First results - help please

[soupybp]

My husband has multiple health issues - most stemming from a structural congenital heart defect that required major heart reconstruction as a child. His heart functions in a backward manner and is filled with scar tissue resulting in arrhythmias. He also has mental health issues. I have attached a picture that has a list of his current medications (they have been stable for at least 6 months) as well as his health conditions.

His mother has been hypothyroid (treated) since she was a teen, and she was finally diagnosed as Hashimoto's in 2002. Our daughter has recently been diagnosed hypothyroid as well. His brother and two nieces have been diagnosed with bipolar disorder, but all of them successfully have antidepressants as part/most/or all of their treatment...which is highly suspicious as usually bipolar disorder and antidepressants don't play well together.

He has had very limited thyroid testing over the years before this week, a handful of TSH and once fT4. He usually has his blood drawn in the morning, but I cannot confirm that it was always the case for these results. Here are the historical ones I can access.

Jan 2014 - TSH 4.67 (.45-4.5) (on lithium for a short time), no fT4 drawn

Jun 2014 - TSH 1.62 (0.3-3.8), fT4 1.28 (0.8-1.8)

Feb 2016 - TSH 1.27 (0.3-3.8) and 1.57 (0.3-3.8), no fT4 drawn

New results this week, drawn about 8:00am, no food, none of his meds shown in the picture before hand:

TSH 4.61 (0.3-3.8)

fT4 1.3 (0.8-1.8)

fT3 3.32 (2.3-3.8)

rT3 - pending, has to be sent out to a different lab

TPO 10.4 (0-31)

TgA <10 (0-60)

Vitamin D 23 (30-100)

folate 16.9 (>4.5)

ferritin 31.8 (22-324)

B12 992 (200-900) (note - he does not take any supplements)

Calcium 9.9 (8.5-10.3) (just happens to be in part of his congestive heart testing)

Now, symptom-wise it is a challenge because he has issues. He suffers from insomnia - both difficulty falling asleep and difficulty staying asleep - he takes trazodone for this. He requires a lot of sleep, tires out easy, and is always fatigued, but he also has a significant heart condition and many of the mood meds are sedating. At this point, he is on oxygen full time, has a lot of challenge managing his congestive heart failure. Bipolar disorder with rapid cycling and mixed states - right now seems well managed but I know he would prefer a better quality of life and less meds. Earlier this year when he tried to reduce some of the mood meds, a very unpleasant (for us living with him) mania developed. Anxiety - pretty well controlled by meds but he does have it pop through with no instigating event and is claustrophobic. It is really hard to say what are underlying symptoms of known medical conditions (structural heart/lungs), what are medication side effects, and what might be possible hypothyroid symptoms or hypothyroid symptoms misdiagnosed as something else.

My thought is that the fT4/fT3 and antibodies don't look terrible. Not sure why his B12 is so high. Really needs to supplement the vitamin D and do a full iron panel to get things working at their best. What do you folks think?

[HughH]

The high incidence of thyroid and mental health issues in your family points to a genetic thyroid condition. The condition is known as Impaired Sensitivity to Thyroid Hormone, sometimes called Thyroid Hormone Resistance.

With the condition you require very high levels of thyroid hormones to overcome the resistance and T3 generally works best.