We had a follow up appointment with the psychiatrist last week for my teen daughter. He has made no medication adjustments in over 5 months...just wants to keep things as they are. Her mood has been *more* stable, but she still has some periods of hypomania, and the depression isn't lifting. Two counselors and a psychologist all feel more needs to be done from the psychiatric side. We pushed psych on this point.
He asked when we last had lipids and blood sugar checked. I indicated he likely didn't have those results as we had to use a different lab, but I could pull them up on my phone for him. I had the full lipid results on the screen and he had the audacity to start scrolling through!
I knew that the thyroid results were right above the lipids...and I knew that we had a row last appointment over her thyroid. He asked my daughter to leave the room and then started in on me how she was being severely overmedicated for her thyroid and that I was putting her at risk. I pushed back that on NDT one should expect the TSH to be suppressed. He said I was wrong. I said, no...the TSH is suppressed, but the fT3 and fT4 are unequivocally normal...if anything she is slightly undertreated. He asked where I was getting this information because it is wrong. I replied that it was from two of her other doctors as well as my own studies on the matter. He again said I was endangering her. I told him he was wrong. He said that it seems she is a case outside his expertise, then, and maybe we should find another doctor... The unmitigated gall...
Here are the results that say she is heavily over-treated (per his expert opinion), taken per all the normal guidelines shared on this lovely website (early morning, fasting, proper med timing, stopped supplements 1 week prior) at 60mg Armour:
TSH .0008 (.45-4.5)
fT4 1.37 (.93-1.6)
fT3 4.4 (2.3-5.0)
T4 7.3 (4.5-12.0) - new doc likes to test this too
T3 154 (71-180) - new doc likes to test this too
(no rT3)
TPO 11 (0-26) - note other antibodies previously tested as negative also
Other items:
Serum B12 816 (232-1245) - integrative doctor has started her on supplements after this test
Folate 7.0 (>3.0) - integrative doctor has started her on a B-complex after this result
Calcitriol (1,25 di-OH Vit D) 53.7 (19.9-79.3)
Vit D, 25-hydroxy 75.7 (30-100) - has been supplementing at 5000IU w/ vit K2-MK7
Ferritin 48 (15-77)
Iron 147 (26-169)
TIBC 319 (250-450)
UIBC 172 (131-425)
Iron Sat 46 (15-55)
Transferrin 249 (200-370)
Calcium 9.7 (8.9-10.4)
Potassium 4.1 (3.5-5.2)
Sodium 142 (134-144)
So now we are off in search of a new psychiatrist...again...
Side note - school lets out tomorrow, so looking at trying an increase on her Armour dose...I have the meds to do it. Also, she was taking bio-identical progesterone for estrogen dominance, but recent labs show the dose was insufficient...dose and schedule were just changed to try to address that. The mood stabilization that we have seen happened after a trial of LDN and instigation of the progesterone.
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soupybp
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Can’t really add any advice, but feeling for you and your daughter...but i am a great believer that hypothyroidism, whatever the cause, can muck up the brain and nervous system....and your psych. perhaps doesn’t understand, or feel comfortable, with this!
Maybe the following will be helpful. It was one of Thyroiduk's Advisers who died through an accident. He withdrew his licence so that he could treat patients whilst not being restricted to how best to treat them. He'd never prescribe levothyroxine. He stated that it was all due to corruption that levo (T4 only) became the commonest replacement hormone worldwide replacing NDT (natural dessicated thyroid hormones which contain T4, T3, t2, T1 and calcitonin) and made from pigs' or cows' thyroid glands. The original NDT, which saved lives was first introduced in 1892 - without blood tests and only symptoms taken account for diagnosing and dose gradually increased.
Unless we are good converters of levothyroxine (those people wont be on this forum) we need good Free T4 and Free T3. T3 is required in our millions of T3 receptor cells and the brain/heart contain the most.
Dear soupybp, how lucky your daughter is to have you as an advocate! Funny, just last night I was thinking how lucky I was that my (American) psychiatrists at some point in my 30s just started giving me T4 and then T4 and T3, without blood tests. If I had known how critical the t3 was to my health, and that I was probably undermedicated most of that time at 75 t4/20 t3, I would have demanded even more thyroid meds! I posted on my twitter just two days ago how incredibly important thyroid health is to mental health and how I believe that if your shrink won't give you meds, to find another! So I hope you find a new doc fast, and I am so thrilled to read of your advocacy and support of your brave daughter.
Reading your post made me think about a few things. Like your daughter I have very low antibodies and no hashimotos which means there may be another reason for her hypothyroidism. You say she is estrogen dominant and she's on bioidentical progesterone as am I. As she is a teenager is she perhaps not ovulating properly? Perhaps it would be best to rewind and look at her sex hormones. The problem is you need to look at the big picture because everything works in sequence and if anything is out of balance it messes everything up. I have discovered using progesterone is helpful but my body is now addicted to it and if I don't use it everyday my heart rate goes silly because it is craving it. I have cut the dose down but I can't stop it my anxiety goes through the roof. So be careful as your daughter is young. Not ovulating and low progesterone would cause depression. How was her thyroid before medication? Problem here is her thyroid is now suppressed and progesterone is also being substituted. The way things work is that cholesterol and thyroid hormone are needed to produce pregnenolone. This is the master hormone. A young girl should be ovulating to produce her own progesterone so if I were you I would return to square one and question why she's not ovulating and why her sex hormones are out of balance. Non ovulation can be due to stress. Perhaps all her pregnenolone is being stolen to produce cortisol. High cortisol and estrogen go together. Both suppress thyroid function. So you see it becomes a circle of problems and if you correct the wrong one you upset the balance. Her thyroid problems are not auto immune so something has caused it to go all wrong. I would have her cortisol checked because the bioidentical progesterone will support her cortisol levels but could make it worse if cortisol is already high. By supplementing everything you are over riding your daughter's natural breaking system and putting things into over drive. Go back to the beginning find a good functional Dr that can look at the whole picture and help your daughter.
We were working with a FertilityCare ob/gyn. All signs point to her ovulating properly-changes in cervical mucus that coincided with shifts in basal body temperature. He did a very thorough sex hormone work up. Cholesterol levels were very good. When we started thyroid supplementation, TSH was over 6 and fT3 was at very bottom of range. Hashimoto runs in my husband’s family, and I can’t get anyone to do ultrasound. (I am having ultrasound on thyroid in a few weeks-I also am having thyroid issues)
Ob/gyn felt there was more going on and referred us to an integrative doctor who is an internist. We are only a few appointments in with him.
I agree with you, your daughter isn't overmedicated, and has room for an increase if she wants it, because freeT3 hasn't reached the top of the range.
Is Armour the only thing she's taking? No additional T4? This result looks a littl unusual to me, in that freeT4 is still quite far up the range, similarly high to freeT3. Usually freeT4 is quite low when taking NDT.
Your daughter is unlucky in that her TSH is very very low, while her free hormones aren't all that high. Your psychiatrist was probably looking at that more than anything else.
Teens can take a while to settle into a regular cycle, particularly when stressed. If she's estrogen dominant that's pretty common, especially in things like PCOS, endometriosis and PMS which are particularly susceptible to foods that contain high levels of prostaglandin promoting agents and histamine.
I'd be inclined to look at an autoimmune diet to reduce these inflammatory agents. Flax seed oil is very good.
She was actually very regular, almost from her first period. Basal temps and cervical mucus indicate she was ovulating regularly too. Some of the docs think PMDD. We are trying to work her toward a more autoimmune diet, but it is taking a lot of adjustment. School lets out today, so that is going to help.
Well, it may be worth checking out her Red Blood Cell (RBC) levels of Magnesium. Low Magnesium is very common in any kind of anxiety disorder. Magnesium levels always hit their biggest low just before a period (which is why women crave chocolate), so chronically low Magnesium could be responsible. Also B6 is really important as a cofactor. I take p5p (the best form of b6) for my adrenals and regulating blood sugar. It's also vital for fighting PMS. This controlled experiment proved how useful Magnesium and b6 are for reducing PMS.
Thanks. New information for me there. Genova NutrEval showed borderline magnesium levels and integrative doc has her supplementing. It also showed B6 deficiency. I appreciate the links especially.
I like the results table that shows the benefits of the combination of Mg and B6 compared to Mg alone and the placebo.
Note that in this table the placebo did improve cravings and depression to a certain extent, but, the placebo also had 0 impact on anxiety - which in my mind suggests that anxiety, unlike cravings, and in some cases, depression, is less likely to be 'cured' by psychological intervention: the Magnesium /B6 combo worked very well on anxiety.
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I have been summoned to see the local Endo at Addenbrooke's as I take T3!!!
Very Low TSH With Low T4
Disappointing endo appointment AGAIN - London 
Is this doctor worth keeping...?
Endocrinologist letter - what now?
