think she will be safe in the near future.

My thoughts are moving toward encouraging my daughter to hook up with an endocrinologist. I have heard the name of one good doc in Milwaukee, WI. Does anyone out there know of a good doc in Philadelphia? You can private message me if you know of someone who has good references. There is a chance my daughter may stay out here for the summer, and of course she will need a good doc to consult with in the fall.

If my daughter really doesn't want to see an endocrine doc unless her thyroid levels continue to be out of balance, can anyone recommend a good home TSH testing device? Thanks in advance for all of your thoughts, prayers, and helpful advice.


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## Andros

Debbie from Milwaukee said:


> Well, I spoke to my daughter's doctor this morning. The doctor seems to think my daughter will be able to pursue her normal activities in college in a few days, which is good. This doctor refuses to pursue any more thyroid testing, however. She states that "the TSH is in the normal range, and that vitals taken everyday do not reveal an abnormal heart rate or respiration." I at least got the doc to agree to consult with my daughter's primary doctor, who detected abnormal TSH levels only very recently (Hello!--and why didn't the psych. doc think of that in the first place???).
> 
> As most of you can tell, I am a *bit* agitated over all this. Well, the situation is what it is, and I can be thankful that my daughter is doing well and her docs think she will be safe in the near future.
> 
> My thoughts are moving toward encouraging my daughter to hook up with an endocrinologist. I have heard the name of one good doc in Milwaukee, WI. Does anyone out there know of a good doc in Philadelphia? You can private message me if you know of someone who has good references. There is a chance my daughter may stay out here for the summer, and of course she will need a good doc to consult with in the fall.
> 
> If my daughter really doesn't want to see an endocrine doc unless her thyroid levels continue to be out of balance, can anyone recommend a good home TSH testing device? Thanks in advance for all of your thoughts, prayers, and helpful advice.


I am so glad to hear that things are going better and that your daughter will be re-joining her classes.

At a certain point, TSH becomes irrelevant. Especially with hyperthyroid. The FREE T3, FREE T4 tests and the TSI would be very important test to have.

Also, psychiatrists firstly become medical doctors and then go on to get psyche degree. More than anyone, they are the first to diagnose a physical problem such as thyroid before jumping to conclusions otherwise. They will either rule it in or rule it out. I would say it is safe to be confident in that.

The main thing is your daughter is doing well.

Hopefully others will help w/ a recommendation. Is there a home testing kit for TSH? I knew they were working on one many years ago but never heard another word about it.


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## Debbie from Milwaukee

Latest developments RE: my daughter and her medical/emotional evaluations: 1) I had not added that when I last saw my daughter in Philly on Saturday, she told me that the psychiatrist told her that they thought the best diagnosis for my daughter was borderline personality disorder! This was a bit of a shock, to say the least...

2) My daughter called me on Monday, and I finally felt vindicated. She told me that the new doctor, a psychiatrist that the university she attends employs as a consultant, spoke with her on Monday morning. He is very concerned that her thyroid is out of control and wants to to hook her up with an endocrine specialist ASAP! This new doctor came to this conclusion just from questioning my daughter RE: her health history and her recent actions that landed her in the psychiatric unit.

So, the university is very supportive of helping my daughter get these needed thyroid tests (I will check to make sure they order the free T3 & free T4 as well as the TSI to confirm or rule out Grave's disease). I will update the forum as I hear more news in the coming week or so. Thank you all again for your support, thoughts, and prayers in this situation. I'm glad that my daughter finally has some competent medical support to get to the bottom of why she has been experiencing difficult symptoms since December of 2009.


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## GD Women

Thanks Debby for the up date on your daughter and do please keep us up to date on her diagnoses and progress. I wouldn't be surprised if it was her thyroid gone amiss again.

I can relate!


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## Andros

Debbie from Milwaukee said:


> Latest developments RE: my daughter and her medical/emotional evaluations: 1) I had not added that when I last saw my daughter in Philly on Saturday, she told me that the psychiatrist told her that they thought the best diagnosis for my daughter was borderline personality disorder! This was a bit of a shock, to say the least...
> 
> 2) My daughter called me on Monday, and I finally felt vindicated. She told me that the new doctor, a psychiatrist that the university she attends employs as a consultant, spoke with her on Monday morning. He is very concerned that her thyroid is out of control and wants to to hook her up with an endocrine specialist ASAP! This new doctor came to this conclusion just from questioning my daughter RE: her health history and her recent actions that landed her in the psychiatric unit.
> 
> So, the university is very supportive of helping my daughter get these needed thyroid tests (I will check to make sure they order the free T3 & free T4 as well as the TSI to confirm or rule out Grave's disease). I will update the forum as I hear more news in the coming week or so. Thank you all again for your support, thoughts, and prayers in this situation. I'm glad that my daughter finally has some competent medical support to get to the bottom of why she has been experiencing difficult symptoms since December of 2009.


Well, my goodness. So good to hear from you and I know we will all be anxious to hear about your daughter's thyroid labs. I am happy. I do hope this is the answer.


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## Debbie from Milwaukee

My daughter made the decision to come home to Milwaukee from Phiadelphia. She flew home this weekend. Now that the school pressure is off, she seems a lot better. I still want her to see an endocrinologist ASAP. If anyone has had experience with any of the endo docs in Milwaukee, feel free to private e-mail me. Thanks in advance!


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## Debbie from Milwaukee

Well, things are progressing for my daughter, but not in the way any of us would want...

My husband drove my daughter back to Philadelphia last week to get some academic tasks out of the way. One the way back they made the journey into a short road trip that was meant to be relaxing for both of them.

Our daughter came home from the trip this past Monday evening and told us she wanted to go to a psychicatric hospital, since they told her at the hospital in Philly that she could come back if she felt she needed it. So, I took my daughter to a reputable psychiatric hospital in Milwaukee, and they admitted her about 2 a.m. that night. She (understandably) slept most of Tuesday. More alarmingly, she slept most of yesterday, this morning, and this evening as well while displaying extrememly flat affect and is withdrawing from most activities! I supplied a 2 1/2 page letter of her thyroid history over the past 3 years, and they have at least been making an attempt to test her thyroid levels. I have not yet seen paperwork that lists all of the thyroid tests over the past 6 weeks, but there seems to be a pattern of alternating above normal and normal thyroid functioning. Even scarier, the docs at this hospital are trying to adjust our daughter's thyroid meds on a daily basis (.125 one day and .137 mg. the next)!

My husband spoke to a nurse and a doctor today, and I think both of us may go in tomorrow. I would like the staff to bring in a good endocrinologist on a consult if possible or else transfer our daughter to the general hospital down the street and have a full workup done for her. This pattern of 24/7 sleeping and withdrawing from activities is NOT normal for our daughter. The behavior we have seen from her the past few weeks is mostly normal affect and behavior during the day, then a distinct change comes over her in the early evening. The change presents as flat affect, some irritability, and withdrawl from social activities (but no sleeping). She is sometimes able to snap out of it in 2-3 hours and sometimes she needs to sleep before she is back to normal.

I would appreciate hearing if folks have ANY inkling of what may be going on with our daughter. Of course we want to get her in to see an endocrinologiest ASAP. I have the names of 2 good endo docs in Milwaukee from an internist in town, and I am hoping that the docs at this psychiatric hospital can help us get an emergancy appointment VERY SOON!

Thanks in advance for your thoughts and prayers.


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## chopper

Google this term below and look into this. It is extremely rare but you never know. Some of the mental aspects seem to fit:

Hashimoto's Encephalopathy

also, if you would like, post all thyroid related labs with reference ranges. Has she had a TSI test? Thyroid antibodies? Other tests that would be helpful are TBII, TBG, vit D, prolactin, cortisol, ACTH, fsh, LH, tpo ab, tg ab, ferritin, TIBC and finally I would want a 24 hour catecholamine test (epinepherine, norepinepherine and dopamine) 24 hour urine test.

you can google any of these tests if you are not familiar with them.


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## Debbie from Milwaukee

Thank you, Phil. I'll print your post out and ask about some of these tests. All I can ask for from a forum like this is guidance on asking doctors the right questions. I just know that my daughter is simply not functioning right now, and I want to find out what physical processes are causing her symptoms.


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## chopper

I know your time is probably limited but it would be in your best interest to google some of those tests and really learn about what they do. It may help you put the pieces together. Additionally, from my experience, doctors absolutely hate internet input. If you present him with a list you printed from the internet, he will probably put up his defenses and stonewall you, however, if you can learn about these tests and discuss why you want the tests, it will really help you support your cause.

Here are some quick links that may be of help:

Ferritin test: http://www.mayoclinic.com/health/hemochromatosis/ds00455/dsection=symptoms

http://www.webmd.com/a-to-z-guides/ferritin

24 hour catecholamine test:
http://www.nlm.nih.gov/medlineplus/ency/article/003613.htm

http://www.webmd.com/heart-disease/catecholamines-14697

ACTH test:
http://www.labtestsonline.org/understanding/analytes/acth/test.html

http://www.cushings-help.com/acth.htm

TSI Test (important):
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

http://thyroid.about.com/cs/hyperthyrdgraves/a/10things.htm

Hashimoto's Encephalopathy:
http://thyroid.about.com/cs/hashimotos/a/encephalopathy.htm

http://thyroid.about.com/od/relatedconditions1/a/sreat.htm

Hashitoxicosis:
http://www.bellaonline.com/articles/art47593.asp

http://www.bellaonline.com/articles/art54966.asp

http://graves.medshelf.org/Hashitoxicosis

TPO Ab (Thyroid Peroxidase Antibodies)
http://www.medicinenet.com/thyroid_peroxidase_test/article.htm

http://www.medscape.com/viewarticle/452668_5

http://www.mayoclinic.com/health/thyroid-disease/an00806

TG Ab: (Antithyroglobulin antibody)
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm

http://www.labodia.com/en/thyroid/review_thyroid_english.htm

3T (3 Tesla) MRI - a very powerful MRI machine:
http://www.neuro.jhmi.edu/brainwaves/2004_Fall/3T_MRI.htm


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## hillaryedrn

Phil has given you some incredible information. I can't add anything to that except my prayers for you and your daughter. This must be such a hard time for you all! ((HUGS))


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## Debbie from Milwaukee

Well, I DID have some time today and at least skimmed all of the articles that Phil sent links for. The article that caught my attention the most is the one from medshelf.org on Hashitoxicosis. I am going to ask our daughter's doctor questions about the possibility of this condition. I am wondering if this Hashitoxicosis has been gradually coming on since December. Around April 1st our daughter's doc took a blood test and found the thyroid levels above normal. This doc reduced the levothyroixine level from .150 to .125. 2 weeks later (around the time of her period), our daughter acted impulsively and ended up in the psych. hospital in Philly. Since she has returned from her trip she exhibits extreme hypothyroidism.

We DID find out today that our daughter IS being treated by an endocrine specialist while in the Milwaukee psych. hospital. This doc is alternating the dosage every other day (from .125 to .137 mg.) because he thinks the raised increment should be .131 mg. He is also giving our daughter some medicine that he believes will perk her up and be more responsive.

We will be requesting copies of all of her thyroid tests and talking to the endo doc about the possibility of Hashitoxicosis. Again, thanks to all of you for your info., thoughts, and prayers!


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## chopper

I have hashitoxicosis and just wrote an article about it this morning actually if you would like to check it out:

http://www.thyroidboards.com/hashitoxicosis/index.html


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## Debbie from Milwaukee

Our daughter also has to face numerous psychiatric labels. The latest one is Borderline Personality Disorder. At least there is a doctor on staff at her hospital who is an endocrine specialist & is treating her for thyroid symptoms. This does sound like a complex disorder. Do you know if there is any standardized way of diagnosing the condition (i.e., are there one or two test results that will play the role of the proverbial smoking gun)?

Thanks for showing me the article, Phil. Are you sure you aren't Dante in one of his levels of hell? My thoughts and prayers will be with you as you seek a competent surgeon to trash your thyroid!


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## chopper

In your daughters case, since you highly suspect a thyroid disorder, I would accept nothing less than a full thyroid panel:

TSH
Free T4
Free T3
Total T4
Total T3

Thyroid Peroxidase Antibodies (TPO Ab)
Thyroglobulin Antibodies (TG Ab)
Thyroid Stimulating Immunoglobulins (TSI)

if you get all the above tests and they are normal you can rest assured there is nothing wrong with the thyroid. If one or more of the tests comes back abnormal they will diagnose accordingly, depending on which test is messed up. I would be most curious to see if she's got high antibodies, TPO and TSI.


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## Andros

Debbie from Milwaukee said:


> Our daughter also has to face numerous psychiatric labels. The latest one is Borderline Personality Disorder. At least there is a doctor on staff at her hospital who is an endocrine specialist & is treating her for thyroid symptoms. This does sound like a complex disorder. Do you know if there is any standardized way of diagnosing the condition (i.e., are there one or two test results that will play the role of the proverbial smoking gun)?
> 
> Thanks for showing me the article, Phil. Are you sure you aren't Dante in one of his levels of hell? My thoughts and prayers will be with you as you seek a competent surgeon to trash your thyroid!


I have shared this with many, all of whom have been misdiagnosed over the years. You may find it of interest.

http://www.psycheducation.org/thyroid/introduction.htm


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## Debbie from Milwaukee

nasdaqphil said:


> In your daughters case, since you highly suspect a thyroid disorder, I would accept nothing less than a full thyroid panel:
> 
> TSH
> Free T4
> Free T3
> Total T4
> Total T3
> 
> Thyroid Peroxidase Antibodies (TPO Ab)
> Thyroglobulin Antibodies (TG Ab)
> Thyroid Stimulating Immunoglobulins (TSI)
> 
> if you get all the above tests and they are normal you can rest assured there is nothing wrong with the thyroid. If one or more of the tests comes back abnormal they will diagnose accordingly, depending on which test is messed up. I would be most curious to see if she's got high antibodies, TPO and TSI.


Well, my husband and I met with a social worker and our daughter for a meeting today. Turns out we will have to take a big step back from all this. We were making progress in convincing the social worker of the importance of checking out the thyroid, but in the process our daughter reacted and withdrew her consent for either of us to be included in any of her treatment/information.

The social worker quoted the TSH (high), free T3, free T4, and T3 tests, but I didn't write them down because I thought I would be getting copies of the results. A couple of the "T" tests were in the normal range, and one (I think it was T3) was low. The social worker also said that it might be best if a future endocrine doctor order the tests because they would be set up better to look at the thyroid and well as any other possible source of trouble (i.e., the pituatary, adrenal, etc.)

This is very frustrating for us, because we think that our daughter's judgment and emotions are being affected by her thyroid being off. Our daughter is saying that she needs to address the psychiatric issues first. Our daughter's Graves' disease was first diagnosed at 17, and we suspect that she may have been suffering from a lessened form of it since she was in middle school. So, if she identifies issues that she has been dealing with for a number of years, then a poorly functioning thyroid may also be the culprit.

I guess I am just venting a bit. I was feeling really helpless and angry after the meeting, but I've cooled down a bit since then. Our daughter wants us to trust that she can make treatment decisions for herself. I just hope that she eventually trusts us to help her with endocrine resources. I also pray that she doesn't experience something like a thyroid storm or another emotional meltdown from her crazy thyroid and even crazier psychiatrists trying to medicate emotional symtoms that may well have a physical cause!


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## CA-Lynn

Debbie,

I'm fairly new to this board and don't often have time to check out the Graves forum.

I did want to mention one thing: neuroendocrinology is a specialized field in medical science that deals with endocrinology and brain function. There are not a lot of specialists yet. But keep this in mind if the time comes that you're part of the treatment and decision making.

I cannot stress enough that the very first rule of all psychatrists is to rule out physical problems. There's so much legal liability nowadays that if a problem is remotely suspect, tests will be ordered.

I know you have your daughter's best interests at heart but I'd use the time to more throughly check out the links that the others have given you. At least you will have all the facts in front of you.

I wish your family the best.


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## Debbie from Milwaukee

Lynn--thanks very much for mentioning a neuroendocrinologist. I didn't even know such a doctor existed.

Our daughter told my husband tonight that her doctors want to do electroshock therapy on her! I admit I really don't know a lot about this, but I can tell you that hearing this was really tough. Does anyone here have any knowledge or experience with this type of psychiatric treatment?

So much for the first rule of psychiatrists doing whatever they can to rule out a physical cause. The social worker told us that it would be better for an endocrine doc to do the specialized tests, and now they are proposing this electroshock therapy. I know I need to research what is the latest in this field, but it seems extreme. I was under the impression that it is still used, but more for conditions like bipolar disorder when it does not respond to medication or talk therapy.


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## chopper

I don't know much about it but that sounds a bit drastic. Any way you can get a second opinion or take her somewhere else?

I don't understand why she is not being seen by an endo first if you so strongly believe her thyroid has something to do with it. Can you get her to a regular hospital perhaps?

Has she at least received a mental diagnosis yet? Does she suffer from schitzophrenia? It just seems odd to me they would start such a controversial and aggressive procedure without an official diagnosis.


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## hillaryedrn

Yes, electroshock therapy sounds scary. I'm so sorry that you and your family are having to deal with this! ((HUGS)) I'm not even going to attempt to rationalize the phych's decisions, but I am going to try and comfort you just a bit. IF (and that's only if, not saying it's what needs to be done) they decide to go through electroshock therapy, she will feel no pain. Many people just hear "shock" and think that their loved one is being electrocuted. She would be made comfortable with medication, and she will not remember it at all. Again, I am so very sorry that you and your family are having to go through this, but I hope that I can perhaps bring you just a tad bit of comfort in case they do go this route.


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## Debbie from Milwaukee

nasdaqphil said:


> I don't know much about it but that sounds a bit drastic. Any way you can get a second opinion or take her somewhere else?
> 
> I don't understand why she is not being seen by an endo first if you so strongly believe her thyroid has something to do with it. Can you get her to a regular hospital perhaps?
> 
> Has she at least received a mental diagnosis yet? Does she suffer from schitzophrenia? It just seems odd to me they would start such a controversial and aggressive procedure without an official diagnosis.


Yes, our daughter HAS received some diagnoses. We only heard them officially on Monday, and from a social worker who read them from her chart. The firm diagnoses of major depression and eating disorder I can agree with (I'm not sure how extensive the eating disorder symptoms have been, but I they have been enough to scare our daughter), but the borderline personality disorder doesn't seem to match our daughter if you know her. The docs in Milwaukee are also not so firm on that label. I think the electroshock therapy is being recommended because our daughter still shows periods of significant depression that does NOT seem to be responding to Celexa after about 5 weeks. Of course, fluctuating thyroid hormone (perhaps like in hashitoxicosis that Phil writes about in his article) could also be responsible for her fluxuating moods!

I just posted on another online support forum and actually got in contact with a woman who is local to my area. She has given me the name of a local doctor who I am going to contact right now. I'll keep everybody informed on how things transpire. Again, thanks so much for your kind thoughts and prayers!


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## Debbie from Milwaukee

I tell you, I am singing the Hallelujah Chorus from being validated, but also feeling empathy for my daughter! I was miraculously able to get my daughter in for an appt. with the new thyroid doc this morning. She 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 she 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 her on it.

Have a great weekend, everybody!

- Debbie from Milwaukee


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## GD Women

Thanks Debbie for the up date. My goodness she had a few things amiss. Seems like you are getting closer to an answer and hopefully solution. Is your daughter still on Armour. Her TSH seems OK but her FTs are askew. I assume due to Armour with FT3 so high. If it weren't for her taking Armour I would guess a reverse T3 issue with such a low FT4. I'd be flying high with that high of FT3, maybe to the moon. No wonder she has been off and having problems.

Still keeping you all in my thoughts and prayers.

Let us know what happens at the next meeting with Doc.

Good luck :hugs:


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## CA-Lynn

"Fatigued to Fantastic" - isn't that one of the products manufactured and sold by internist Jacob Teitelbaum? I know he's licensed in Hawaii, but I'm not sure that he sees patients. I'm always turned off when MD's become marketeers.

http://theiciexperience.blogspot.com/2008/05/report-firsthand-experience-with-paul-e.html

Do a "find" for Teitelbaum.


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## Debbie from Milwaukee

Lynn:
All I know is that a local women who is very well self-taught in all things connected with thyroid problems (from her own experience) uses this product. I made sure that my daughter's doc OK'd it first. Also, I think I read that Dr. T donates much of his profits to charity.


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## Debbie from Milwaukee

(thoughts from last night): 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.

(thoughts from this morning): 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.


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## CA-Lynn

Electroconvulsive therapy is not the big bad monster that a lot of people seem to think it is.

Your daughter is of legal age, as I recall.


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## Debbie from Milwaukee

Lynn:
The more important issue for my daughter is that recently her magnesium levels were the lowest her thyroid doctor had ever seen in a LIVE patient, low enough to put her at risk for seizure. ECT induces a grand mal seizure. Her thyroid doctor has already taken a stand to oppose ECT at this time for my daughter because she judges it to be too dangerous. The doctors at this psychiatric hospital failed to test my daughter for magnesium level (even though one of them is an endocrinologist) before they recommended the ECT treatment for her. I think that is more than a little negligent!

My concern is that my daughter get EFFECTIVE treatment, whether that means physical or emotional-mental. She knows I am not crazy about the ECT treatment, but I have been very careful not to argue against it in her presence. It is a piece of hope for improvement that she is holding on to, and she needs to see significant improvement from meds and supplements from her thyroid doc before she really completely buys into the physical treatment route.


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## CA-Lynn

Debbie:

Sounds like your daughter is crying out in every way to Sunday to get psychiatric care. Hope she's getting it.


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## Debbie from Milwaukee

I visited Kalina last night, and it seemed like she was finally coming out of her "thyroid fog!" She was taking charge of making doctor appointments and even gave me a homework assignment to get her one appointment.

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.


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## hillaryedrn

I'm very glad that your daughter seems to be headed towards health again. I'm sure your whole family is breathing a sigh of relief right now. ((HUGS))


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## Debbie from Milwaukee

Hi again, everyone:
I just wanted to thank everyone and ask one question. Your support and prayers have been SO helpful to me. I try to protect my daughter's privacy, so I haven't told poeple in our church (except for a few) about the hospitalizations. It's a bit hard when the pastor asked my husband, "Is she in sin?" Felt like asking him if HIS elderly father was "in sin" because he was recently diagnosed with Parkinson's! Anyway, I got over being hot about that one, and we are working hard to EDUCATE folks about how complex these endocrine disorders are and how they mask as mental illness.

Here is my question: the psych. docs just put Kalina on Cymbalta (don't know what dosage) about last Wednesday. Has anyone heard of any interaction issues with Cymbalta and Armour thyroid? Just on Tuesday it seemed to me that the brain fog was lifing and Kalina was starting to actively plan about getting discharged. Now she is reporting to her dad that she is having trouble sleeping, her anxiety is increasing, and she is trying to make fine cuts on her arms (with the plastic wrist band that she pried off). Sounds like bad side effects to me!

Right now I am going to check out 2 other hospitals that have mental health inpatient units. This current hospital is not only NOT helping her, it seems to be making things worse. One of the hospitals I will check out is a hospital where the new doc she has an appt. for tomorrow morning has privleges. Since it doesn't look like she will be ready to be discharged today, maybe this will be a way to finally get her thyroid treatment pushed into first priority. I would appreciate your thoughts and prayers!!!


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## CA-Lynn

I wouldn't count on the current observations being side effects or drug interactions even though there is a black box warning for Cymbalta [as there are for many anti-depressants]. There are no known interactions between Armour Thyroid and Cymbalta.

Cymbalta is prescribed for MDD [Major Depressive Disorder]. Several hospitals have already diagnosed your daughter with that [in addition to other mental health codes] and she is cutting again and getting agitated about leaving the facility. She also has a history of taken overdoses of meds - all before being placed on Cymbalta. It's worth knowing that MDD is very different from brain fog associated with some drugs. A diagnosis of MDD comes after examining strict criteria.

I don't mean to be unkind, but bluntly stated, it's time to consider that her issues are not caused by thyroid or interaction of meds, but are indeed psychiatric, and that she needs psychiatric treatment. Perhaps she's complaining to her father because she does not want to leave the psychiatric hospital she is currently in. She can't get appropriate help if she's moving in and out of hospitals.

If it was my kid I"d make sure that psychiatric treatment was the top priority.

http://www.drugs.com/drug-interactions/armour-thyroid-with-cymbalta-2189-1435-949-2273.html

http://www.jad-journal.com/article/S0165-0327(09)00430-3/abstract


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## Debbie from Milwaukee

Well, we got through the appointment. The social worker was fairly sympathetic with both thyroid issues as well as depression, since he shared that he has had his thyroid removed to help deal with his depression.

We learned a couple of things. Kalina DOES need further treatment for both her depression as well as a bulimia eating disorder. She has been telling us about the eating disorder (which has been active since about March), but for weird insurance reasons the current psych. hospital was unable to treat her for it there. We are fine with her getting further treatment. The other thing we learned is that Kalina's psychiatrist/family medicine doc has only paid lip service to follup up with Kalina's thyroid specialty doc. There are NO transfered lab reports/records from the thyroid doc in Kalina's file, there is NO record that the current hospital has done any thyroid tests, and I heard through the grapevine that Kalina's psychiatrist made the comment, "I never heard of anyone who died from low magnesium." He may have called Kalina's thyroid doc, but I think he discounts this doctor because she is a D.O. rather than an M.D. D.O.s have just as much or more training than M.D.s, but I guess there are mainstream physicians that don't take them seriously.

Well, Kalina is looking at 2 other hospitals that CAN give her treatment for her eating disorder and depression (although I'm not sure if it will be inpatient, outpatient, or somewhere in between). I asked Kalina what she had found helpful to her during her current stay, and she really couldn't think of anything (although I think she DID learn the value of journaling to help her sort through the thoughts and feelings she is struggling with).

I've asked Kalina if she will please advocate for herself when she gets into this next phase of treatment to ask that her medical doctor be brought on board along with the other treatment people. One of the unfortunate things that is happening is that Kalina was SUPPOSED to be seeing her new doctor this morning, but because she is not discharged from the psych. hospital she can't make the appointment. I am hoping and praying that the clinic will be able to squeeze her in another appointment soon, since this new doc will be gone on vacation for part of July.

My last thought on all of this is that I truly believe that Kalina's struggles are very closely linked with her recent thyroid troubles. I do NOT know for certain that Kalina's newly diagnosed Hashimoto's disorder (which was never properly discovered 3 years ago) has caused her depression and eating disorder, but all of these problems are concurrent since about March. The stress of college, going a few months as a vegitarian, the possibility that Kalina is gluten intolerant, and her low nutrient levels of magnesium, B12, and ferritin all play into her current psychological issues. For this reason I will continue to urge Kalina to actively involve her medical doctor in any psychiatric treatment she receives from here on out. Kalina asked me yesterday if she could just concentrate on "one thing at a time." She may choose to do that, but I truly believe she will just be setting herself up for a longer recovery time.


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## CA-Lynn

You wrote that, "I do NOT know for certain that Kalina's newly diagnosed Hashimoto's disorder (which was never properly discovered 3 years ago) has caused her depression and eating disorder, but all of these problems are concurrent since about March."

Consider, if you will, that the psychiatric problems may have been there for a long time before March. Perhaps overlooked or perhaps no one wanted to see them.

I've never known a DO to receive more training than an MD. DO's focus on preventative medicine and practice from the perspective of the bone. Given your daughter's situation, it doesn't seem to be much of a match unless the DO has some highly specialized training to bring his/her expertise up to that of an endocrinologist [MD].

I've also never known thyroid disorders to cause MDD or eating disorders. Instead, consider that the thyroid condition may have provided an opportunity for these ongoing psych disorders to make themselves known through intake, evaluation, and discussions with the patient [but not CAUSE them]. [Is it possible your daughter has had these problems, i.e., MDD and ED, for a lot longer than you think?]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139917/

http://ajp.psychiatryonline.org/cgi/content/full/157/10/1689

It's been suggested that T3 may lift "depression" to a small extent. But it would be unlikely for T3 to eliminate MDD.

It's not uncommon for people with eating disorders to present with thyroid disease. However, when there are concurrent thyroid and eating disorders, odds are that the cause of the eating disorder is extrinsic, rather than hormonally-based.


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## Debbie from Milwaukee

My daughter entered an eating disorders inpatient program yesterday, and we plan on supporting her in her efforts toward emotional and physical wellness. Our daughter has been asking this psych. hospital for help with her eating disorder in addition to depression treatment since the beginning of her 1st stay. We think it is a bit odd that the hospital only yesterday figured out a way for her to be treated at their affiliate institution only a few short hours after we had presented 2 other area psychiatric hospitals with eating disorder programs (competition). Her doctor only yesterday ordered thyroid tests after we asked in a family meeting on Monday if lab tests/medical records were transferred from her doctor or if any thyroid tests had been taken while our daughter was in this hospital. Forum members can reach your own conclusions on all of this.

I WANT my daughter to get effective treatment for her depression and her eating disorder. However, I feel it is crucial for her to have her physical system (including thyroid, any low nutrients, and possibly low adrenals) attended to WHILE she is receiving her mental health treatments. Otherwise, she may be banging her head up against a wall because she is experiencing physical symptoms that interfere with her treatment. I am also aware that LEARNING about her physical thyroid condition may help her adjust her thinking and expectations, especially with her eating disorder. If she realizes that normal food intake may result in gained weight when in a hypo state and pounds may shed too easily if she returns to a hyper state, she will be better equipped to deal with her food and body issues.

I plan on encouraging my daughter to advocate for her own psychological and physical health. I believe it is very difficult to be young and have all of this happening to her. She needs all of the encouragement she can get from family, friends, and health professionals. If you can spare a thought or prayer directed her way, I'd apprecicate it.


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## Debbie from Milwaukee

Here is the latest from my daughter's medical doctor in the inpatient eataing disorders program: basically he said that nothing is critical right now with either her thyroid or adrenals. The TSH was low (he didn't tell me the result or the range) on May 30th, and the TSH and free T4 were repeated yesterday (I asked if the free T3 was taken, but he said they didn't need that info.). He said if the TSH would be low again, he would slowly reduce her Armour thyroid dosage.

Kalina is currently on two 60 mg. pills, taken at once in the morning. I asked him if Armour should be taken in 2 or more doses, and he said taking it all at once is fine. Kalina was previously on .150 mg., was reduced to .125 back in April (before her first crisis) due to a low TSH, and was upped to alternating .125 and .137 when in her 2nd psychiatric stay before she saw the D.O. doc who put her on two 60 mg. tablets of Armour. This doc also said that prescribing of Armour was "unusual."

This doc also said he gave Kalina a morning cortisol blood test, and it was in normal range (again, he gave me no value), so he believes her adrenals are OK. He explained to me that the binging and purging Kalina did from March through June has likely disrupted her thyroid function and it may take a few months for it to return to normal. This doc highly recommended that Kalina see an endocrinologist in addition to a primary physician just be monitor her after she is discharged from this program.

I am just wondering people's thoughts on all this. I AM relieved that this doc does not think that she has any critical problems with either her thyroid or adrenals at the moment. One of the reasons I encouraged Kalina to ask about adrenal testing is that she had not been able to sleep well at night for the past several weeks so that this hospital put her on Ceraquill a few days ago. She is better able to sleep, but she still wakes up briefly throughout the night.


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## CA-Lynn

Glad to hear she's on Seraquel. How is her treatment going for MDD and eating disorder?


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## Debbie from Milwaukee

I think she's progressing quite well with both her mood and eating disorder. She's been complient with most everything. She had a bit of a disappointment the other day, but I thought she processed through it quite well. There is a problem with her insurance, but the folks at the treatment hospital are helping her fill out forms so she can stay as long as she needs to be there as well as outpatient treatment later.

Once Kalina becomes more stable from symptoms of her depression and bulimia, I believe she will take an active interest in managing her thyroid problems. She keeps hearing from her older sister how important it is to stay on top of thryoid meds to avoid more serious problems (yes, everyone in our immediate family has some issue with thyroid except our 15 year old daughter).

I have also heard some talk from her university that they are willing to let her stay here to get general ed. credits locally while she gets her health stablized. That way she will have a greater chance of successfully completing her art degree.


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## Debbie from Milwaukee

Just giving a report on my daughter's overall health, although we still won't have the whole picture on her until the end of August when she will see a family medicine doctor RE: thyroid and female hormone levels. She will be starting with our family insurance in mid-August, and she is required to go through a primary care physician before she can see a specialist like an endocrinologist. We are also are working through her counselor's office to get a referral to a psychiatrist who accepts our family insurance to monitor her psychatric meds.

Well, Kalina has been discharged from the eating disorders inpatient unit for 10 days now, and she is doing amazingly well. She is adhering to an "exchange system" type food program, and the rest of our family is joining her in it. Her mood and ability to think, problem solve, and recover after minor upsets are 1000% improved over her mental state over the past 3 months.

Kalina has also accepted an offer from her university in Philadelphia to take a leave of absense for the first semester. If financial aid and courses are still available she will sign up for general education classes at a local community college so she won't get too behind in her program. This time at home will allow her to stablize herself physically and psychologically before she goes back to Philly and a very challenging college major. She is majoring in illustration at her university, but she won't likely take art classes here in Milwaukee.

I am happy to report that Kalina has increased her dosage of Armour thyroid from 2 pills (120 mg.) to 3 pills (180 mg.) a day, and she is spacing them out between before breakfast until about 2 or 3 pm. Her prescribing doctor told her she could go up to 3 pills a day if she needed to, but the docs in the hospital kept her at 2 pills because that was what she started with. The spacing of the Armour allows Kalina to stay energized throughout the day and avoid an afternoon "crash" from lack of T3.

I wanted to thank everyone here for all of the kind thoughts and prayers over the past 3 months. Support from people here has helped me research accurate info. to check with health providers as well as been a great help to me when I was unable to talk to some of my daughter's doctors about her thyroid problems. The information I have been able to pass on to my daughter is and will be invaluble as she monitors her hormone levels in the future.


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## Andros

Debbie from Milwaukee said:


> Just giving a report on my daughter's overall health, although we still won't have the whole picture on her until the end of August when she will see a family medicine doctor RE: thyroid and female hormone levels. She will be starting with our family insurance in mid-August, and she is required to go through a primary care physician before she can see a specialist like an endocrinologist. We are also are working through her counselor's office to get a referral to a psychiatrist who accepts our family insurance to monitor her psychatric meds.
> 
> Well, Kalina has been discharged from the eating disorders inpatient unit for 10 days now, and she is doing amazingly well. She is adhering to an "exchange system" type food program, and the rest of our family is joining her in it. Her mood and ability to think, problem solve, and recover after minor upsets are 1000% improved over her mental state over the past 3 months.
> 
> Kalina has also accepted an offer from her university in Philadelphia to take a leave of absense for the first semester. If financial aid and courses are still available she will sign up for general education classes at a local community college so she won't get too behind in her program. This time at home will allow her to stablize herself physically and psychologically before she goes back to Philly and a very challenging college major. She is majoring in illustration at her university, but she won't likely take art classes here in Milwaukee.
> 
> I am happy to report that Kalina has increased her dosage of Armour thyroid from 2 pills (120 mg.) to 3 pills (180 mg.) a day, and she is spacing them out between before breakfast until about 2 or 3 pm. Her prescribing doctor told her she could go up to 3 pills a day if she needed to, but the docs in the hospital kept her at 2 pills because that was what she started with. The spacing of the Armour allows Kalina to stay energized throughout the day and avoid an afternoon "crash" from lack of T3.
> 
> I wanted to thank everyone here for all of the kind thoughts and prayers over the past 3 months. Support from people here has helped me research accurate info. to check with health providers as well as been a great help to me when I was unable to talk to some of my daughter's doctors about her thyroid problems. The information I have been able to pass on to my daughter is and will be invaluble as she monitors her hormone levels in the future.


Debbie; this is just the most wonderful news. I am just thrilled and it is so good to hear from you!

Kalina (and all) will remain in my prayers. It sounds like she is really on track.

God bless,


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## CA-Lynn

Excellent news, Debbie. I also think that keeping her stressors minimal for the next several months is the best way to go. She can always take some of the general ed courses locally and have them transferred toward her degree requirements.

Hopefully they've uncovered the triggers for the eating disorder and MDD.

Best of luck moving forward.

Lynn


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