Daughter asked me to check with you folks regarding some symptoms she is having. Refresh - labs show hypothyroid and low vitamin D. She started vitamin D3 5000IU on October 15 and Armour thyroid 30 mg on October 18. She takes it daily at 6am on empty stomach with water and waits to eat/take remaining meds (lithium/vitamin D) until later in the morning.
Since about Saturday, Nov. 3, she gets a period of feeling shaky or shivering that lasts 30-60 minutes in the timeframe of 6-9pm. She doesn't feel hot or cold at those times. It isn't something so severe that is visible by looking at her.
I think it is reasonable for her to think that it is related to the thyroid med with this starting up about 2 weeks in an no other med changes happening. I am planning to call the doc about it, but I agree with her that having a bit more education from you folks on the topic may be beneficial to that discussion.
If she started on 18th October, she's due for an increase in dose. These new symptoms could just be that her dose is now too low.
That's what I was wondering. If I understand correctly, the dose kicks in, the thyroid kind of sighs in relief and puts its feet up on the desk, then then levels end up being too low. Is that a correct general gist?
Doctor had asked for repeat labs at 6 weeks before making further change so that things were settled in, and I have seen conflicting information as to whether first check/changes after first starting meds should be at 2 weeks or 6 weeks. Right now we have other testing going on, so it would be easy to do a repeat (we are in the US, and we have met our insurance deductible for the year) if he felt it was necessary before increasing. Are labs necessary before increasing?
We do have the following new results:
folate - 17.3 (>4.5)
B12 - 820 (200-900)
ferritin - 38.1 (20-324)
lithium - 0.4 trough (0.5-1.5 therapeutic range)
<- this is an issue
That's the general gist, yes.
Testing six weeks after a change in dose, and before another change in dose, is necessary for T4 only. When taking Armour, you can increase by 1/4 grain every two weeks until you reach 1 whole grain, and then hold for 6 weeks and retest. So, she can in crease now without retesting.
Her folate and B12 are good. But her ferritin is rather low - should be at least mid-range. It might be a good idea if, next time you're testing, to get a complete iron panel done.
I don't know anything about lithium, I've never seen that tested for before.
Thanks so much. Very useful.
She is taking lithium for bipolar disorder treatment. Regular serum level monitoring is required. Her level has dropped below the low end of therapeutic - I don't know for sure if that could be related to initiation of thyroid treatment or vitamin D supplement.
Hi Lithium is very thyro toxic. I am wondering if he hypothyroidism is due to its use. I sometimes think that there are too many correlations between bipolar, under an over active thyroid disease and mania and depression.I am not suggesting she stop the lithium but I wonder if a discussion with psychiatrist about using an alternative mood stabiliser might be helpful. She might also want to avoid fluoride. The vitamin D is great for all sort including depression, may be because it boosts thyroid function.Do you know if she has antibodies?
She had had issues with multiple mood stabilizers (which leads me to think that the underlying problems were perhaps more likely thyroid/adrenal/sex hormone and not bp). She has also had strong undesired reactions to multiple antidepressants. Bipolar runs in my husband's family, but I am beginning to wonder if it isn't actually a thyroid problem that runs in his family...
July 2018 antibodies:
TPO 11.4 (0-31.0)
Tg <10.0 (0-60.0)
Well, lithium is bad news for thyroids. It can reduce production of thyroid hormones:
verywellhealth.com/lithium-...
On the other hand, bi-polar can be a hypo symptom. Does she know what her levels were before she she started the lithium?
Lithium was recently started (mid-August). My research indicates it typically takes much longer than that to see thyroid effect. She has been on Seroquel off and mostly on since April. Short stint on Depakote in July. New psych is doing a careful review of test results before deciding course of action.
TSH, antibodies, fT4, and T3 results were from early/mid July.
TSH 6.81 (.3-3.8)
fT4 0.91 (.8-1.8)
Total T3 102 (80-200)
fT3, rT3 were from mid October.
fT3 2.71 (2.3-3.8)
rT3 9 (8-25)
There was limited testing prior to that in April before she was put on any psychiatric meds:
TSH 2.05 (.3-3.8)
fT4 1.26 (.8-1.8)
I know, missing key info - but taken with the symptomology of persistent depressive state, heart arrhythmia could be subclinical levels, especially with the recently identified Ehlers-Danlos hypermobility type diagnosis.
Interestingly, in November 2015, went to gp because daughter was sleeping 12-14 hours per day, extremely fatigued, not eating, depressed. Again, limited testing done:
TSH 2.89 (.3-3.8)
fT4 1.06 (.8-1.8)
I know that she wasn't on any meds then...
Hypothyroid runs in husband's family (haven't gotten answer as to if it is Hashi's - but MIL has rheumatoid arthritis too...). Based on what I have learned, I strongly suspect there is undiagnosed hypo in my mom and brother and probably me.
In April when daughter ended up in psych hospital, psych encouraged us to see endo. Prior to that the geneticist that diagnosed the EDS recommended endo eval. Endos in our area will not take kids. Pediatric endo clinic in our area will not accept patient without referral. Psych and geneticist would not write referral - said get from gp. GP would not write referral as "he could handle it" but didn't do anything. A friend recommended the Catholic fertility clinic in the area because we were seeing more psychotic type symptoms at time of period. They told me that her psych symptoms could be a result of thyroid/adrenal/sex hormone issues/imbalances...maybe.
More than likely, I would say.
Has she only ever had the one antibody test? You cannot rule out Hashi's with just one negative test. Sometimes people with Hashi's never develop high antibodies.
I think you should report your doctor for negligence.
I am hopeful that we are on the right track. Daughter is still hopeful too, but sick and tired of feeling no joy in life.
At this point, she has only had the 1 antibody test. Since they haven't been checked since July, I will ask GP for an order for repeat of the test for us to include in one of her upcoming draws. I need to request the full iron panel too.
Right now, gp knows I am working with a new psych and the specialist ob/gyn and am researching on my own. He is giving me any lab order I ask for. He knows that he didn't do right on this one. As long as I can play doctor through him to get to the information I need, I will keep him on...
Well, that's one good thing, anyway! You could ask for an ultrasound on the thyroid, too.
I think you're on the right track, too.
I'm holding off on the ultrasound request pending the results of the progesterone/estradiol blood test series we are running (ends Tuesday). I expect that if these levels are off kilter in a particular way, the ob/gyn may order pelvic ultrasound to check for abnormalities, and I would try to get them scheduled together.
OK, but it wouldn't be at all surprising if her sex hormones were off kilter. When one hormone is, the others often are. They are all inter-linked.
It is clear that she has been hypo for a while re thyroid. Hopefully the ndt increase will start to help and maybe a path to her feeling much better all round. I presume if she is bipolar she get elated at time too.Sometimes in the recent past in uk pyschatrist were diagnosing bipolar because somebody was severely depressed on a few occasions but did not ever experience the highs. I think just in my experience as a pshc nurse that there is limited benefit to mood stabilisers for nasty depression if there are not both the highs and lows.
She has had some periods of high energy, high creativity but I am not sure that it was mania. She has periods of more mixed states - the depression turns into whirlwind feeding itself to a frenzy of bad thoughts.
In recent initial consult with new psych (2.5 hours!!), it seems that there was a definite shift in her that she saw in herself at about 4th grade...6-12 months before her first menstrual cycle occurred.
Gosh poor girl so young as well to be that ill. I am sure this is thyroid and it sounds like theses creative periods are how she should be.High energy is not a problems as long as people are getting some reasonable sleep, eating and drinking well, looking after themselves and not upsetting everyone else other wise it is lovely to be creative. Some mindfulness might really help with this frenzy of bad thoughts.I have been using a mindfulness practice CD for myself and children by a Jon Kabot Zinn.The one I use is mindfulness meditation of pain relief. It has some really great stuff about the words we use in our thoughts. It is all very wise and lovely, very mature and aimed at adults but my children sit and listen with me.