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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Minnie-Haha on March 18, 2004, at 18:15:52
I was referred to an endocrinologist last fall after I got really sick with the primary symtoms of severe nausea, depression, anxiety insomnia (I would go to sleep OK, but wake up in the middle of the night) and chills. This came upon me very suddenly and was different than anything I'd ever experienced before. (I have had a Bipolar Type 2 diagnosis for about 5 years.) The illness persisted for almost two months and I lost about 15-20 pounds in the first month.
My symptoms lessened after I started on a low dose of Ativan (anti-anxiety drug), but I still wasn't feeling well.Upon physical examination, the endocrinologist ordered an ultrsound on my thyroid. This was done in Dec. and confirmed the presence of
nodules. He then ordered a thyroid uptake and scan. That was done in Feb. The imaging report said under IMPRESSION: "Inhomogeneous
activity with focal areas of increased activity possibly corresponding to the nodules of active nodules without toxic condition of hyperthyroidism."The endocrinologist then ordered bloodwork: a Comprehensive Metabolic Panel, a Lipid Panel, and some thyroid tests. The results showed high cholesterol (no surprise, cause that's been going on for a couple of years), but all else in the normal/reference range. (T3 Uptake 30.8; T4, Serum 8.2; TSH 1.02; T3 Total 125)
I saw the doctor yesterday and he prescribed 0.05 mg Thyroxine (T4). He says he is not doing it for my symptoms so much as to see if the nodules will shrink. He says it may also help me to lose weight and lower my cholesterol. (I had become obese 2-3 years ago after taking Depakote for my Bipolar disorder. The 20 pounds I lost while sick helped, but I am still overweight.)
I am reading The Thyroid Solution. The author, Dr. Ridha Arem, suggests taking T3 with T4. So my question for the group is: Is there anything about my doctor's actions (prescribing T4/Thyroxine alone) so far that seem out of
step with modern thyroid therapy? I have really mixed feelings about whether this is the right way to go. I worry it could increase my anxiety, which I only recently got under control. (I am also now back on a mood stabilizer, but not Depakote -- I am taking Trileptal.)Any words of reassurance -- or of warning -- would be greatly appreciated.
Posted by Pfinstegg on March 20, 2004, at 12:57:12
In reply to Calling for advice from BP2 Thyroid types, posted by Minnie-Haha on March 18, 2004, at 18:15:52
I have a somewhat similiar story- thyroid nodules found 10 years ago, treated with T4. In my case, the TSH was initially about 5. Because the onset of my severe depression coincided with the onset of the thyroid abnormalities, I kept trying to find out more about possible connections. To make a long story short, last year I asked my endocrinologist to cut the T4 supplementation in half, and add Cytomel (T3). For me, I think it's made a HUGE difference in the amount of depression I have.
My endo keeps the TSH below 0.5 (last reading was 0.38) and has me have a bone scan every year or two for possible osteoporosis, which can be a side-effect of keeping the thyroid values at these levels. With psychotherapy, I now am off all AD's for the first time in 10 years. Just therapy, T3 and T4 seems to be doing what's needed!
Posted by Minnie-Haha on March 20, 2004, at 13:35:33
In reply to Re: Calling for advice from BP2 Thyroid types » Minnie-Haha, posted by Pfinstegg on March 20, 2004, at 12:57:12
> I have a somewhat similiar story- thyroid nodules found 10 years ago, treated with T4. In my case, the TSH was initially about 5. Because the onset of my severe depression coincided with the onset of the thyroid abnormalities, I kept trying to find out more about possible connections. To make a long story short, last year I asked my endocrinologist to cut the T4 supplementation in half, and add Cytomel (T3). For me, I think it's made a HUGE difference in the amount of depression I have.
>
> My endo keeps the TSH below 0.5 (last reading was 0.38) and has me have a bone scan every year or two for possible osteoporosis, which can be a side-effect of keeping the thyroid values at these levels. With psychotherapy, I now am off all AD's for the first time in 10 years. Just therapy, T3 and T4 seems to be doing what's needed!I am encouraged by hearing your story. May I ask if you're male or female. (I am female.) What prompted you to ask to change from T4 only to T4 and T3? (That is one of my concerns, why the endo wants to do T4 only. I keep reading conflicting stuff on this.)
I am concerned because although I'd say earlier in my life I leaned toward hypothyroid in my symptoms -- depressed, sluggish, overweight, slow metabolism -- I also have problems with anxiety and in recent months have been frequently nauseated and lost weight -- hyperthyroid symptoms. Where these are atypical seems to be my temperature. When I was hypo/fatter, I always felt hot and now that I am hyper/thinner (though still overweight by at least 20 pounds), I often feel cold! I've reviewed my labwork from the last 5 years or so and my TSH tends to be normal to low-normal, which would seem to me to be more hyper than hypo. I just worry about the effects of thyroid meds on me if I'm already battling anxiety and nausea. I don't know! On the other hand, if my nodules need to shrink and this is the way to do it, I guess I should do it.
Anyway, thanks again for sharing.
Posted by Minnie-Haha on March 20, 2004, at 13:37:57
In reply to Re: Calling for advice from BP2 Thyroid types » Minnie-Haha, posted by Pfinstegg on March 20, 2004, at 12:57:12
Doh! And I meant to ask, too, are you BP?
Thanks again for sharing!
Posted by Pfinstegg on March 20, 2004, at 14:29:05
In reply to Re: Calling for advice from BP2 Thyroid types, posted by Minnie-Haha on March 20, 2004, at 13:37:57
Not as far as I know, although more and more people here seem to be getting that diagnosis. My therapist, who is a psychoanalyst, says I have an Ego State Disorder, with affect dysregulation caused by Complex PTSD from childhood trauma. I haven't seen that exact diagnosis mentioned by anyone else here, but it seems to fit me very well. I personally don;'t think all the DSM IV diagnoses are too relevant or accurate. When you come right down to it, almost everyone seems to have "Affect (Emotional) Dysregulation- and there is neglect, maternal misattunement, and physical or sexual abuse in the backgrounds of everyone who has difficulty in regulating mood or moderating anxiety. I would make one or two exceptions- people who have schizophrenia or Bipolar One- there genes and the physical (even pre-natal) environment seem to be very important.
Posted by Pfinstegg on March 20, 2004, at 14:43:28
In reply to Re: Calling for advice from BP2 Thyroid types, posted by Minnie-Haha on March 20, 2004, at 13:35:33
Oh, I am getting a fuller picture now. It doesn't sound as though you need either T4 or T3 supplementation, as you values are all low-normal. The T4 is just to get rid of the nodules. You obviusly had a biopsy, and know you don't have thyroid cancer.
The idea for the T3 cme to me by reading a 1999 article in the New England Journal of Medicine about first, how some people don't convert T4 into T3 in their own bodies- and T3 is the only form your body can use, and second, that there was a noticeable improvement in depression if T3 was given along with T4 in dedpressed, hypothyroid patients. I'm sorry that i don't have that reference at hand for you- I put it in the PB archives during the fal of 2002, so you might be able to find it there.
However, your situation sounds a bit different- you are not a bit hypothyroid, and may even be moving towards hyperthyroidism. Can you get a second opinion from another endocrinologist?
Posted by Minnie-Haha on March 20, 2004, at 17:44:42
In reply to Re: Calling for advice from BP2 Thyroid types » Minnie-Haha, posted by Pfinstegg on March 20, 2004, at 14:43:28
You seem well-informed on this. Yes, I was thinking exactly of getting a second opinion. The haven't ruled out cancer -- haven't done a biposy -- but the endo thinks its highly unlikely based on the nature of what he's seen in an ultrasound, a thyroid uptake scan, and the blood tests. Like I said, if I was leaning more toward depression and sleeping and eating all the time, the T4 wouldn't worry me so much, but since I'm trying to control anxiety, insomnia, and low-level nausea, I'm not sure that's a good way to go now.
Thanks again.
Posted by jane d on March 22, 2004, at 16:23:44
In reply to Re: Calling for advice from BP2 Thyroid types, posted by Minnie-Haha on March 20, 2004, at 17:44:42
MinnnieHaha,
You should definately ask your doctor for his reasoning in prescribing T4 but keep in mind that that is a very low dose. There is a feedback mechanism that tells your body how much thyroid to produce based on how much you have. If you add a thyroid supplement when your own thyroid is working, your own thyroid will produce less of the hormone. So, in the end you might not have anymore thyroid hormone in your body than you do now but less of it would be coming from your own thyroid. That might be what your doctor is trying to do. Ask him.
You might want to take a look at this for some quick information. It's one of my favorite sites.
http://www.nlm.nih.gov/medlineplus/thyroiddiseases.htmlJane
Posted by jane d on March 22, 2004, at 16:27:40
In reply to Re: Calling for advice from BP2 Thyroid types, posted by Minnie-Haha on March 20, 2004, at 17:44:42
When you add T4 your body will not necessarily stop producing the same amount of hormone as you added so you could get a little more hormone than you started out with. If you are worried that more hormone will make you worse make sure the endocrinologist knows about (and pays attention to) your psych worries or check with your pdoc.
Jane
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