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Suggest Treatment For PTSD And Hashimoto's Disease

Posted on Sat, 21 Feb 2015

Question: My sixteen year old son had orchiopexy surgery two years ago It was traumatic for him and he was diagnosed with PTSD but his chemistry has also been bad. He was diagnosed with hashimotos and takes synthroid. His testosterone is normal but he is five times the upper limit on LH and fsh. He is also high on progesterone. He is exhausted unless he gets twelve or more hours of sleep, which is almost always impossible. when he gets tired he gets pretty bad depression and his face breaks out. In summer when he gets enough sleep he does not get depression when school starts and he gets less sleep the depression and anxiety come back. His cortisol has been on the upper limit but within normal. He is often nauseous and he switches back and forth between consipation and loose stools. He is 5 10 and only weighs 130 pounds. Not a good eater. Gets sick if he eats in the morning.

Answered by Dr. Deepak Kishore Kaltari (46 minutes later)

Brief Answer:
Additional information required

Detailed Answer:
Hi
Welcome to Healthcaremagic
Greetings of the day
Dear Ms

Orchidopexy in the presence of normal Testis on opposite side usually should not lead to hypogonadism. Associated Hypothyroidism could be the cause which requires highee level of FSH and LH to maintain normal circulating levels of Testosterone.

majority of symptoms can be explained by persistent Hypothyroidism inspite of being on Thyroxine replacement therapy. I would suggest you to provide me latest Thyroid profile report.

Also let me know the following additional information

1. Was Ultrasound of Testis done after Orchidopexy surgery ?

2. has the child attained puberty milestones like growth of public hairs , increase in testis size

3. Does he consume sufficient quantity of water

Awaiting your response

Take care

Best regards
Dr Deepak Kaltari
Consultant Pediatric Surgeon

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Deepak Kishore Kaltari (57 minutes later)

He has testicles that fit in normal range albeit the low end of normal. did have an ultrasound that was normal. Testosterone has been around 650 (two years ago right after surgery his testosterone was 222. .Progesterone has stayed at 225 versus upper limit of 175 . His lh has been 22 (normal 1 - 9.8), fsh 63 (normal range (1.5 - 12.9). 1) TSH 9/12 9.69 free t4 .83, 2) TSH in 11/12 was 8.11, free t4 was ,94 which was in normal range. Started taking levothroxine. tsh 12/12 tsh - 2 free t4 1.27, 7/13 TSH .22 Free t4 .82, tsh 4/13 TSH 6.12 free t4 1.09, 7/13 TSH .8, free t4 .8,
As for hashimotos thyroid peroxidase 541 (normal 0 -26), anti globulin ab 1988 (normal range 0 - 40)
He does not drink much water drinks sprite some, hit XXXXXXX stage five early for his age and has lots of testicle hair.

Answered by Dr. Deepak Kishore Kaltari (24 minutes later)

Brief Answer:
Repeat Thyroid function test

Detailed Answer:
Dear Ms

Thanks for providing the detailed reports. Puberty is usually associated with LH/FSH surge which stimulates secretion of Testosterone from Testis. This high Levels of LH?FSH is usually maintained during the puberty. As his Ultrasound shows normal testis, there is definitely no need to be worried about high LH/FSH levels. Rest be assured there is no cause for concern regarding the hormone status. As Progesterone is precussor of Testosterone, the levels could be elevated during puberty, as secondary sexual characters are well developed there is no cause for concern.

As thyroid profile is normal(initial there was subclinical Hypothyroidism evident by elevated levels of TSH ). Majority of the cause of constipation in children is related to diet factors. Its more common among those children who have the following
1. Diet mainly consists of milk based feeds
2. Decreased intake of water
3. Decreased intake of fibre in diet

I would suggest you the following which will definitely help

1. Repeat his Thyroid profile again to rule out ongoing Hypothyroidism
2. Ensuring adequate intake of water: One cup of plain water 1 hour before and one hour after feeds will ensure adequate intake of water which will help in making the consistency of stools soft
3. High fiber diet: 2 serving of vegetable salad and citrus fruits a day will be very helpful in ensuring adequate fiber intake
4. Laxative like Lactulose will be helpful

In case you need any further assistance, will be glad to assist you.

Wishing you happy and healthy life

Take Care

Best Regards
Dr Deepak K K
MBBS,MS,MCH

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Deepak Kishore Kaltari (23 minutes later)

Thanks for your thoughts. They sure make sense to me. One final question, I read somewhere that people aren't getting enough iodine and that is causing lots of thyroid problems. Do you think it make sense to take some kind of iodine supplement to improve his thyroid performance. Thanks again.

Answered by Dr. Deepak Kishore Kaltari (21 minutes later)

Brief Answer:
Iodine supplement won't help

Detailed Answer:
Dear Ms

Hashimoto's Thyroiditis is autoimmune disorder which slowly causes destruction of thyroid follicles which help synthesis in thyroxine hormone. When more than 50 percent of cells are destroyed it leads to Hypothyroidism. Iodine is only one requirement of substance for production of Thyroid hormone. As majority of Hypothyroidism occurs due to Iodine deficiency , Iodine supplement will be helpful. In Hashimoto thyroiditis as there is destruction of cells producing hormone, Iodine supplement will not help. Giving external supplement or Thyroid hormone replacement is the only option..

I hope i have cleared your doubt.

Wishing you and your family a very happy and healthy life.

Do write to me directly for any assistance anytime

Take Care

Regards
Deepak

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Deepak Kishore Kaltari (14 hours later)

I've really appreciated your thoughts. Any thoughts on why a 16 year old would need twelve hours of sleep or he is completely exhausted. He gets anxious and depressed if he doesn't get an incredible amount of sleep.

Answered by Dr. Deepak Kishore Kaltari (2 hours later)

Brief Answer:
Some adolescent may experience excessive sleep

Detailed Answer:
Dear Ms

Some adolescent may experience lack of energy and excessive sleep . These could be the cause

1. Inherent tendency during adolescent age group

2. Lack of physical activity and exercise

3. Associated Hypothyroidism

I would suggest you the following

1. Encourage him to exercise : 30 minutes of brisk walking everyday will help improve mood by release of Endorphins

2. Well balanced diet

3. Encourage him in outdoor activities

Rest be assured he should get over it

Take care

Regards
Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (7 hours later)

Sorry if u get this twice but my questions didn't seem to go through. My son is always low vitamin d and last month he was low iron. He was tested for and did not have celiac. Are there other types of stomach issues that he might have that keep him from absorbing food and vitamins. He does have an upset stomach a lot and shifts between constipation and loose stool. He does seem to do better if he supplements with probiotics. Just wondering if a bad stomach that doesn't absorb nutrition very well might be part of his exhaustion. Thanks.

Answered by Dr. Deepak Kishore Kaltari (3 hours later)

Brief Answer:
Kindly get Peripheral smear examination

Detailed Answer:
Dear Ms
If malabsorption is ruled out then the cause of weakness is unlikely to be vitamin deficiency.

I would suggest multivitamin supplements which will help him in getting over weakness. Also do get peripheral smear examination along with Serum Iron assay to rule out Iron deficiency anaemia.

Take care

Best regards
Dr Deepak

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar