Labs for Daughter with new Dysautonomia/POTS on top of Hashimoto's

[LostinHeadSpace]

Thank you all so much for all your help before, we have the lab results for my daughter is unwell in such a new way this year, especially in the last month. She's gone from dancing at school to having her heart rate spike from walking across the room. Her pediatrician thinks that the POTS is secondary to her thyroid being out of whack, but her problem is the same as other people mention here on the forum: with a fully suppressed TSH from taking Armour, everyone will think that she's hyper, even though her Free T3 is still less than halfway through the normal range.

I'll copy the thyroid labs here, then put the rest of the CBC from the same draw in the comments. I'd love to hear what you all think I should communicate to the doctors.

One new theory I have is that the POTS could have been triggered by going on Cymbalta/duloxetine for her migraines. She tolerated the 20 mg with no side effects we saw, but her extreme inability to walk around and do anything did start just after her dose was bumped up to 40 mg. So the neurologist agreed we should go back down to 20, just in case, but the symptoms haven't improved.

Thanks again for your thoughts!

- Lost

[LostinHeadSpace]

And here's the rest of the labs drawn a week ago.

CBC

[Star13]

Some of the symptoms you speak of made my GP take me off Duloxetine and write it up as an adverse reaction. It’s now on my list of allergens! I found Topiramate a much better match for migraines and I tried quite a few before we got to that.

With the POTS increase her hydration, especially before she gets up out of bed - drink a whole glass of water and start increasing slightly her salt intake. I found this advice from my specialist was enough to avoid any POTS medication.

[LostinHeadSpace in reply to Star13]

Thank you…That’s so helpful. We’re talking to the migraine doctor tomorrow about how to taper off of it! My daughter did officially test positive for POTS yesterday.

[SlowDragon Administrator]

no vitamin D, folate or B12 results?

[LostinHeadSpace in reply to SlowDragon]

I asked the doctor to test them, but apparently she did not put them in the order. Her B12 was great in December, and the vitamin D is coming up as well.

We’re seeing a new doctor today about the T3…Is there a chance she’s still under medicated, with the T3 not halfway through the range? I’m confused because her fatigue would suggest she needs an increase in Armour as well…but the skyrocketing heart rate and shakiness, even if officially caused by POTS, sound more hyper than hypo?

I’m about falling apart this week, trying to race to these doctors’ appointments while working full time. I’d love to hear your guesses as to what dosage change you’d recommend on these labs?

[SlowDragon Administrator in reply to LostinHeadSpace]

but the skyrocketing heart rate and shakiness, even if officially caused by POTS, sound more hyper than hypo?

Could be adrenal?

Did she try levothyroxine plus small doses of T3 alongside?

[LostinHeadSpace in reply to SlowDragon]

Thank you so much. . . I remember that they talked about checking adrenal involvement, but I see no labs for cortisol in the last two batches!

Yes, she's tried levo with t3 in so many formulations, the last one was Tirosint + Cytomel, and I have no idea why she felt immediately better when going to Armour. I admit it's been 4 years since her last round of trying every variation with the endocrinologist. I'll post the December labs below. . .

[LostinHeadSpace]

SlowDragon These are the December labs, which to me show clearly a need for an increase in Armour, because the Free t4 is low out of range, and the T3 is still below half. I'm only confused because the shakiness and POTS feel like they'd belong more with hyper?

Her March labs are better--but it's the symptoms confusing me.

We see the doctor at 3pm today--Given all the labs that were just done this month (in the post and the first comment), what would you recommend we hope to test now? Retest folate, Vit D? morning cortisol?

My gut feel is that the most important things are to taper her off the Cymbalta, and very gradually increase the Armour dose to see if things get worse or better? Does that make sense?

December labs